Membermember members, the factors that may be linked to militaryrelated suicides and preventive strategies. The Senate Armed Services subcomm subcommittee is just shy of 90 minutes. The hearing will come to order. Senate Armed Services subcommittee on personnel meets this afternoon to receive testimony about Service Member, family and veteran suicides and to learn about effective evidencebased Suicide Prevention strategies. Were fortunate today to have a panel of experts from government and academia. We will hear from five witnesses, catch it and michael colston, u. S. Navy director for Health Programs at the department of defense, dr. Orvis, director defense Suicide Prevention office for the office of force resiliency at the department of defense, dr. Miller, acting director of the Suicide Prevention program at the department of Veterans Affairs, dr. Mckeon, Suicide Prevention, branch of chief, center for Mental Health services and Substance Abuse at the department of health and Human Services and dr. Kessler, family professor of Health Care Policy at the harvard medical school. Thank you all for being here. Were sorry we are a bit late. Our topic today is a heavy one, one that is difficult to discuss, but we must address it to ensure the readiness and well being of our troops, their families and veterans. Tragically rate of suicide for active Duty Service Members and vat ran populations have increased in the latest reports, particularly affecting young men under 30, who make up nearly half the military. Veteran suicide is a national epidemic. As a member of the Veterans Affairs committee working to reduce the number of veterans who die by b i suicide is one of my top priorities. The department of defense and Veterans Affairs have improved capacity and other services yet the rates of suicide have not decreased. I see today as an opportunity to understand what more we can do as a subcommittee to make a positive impact in this area. Military families for the first time i hope to hear more about how the dncht oncht d. Will track and support spouses and dependents affected by suicide in the future. While it represents a growing Public Health challenge in the civilian world, the unique composition of our military makes this challenge one of particular importance that we m it mus be a top priority. I look forward to hearing from the d. O. D. And v. A. Witnesses and how theyre elg evidencebased suicide methods to kol bat the rise in suicides among Service Members, veterans and their families and from dr. Keon and kessler about civilian sue described research and methods and strategies that can help combat suicide in the military. I want to thank all of the witnesses to being here today. I look forward to your testimony and i turn to Ranking Member gillebrand for an opening statement. Thank you. Suicide in the military is a serious and growing problem. No, welcome and thank you for sharing your expertise with us today, your insight of the prevalen prevalence and contributing factors are critical and i appreciate you inviting an expert from the Veterans Administration as it critical for us to understand the connections and distinctions. According to the 2019 report, the rate has steadily increased over the last six years, spiking in 201 by over 6 from 2013. Theres been a narrative for a long time that military suicide is due primarily to ptsd and combat missions and we must take the toll of kol bat on military members very seriously. But the report clearly demonstrates that combat missions are not directly correlated to the Service Members who die by suicide. Suicide is complex and individual. There are a multitude of factors that lead to Mental Health challenges and can in turn lead to the devastation of suicide. Military service is very difficult. Our Services Members when they enter into military service, they lose control of where and how often they must relocate, the kind of housing they will live in, which schools their children will attend. It often impossible to main tab and frequently our Services Members are expected to sacrifice the needs of their families to accomplish a mission. Our gratitude for their sacrifices isnt enough. We must also recognize the unique burdens that they face and that those burdens can lead to persistent Mental Health challenges, like chronic anxiety and depression. And too often those Mental Health challenges can contribute to suicidal ideations. Of course some of the burdens are integral to the way of the did and to ensure Service Members learn Critical Skills and are prepared to serve in a war zone. But it incumbent upon the leaders in this committee to determine when such factors are military and civilian leaders also must determine when factors are most disruptive than is necessary to accomplish the initial so they can develop more appropriate strategies for todays military. The military and the department of justice of defense mbd but there is not nearly good enough. Id like to challenge you to think about multisuicide in a more holistic way, understanding the factors that relate to suicide. If the military is able to understand how the day ho tay and create the system that support Service Members need to be successful. This also means taking a real look at the existing systems of support. Currently the department of defense has a