Programs in the department of defense director of Defense Suicide Prevention Office and the department of defense doctor miller acting director Suicide Prevention program at the department of Veterans Affairs and Suicide Prevention branch chief and deferment of Human Services and doctor kessler professor from the department of Health Care Policy at harvard medical school. Sorryea we are late. The topic is heavy and one that is difficult to discuss but we must address it to ensure the readiness and wellbeing ofut troops and families and veterans. Suicide is a homefront threat tragically rates of suicide for active Duty Service Members increased in the latest reports affecting young men under 30. It is a National Epidemic as a veteran Affairs Committee thats one of my Top Priorities the department of Veterans Affairs improveve capacity and access to Mental Health and the rates of suicide have not decreased. D i see today as an opportunity to understand what more we can do to make a positive impact in this Area Military families are affected and for the first time the department of defense i hope to hear how the dod support spouses and dependents affected by suicide in the future. While a growing challenge unique composition and ensuring adequate care and those of Financial Difficulties and access to healthcare it must be a top Priority Program look forward to hearing from the dod and how they are developing evidencebased Suicide Prevention methods to combat the rise among servicemembers and veterans and their families and also from research and methods and strategies to help combat suicide in the military. Thinking to the witnesses for being here today look forward to your testimony. Thank you for holding this hearing this is a serious and growing problem and to address the factors to all witnesses thank you for sharing your expertise your insight of contributing factors are crucial to support our Service Members and i appreciate as it is critical to understand the military to address those. According to the annual suicide report it has steadily increased over the last six years spiking in 2018 over 6 percent narrative primarily to ptsd combat missions and we must take this very seriously that the report clearly demonstrates that combat missions are not directly correlated to servicemembers who die by suicide. It is complex and individual there are a multitude of factors that can in turn lead to the devastation of suicide military service is very difficult hours servicemembers make sacrifices that are hard for some of us to even fathom when they Enter Service they lose control of where and how often they must relocate, housing, schools their children will attend often impossible to maintain a healthy worklife balance and frequently servicemembers are expected to sacrifice the needs of their families to accomplish the mission our gratitude isnt enough we must recognize the unique burdens they face and those burdens can lead to persistent Mental Health challenges like chronic anxiety. Too often those challenges contribute to suicidal ideations. That isnt her goal to the way the military functions and to ensure servicemembers have Critical Skills and are prepared to serve in a war zone and then to determine what factors are problematic enough that a greater system of support must be provided. To develop more appropriate Strategy Fund strategies so then to spend more and more each year on Suicide Prevention but the results are not good enough i would like to challenge the military leaders to think about military suicide in a more holistic way the factors that contribute to the challenges in suicide. If they understand the servicemembers they can work to minimize those stressors based on the requirements and create a system of support servicemembers need to be successful. This also means taking a real look at the existing systems of support currently there is a policy that requires Mental Health professionals with servicemembers to a commander leading to mistreatment because servicemembers fear the repercussions to their career if they come forward with Mental Health challenges of course dod must have policy that the standards are vague and go much further for civilian Mental Health professional or military chaplains. And for those to suffer in silence to maintain order and discipline i urge the department to review the reporting rules for Mental Health professionals to ensure while protecting those to be around them ever access to Mental Health care and then to make progress at the suicide rate mister chairman we look forward to working with you on this committee and the military and the dod to further support our Service Members. Chairman to listen Ranking Member thank you for the opportunity to appear before you with our colleagues from veterans in menstruation and Harvard University i am with my colleague director of the Mental Program and we are very concerned we look forward to discuss the Suicide Prevention efforts we are worried they are not going in the desired direction each one has a deeply personal story with each death there are families and children and the dod has the responsibility of supporting and protecting them and it is imperative we do Everything Possible to prevent suicide in the military community. So to take meaningful steps the department has expanded with the data this past september we published the first annual suicide report to supplement our long standing report and in the 20 year 18 suicide rates are consistent with the prior two years when compared to the past five years they have been steady for the National Guard they have seen for the active component while hardly acceptable suicide rates are comparable to the Us Population rates after accounting for age and sex differences with the exception of the National Guard we continue to observe heightened risks for National Guard members as part of the asr the Department Published suicide data for military members for the first time suicide rates for spouses and dependents and calendar year 2017 were comparable to or lower than the Us Population rate after accounting for age and sex based on those findings the department targeted areas of greatest concern the young and enlisted members as well as continuing supporting her familys suicide is a complex interaction we must address those many aspects we are committed to addressing suicide comprehensively to the Common Health approach guided by the Defense Strategy the dod has ongoing efforts underway they support seven key strategies which include identifying and supporting people at risk to have delivery of suicide care teaching coping and problem solving skills with a protective environment to strengthen economic support and to prevent future risk. Take for example identifying and supporting people at risk teaching young servicemembers how to respond to red flags on social media to help those with respect to strengthening suicide care or partnering with the v. A. With the accessibility to Mental Health care during drill weekends. With respect to teaching and coping a problemsolving skills we have interactive Educational Programs to teach foundational skills to help with everyday life stressors and as a final example to protect a creative environment with the campaign to promote social norms to ensure family safety. In our written testimony we have efforts that we pilot and evaluate to aligned to the seven strategies and i will talk about these in more detail the enterprise wide framework to better measure effectiveness and prevention efforts partnership is integral working closely with the federal state and local and other stakeholders to continue and enhance the toolkit to ensure availability