>> i am a huge supporter and fan of the nhs. there are many things that are truly wonderful about nhs and we should celebrate that. but i have to say, under the last government the number of managers in the nhs doubled the number of nhs managers with increasing six times faster than the number of nurses. and nhs -- if you inherit a situation like that it makes sense to make changes and that's why you can see since we have come in, 14,000 fewer nonclinical staff, but we've actually got more doctors, more midwives, more operations taking place. and if she wants something to celebrate in the nhs -- if you're going to summer in nhs, make makes a sex wards. >> is my right honorable gentleman a where --

[inaudible] receiving less indirect benefits than he was els an entire country. while my constituents appreciate that under the plan for last labor, they will be paying even more, will he accept that for them and others in rural areas it has become an intolerable burden? >> i do accept what my honorable friend says. that's why the budget we took the decision not only to cut, not want to get rid of the tax increases on petrol that were coming down the tracks but also to make a cuts in petrol duty. so effectively that was 6p off a liter of diesel and petrol. there seems to be his decision to at time of economic difficulty we demonstrate that we're behind the people want to work hard and do the right thing. freezing their council tax, scrapping flavors job tax and helping them with their expensive because government is committed to doing a. it's all very well. members opposite chatting about

the tax, they do a good job. [shouting] and also, the difference is they don't actually pay as to put down amendments. >> mr. speaker, i think the whole house, trying to i think the whole house will approve the justice secretary to opposite chief corner, but there's so many concerned in this house about war memorial to the other week i got a petition that 3000 people signed. will he now use his office and his weight to persuade the justice sector and his ministers they need look urgently at new penalties and new protections both for war memorial and those who -- spent i think the honorable gentleman speaks with whole house and after the whole country and sing what's been happening to our war memorials is completely unacceptably i don't think there's a single answer but i suspect it may lie as he says in some new punishments and rules, but it

also lies in looking at the scrap metal market and how that is truly regulated. i hear precluded what he says about the office of the chief corner. i'm delighted that we been able to put forward an amendment and to accept some other points. i think the one thing we should try to avoid and i think this is really important because all of us want to do the right thing for the soldiers and their families have given so much to our country, i don't think having an end as right of appeal after inquest would be a good idea. i think that would damage the interest of family. but establishing -- >> mr. toohey andrew. >> over the last 30 years thousands of honorable and disadvantaged children in the u.k. have been support to projects that up have been found by children in need. would my right honorable friend join me congratulate him and raising over 600 million pounds over the years and pay particular tape it to my constituency that came together and raise thousands of pounds

in? in. [shouting] spent i'm very glad my honorable friend managed to get in, and i apologize, thank you for almost squeezing him out. is be a tragedy if we did have this opportunity to pay tribute to patsy and all that id has achieved over many, many years. >> thank you, mr. speaker. last week i visited afghanistan to arms forces and had the opportunity to go to helmand province. [inaudible] [inaudible] can the prime minister assured this house today that these requests will be delivered prior to any 2014 withdrawal from afghanistan? >> i think the honorable gentleman is right to speak up on this issue and to repeat what he heard in afghanistan. he's absolute right, we need to of the neighboring countries, my

national security advisor and other members of my team are in pakistan speaking with the pakistani government even as we speak. in terms of the equipment, the citizens and drink into the afghan national army, we now publish a monthly report to this house so that everyone can see the progress we are making with equipping and training the afghan national police and the afghan national army. and despite all the difficulties in afghanistan, that is broadly on track. >> order. statement. the secretary of state energy and climate change. mr. secretary human. >> here on c-span2 will be the british house of commons now as they move onto other legislative business. you have been watching prime minister's question time airing live wednesdays at 7 a.m. eastern while parliament is in session. you can see this weeks questions and time again sunday night at nine eastern and pacific on c-span. for more information go to c-span.org and click on c-span series for prime minister's

questions, plus links to international news media and legislators around the world. you can watch recent video including programs deal with other international issues. >> on c-span2 this morning with a report on the rising problem of suicide among members of the military. >> there was a flood in fort wayne. people were down there filling sandbags time to keep the river. air force one stopped at a motorcade down to the flooded area, took off his jacket. my name is he filled three sandbags said hello and hi to everyone, got back in the car, went back into playing. but that night what was billed as airways was not three sandbags, it was raking filling

sandbags with his shirt off. >> thanks giving day on c-span abc's sam donaldson, andrea mitchell and former senator chris dodd talk about the legacy of ronald reagan. bloomberg and arianna huffington discuss the american dream and the opportunities in the u.s. and asked us john glenn, neil armstrong, buzz aldrin and michael called and are awarded the congressional gold medal. >> you are watching c-span2 with politics and public affairs weekdays featuring live coverage of the u.s. senate. on weeknights watch key public policy events. into the weekend the latest nonfiction authors and books on book tv. you can see past programs and get our schedules at our website, and you can join in the conversation on social media sites. >> a recent report by the center for a new american security found that members of the military committed suicide an

