brain disease linked from concussions. from the damage to his brain the neurologists concluded that he suffered from short term memory loss, inhibition, impulse controls and loss of other executive functions. these findings answered many of my family's personal questions, but with suicide, the question of what if is persistent, rather than succumb to what if, i am determined to answer the question what now. now we know we face on enormous and complex problem. suicide remains hidden in the shadows of stigma, myth and shame, the same people we wish to help will be our biggest obstacle, but in the depths of darkness, they're our beacons of hope. suicide is preventable and depression is treatable. if only those that are lost would seek guidance, for most refuse help because of fear,

because of shame, in the battle of fear and shame, i believe the friend, sibling, son or daughter is the strongest ally for the depressed, and hope is the best weapon. whenever we reach out to our fellow man during their moments of despair, we send forth ripples of hope, in time, ripples of hope will cross other ripples of hope, and build into a tidal wave of love, a tidal wave of love can sweep down the mightiest walls of depression, that is our hope. we must never give up and we must never give in to the dark hands of depression. my father's last message to me was negative thoughts lead to negative consequences. he then left me with his favorite biblical verse from my own battle with life, and i close by sharing it with you. "but they that wait upon the lord shall renew their strength,

they shall mount up with wings as eagles, they shall run and not be weary, and they shall walk and not faint." isaiah 40:31. thank you. thank you very much. [ applause ] thank you, tregg. for those of who do not know mental health america we're the oldest community-based network for organizations focused on mental health and mental health issues in the united states.

we're 103 years old this year and we were founded by a gentleman named cliff lard biers who himself was involuntarily committed for two years and so appalled by what he found in the asylum system that he dedicated the rest of his life publicly, which was unusual in 1909 to end stigma associated with mental health conditions. t regg came to your chicago affiliate a few months ago and carol the executive director called me up and said this guy is great, you got to get him involved nationally. as of this morning he's our new national spokesperson. he doesn't know that yet. [ laughter ] and we are -- proud and fortunate to have him indeed. we have -- let me tell you just a bit about our mission briefly. it's to advocate, educate and serve. we advocate on behalf of those who are living with a mental health condition, broadly defined, we educate the american public about the harm and often

mortal harm that stigma does in this country about mental health conditions each and every day, and we serve the american public through our 240 affiliates in 37 states, and we're proud of that mission. our symbol is the bell of hope, it sits in our lobby, in 1953, when they shut down the barbaric asylum system in this country, our ceo at the time was precious enough to send out a national to send us the chains and shackles used to strain asylums to the walls. we this them melted down into a factory in baltimore and forged into a 300-pound bell that sits in our lobby and we ring it on special occasions because the message of that bell is end stigma, end it now and this population, the people in this room understand that stigma kills, especially in the u.s. military, and we have to address it every day. i want to read you some excerpts

from our real live website briefly. these are, we have a real lives website, you can go on and talk about what is on your mind. there's different categories and i went into the section on suicide and suicide ideation, so these were people who actually attempted suicide, from a forgotten dad in washington, first and foremost i am a survivor. i've had difficult times with relationships, i keep everyone at a distance. even those i know who i can trust, trust say big issue. i can count the number of people i trust on one hand and even with those people, there are doubts of trust. by charlotte in kentucky, lost her son in a boating accident, doctors wrote me prescriptions for many medications. i don't know why but i simply refused to take the medication for the first few years. after that, i began to try some of them but i just could not remember to take them. i couldn't even remember to eat when i was hungry. i lost all interest in doing anything fun, so friends stopped coming by and eventually stopped

calling. by karen in missouri, who planned suicide but was saved by an intervention, i would like to ask one thing of anyone who reads this, please, listen. that's it. listen. listen to your kids when they say they're sad, never underestimate the importance of the topic. remember that we are all unique individuals. what is important to you may not be important to them and vice versa. listen to your spouse. listen to your friends. listen to your kids' friends. listen to your co-workers. listen. if i didn't have anyone to listen to me, no one would have ever heard my voice again. the theme that tregg and i settled on for this talk today is from anguish, hope. certainly his dad bent the curve of awareness in the nfl of the seriousness of traumatic brain injury in that sport. he made a difference. there is hope because of his life and the things that he contributed to the sport, and to