policy that requires Mental Health professionals to report to a commander. This policy leads to mistrust and acts as as a barrier to true if this could and of course dod must have policies to keep their Service Michael gaetz safe but their standard are vague and go muff further than standard for sifian Mental Health use. This policy is more loo to suffer in silence and does in federal budget i urge the department of defense to review the reporting rules for Mental Health professionals to ensure that they are allowing for confidentiality for sfrr if we can ely nate the barriers that stand between our Service Members and access to m m plaintiff mr. Chairman, i look forward to hearing from our witnesses and independent committeeses innd the military to further support our members and their well being. Well start from left to right. Dr. Orvis. If and allowing us to it no and with me today is the director of mental Health Programs. We are very dernd we twrr and we disheartened we are not going into the right direction. The lot of every. The d. O. D. Has the responsibility of supporting and protecting those who defend our country and it impa because in a the department has expanded our reporting on suiciderelated data this past system, we accomplished our first suicide event. In with the prior two years across all could be opponents. When compared to the five however, weve seen a statistically and after accounting for age and sex differences, with the exception of the National Guard. We continue to on heightened risk for our m suicide rate for ou frrt in 2017 were comparable or lower to the rates. The Department Must and will do more to target our areas of greatest concern. Our yong we know suicide is a complex interaction of many fact be were committed to addressing suicide. Guided by the Defense Strategy sfrt these efforts if the include houfing and supporting people at risk, strengthening access and delivery of sue sued care,from creating rn to provide a few example, take, for example, sfsh fsht many. Were partnering with the v. A. To increase National Guards members accessibility o to. Withee expect to federal budget interak tir if to help with every day life stressors f were developing a Communications Campaign to promote safe storage for firearms and medication tone sure familys safety. We provide additional current efforts, floonk and im happy to explain of to better measure effectiveness of our suicide efforts. Partnership is integral in reaching our goals. We work closely with federal, state local and other government lawmakers to continue to ensure our tool kit and improve our resources for Service Members and their families. I thank you for your unwavering dedication for the support of our men, women and families who support our great nation. I welcome your insights, your input and your partnership. I fully recognize that we have more to do and i take this chairman tillis, Ranking Member gillibrand, thank you for having us here. Im honored to be here. Every life lost is a tragedy. As a physician and former line officer, ive been shaken by sue suedes, so let me discuss what ive seen. Our military suicide rate was once low. When i was a resident at walter reed in 2001, our active duty suicide rate was happen the rate of a similar population, but like the rest of america, dod has seeb sn sunday sides increa. Our active duty suicide rate now approaches 25 per 100,000. The inaugurate is yet higher. So what are we doing . First were being transparent. Weve been working over the past ten years to decrease the suicide rate and clearly our rates show more needs to be done. How might we reach our goal . By ensuring all evidencebased interventions for suicide are used and evaluated for outcomes. Dr. Lisa brenner and dr. Amy bell were recently published and found evidence for cognitive therapy. On the other hand, our Evidence Base remains thin. The effect sizes of interventions are small. This maengs we need to treatm treat a number of people to achieve a single outcome. Dod stemmed an opiate crisis in its ranks with evidencebased practice, achieving a death rate under one fourth of the national rate, along with low rates of addiction and positive drug screens. Our Public Health effort included hard assessments of policies, pain perot callrotoco. Our efforts saved lives. We need to continue work on precip tense of suicidal behavior. I found enlistees like other Young Americans were easily separated from their money, placing them in financial peril. Does spite our gains on drug abuse, the force still uses too much alcohol. I never anticipated that mentoring sailors on safe relationship would be a leadership skill. But it remains so. Our partners and kids a source of strength and our children sustain military culture. Interventions we leverage now are critical. Veterans who get health care at v. A. Die less by suicide. So we aid transition into v. A. Care as we smar 138 clinic sh clinical spaces. Finally, well stay focused on the people in front of us. Hopelessness of suicide can stem from belonging. Thank you, i look forward to answering your questions. Thank you, dr. Miller. [ no audio ] as a veteran, im deeply disturbed by suicide. Im honored to be a guest on this distinguished panel addressing veteran suicide. Within my position im often asked why. In the context of