average of once every 36 hours between 2005-2010. but he was under for a record number of suicides in july of this year. at this presentation of the reports findings, the vice chief of the army and an official within the department of veterans affairs discuss recommendations for preventing military suicide and promoting veterans mental health. from washington, d.c., this is an hour and 20 minutes. >> thanks for being you. my name is joh john nagl. on behalf of all of us are at the center for to american security, i'd like to welcome you to this discussion on the important, challenge and very, very right now question of military suicide. our nation has now been engaged in a war for more than a decade, the longest period of continuous combat in our history. the all-volunteer force has performed magnificently, but is showing signs of strain. including traveling, steady increase in the number of

servicemembers who are falling by their own hands. the problem is urgent. a good friend of mine currently serving serving as brigade command has lost five soldiers to suicide just this calendar year. this problem demands everything we can do to solve it. those who volunteer deserve us, deserve our support, when they themselves are suffering. doctor meg carroll, director of our joining forces initiative has written a policy brief titled losing the battle, the challenge of military suicide. losing the battle examines this crisis dispassionately and suggest a number of solutions that may help diminish this horrific loss uppermost precious national resource, the lives of her sons and daughters who have chosen to serve their country. to discuss this issue with meg we are honored to have back with his general peter chiarelli, vice chief of staff of the united states army. no one has worked harder or done

more to solve this problem. no one has done more. thank you, sir. [applause] >> we also welcome dr. jan kemp, national mental health program director from the departments of veterans affairs which has an important role to play in helping those who continue to carry the scars of their service after they've taken off the uniform. the panel will be moderated by juliette kayyem, national security columnist for "the boston globe," and a lecturer in public policy at harvard university. from its founding, cnas has focused on health of the force as an important component of our national security. the reason soldiers fall by their own hands are many and complex, and they reinforce each other in ways that are hard to understand.

solutions are also complex. no one agency or organization can do everything that is necessary to solve this problem. but many can help. we are honored to have the support of a number of philanthropic partners listed at the end of losing the battle, who share our concerns about the health, employment prospects, and education of those who have sacrificed to serve us. our partners have joined forces with us to think about this public, is pressing public health issue, and to attempt to find solutions. thanks to them, thanks to all of you here, and to all of those joining us nationwide via webcast for being part of this important discussion, and juliet, the floor is yours. >> thank you very much. it is an honor to be here and i want to thank cnas, meg, nancy is a co-author but not here with us today, and the committee for the effort to explore the issue of suicide among our servicemembers and veterans.

i have been in government and recently left as assistance to the department homeland security and to boston i do right twice a week calling for the globe. and it was starting to write about the wars and how they were ending that this issue began to interest me and didn't have enough national focus as it should warrant. for someone like me not to me with these issues, my several months exploration with the help of dr. harrell and cnas and how this nation will address the end of wars and the impact they have had on our military is surely going to a critical challenge for not just a military, but the united states government, our political leaders and our citizens in the decades to come. the wars may be ending in some respects, but they are not over. the report which i've had an opportunity read is a straight forward examination of what can and should be done to address one persistent and troubling problem, suicide.

as the report notes from 2005-2010, service minister their own lives at a rate of approximately one every 36 hours. the va estimates that a veteran dies by suicide every 80 minutes. we will talk about drilling down on those numbers. these numbers are complicated. in the army is in a position different than the air force or the navy or the coast guard. veterans data is difficult to manage, and understand given challenges with data collection. but as you read and examine the report and listen, there are two important takeaways, i believe, for those of us who are grappling with policy. and, of course, for many of you the personal consequences of this issue. first is to how. how can we best adopt policies and eat some of the recommendations are in you at a time when resources are scarce, congress is divided and much of our political focus is of course on the economy. and then the second is the why. i know this sounds obvious. given the issue were talking

about, but important aspect of this report is in making clear why we need as a government and the people to get this right. it is of course about our present service members and our veterans, but as the report and dr. harrell and nancy also make clear, it is also about the future of our military. with an all-volunteer military pics i want to begin with setting the stage for the report and the fines in the report with a co-author, dr. harrell. >> thank you. thank you to everyone for joining us today, both here in this room and also online. thank you especially to my co-pay no members for bring your tremendous expertise to today's discussion. one challenge of the topic of suicide is that research is unable to quantify fully the number of lives that are saved by the tremendous effort of individuals such as general chiarelli, dr. jan kemp who devote energy to understanding and improving the resources available for our servicemembers and veterans.

today's panel is the first event of our joining forces initiative at cnas. as an independent partner to the white house joining forces initiative, cnas has determined are joining forces research agenda to include research and analysis in three areas. employment, education and wellness. as those areas pertaining to veterans, service members into military families. this work on military suicide was conducted in the context of our wellness research. i had been asked whether, for the first cnas joining forces product and event, we should have led with a different topic. rather than military suicide. ..