his family. similarly, mha believes right now there is a unique opportunity in american history in our society and in our culture that is an extraordinarily hopeful opportunity. you can go into any community in this country right now in the most informal setting and use the term ptsd and americans know what you're talking about. that is an amazing transformation in the awareness and the sensitivity and the receptivity of the american public to mental health issues. we can't blow this opportunity. we can't miss this chance. we can raise the bar forever in american society. mental health conditions are the number one most debilitating, chronic condition in the world today, and the united states leads the rest of the world. we can really make a difference. [ muted audio ] -- on wellness, prevention, resilience and recovery. we have a metaphor called the

wellness circle. find it on our website, there's three states in our circle, treatment, recovery and wellness. the reason that's a symbol we like to use is because if you are in the green wellness section of that wellness circle, it is ludicrous for you to point across the circle at somebody in the blue treatment section with a finger of stigma, because you are exactly one life's event away from being on the other side of the circle. and the really hopeful aspect of the circle is the fact that no matter where you are on the circle because it's a circle, if you ask the right person and you seek out the right help, you can always find the path back to wellness, the wellness circle, it's a powerful symbol that we like to use. i came on board mental health america just under three years ago, retired air force colonel, i worked at wounded warrior project before i came to mha, and it was clear to me with mha's breadth and depth of experience in this country, i sat down with our ceo and said david, we have to be in this space. there is amazing white noise out in the civilian community across

this country about mental health conditions and how to respond in an effective and efficient bay. we're not effectively addressing that issue, and we've been trying for ten years as a country to do it. we have to figure out how to do this. and mental health america is uniquely positioned to do that, but there are so many players in this space. there is so much white noise in this space right now. we cannot simply be yet another program, and yet another effort, and more noise that takes up more resources. we have to do this in a smart way, so we said let's have a conference, as everybody always does to start these kinds of things. we had a one-day conference, imtromp tu, brought everybody together we could think of that had any stake in this game. we put 35 national experts in the room, terry temilan, the author of the 2008 rand stud yu, the white house was respected, va was represented, dod, the peer assistance program was represented, umda in new jersey had the vet-to-vet program, larry fritz, one of the national acknowledged experts in peer

counseling was there. it was a great conversation and we started off with what we thought was an effective model to begin to bridge the gap between this dire need and now what we thought were enough raw resources after ten years of war to meet that need and the gap in between. but we said we don't have a hidden agenda at this conference and we really meant it which was good because by lunch time all 35 people at that conference had told us this is the dumbest idea we've ever heard, get rid of it. it's not going to work, forget it. after lunch i talked to david, what are we going to do? he said let's start over. we started the afternoon with what do we agree on, 35 national experts and we came to a consensus and i'll share that consensus with you in just a second. but after that conference, i hit the road and traveled around the country, and we visited or talked about or examined or studied what we thought were 11 very successful national programs that are addressing this issue. with an eye towards what are the best practices, and how can we

bring our national network to bear in a community way? and the results of that year of travel have resulted in what we are now calling the bell of hope project, which is going to be our signature project in the military community for as far forward as i can see. let me give you some conclusions, though, based on that analysis and based on some of the things we've seen at this conference. we believe there still remains a gap between the population's need and the service delivery, the services that are being delivered, and what's interesting here is, i personally think that the need is growing and the service, available services and resources are growing, so these circles on either end are getting bigger and bigger and bigger and that's good news except while they're getting bigger and bigger the center point of those circles is moving further apart. there's a larger gap between our military community at the local level and our civilian community than i think i'ven seen in my