suicide. Ive asked this question myself for several years after losing my friend and my colleague, a marine cobra driver, to suicide during oefoif. In my quest to learn what i may have done wrong or what i may have missed with john, its become clear to me that you is side suicide is a complex issue with no single cause. Beyond its a National Issue that affects people from all walks of life, not just veterans and Service Members. Suicide is often the result of a complicated combination of risk and protective factors at the personal, communal and societal levels. Thus, i have wholeheartedly signed on to fully commit heart and mind to the secretaries, to the executive in charge and to the v. A. s top clinical priority, Suicide Prevention. In response and in daly action, the v. A. Is implementing a comprehensi comprehensive, including those who do not receive vha health services. We look to the current annual report to inform our current awareness. One of the key ways in which this report is different from those in prior year is it places veteran suicide in the broader contexts of suicide in america. We know the suicide rate is alarmingly rises in and around our nation. The average number rose from 86 in 2005 to 124 in 2017. These included 15. 9 veteran suicides per day in 2005 and 16. 8 per day in 2017. We know that suicide is one of the leading causes of death in the United States. As the father of the fact that you sued side has become the second leading cause of death within their current age demographics is difficult for me to even comprehend. Amidst of haunting questions and the daunting data, there is hope. Although the rates of suicide are increasing across the nation, we know that the rate of suicide is rising more slowly for veterans engaged in vha care compared to those not engaged in care. We know that depression and suicide all too often share a tragic relationship but suicide rates have leona helmsleyi helmsleyingfully decreased among veterans with a diagnosis of depression and who were engaged in recent care. This rate of decrease translate to 87 veteran drives although fee may veterans are the eyer risk in suicide, there was no an increase in female veterans with recent vha care compared to those not using vha services. Evidencebased treatments can effectively address suicide. The vha is a National Leader in advancing best practices as well as sameday access in Mental Health and primary care services. Over 4 million veterans have been screened for suicide within the last year alone. Over 1 million sameday access Mental Health appointments have been fulfilled in to we know that providing aroundtheclock, unfailing access to Suicide Prevention services is meaningful. Often the time between can be as brief to 50 to 60 minutes. The have. A. Therefore has become the worldwide leader of provision of Crisis Services through the veterans and military crisis line. 1,800 calls per day answered with an astounding average of 8 seconds. Amidst positive anchors of hope and progressive actions we fully acknowledge and commit to the fact that more must be done in the name of Suicide Prevention. The mission is obviously and painfully far from complete. One life lost to suicide is one too many. We therefore appreciate this committees partnership with the sht arsht and Evidence Based clinical and sued side prevention strategies. This concludes my testimony. Im prepared to answer any questions. Thank you. Dr. Mckeon. Thank you for inviting us to participate in this important hearing on Suicide Prevention. An american dies by suicide every 11 minutes suicide is the tenth leading cause of death in the United States and the second leading cause of death between ages 10 and 34. We lost over 47,000 americans to suicide in 2017. Almost the same number we lost to opioid overdoses. For each of these tragic deaths there are griefstricken family and friends, impacted workplaces and schools and a diminishment of our communities. A National Survey on drug use and health has also shown approximately 1. 4 million American Adults report attempting suicide each year and over 10 million results report seriously vr with 25 of the states experiencing increases of more than 30 . These increases have been taking place among both men and women and across the life span. While federal efforts to prevent suicide have been steadily increasing over time, thus far they have been insufficient to halt this tragic rise. We know that our efforts must engage multiple sectors, including health care, schools, workplaces, faith communities and many others. We have seen that concerted, coordinated efforts can save lives. Evaluation of youth Suicide Prevention grants has shown that counties with grants sported youth Suicide Prevention activities had fewer Youth Suicides than matched counties. This underscores the need to embed suicide presense in the White Mountain apache tribe in arizona, Youth Suicide was reduced by almost 40 . In that Community Youth are experiencing suicidal thoughts wherever they may be on the reservation, will be seen rapidly by a trained Apache Community worker. Samson also supports grant. Zero suicide is a package of interventions that uses the most recent evidencebased science on screening, Risk Assessment treatment planning and protocols and care transitions. Its inspired by a program reduci