>> we're making huge strides in 3va with our dod and cbc partners to do that, but it's not happening quickly. secretary shinseki has taken on this goal on himself, has brought in the support of the governors of our states, we're now getting data on a more timely basis that talks about veterans' citizen, we're able to put that together and come up with estimates which you've

seen. and you've seen the estimated numbers of 18 veterans a day dying by suicide. honestly, i don't know how correct we are in that it's our best guess right now. i think as long as any veteran or service member dies by suicide, we are, in fact, losing the battle. but i do maintain that we've made huge strides towards winning the war over the past several years, and, um, we will continue to do that. the va has taken the stance that suicide prevention is based on ready access to high quality mental health care, and to that end we've instituted a whole series of programs that i won't, um, go into now but, certainly, i'm available to talk to any of you about it anytime. probably the most visible access

mechanism that we've institute inside the past four years is the veterans -- [inaudible] which now has taken over 450,000 calls into the line from veterans, families and service members. when i was first approached about opening the crisis line, i said, you know, i don't think veterans will call. i think we have crisis lines in the country, why don't we use those? i'll help facilitate those connections, and i was told, jan, why don't you start a crisis line? i said, okay, i'll be glad to do that. and i have never been so wrong about anything in my entire life. veterans do call. all genders, all ages, people with all sorts of needs.

if services are there and help is there, people are reaching out to get them. and so our task has become being available. um, which you all know is a slightly different take on on va services, and it's working for us in all sorts of ways and shapes that we didn't imagine, and we'll continue with that effort. getting people into services, um, is a major issue, providing those services once we have them is another major issue. and we, too, have expanded programs, we've opened telemental health programs, we've increased mental health services at community-based clinics. but you're all sitting there looking at me and saying it's not enough. and we know that s and we'll continue to find out where we need to put more services and more time and more energy, and we will continue to grow those

programs and to offer people what they need. um, and that's a promise we're making. >> i wanted to on the numbers, i think this is a key part as well. can you explain to the audience why is it so hard for the va because i don't know why people understand numbers are that hard for the va. >> if someone is active duty or they're missing out of their unit, they're, obviously, gone and someone looks for them and finds them and finds out what happens to them. um, and knows that they died. um, veterans have no obligation to check in anywhere at any given point in time ever about anything.

and so -- [laughter] and either do i. so we don't have the luxury, i should say, of knowing when someone chooses to take their own life when they choose to do that. so we need to rely on for veterans who get care in the va which is, um, not everyone by any means, them not showing up for an appointment which may or may not be scheduled, if you or i don't go to our doctors' appointments very seldom does someone call and find out where i am or why i didn't come. but we have instituted programs in the va to do those follow-up calls and fine people. if they don't get care in the va, they don't know they've died. so we rely on the state death certificate data to provide us with that data. not all states collect or report veterans' status to the centers for disease control which is the

overarching group that main tapes, um, death numbers in the united states. there's a small percentage of states, um, 17 right now to be exact, that report these numbers on a regular basis. so we've had to take those numbers and draw conclusions from that. there's a huge time delay, right now we're working with the cdc to get the 2009 data, so it's not available yet -- >> [inaudible] >> right. >> we don't have any data to compare civilian suicide after the economic downturn. >> right. >> the cdc hasn't published it. >> so it's a struggle to figure out, um, even if we're making an impact. with the programs that we've implemented. >> general, i wanted to follow up on an important point you

made on the review of each suicide. every suicide is a different story. if you could, though, make one sort of systemic recommendation for at least the army, um, either it's an obstacle that should be removed or something that should be done. looking at this, what do you think that would be? >> the number one recommendation i would make is the study of the brain. i promise you, if there's anything we need to do, that's what we need to understand, and we just don't understand enough. please, don't take what i'm saying as we don't want people to seek help from behavioral health specialists, we do. but in studying those suicides over every single suicide, 50% of the soldiers who commit suicide in the united states army had the behavioral health care. it's 50/50, almost a complete wash. they are seeing somebody or have seen somebody, sometimes numerous times. sometimes, and barney will attest to this, we see them

listen to cases when they were seeing a behavioral health specialist who indicated they were a low-risk case, and within 24 hours they were found dead. i mean, that is what is so perplexing about this. and until we understand more about how the brain works, until we understand the effects of posttraumatic stress, i mean, one number that i've seen out there is that if you have posttraumatic stress, you are six times more likely to commit suicide than if you do have posttraumatic stress. you are six times more likely to participate in partner aggression which is a nice term for something else. i mean, we just don't know, and if anything, we need to continue the research. now, we think we're close to having a biomarker for concussion which will be huge. there are no biomarkers for the brain right now. i mean, if, you know, the scary

part for me at my age is going to the doctor is not the examination, it's when the blood work comes back. you just hope the guy has a smile on his face because he can tell from that blood work just about everything about you except how your brain is doing. and we think we are very, very close to having a biomarker where we're going to be able to when a soldier is in some kind of an event which we think is a concussive event we can go up to them, ec prick their finger -- we can prick their finger, and we will be able to tell whether or not that individual has had a concussion. the co-morbidity between the symptoms between post traumatic stress and brain injury are this. they share the same symptoms. and part of the problem is trying to diagnose those folks when they come back who, the ones that produce themselves and indicate they have a problem as opposed to those who try to hide it because they're type a people

who just because of the stigma attached to this just don't want to tell anybody. >> okay. i'm getting the cue for q&a, um, which i would like to begin and delve into the recommendations. um, a couple things on the q&a. we know this is, obviously, an emotional issue for many people and want to respect that, but also to utilize this forum, the open forum for a discussion about the recommendations and some things that can be done by the government, by citizens, by local and state governments to help with this. so i wanted, if you could, announce who you are and ask a question. if it's for the whole panel, let me know. if it's for one particular question, let them know. >> [inaudible] this is for general chiarelli. >> here's a microphone, i'm sorry. >> thank you. >> one of the myths about suicide for the military is that it's somehow tied or related to the quality of the volunteers