lifeti lifetime. so the gap, the absolute gap between the edges of the circles is roughly the same, after ten years of war. we have to bridge that gap. this piece in here is where we need the help. let me give you a couple of stories to illustrate that gap. i was in charge of the care giver conference, a team of three or four of us had legislation that became law in 2010 as our principal project that we spear-headed from a cold start. we brought 18 care givers with severely disabled vets into washington. we had a session that was supposed to last for an hour and a half and it was a horseshoe shaped setup in the room and on one side were all the service representatives, the white house, va, dod, all the individual service representatives and that were familiar with all the programs that were available for care givers of severely disabled vets and the other side were 18 caregivers and for an hour, all of those government representatives talked about all of the programs that were in place to help those care givers,

everything they'd done and all the progress they've made to help those caregivers and at the end of that hour there was a pregnant pause and one of the caregivers raised their hand and said, thank you very much, i'm sorry, i think i speak for all the caregivers in this room when i tell you, we don't have a clue what you're talking about. so for the next three hours, and some of the senior officials that were in that room canceled meetings, they talked about how can we begin to bridge this gap. the second story happened last october, we took the bell on a mini tour and one of the places we went was the indianapolis national guard armory. many of you may know that the va medical center is in indianapolis and has one of the top behavioral health care facilities in indianapolis. the armory is five miles up the highway around the beltway and we had a slot for david and i to explain the bell of hope project to about 200 guard members and their families and the slot was 9:00 on a sunday morning, and i kind of leaned over to david and i said, "david, this could be a

huge thud. this is probably a mandatory formation, it's 9:00 on a sunday morning, and there may be no engagement at all here so i don't want to you get your hopes up." so off we go. we did our presentation. they kept us 45 minutes after the scheduled one hour talk, and let me give you some of the comments. the first person that stood up said, "look, we know we have mental health issues. we're not ashamed to say that. we talk about it all the time. but what i really need help with is day care, because i can't find any, and i don't know where to turn to get day care help." one of the comments was "you are the first civilian organization in ten years to talk to us about mental health." now, this illustrates the gap that we have to address in order to make practical reality the kinds of wonderful projects and programs that i've seen evidenced in the last three days of this conference. we feel very strongly the

solution is not a top-down solution. i was in wounded warrior project. i went to a lot of congressional hearings. i don't know how anybody works in va. you guys are walking around with targets, not just on your front and back, all over your body. you're just covered with targets, and it's not right and it's not fair, because every person i've met in the va is dedicated, professional, world class, they're top notch. i don't think -- [ applause ] thank you. thank yourselves. i don't believe the va and dod can or should be charged with the principal responsibility of solving this problem, and we are losing this generation and the last generation of heroes from the military community because we're not yet solving this problem. we must bend this curve in a significant way and we have to do it now. point in case, i went on the va website last night. there are 22.7 as of 2010, there

are 22.7 million vets in the united states. this is not dependents, this is vets. of them, 8.3 million or 37% are enrolled in the va health care system. of the ones who are enrolled in the va health care system, 47% avail themselves of outpatient care. if you combine those two numbers, that means it's 17.39% of veterans are seeking va care, 17%. that number does not even begin to address the dependents and families that aren't eligible for care. i'm not sure of the current regulations. it may have changed but i'm pretty sure the majority of people in that armory on that sunday morning in indianapolis were not allowed to use the best behavioral health care facility in the va five miles down the road. how do we solve that problem? their dependents couldn't use that facility. how do we solve that problem? i think it's incumbent upon the civilian community to stop simply putting yellow ribbons on

their bumpers and actually stand up at the community level and start to solve this problem en masse. [ applause ] an interesting side note, 21% of the enrollees who were enrollees didn't know they were enrollees. that's an amazing statistic. but remember, if the va and everything we've talked about over the last three days worked perfectly, you'd reached 17% of the affected veteran population, and that, again, doesn't count dependents. we think another conclusion that we've reached over the last year, and it's been reinforced at this conference is our informal analysis indicates that integrated care is the answer, very early in the process. we think that the best way to respond with a suicide prevention protocol is not to respond effectively when suicide ideation is perceived at the chain of command or the va

