And to learn about effective evidencebased Suicide Prevention strategies. To have a panel of experts director for Mental Health programs for overset office at department of defense, the director of defense of Suicide Prevention office for the office of the department of defense and acting director at the department of Veterans Affairs the Suicide Prevention chief of Substance Abuse and Mental Health at the department of Mental Health and Human Services healthcare policy department of Health Care Policy at Harvard Medical School thank you for being here and our topic today is a heavy one that is difficult to discuss but we must address it that the readiness and wellbeing of troops and families and veterans suicide tragically rates of suicide with veteran populations have increased from the reports affecting young men under 30. Veteran suicide as a member of the Veterans Affairs committee of those who die by suicide is one of my Top Priorities the department of defense improved capacity at the rates of suicide have not decrease. With an opportunity to understand more we can do to make a positive impact in this area. Military families for the first time the department of defense with the suicides by spouses and dependents i hope to hear how they are affected by suicide in the future while growing Public Health challenge in the civilian world the composition makes it one of particular importance we must address to ensure adequate care for support for servicemembers and families and veteran veterans with Financial Difficulties and access to healthcare it must be a top priority. I look forward to hearing from evidencebased Suicide Prevention methods with the among servicemembers and veterans and families and also of civilian Research Strategies that could help combat suicide in the military i want to thank all the witnesses for being here today i look forward to your testimony now to Ranking Member gillibrand. Thank you for holding this hearing suicide in the military is a serious and growing problem not enough is being done into all of our witnesses thank you for sharing your expertise of the contributing factors is crucial to help the Committee Support the servicemembers and that you have an expert from the connections and distinctions between military and veteran suicide according to the 2019 report the rate of suicide has steadily increased over the last six years spiking in 2018 it has been a narrative for a long time primarily to ptsd and combat missions and we must take the toll very seriously but the report clearly demonstrates that combat missions are not directly correlated to the servicemembers who die by suicide it is complex and individual a multitude of factors that can lead to the devastation of a suicide the servicemembers make sacrifices when they enter into military service they lose track of the housing they live in what schools their children would attend its often impossible to maintain a healthy worklife balance and they are expected to sacrifice the needs of their families to accomplish a mission the gratitude for their sacrifice is not enough we must also recognize the unique burden that can lead to persistent Mental Health challenges like chronic anxiety and depression and too often those challenges can contribute to Suicidal Ideation of course some of those burdens are intragoal to the way the military functions to ensure servicemembers are prepared to serve in a war zone but it is incumbent upon the leaders to determine when the factors are problematic enough that support must be provided military and civilian leaders determine when factors are disruptive and necessary to accomplish the mission 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 away, understand the factors that contribute to Mental Health challenges and to suicide, if the military is able to understand how the daytoday stressors can Impact Service members they can work to minimize the stressors based on a Mission Requirements and create the systems of 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 many cases of Mental Health concerns to a commander, this policy leads to mistrust and acts as a barrier to treatment because Service Members fear the repercussions to their career if they come forward with their Mental Health challenges, of course d. O. D. Must have policies to keep their Service Members safe but there is standards for importing the mental standards are vague and it goes much further for civilian Mental Health and civilian chapel,s it is more likely to do nothing to help commanders maintain good order and discipline, i urge the department of defense to urge the rules for Mental Health professionals to ensure that they are allowing for a maximum confidentiality for Service Members but also protecting them, if we can eliminate the barriers that stand between our Service Members and have access to Mental Health care i believe that we can begin to make progress towards addressing our suicide rate, mister chairman i look forward to hearing from our witnesses, i look forward to committee with you and further supporting our law veterans. Chairman tillis and Ranking Member gillibrand thank you for the opportunity to appear before you, with me today is my colleague captain mike the director of Mental Health programs, like you we are very concerned about the suicide rates in our military and we look forward to discussing the department Suicide Prevention efforts, we are disheartened that the rates of suicide in our military is not going in the desire direction, the loss of every life is heartbreaking and each one has a deeply personal story, with each death we know that there are families and often children with shattered lives, the d. O. D. Has the responsibility of supporting and protecting those who defend our country and it is imperative that we do Everything Possible to prevent suicide and our military community, because data informs our ability to take meaningful steps and transparency, on this past september of published our first annual suicide report to supplement our law standing suicide reported and briefly calendar year in 2018 are consistent with the prior two years across all components, one compared to the five past years the rates have been steady for the reserve and National Guard however we see a statistically significant increase for the active component, while hardly acceptable military suicide rates are comparable to the u. S. Population rates after accounting for age and sex differences with the exception to the National Guard, we continue to observe heightened risks for