who are signed up over the last ten years and related in particular to recruiting decisions made during the midpoint of the iraq war. it's not mentioned in the report, meg, and general chiarelli, if you could speak to that and tell us whether there's any relationship between fitness measures, recruiting measures and the folks committing suicide. >> we found none whatsoever. hipaa kicks in here as the report properly points out. there are all kinds of hipaa issues that are involved with screening recruits, and as many of our srg briefings go, we see many, many times that an individual who commits suicide had mental health problems prior to joining the service, and that only becomes visible to us after they commit suicide because we can't get at those records. but we have seen nothing in data that has anything to do with waivers or anything else that leads toward a higher incidence

of suicide. i think that when you look at our numbers, when the cdc-corrected numbers and, again, i totally agree, we don't have numbers for 2009. our latest numbers are 2008. when we collect that, correct that population for the population we have in the service, we -- that's, in civilian life it's 19 per 100,000, just over 19 per 100,000 commit suicide. in the military, in the army last year it was 22 per 100,000, an increase of three. that is three, that is 22 too many. and in no way do we not want to attack this problem. but the issue for me is, is trying to understand it. and it is so much more complicated than i thought it was when i set out to solve it. i moon, one statistic that i can tell you right off the back is in the cases that i look at, 72%

of those cases is an individual's got a relationship problem. 72% of the cases in the united states army last year had a relationship problem. and you say, aha, that's the reason. anybody who has a relationship problem goes into a higher risk category. well, that's not necessarily the case because what you see with posttraumatic stress is relationship problems are the result of all the other things that happen from alcohol abuse to drug abuse to problems getting along with your partner. you name it, and finally it ends in a relationship issue. that relationship issue could be the culmination, the straw that broke the camel's back, i don't know. but that's what makes this so difficult. but i won't say that relationships cause suicide. >> if other panelists want to add anything, let me know. otherwise we'll go to right there. >> hi. my name is christy, i'm a ten-year army wife and the executive director of co-support

foundation. as i really appreciate this in-depth conversation, the general and i have poken about -- spoken about some of these issues, i think one of my concerns is when you have the report titled suicide, and no one's mentioning the suicides we're seeing among family members. general chiarelli and i have talked about them, but if you're going to start tracking the veteran population and if you look at the cracks efforts you -- collaboration efforts you mentioned, unless we can get some numbers behind this, i can stand up at these conversations and say the same thing, i've lost three army wives friends to suicide, and it's difficult to develop traction behind it. based on some of the recommendations you made i would say the federal exemption of the state licensing is a huge one. it's been a big problem for us within a community when you build a relationship with a therapist and then having to leave that therapist. dod had something called in

transition, i'm not sure it still exists, but it was a program that tried to keel with that -- deal with that, that did not apply to the family members. that's kind of the issues. when we talk about suicide prevention or just mental health in general, we have to be better at looking at holistically and integrating the families into it. i think there are sops that are missing, and general chiarelli and i have talked about this, when a soldier commits suicide, we have a sop report. there's nothing when a family member attempts or commits suicide, and unless we have that data, again, it's going to be difficult to get to some of those issues. finally, i just wanted to say even if everything in the dod was working perfectly, we simply do not have the resources in-house to take care of the need, especially after ten years of war. and then there are external challenges that we all on the

501(c)(3) need to be more effective in integrating our services into that community. thank you. >> thank you so much. meg, do you want to respond? >> just that i think you're absolutely right. i think there are lots of data challenges, and the need to know more about not just service members, veterans whether affiliated or unaffiliated, i think we need to know more about military families and veterans. >> is that tracked at all through the military veterans? >> we're tracking civilian suicides of family members. this year we've had ten as opposed to last year, we had 12. the cdc tracks suicides on a calendar year which confuses some people. so our years are calendar numbers, and this year we've had ten, last year we had 12. we also track va civilians, and this year we've had a total of 22, and last year we had a total

of 26 for the year. >> i think unone of the things the report calls for is a strong partnership between the dod and the va and the department of health and human services, and the department of health and human services, um, has taken on somewhat of the cause of family tracking, and i think we need to work closer together. >> but i just want to remind everybody, i can't make a family member report a suicide or even attempted suicide. that's one thing that lies outside of our ability even in the military to do. so i look with suspect at each the numbers that i'm collecting. >> [inaudible] so that inside stigma campaign that's working so well within the army -- [inaudible] particularly on officers and ncos' wives, and we have to get our messaging -- [inaudible] >> okay. thank you. steve, i believe?

