for us is that it's not just deaths from suicide. that is incredibly critical because the deaths from suicide in our country exceed the deaths from hiv/aids and the deaths from traffic fatalities. these are issues that all of us as a public health matter look at carefully and pay a lot of attention to and provide a lot of resources for. suicide deaths exceed that. unfortunately, whether for kids or for adults, certainly people in the military and their families, the people who have serious thoughts of suicide and the people who make a plan about suicide and the people who actually attempt suicide, these numbers are astronomical. they are much more and they represent a lot of distress going on behind the mortality rates. we are very concerned about all of those issues. 90% of the people who die by suicide, i'm sure you all know by now, have a mental disorder, many times unidentified.

the suicide rate among people with major depression is eight times that of people without. an estimated 20% of individuals who die by suicide were veterans. those numbers are not precise, but that is way too many suicides and it's way too many veterans dying from that cause. we also know that suicide's very connected to substance abuse. 30% of the people who die by suicide have a blood alcohol level above the legal limit and just for those tested, so not everyone who dies by suicide is, but for those tested, 10% of them involved substances such as amphetamines, cocaines, opiods and marijuana. for young people, this is an age group that has bigger issues and less willingness to do something about it or reach out and ask for help, and that is true for the age group about 18 to 25 or up to -- between 15 and 24,

suicide's actually the third leading cause of death so to the extent that military recruits and others are in that age group, this is a high priority issue for families as well. the other thing we're looking at is how the health care system deals with people who might be depressed or have anxiety disorders or ptsd or other kinds of issues that may be -- may precede suicide. we know that a lot of individuals who go to an in-patient unit for suicide attempts, when they leave, they continue to be at even higher risk for suicide and the connections are not well done. so one of the things that we are really trying to think about is how do we get at people who have attempted suicide once or more times and then are leaving our care systems without good connections to post-care. we also know that there's missed opportunities. there are a lot of people who go to their primary care

physicians. 77% of individuals who die by suicide have seen their primary care doc within the last year. 45% of them have visited their primary care doc within the last month and 18% of elderly patients in which there's a very high rate of suicide visited their primary care doc on the very same day as the suicide and yet, no mention or very little -- seldom was the question of suicide or related issues raised. so we have lots of opportunities and the national suicide prevention, national actualized for suicide prevention was launched a couple years ago by secretary sebelius and gates and the idea was to champion suicide as a national public health priority and to make suicide a nonevent. we think it is a preventible public health issue that we can address nationwide. one of the things that this

national action alliance, a public/private partnership, is working on is the national strategy for suicide prevention. it was done in 2001 by the surgeon general then and is being updated. we are working hard to get it out by this fall. you may know that the public/private partnership for this suicide action alliance is the honorable john mchugh, secretary of the army, and also senator gordon smith, who is currently the national association of broadcasters ceo. so we have a very strong public/private partnership. the national suicide strategy is -- has got four strategic directions. we're trying to look at both healthy and empowering individuals, families and communities, getting the word out, getting awareness raised, getting people to understand that this is a preventible issue, trying to look at community and clinical preventive services and treatment and support services. we're also looking at surveillance, research and education and we have a number of federal agencies and departments, including the military agencies working with

us. one of the task forces, there are many, one of the special population task forces focuses on military families. that means not just current personnel and not just veterans, but also their family members as well as the national guard and other parts of the military. we are collaborating a lot with the veterans administration and we are very pleased with the collaboration, as janet said. we're doing a lot of work on sharing resources so the veterans administration has actually adopted samsa's addressing suicidal thoughts and behaviors in substance abuse treatment and likewise, they then helped us to create a training video that's used by both va and community providers. samsa also assisted the veterans administration in updating the suicide prevention gate keeper training for use in communities and we're also participating in a group to develop dod and va joint clinical practice guidelines to prevent suicide. in the behavioral health field,

the military's actually been part of the world that has done very cutting edge work in behavioral health that we have been able to use over the decades in communities. so we're very pleased with that. we also have work going on with tricare, working to try to expand behavioral health provider capacity and do some pilots there. so there's a lot of work going on between samsa and the military parts of the federal government. we have a strong commitment to military families as one of our strategic initiatives and i'm very pleased with the interrelationship that we have on these issues. there's much more i could say but my joy and job is to introduce the secretary. and i think i see her down there. i think secretary, we got the memo about the colors today. so this is a good thing. i do want to introduce my boss. i've worked for lots of governors and mayors and

political leaders in my career and none of them are more committed or more energetic and focused on the right things than secretary sebelius. as part of the historic affordable care act, she's implementing reforms that have ended many of the insurance industry's worst abuses and is going to help 34 million uninsured americans get health coverage. she's also working with all of us, and with doctors, nurses, hospital leaders, employers and patients to slow the growth in health care costs through better care and better health. she actually has called on all of us at hhs to collaborate at the federal level and with states, with tribes, with communities, with federal partners to make america healthier and to be the most efficient and effective government agencies that we can be. she's an extremely strong supporter of behavioral health as part of this health care effort and leads the charge on the messages that prevention works, treatment is effective and people recover.