Suicide Prevention resources for members and families in closing thank you for your unwavering dedication in the support of men women and families who defend our great nation i welcome your insights input and partnership i fully recognize we have more to do i take this charge incredibly seriously and i look forward to your questions to make chairman and members of the subcommittee thank you for the opportunity to discuss dod Public Health challenge of suicide to be here with the Suicide Prevention director every life lost is a tragedy as a physician and former line officer to be shaken by suicide for me discuss what i have seen military suicide rate was once low when i was at walter reed in 2001 active duty suicide rate was half of a similar population like the rest of america dod has seen a slight increase even with the infrastructure and in large communities active duty suicide rate approaches 25 per 100,000 the National Guard rate is higher. What are we doing . Be transparent we have been working over the past ten years to decrease the suicide rate clearly more needs to be done. How do we reach our goal to ensure all evidencebased is used to be evaluated in regard to suicide outcomes. The v. A. Dod Clinical Practice Guidelines by co champion leeson brenner and doctor bell was recently published of the annals of internal medicine Crisis Response planning as evidence against suicide and on the other hand evidencebased is remaining thin many require the development of intervention is small this means we need to treat a number of people with the treatment that has been proven to work without a single changed outcome we need to translate publichealth successes into the management of suicide dod has opiate crisis of evidencebased practice from intentional and accidental to one fourth of the National Rate along with positive drug screens including hard assessments of policies and screening and pharmacy control implemented policies and procedures from outcomes we need to continue work on suicidal behavior as a line officer i found that they were easily separated placed in financial peril is not hard for them to find trouble today despite drug abuse they still use too much alcohol i never thought mentoring sailors on leadership skills would be a skill that we have to stop sexual trauma and child abuse our partners and kids are a source of strength and sustained military culture. Interventions now are credible those that get help die less by suicide so we transition into v. A. Care when i served at the Healthcare Center in North Chicago shared clinical spaces worked finally to stay focused on the people in front of us suicide can stem from a loss of belonging from us and our families as we protect Freedom Worldwide thank you i look forward to answering your questions. Thank you doctor miller. I appreciate the opportunity. [inaudible] i am honored to be in attendance today as part of the collaborative efforts addressing veteran suicide. Within my position i am often asked why in the context of suicide i have asked this question myself for several years after losing my friend and my colleague a marine cobra driver to suicide. In my quest to learn what i may have done wrong or missed with john, it has become clear to me that suicide is a complex issue with no single cause. Beyond a National Issue that affects people from all walks of life not just veterans and servicemembers suicide is the result of a complicated combination of risk and factors at the personal communal and societal levels i wholehearted the signed on for heart and mind to the secretaries and executive in charge and the v. A. Top clinical priority of sin is one Suicide Prevention and response of daily action to implement a comprehensive plan to reach all veterans including those that do not see vha Health Services in this context looking to the 2019 National Veteran suicide annual report to inform the current Situational Awareness one of the key ways this is different from those in prior years it places veteran suicide in a broader context of suicide death that american from the report we know the suicide rate is rising alarmingly across the nation the average number of adult suicides per day rose from 86 and 2005 to 124 and 2017 these numbers included 15. Nine veteran suicides per day and 16. Eight per day in 2017 we know suicide is one of the leading causes of death in the United States and as a father of four young daughters the fact that suicide has become the second leading cause of death within their current age demographic is difficult for me to even comprehend. Amidst the haunting question and the daunting data, there is hope although rates are increasing across the nation we know the rate of suicide is rising more slowly for veterans engaged in vha care compared to those not we know to share a tragic relationship that suicide rates to decrease with a diagnosis of depression with recent vha care. To translate 287 veteran lives saved compared to 2016 although at higher risk for suicide there was not an increase of suicide among female veterans with recent vha care from those recently not using services we know evidencebased treatment can effectively address suicide therefore a National Leader to advance best practice of universal screening for suicide as well the same day access of Mental Health and primary care services. Over 4 million veterans have been screened for suicide within the last year alone over 1 million same day access appointments have been fulfilled in 2018 we know providing aroundtheclock unfailing access to crisis Prevention Service is meaningful often the time to enact suicide and Suicide Attempt or death can be 50 or 60 minutes the v. A. Is a worldwide leader in the provision of Crisis Services to the veterans and military crisis line 1800 calls per day within an average of eight seconds amidst positive anchors of hope and actions we fully acknowledge that more must be done with Suicide Prevention the mission is obviously painfully far from complete one life lost is one too many we appreciate that Committee Partnership with the v. A. And dod to facilitate cross cutting with evidencebased clinical Suicide Prevention strategies this concludes my testimony im prepared to answer any questions. Chairman and Ranking Member and members of the committe committee, thank you for inviting us to participate in this important hearing on Suicide Prevention in american dies by suicide every 11 minutes the tenth leading cause of death in the United States the second between ten and 34 losing 3,702,017 almost the number we lost with opioid overdose for each tragic death there a grief stricken families and friends impacting workplaces and schools in diminishment to our Communities National survey has also shown approximately one. 4 million American Adults before attempting suicide and 10 million report seriously considering suicide. Our concern is intensified by the cdc report it is increasing 49 of 50 states that experience increases of more than 30 percent these have been taken place among men and women federal efforts to prevent suicide increasing over time thus far are insufficient we know our efforts must engage multiple sectors of healthcar healthcare, schools, workplaces and communities and others we have seen a concerted coordinated effort the evaluation of Suicide Prevention grants has shown counties with grants supporting Suicide Prevention activities had fewer Youth Suicide than match counties that were not the greatest impact was counties with the longest period of sustained funding for their prevention efforts this underscores the need for Suicide Prevention in the infrastructure of local government and tribal communities Youth Suicide was re