>> i'd like to thank you for the report. it's going to spark a lot of conversation. meg, this question's for you. military leaders must eliminate stigma, and eliminating stigma must include a multi-pronged approach which must include accountability. on page 10 of the report, you said military leaders must be held accountable, so my question is, what do you think accountability is, and i'd like to ask the same question to general chiarelli, what's accountability? and how many leaders in if all of the investigations you've conducted have been held accountable, or what changes have you made to train them or, perhaps, you know, in the military that i served in, if you did something wrong, it was reflected in your our, our ncour. >> do you want to begin? >> i will, thank you. we do think leaders need to continue to address stigma. that may be the hardest challenge of this report, and

it's something that leaders at all levels in the military have take on. i don't think anybody would say that we've reached success yet. it's something that needs to continue. um, it's, again, it may be the toughest thing there. as far as accountability, ride like to -- i'd like to underscore that this policy brief wasn't about pointing fingers or assigning prime. the real point here, our intent is that things need to be done as we move forward to try to address this. >> general? >> we've got to go back and take a look at some of the policies we've put in place that make it very, very difficult for military members or anybody else. one of them is, is that we used to because of the stigma associated with seeing behavioral health folks, there is a complicated and legalistic way that if e want to command -- if i want to command somebody to behavioral health, then i have to do it. i've had cases come in front of me that aye had to adjudicate

where the individual has done exactly the right thing in insuring that somebody got a bill health professional, but in doing so did not follow current policy that requires certain things be done lockstep before you're allowed to do that, and i've had to take action on those cases. the action i've taken is to call them into my office for a counseling where i tell them, thank you very much for what you did. but we've got to change those kinds of things so that we can get into the 20th century and understanding that behavioral health issues and injuries are real, no kidding, injuries. and that's what we, i think, as a society have failed to do, and i hope the military can help lead an effort to do that. >> i'm going to take, and then i'll head over here. >> this question is for you, general chiarelli. you talked about the after action -- >> will you pass it to her? thanks. >> review you do after even suicide, and i'm wondering a little bit more about that process, and is that

standardized across all the services? >> i can't speak for the other services. i can tell you a death in the united states army starts with what we call a 36-liner. you know, we're big into reports. probably ten lines more than it needs to be, but it's 36 lines. and in that we go through everything from the prescriptions an individual was on, how many times they've seen a behavioral health specialist. this is all privileged material that comes to us. and once the medical examiner, not only the medical examiner has indicated, yes, this was a suicide, do we call this srg with the commander who, in fact, talks about the individual case, what went right and what went wrong, and it's always what went wrong and what they could have done about it. and it's just an open discussion to try to pass lessons learned to all other commanders who were up listening to this. i talked to folks in afghanistan and iraq, no one is immune from having to be up to talk these. if they've got cases, they've

got to talk and brief it to the vice chief of staff of the army every single month, and we're trying to learn from those. and they have proven to be very beneficial at pointing at some of the policy issues we've got, you know? i just recently, we just recently published a policy, and i think the report correctly points out is that i am not allowed to ask a soldier who lives off post whether that soldier has privately-owned weapons. i have to go through a very distinct process, a commander does, before he can ask those questions for a soldier who lives off post. and when you have somebody who is moderate to high risk and seeing a behavioral health specialist, the studies that i have read indicate that when you can separate the individual from the weapon because suicide is, in most instances, a spontaneous event often accompanied with alcohol or prescription drug

abuse, um, when you can do that, you can lower the incidence of suicide. and we have issues in even being able to do that. >> we have lots of questions, so you, yes, sir. >> thank you. chaplain johnson, army reserve, sir. i think i would like to hear you speak about the real successes in how we intervene with those who actually do come up and declare themselves suicidal, having some kind of suicidal ideation. also because i'm a reservist, 28 days a month i'm wearing civilian clothes and working back in the philadelphia area. and part of that is with the local suicide prevention task force in our county. and there is not, despite all of the mental health resources available, there is not within the general population the kind of attention to and training

that people can identify and respond to someone who's suicidal. and so my whole point, sir, and i would like to hear you speak to the successes which is those who comp up -- come up on the radar, we deal effectively with them. >> we do. many times soldiers do exactly what they're supposed to do, chains of command follow exactly the way you would want them to do that. but if a person wants to commit suicide, it is very, very difficult to stop them, ultimately, from doing that. it really is. you can get them the help, you can do so much, and we have many, many success stories at being able to help them, and i will tell you, the va's line is one of the -- it is truly a great national resource in being able to get to somebody who can help you over the phone. and they do a fantastic job. but there are all kinds of success stories out there where

soldiers have intervened, got a soldier help and gotten them past the immediate crisis. but we are concentrating, quite frankly, on those where we don't have success and trying our darnedest to figure out how we can fix that. >> there are a few -- >> thank you, dr. kemp. >> i want to interrupt you. there are a few interventions that i think both the dod have found effective in the immediate need arena, and i think that everyone in america should know what those. and in one of those you alluded to, and that's removing the weapon from, um, from the person's home. um, at that point when someone is in danger, temporarily making it difficult for them to seek any means from which to hurt themselves is effective. there's a stalling technique involved, there's, there's studies that say if someone planned to jump off a bridge and

the bridge is closed, they won't necessarily walk to another bridge. they'll think about it. if they go to get their gun and the gun has a gun lock on it or it's not in their home, there's a stalling technique there. and i think that in itself is the single most effective thing that we can do as a society to help anyone who we think is, um, in danger of taking their life. um, i think the other, um, thing that we've learned over time is that making sure people know that help is available. that, um, they have a number to call, they have something in their pocket they can pull out and use, um, and that we as a society aren't afraid to ask the question; are you thinking about hurting yourself? are you thinking about killing yourself? i don't want you to do that. i care about you. can i help you get help? and that's just my public service announcement.