please join me in welcoming secretary sebelius. >> good morning, everyone. i am really pleased to have a chance to be part of this very important conference and i want to start by recognizing one of our great health leaders, pam hyde, who leads this incredibly important agency on substance abuse and mental health services and as pam said, our strategy among other things is to not only look at the cutting edge research and best practices but actually to collaborate and leverage assets across the federal government. i've been really pleased at the level of cooperation and

collaboration with two of the military partners, secretary shinseki and i know that janet kemp is here with the office of mental health and that has been a terrific effort on all kinds of fronts, this being among them, but we're working on veterans homelessness and a whole series of activities, and also, secretary leon panetta, who will follow me because he has a deep and personal interest in this area. i don't think there's any more important work than taking care of those who have stood up to protect our nation. our men and women in uniform put their lives on the line for us each and every day and we need to be there for them when they return. now, what we know about the snapshot of soldiers today is that they carry an especially heavy burden and have over the

last decade. there have been longer deployments, more frequent redeployments, shorter breaks in between. the stress has been more constant not only on the active duty military but certainly on their families. tragically, as a consequence, we've seen suicide rates continue to rise among service members and veterans. so the defense department and the veterans administration have taken this crisis on and made it a top priority, but the responsibility of meeting the mental health needs of our service members, veterans and their families, lies with the entire country. when the people who fight and defend our freedom need help, we all have an obligation to make sure they get it. that's why in 2010 i joined then secretary robert gates and secretary of the army, john mchugh, to launch the national action alliance for suicide prevention.

our aim was to make suicide prevention a national priority, especially for service members and vets. so in our department, that has meant working to make life-saving services and support more accessible and more responsive to people in crisis. for example, we operate the national suicide prevention lifeline number, a national network of crisis call centers for those experiencing a suicidal crisis or in serious emotional distress. last fall, the lifeline received its three millionth call. knowing we had this large and effective network already in place, the va reached out to us several years ago and we formed a partnership. today, service members, veterans and their families who call the lifeline can press number 1 to be connected to a va call center that provides specialized crisis

services. the veterans crisis line or military crisis line, as it's known within the services, is also available in a number of european countries and in just the first five months of this year, over 85,000 lifeline calls were answered by the veterans crisis line. more than 550 calls a day. our department has also organized a series of policy academies that bring together community leaders, guard and reserve members and veterans officials from several different states to team up and share best practices. one great example was a program known as operation immersion, an initiative that brought community-based health care providers to a national guard base where they live like soldiers for a few days. they eat mres, run drills, do pt and in between, they meet with

soldiers of every rank and their families to hear about military culture, life on the front line and what it's like to be back home. now, that has given health care providers an in-depth understanding of what service members and their families are actually going through and helps them provide better care. operation immersion started in tennessee but when organizers brought it to one of our policy academies as a best practice, it sparked a lot of interest. so we flew representatives from other states to tennessee, where they experienced operation immersion for themselves. and now a number of them have replicated this program in their own communities. so one of the things that we're trying to do and will continue to do is find best practices and help them come up to scale throughout the country. our ultimate goal is to work in support of states together with the department of defense and

the veterans administration to create a system where there's no wrong door for any service member, veteran or family seeking help, where no matter where they go for help, they get the care they need. and to do that requires some real work. educating community-based doctors and nurses about how to ask patients if they've served or seen combat, how to screen for ptsd, how to best refer patients to the va and to tricare. we want to give state officials the technical support to create accessible integrated data bases they can use to connect service members and veterans to local services from child care and employment to local chaplains and peer support networks. and we're helping state and local agencies collect and share data so we can get services in communities where they need it most, mapping out what exists and trying to fill those gaps.

the thing that ties all of these efforts together is a commitment to care for the whole person. we want to make sure that people stop making distinctions between behavioral health and physical health, and i know that all of you feel the same way. i'm a former governor. i was governor of kansas, and my adjuta adjutant general at the time was todd bunting. he took very seriously the effort to address the mental health needs of returning national guard men and women. he used to talk to me about how when a soldier is going into the field, how he would take his bradley tank and run a check on the vehicle, things like checking the treads, making sure the guns were operational, making sure they have all the correct ammo, and that we would

never send that machine into the field unless it checked out, unless everything was right. but we actually weren't taking the same care with service men and women who were in that tank and guiding that machine. so in this administration, we're committed to ensuring that we meet the full needs of our service members and veterans and that means taking care of the whole person, their physical health and their mental health. i know exactly the important life-saving work that so many of you do every day and we want to help give you the support to keep doing it and doing it well. i want to thank you for sharing your experience and your expertise at this conference here this week. our men and women in uniform, veterans and their families, have given so much to defend this nation. by giving them the support they need to stay healthy and get

help when they need it, we honor their service and fulfill our shared responsibility, and at the department of health and human service, we regard this as a priority initiative and look forward to our ongoing partnership. thank you very much. [ applause ]

>> here i am. you've done this before so if you could just sit patiently in your seats, we anticipate the arrival of the secretary of defense momentarily.