hospital, it's when somebody calls up i need day care thursday so i can go to my job interview, do you know how i can get that? that's where we need to address suicide prevention. only america's communities can solve this, and believe me, i've been out since 1997. america's communities are trying dels pra desperately to do exactly that. they just don't know how and they're competing for ever dwindling resources. let me tell you, i've been in the non-profit community since 199 and it's been pretty bleak out there. with the economy the way it is now, every non-profit is fighting tooth and nail for every penny we can get. here are the comments that came out of the conference in 2011. peers work, four lessons, number one, peers work. did everybody remember undersecretary petzel's compelling story he told of the crisis line? how many of you heard carefully

that sequence started with a peer connection? it didn't start with a call directly to the line. it started with a peer connection. peers work. they need to be trained. they need to be certified to a national standard. we think we are, i hope i was going to get word sometime today but maybe not, we're hoping by next week we will have hopefully full funding from a foundation that asked us to design and implement the first national peer training and certification program. i know the va just issued an rfp for exactly that. we've talked with the va and we said if we build one as well in the civilian community that's completely not attached to the va, would you guys certify it? they said absolutely, go for it, so that's what we're going to do. peers work. number two, peers navigate. their principal function is to navigate at the community level. it isn't just about mental health and being a peer specialist for mental health. it's about navigating and answering every single need. which means they need to know what the community has available

in all the sectors of service. when that person calls and says i need day care next thursday, the peer says, got it. i heard that. to go find you da. and i'm going to call you back and we're going to continue to follow up until you get that day care. number three, effective local community resource directory and local community collaboration. it's a terrific program that is trying to collaborate and create a blue print for how you collaborate with community services. it's a very important function. we think that military family members, military community members which is veterans and care givers and dependents, it's the whole gamut, retired, active duty, they need to have access to an online resource directory at their community that really rates the services that are available. it tells them what insurance plans do they accept, how much is it going to cost, what's my point of contact, are you accepting new clients. i've had 25 people rate this three stars out of five.

those functions have to exist at the local community level so there's an easy way for people in the military community to find what community resources are available. and last, it was touched on before, we need a really aggressive outreach program. let me tell you a tragic story about outreach. coleman beane took his own life in 2007 in old bridge, new jersey. pretty famous, rush holt, the congressman from new jersey got a bill passed, he was individual ready reserve. i went and talked to linda beane before we started to do this for mha and i said i want to make sure we don't duplicate effort and basically don't solve the problem because we're just turning around in circles like a lot of us tend to do when we start these things off. and she really appreciated the visit. the next day i went to university of medicine and dentistry's vet-to-vet program in miscataway, new jersey, a ten minute car drive from coleman beane's front door. they didn't know about each other. that's the challenge that we have in front of us. that is only going to be solved

at the community level and it is only going to be solved by organizations that exist and have name recognition at the community level. so aggressive outreach. based on our conference findings and our examination of these 11 programs over the last 11 years, we believe that a solution should be based on four principles. peer navigation, has to lie at the heart of it. we're absolutely convinced of that. peers can overcome stigma. it's the first line of defense. it's the friendly front door. peers can overcome stigma. delivery of integrated services. you can't just be this sector or this sector. you have to say what do you need and be able to answer that question at large. number three, measurable outcomes. i'm a stickler on this. if i can't measure it, it is not a success. when you hear about a program in a community and somebody says, we get this all the time, oh, you know, people are already doing that, we already had that program going on. i ask three questions. one, how many clients have you helped. two, what are the long term outcomes for that client of your

assistan assistance. three, what does your client feel about the help you provided. if you can't answer those three questions, you cannot claim success. so anything you do has to have a measurable outcome. finally, this is really important, local flexibility. it is not one size fits all. it's one size fits one. but there has to be some structure, some skeletal structure that will enable the butterflies to fly in formation. that's what we're trying to do. we want to get everybody moving in the same direction in a way where you can pour the unique community resources into that framework and have them be most effective and most efficient forever, and ideally we would like to start with the military community but i can tell you, this template will work for all social services in all communities around america, and americans are ready to hear this message. if i can have the slide up, please. thank you. this is what we call the community guide on model, based on the aspen point and peer navigator model in colorado springs.