.. but what it boils down to, the rate is slightly higher than it is for the general population. within that, there is deeper concern and one of the concerns is women's veterans at our

higher rate than non veteran women to die by suicide. that is concerning because in the national numbers we know that women, though they may be more likely to attempt suicide are much less likely to die by suicide overall. so the fact the we have a group of women veterans who may be changing that dynamic is worrisome. one of the reasons we worry about that is they are more likely to use firearms as an attempt method. and we know that firearms are a more lethal method and the chances of dying are higher if they try to kill themselves using a gun. so i think those are things to be aware of. >> the gentleman here? >> good afternoon. tom berger with vietnam veterans of america. thank you for putting on this briefing this afternoon.

with all due respect i want to return to my colleague steve robinson's question and perhaps not using the term leadership which was only mentioned one time in this report, let collet command structure. when we look at reports from the rand corporation that came out earlier this year on resiliency programs as well as on suicide risk prevention programs, leadership, command structure was mentioned very specifically and both of those reports as reasons why in the case of the resiliency programs they have been failing so i wish that the general would at least comment. >> about leadership? >> one of our leadership programs--one that we rolled up called comprehensive soldier fitness. we have an online test that measures resilience. it is evidence based. most people believe it is evidence based. there are those who don't

because when you get 15 psychologists in a room and ask him to enter two questions you will get 15 different answers i promise you. but the get measures resiliency. it recommends a series of models that are on line that a person can take. in order to reduce the stigma and make this something is older goes through we require they take the gat but we don't want to deter their progress. we also have master resilience trainers we're rolling out each of our battalions will go along with the unit leadership and help teach resiliency techniques to soldiers because we really believe if we want to get to the left of the event we want to increase the amount of resilience er individual soldiers have. >> you need a microphone. you need a microphone.

>> one of the criticisms in the rand report on resiliency study was there were no evaluations done. how are you evaluating this program you just talked about any meaningful sense? >> we have entered into a $50 million study with the national institute of mental health. the first-ever look at suicide in the entire country. it is being framed after the very famous report the reduced incidence of cardiac death in this country by 66%. this is a five year study that i think will go along in what we're trying to do to come up with an algorithm not that says chiarelli will commit suicide at age 29 but is much the same as when you and i go to the doctor and they ask do you have any family history of heart problems, take an aspirin every day, what is your blood pressure and cholesterol. all those came out of framing. we think in the national institute of mental health they will do the same thing when it

comes to behavior held in these issues. this study, i think will be groundbreaking not only for the military, we are in the middle of it all. a soldier study, survey and army survey to gather this data. we will be able to track this along with householders score on the gat and we will draw some conclusions exactly what is the impact of resiliency on suicide. i really feel within two to three years you will see things coming out of this study that will have a huge impact across all of this. >> a question up here. thank you. >> my name is lynn mccall. general chiarelli, you were close to having a by a marker for post conclusive events. is there a link between concuss of events and propensity for

suicide. >> what we know is -- if you look at the work of dr. mcghee in boston that she is doing on talmudic proteins, you are one of the believers like i am and her work that indicates a very important protein in the body in a neurological system, seems to do with excess of blows to the head. i'm not a doctor. but it bends over itself and collect into the brain and has the effect of beginning to eat away at the brain. you heard of brian do worsen who committed suicide not too recently. in a different way than most men do. most men put a bullet through the head or the chest. he put it through his chest and they wanted and needed a biopsy of his brain because that he had a successful nfl career and successful in business and started to display all the systems. early dementia, problems getting along with people, 8 management.

he killed himself. they looked at his brain and he had this same build up of protein she had seen in just about every single case she looked at in the nfl. it has also been studied in boxers. that is the research we need. very exciting thing about this is many people believe that this will help us with the problem of dementia because there is a belief that the same kind of -- it is research. not finished yet. this same build up of protein could be one of the reasons people develop dementia later in life. >> consistent with that there is research that shows veterans that have traumatic brain injury are 1-1/2 times as likely to die by suicide. >> there are a lot of questions but the issue we haven't discussed, we talked about the

length of ten years of war. in the findings all of you are dealing with is something unique about these wars, multiple deployment where we haven't talked about iraq or afghanistan specifically, whether it is compared to previous wars or in the findings about veterans it is different than what the veterans from vietnam or the first gulf war in the data so we talk about those wars specifically. >> we alluded to some of the data to determine at and that is our tracking of veteran suicide. actual wheat suicide in the military and the general population in the early years. so we don't have a good comparison numbers to go back and look at. the information i have and what informs me is information about veterans to get fair -- care within the va system.

i can track and follow that. i know known that our numbers are bought a mobile. when we look over the spectrum, we have an increase of suicide in people who are under 35 age group and then we have another peak that correspond with the national suicide numbers for people in middle age or just past middle age which actually is probably our vietnam era veterans. still two groups of people within the va we are concerned about. i think over time we will find out what happens to this early group as they age and are out of the military longer, but i think that one thing we need to remember is veterans are people too.