>> ladies and gentlemen, please remain seated. our program will resume shortly.

>> good morning, ladies and gentlemen. at this time i would like to introduce the assistant secretary of defense for health affairs. please give a warm welcome to dr. jonathan woodson. >> for those of you, many of you were here the other day, he's back. great. but it's a real pleasure, ladies and gentlemen, and an honor and a privilege for me to introduce our next speaker and my boss, secretary panetta.

as we work to confront the challenges of mental health and suicide prevention, the department could not have a more fortunate leader than secretary panetta. i don't believe there's a single person in government and perhaps in this nation who has confronted and assessed the most complex issues facing our nation from as many perspectives as our secretary. like few others, secretary panetta's life is defined by public service. he served his country in uniform as an army intelligence officer. he served in city and federal government as staff. for 16 years he served as a u.s. congressman from california, eventually rising to serve as chairman of the house budget committee. following his time in elected office, he served president clinton as director of omb and then as chief of staff. he returned to public office under president obama, first as director of the central intelligence agency at a pivotal time in the history of that

agency, during a two-theater war, and on july 1st, 2011, was sworn in as the 23rd secretary of defense. this biography is reflective of an important life of service to this nation but more important than the positions the secretary has held is his passion that he brings to the work, our work. he does not mince words. he does not allow us to hide behind bureaucratic language or euphemisms. he challenges us every day to confront the most difficult issues directly and honestly. that approach could not be truer in the cavse of our efforts to improve access to and quality of behavioral health services. the leadership in the department knows it but more importantly, the soldiers, sailors, airmen and marines know it. we are honored to have him here with us today. ladies and gentlemen, please give a warm welcome to a true patriot, the honorable leon panetta, secretary of defense.

[ applause ] >> thank you. thank you. thank you very much. thank you. thank you very much. thank you, dr. woodson, for the kind introduction and thank you all for your leadership, for your wise counsel and for your commitment to ensuring that our service members and their families receive the kind of treatment and support that they so richly deserve. i would like to express my appreciation to all of you in this audience. appreciation for coming together, appreciation for the work that you've been doing at this three-day conference,

appreciation for the focus that all of you are making to try to give attention and energy on one of the most complex and urgent problems facing our military families, the problem of suicide. lot of people here who have been working with this issue day in and day out and i have tremendous respect for your capabilities. you're the experts in trying to deal with a very difficult issue. i'm reminded of the story of the nobel prize winner who was going throughout the state of california. he had won the nobel prize in a very complex area, physics, and he was going throughout the state of california and giving very complex address on the area that he had gotten the nobel prize, and as he was heading towards fresno one day, his

chauffeur leaned back and said you know, professor, i've heard that same speech so many times, i think i could give it by memory myself. the professor said well, why don't we do that. why don't i put on your uniform and you put on my suit and you give the speech. and they did that. the chauffeur got up, dressed as the professor, spoke for an hour on a very complex area of physics, and got a standing ovation at the end of the address. and the professor dressed as the chauffeur sat in the audience, couldn't believe what just happened. then somebody raised their hand and said professor, that's an outstanding address but i have a question. and he went into a three paragraph question that included mathematical equations, some formulas and basically said now professor, what do you think about that? and there was a long pause.

the chauffeur said you know, that's the stupidest question i have ever gotten. and just to show you how stupid it is, i'm going to have my chauffeur answer it out in the audience. so there are a hell of a lot of chauffeurs in this audience when it comes to this complicated issue, this difficult issue, and i really appreciate the devotion and the dedication that all of you are making to try to deal with this issue. i'm particularly pleased that this conference is run jointly by the department of defense and the department of veterans affairs. building a stronger collaboration between our two departments is absolutely essential. it's essential to meeting the

needs of our service members and veterans, and i am proud of the strong working relationship that i built with secretary shinseki and i agree with what he told this audience on wednesday, that our two departments are now working more closely together than ever before. it's essential and important that we build that kind of partnership if we're going to address issues like suicide. this issue, suicide, is perhaps the most frustrating challenge that i've come across since becoming secretary of defense last year. despite the increased efforts, the increased attention, the

trends continue to move in a troubling and tragic direction. all of us gathered here share a very deep concern about this issue and about the trends that we are seeing. we also share a commitment to take action, to do everything possible to prevent these horrible tragedies and to support those who have served our country with honor and with distinction. greatest frustration, greatest frustration is that there are no easy answers here. there are no quick fixes. there are no simple solutions. to the problem of suicide.

but that doesn't mean that we can't do more to prevent it from happening. we can do more. we must do more. and together, we will do more to prevent suicides. but first, it's important for all of us to recognize the nature of the challenges that we face in our military and veterans community. for more than ten years, we have been a nation at war. repeated deployments, sustained exposure to combat, the tragedies of war have brought stresses and strains on our tr a