our youngest Service Members, as part of the azar the Department Published suicide data for military members for the first time, suicide rates for military spouses and dependents in calendar year 2017 or comparable to or lower two than the u. S. Population rates after accounting for age and sex, based on the findings the Department Must and will do more to target areas of greatest concerns our young enlisted members and National Guard members as well as continue to support our families. We know suicide is a complex interaction of many factors and our efforts must address the many factors that impact suicide. We are committed to addressing suicide comprehensively through a Public Health approach, guided by the Defense Strategy for Suicide Prevention the d. O. T. Has many ongoing and future efforts on the way. They su these efforts support n key strategies which include, identifying and supporting people at risk, strengthening access and delivery of suicide care, teaching coping and problem solving skills, creating protective environments, strengthening economic supports and lessening harms and preventing future risk, to provide a few examples, identifying and supporting people at risk, we will be teaching young Service Members how to recognize and respond to suicide red flags on social media and help others who might be showing warning signs, with respect to strengthening access and delivery to care we are partnering with the va to increase the accessibility show Mental Health care via mobile centers during trial weekends, with respect to teaching coping and problem solving skills we are piloting an Interactive Educational Program to teach foundational skills early members career to help with everyday life stressors, as a final example with respect to creating protective environments we are developing a Communications Campaign cheaper more Family Safety with arms we provide additional efforts and evaluating that allowed to the seven strategies i can show you any of these and more detail we also have developed an enterprise ride Program Evaluation framework to check our prevention efforts. This is a drill to reach our goals, we work closely with the federal, state, local and other non governmental stakeholders to continue to advance virtual kid and ensure availability of Suicide Prevention resources for members and their families. In closing i thank you for your unraveling dedication to support of our men, women, and families to defend our great nation. I welcome your insights, and put in partnership. I fully recognize that we have more to do and i take this charge incredibly seriously, i look forward to your questions. Chairman tillis, greg member gillibrand, members of the committee, thank you for discussing the Public Health challenges, suicide. Along with the Suicide Prevention colleagues, every life loss is a tragedy, i have been shaken by suicides so let me discuss what ive seen. Our military suicide rate was one solo, when i was a resident and walter reid our active duty suicide rate was half the rate of a similar population, like the rest of america d. O. D. Has seen the suicides increase, even as we created a centralized Suicide Prevention infrastructure and enlarge community care, are active duty suicide rate now approaches 25 for 100, 000, the National Guard rate is yet higher, so what are we doing . First we are being transparent, we have been working over the past ten years to increase the suicide rate and clearly it shows more needs to be done. How do we reach our goal . By ensuring all evidence based interventions are being used in evaluated in regard to suicide outcomes. Our v. At t clinical practice guideline for risk, shaped with me by lisa brenner, suicide biologist and chairman of public view, board was refereed and synopses, failed evidence for cognitive behavioral therapy, lethal means restrictions as avenues for suicide, are evidence based remains then many domains of intervention require and the in fact size of interventions are small. This means that we need to create a number of people with the treatment that has been proven to work to achieve a single change the outcome. We need to translate Public Health successes from other domains into the management of suicide. D. O. T. Stemmed an Opioid Crisis with its evidence, going from intentional to accidental, along with positive drug screens, our Public Health effort included a hard efforts, screening, pharmacy controls, training ftc. Lamented policies and procedures stem from outcomes and efforts to save lives we need to continue work on the precipitous of suicide behavior like other Young Americans they were easily separated from their money placing them and financial peril there is more way for Service Members to find trouble despite our gains on drug abuse the force still uses too much alcohol and i never anticipate that seafarers on safe relationships would be a skill but we have sexual trauma and child abuse our partners and kids are sort of strength and our children sustained military culture interventions we leverage now are critical veterans who get Health Care Ad via dial us by suicide so transition into va care as we share 130 clinical spaces when i served in North Chicago shared clinical spaces worked, finally we will stay focused on the people in front of us the hopelessness of suicide can stem from a loss of belonging all of us in our families and meeting to another as you protect freedom worldwide, thank you i look forward to answer your questions,. Thank you doctor mueller id like to submit this letter by the secretary without objection i appreciate the opportunity of both created as a veteran i am deeply disturbed by the status of my fellow veterans and im honored to be a net tendencies among of this distinctness panel addressing veterans suicide, within my position im often asked why in the context of suicide i have asked this question myself for several years after losing my friend and my colleague just suicide, 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 suicide is a complex issue with no single cars, beyond International Issue that affects people from all walks of life, not just veterans and Service Members. Suicide is often the result of risk and protective factors at the personal, communal, and societal levels, thus eiffel hardily signed on to fully commit heart and mind to the secretaries, through the executive in charge and to the vas top political priority Suicide Prevention. And response and in daily action the va is implementing 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