so they are also subject to all the stresses and normal life span changes in suicide rates and imposing that on top of their veteran experience is something we haven't quite figured out how it makes a difference. what i do know is the way we're dealing with and working with our new veterans is different than the way we dealt with are vietnam veterans when they came back. we hope we have learned lessons. we are doing things differently. we hope we are doing them better. and i think that perhaps this is a positive outcome. it is the fact that we are even having this discussion in a public forum with a world full of people speaks to the differences in both our agencies. >> anyone else? >> the link between deployment

and suicide always seemed obvious and intuitive that these should be linked. but the prevailing wisdom was that data didn't support that link at all. and now some analysis done this past summer, what we are seeing is there is a link for the army but it varies for the other services. even before we saw this link clearly we still knew the tie between pbi and pbst and suicide. those who came back with those wounds were at risk. what we now see an army data is those who deployed were about 1-1/4 times more likely to die by suicide than those who did not deploy at all. we don't see that in the other services and the extreme in the air force. the air force will tell you those who do not deploy or never deployed are 3-1/2 times at

likely to die by suicide as those who have deployed three times. exactly the opposite relationship. it is a complicated relationship. >> we don't know what happens over time. >> be very careful about numbers. you will see reports of the time about individual -- the first thing you should ask is what is the rate of suicide in post cancer station. the number of suicides at fort hood is naturally higher when there are 40,000 soldiers. they're all deployed. we follow reports of decrease suicide at locations that normally is because the increase is based on people coming back home as opposed to when they were all deployed. the most likely person to commit suicide in the united states army as a 29-year-old private. that is what we found.

you ask yourself why. if you join the army at 29 one of two things happen. you either got a real shot at patriotism and decided to go down one night and signed up for your going through some life experiences that you are reaching out for lifesaver. what we find with these kids is there left with two kids, have no medical insurance or health insurance. we bring them into the army and put them through six months of training and the think they made it and go to their first post can't station and then looking for somebody to take care of their kids because they have to go down range. one thing we told our leaders is when you get these kids who come in at a later age those are kids who are probably at high risk category. you need to take more time interviewing them and talking to them about what is the condition of their life. >> this is also on the web seminar so we have questions from twitter. is that true? >> a question from twitter.

for the entire panel. what can the american public do to reduce suicide in the military? >> great question. what can the american public do to reduce suicide in the military? i will just go down the panel. >> i will start. i think awareness and support. this is an american problem. it is that the a problem and department of defense problem. it is an american problem. suicide in the military affect all aspects of american life. we heard families are impacted, children are impacted. i think being aware that people have needs and our military service men and women and veterans need to talk about their experiences, they need practical assistance too.

they need jobs. they need support. they need friends. they need community involvement. and being there for people and each other is probably the single most positive thing we can do. >> i would argue pretty simply help us eliminate not only is the stigma in the army but the stigma in civilian life. that is really what needs to happen. we need standards that are applied across the board so we understand the breadth of the problem. i would hope we can get quicker in reporting the statistics. it is a problem like this. 35,000 folks in the country that commit suicide every single year. it is going to be somewhere in that number and we need those statistics. we needed to track those statistics and get at this issue and end as much as we can the

incidence of suicide. >> it was a pleasure to say i agree with you. the stigma and the data. further questions in the back? right there? and i will head to you. >> general chiarelli, your comments about 29-year-old products not withstanding you said finding those or identifying those at risk is the hardest task. assuming you could do that, assuming you could find those people who for various different reasons or combinations of reasons were at highest risk to commit suicide, given the policies and procedures and constraints you have to follow what do you think you can do that would impact the incidents? >> one of the things we try to do, we try to change the regulations. used to be when an individual reported to alcohol abuse center to get help it was automatically reported to his chain of

command. we started a pilot in six locations where that is not the case. and individual self referrals themselves to alcohol -- we call the army substance-abuse program. we do not report to the chain of command. we leave those centers open late at night so people can seek the help they need and on weekends so they can seek the help they need. that program was initially rejected by commanders but in each instance we were able to do it, we have had tremendous success in bringing in a portion of the population at high risk that doesn't want to admit they are high risk because they don't want to be branded as an abuser of alcohol. the problem is bowling that out through the united states army is a national problem. problem with health care. we do not have enough behavior health care folks and someone in substance abuse has an ability overtime to gain the experience to move up to be, behavioral

healthcare specialist who makes more money and of have this problem of trying to fill out the number of asap counselors to get this issue. i don't want somebody to self referrals themselves for alcohol abuse and come back five weeks later when we can see you. i want to be sure to provide immediate help when they do that. it is those kinds of things i really think we have to look at. i think we have to make maximum use -- one problem with kelly behavior health is getting all factors to believe in it. this group of population, youngsters of today, nothing they like better than communicating over some of the things those of us who are a little older might not like to do. what we found when we rolled out these pilot programs in doing this is the kid who gets on skype and talks to a doctor is much more forthcoming talking about his or her problems than they would be a favor sitting