they have kindly worked with us to expand it out and make it a bit more generic. nha's goal as of just a few weeks ago is to create a national network of 500 trained and certified peer navigators within three years using this model. the model's comprised of six rings of service and you can generally consider the inner ring the most important and the outer ring the least important, but all six are very important. all six rings, each of these rings, now, if you say have you implemented the community model and do you have results yes, no, we didn't but i can tell you a number of organizations, there's at least one organization that has implemented each of these six rings and successfully. the aspen point model is probably the best but umdmj has a terrific one. university of michigan has a terrific one, a peer program. they need to be backed up by trained and military clinicians. i don't know how many of you heard of the citizen soldier support project in north carolina. they have mapped every active

duty guard, reserve and dependent in every county of the united states. if you ever want to know what that population is in your county, they can tell you. they also have mapped military accultureated clinicians and they continue to be able to do that, tell you which clinicians can back up that peer structure in your community in a substantive way. they need to be managed by a data base that allows effective continuous follow-up by the peers. the dark red ring is now the community collaboration piece, the best model we found is probably community blue print, but the community blue print folks have told us it is very difficult to get community resources to collaborate with each other and get measurable outcomes. they need to be divided into sectors of service. you can see those sectors there, reintegration which is short term needs and then work force development and then i had over on the left wellness, behavioral health and physical health and we actually had to combine that because i realized i was dividing out types of health which is kind of silly.

i'm being shortened here and i understand why. let me just give you a quick statistic. the peer program's hallmark is they have very precise outcomes. the aspen point model, in three years have served 2921 military families in colorado springs, 500 military families have been actively navigated, 65 incars rated veterans have been placed in jobs, 78% did not come initially for mental health needs, they came for career and reintegration needs. 73% had more than one sector of care they needed help with. only 16% initially touched the system for a mental health need. this is a real interesting one. annual community costs without peer navigator to colorado springs, $6.9 million. annual community cost with peer navigator, $220,000. an 85% reduction in community costs. we can solve this problem but we need to do it at the community level and i can tell you we need your help. we certainly need your money. it is a very, very compelling need but it's going to be solved

at the local community level, not from the top down. thank you all for everything you've done. appreciate it. [ applause ] >> thank you both so much. i think it was a great segue into the next section of our program. for the first time this year, behind the scenes we've had collaborations with health and human services over the past few years and they have been active members of our planning committee for the conference but more importantly, they are very key players in both the va and the dod suicide prevention programs and have been a strong resourcing source for us. so we're happy this year to be able to really formally acknowledge that and hear from them, too. and i think that we are all in this together.

we're not going to do it ourselves, as you've heard over and over again at this conference. so i would like to start off by introducing pam hyde. miss pamela hyde was nominated by president barack obama and confirmed by the u.s. senate in november of 2009 as administrator of the substance abuse and mental health services administration, a public health agency within the department of health and human services. she has a long history of serving america through various public health and mental health administration roles and has a biography in the program which i hope you will all read and spend some time, but in order to move on with the program, i'm going to bring up pam. thank you. >> good morning. that was a challenge. i need to do better about my

step exercises. it's very good to be with you here. thank you, janet. it's very good to be with the department of defense and the veterans administration and all the parts of the military who are working on issues that we care a lot about at samsa. we are very interested in the issue of suicide nationwide and in preventing that issue, and i want to take just a minute to sort of set a larger context. i suspect after three days or two days at a conference like this, you may have heard much of this, but let me just tell you a little bit about how i think about this. these are 2008 data and i'm sure you all know this by now. suicide is the tenth leading cause of death of all americans. that is way too much and unfortunately, while these are 2008 data so that we can compare them across disease types, the 2009 data are getting worse and we anticipate in terms what have the trajectory looks like, 2010 isn't getting any better. the tough reality about