across from you and me. this is one way we can make use of that. so that rather than use the p d h a legal post a plan and health assessment. will we get every soldier starting with a brigade commander, 20 to 30 minute evaluation and see if they will have a problem reintegrated into their community. >> our promise -- nancy sherman, blogger wilson center in georgetown, this follows on your remarks and that has to do with the art of being a clinician. there's science and anti stigma. your statistic was alarming that 50% of suicides or so had been in behavioral care. so resources aside, and standardization a side, is there concern about what this so-called art of building an

airport and getting people to trust you which is what clinicians do or supposed to do whether it be through skype or phone calls or 1:1 consultation. is that something the army is looking at and recommendations regarding that? >> we are looking hard at it. are have spoken about this a lot. we used to in this country -- we use to make use of boards where doctors when they got together would sit around and talk. someone was lost on operating table they would sit and talk about the operation and what happened and what went right and what possibly went wrong. my understanding is many of those boards have gone by the wayside because of the fear of individuals being sued in

malpractice insurance. one of the things we have in the military that is a blessing is you can't do that. i have been working very hard to get my clinicians in high risk or what they thought were immediate risk cases where things go bad to get together and talk about lessons learned, about what they possibly could have missed that would cause them to put the person in a higher risk category and make the man in patient rather than an outpatient. it is difficult to do that even in a higher organization with four stars on your caller across the force but we are starting to make some progress. >> i have a comment. i think one of the things we tend to forget is we are well aware that the new generation like to communicate over electronic media. we have had almost 30,000 shatters into our chat space to talk about suicidal issues.

one thing we don't remembers we have a new generation of medical professionals now coming out of academic institutions horse psychologist leaders of psychiatrists. ville social workers who are going to be providing mental health care to not only the new generation but generations that are already available. they too prefer to communicate over different media. than we are used to. and so it really behooves our academic institutions to take that into consideration when they teach people and prepare people to provide mental health care not only in the future but right now. we know that in medical institutions across the board suicide is not a topic that even today is discussed or talked about or people thought from an

internal medicine or primary care perspective how to work with suicidal patients or ask questions so it behooves us all in our institutions to a lot of political training and support for all sorts of reasons, medium being only one of them. >> one more. a woman on the side here if you could stand. and 30 people and no minutes so we will be able to discuss after but my apologies in this interested audience. >> you must know me to treat me. general chiarelli, can you talk about dealing with prescriptions being part of the report? when we talk about abuse? the prescription drugs? >> are totally agree with your report. i wish we had open season to collect drugs people aren't using. one thing we had was close open

prescriptions. the person who goes in and gets wisdom teeth pulled and has an open prescription, in the army we have gone back and closed that. we have seen -- we are working very hard to reduce the reliance on psychotropic drugs. at walter reed alone we went from 83% of our soldiers on some kind of psychotropic drug. under 8.5%. one of the reasons why we saw an increase and when i went to talk to soldiers and visit six installations in seven days and talk to soldiers they would sag see a behavior health specialist and he asked three questions and froze me a bag of drugs. why did that happen? they're not bad people but there are 15 other people lined up to see this person and maybe this will work in some cases and we

were dispensing too many drugs. that has got to end. we were working hard on alternative pain methods and trying to get this whole issue but there are all kinds of policies and laws that make it difficult for us when we went to pull that back and i think the report points out. i wish it was easier to do that. we have requests in that will allow us to collect those drugs, but we will see who gets approved. >> want to add any recommendations? >> we are going to close this event. certainly not the discussion. i want to give everyone the opportunity of any final comments about the report. >> i want to thank you for the report. i think it is important to remember the issue is not going

away. my other plea is to remember veterans are not going away. this is going to be a problem that we will deal with a over many years to come. it is not going to go away when the wars are over and the conflict are over. veterans will still need help and support. >> i want to thank you for the report. as difficult as i can be on this subject anything that will pull this group together to talk about this around the country is something we should all be thankful for. it is a complicated subject. you have done a good job trying to lay out some of the issues. and would just make that we to people to help us end stigma associated with folks getting the help they need for behavior health issues. >> i would like to thank my

panelists and thank everyone for coming and listening on line. this is a tough issue. we have laid out recommendations we felt were actionable but in no way do we mean to imply any of them were easy. this is something that is going to take continuing work. dr. kemp is right. veterans are in the public eye. as the war's phasedown and military is downsized we will have war veterans out there and there will be less in the public eye. >> i want to thank all of you and the audience for it coming in with your questions to end with something dr. kemp said, this is an american problem and your energy and interest in the subject is something we welcome. thank you very much. [applause]

[inaudible conversations] >> four days of booktv start thursday morning including thursday at 12:30. this year's recipient of the new york peace prize on monday be our power than 11:15. and henry kissinger look that president nixon and china. friday at 5:15 caroline kennedy on her mother jacqueline kennedy. 9:45 david mccallum and american acts cats in nineteenth century paris. saturday and sunday at 9:00 on afterwards the grandson of harriet truman, clifton truman daniel looks at his grandparents''s letters to each other and world former first lady played in shaping her husband's career. these are interviewed by margaret hoover, great-granddaughters' of president herbert hoover. four days of booktv programmi