>> welcome and good afternoon everyone. and you for being here at this particular press conference marked the submission and release of the report from the department of defense task force on the prevention of suicide by members of the armed forces. as you are all well aware, the number and rate of suicide by service members across dod have increased significantly each year over the last several years. frankly speaking, having any of our nation's warriors died by suicide is not acceptable.

not now, not ever. suicide is preventable and this report is intended to improve upon the hard work of each of the military services. the opportunity is here and there is great hope that we can not only prevent suicide and save lives, but further strengthen the force in doing so. i am major-general phil volpe, united states army, military co- chair on the dod task force, along with ms. bonnie carroll, who was also the president and .ational director of taps, th ghanian i have had the distinct honor of serving as cochairs alongside many of the distinguished members of our task force. most are present, but if you were not able to make it today.

in a few minutes -- in a few minutes, i will have each of the members introduce themselves. why are we here? as directed by congressional mandate in section 733 national defense authorization act for fiscal year 2009, the secretary has a dovish a task force to examine matters related to -- to establish a task force to examine matters related to the prevention of suicide in the military force. the task force is made up of 17 professionals who have done research in the field of suicide prevention, clinical care and mental health, military chaplaincy and pastoral care, and military families. additionally, the task force had reckoned -- representation from each of the military branches, army, navy, air force and marine corps. the task was established in august of 2009, one year ago,

and today, submitted to the secretary of defense detail in the research and results and recommendations from a year-long review of data, studies, programs and discussions with service members, their families, and caregivers. the intent of this board is through the day -- to the secretary of defense for actionable measures and policies and programs designed to prevent suicide. the task used by the main data. presentations from saddam matter experts, public participation -- from the subject matter experts, public participation, panel participation, and cut information gathered on eyes on a field visit.

the task force concluded that current service benefits would benefit from a comprehensive strategy cordoba throughout the department of defense. we arrived at 49 findings and 76 associated recommendations, which are discussed in detail in the full report and a complete list of the recommendations are found in the charts in the last few pages of your executive summary. the 76 recommendations roll into four primary focus areas. organization and leadership, wellness and and and and training, access to and delivery of quality care, and finally, surveillance, investigations, and research. the 49 findings and 79 associated recommendations are divided up among these focus areas. the task force also provided a set of foundational recommendations that aggregate several of the targeted

recommendations which the task force believes our critical in preventing suicide. the foundational recommendations are also listed in the executive summary on page es-9. at this time i would like to have the members of the task force present today introduce themselves, beginning in my right, dore left, starting with dr. jobs. >> dr. david jobs at the catholic univ. of america in washington d.c. my research focuses on primarily in the assessment and treatment of a suicidal individuals. i have been a consultant to the dod, veterans affairs, and i have worked as a consultant across the branches of the army, navy, air force and marines. i'm a clinical psychologist and i am in practice here at the washington psychological center here in washington. >> good afternoon. i am chief master sgt jeff seb

relczik. i have 20 + years in the air force with a background in resource personnel. >> i am robert sertain. i am in the episcopal priest. chaplin. is a retired javeli it covers part of my career was a b-52 navigator and had over 100 combat missions in vietnam and was a prisoner of war. >> good afternoon, john preppy. i have been involved -- i am john bradley. i've been involved in clinical

care for the past 26 years. carroll, an army surviving spouse. i am therefore is reserve officer. my career has included chief of casualty operations, headquarters in an states air force. by and former white house liaison to the department of veterans affairs and i directly, tragedy assistance program for survivors -- i direct a the tragedy assistance program for survivors. we have over 1000 family members who have lost a loved one to suicide. >> hello, i'm david lift, director of the national science policy, which is the funded technical assistance center for the development of the strategy of suicide prevention. i am also in medical service --

a retired medical service officer. i helped write the national strategy for suicide prevention, which was released in this room nine and a half years ago. >> i am an infantry unit leader and adviser to these as a prevention program. by 29 years of service in the marine corps. -- to the suicide prevention program. i have 29 years of service in the marine corps. >> for the last 15 years i've served as the executive director of suicidology here in washington. >> good afternoon. i am the va national program director for suicide prevention and in that role, manage and supervise all of our suicide prevention coordinators across

the country. by most of the program manager for the suicide v.a. hot line -- i am also the program manager for the suicide va hot line. >> i major general phil volpe, currently the commanding general of the western regional medical command. i am a career soldier, a practicing physician by trade, and i've had the distinct privilege and honor of serving alongside them bravest men and women serving in the uniform in the army, navy, air force and marine corps. to create a set of strategy and recommendations that are useful and obtainable, the task force developed six guiding principle as we conduct our work off throughout the year. the first is a suicide and suicidal beaters are preventable. second, suicide prevention begins with leadership and requires an engagement in all

facets of the military committee. third, a suicide prevention requires long-term sustained commitment using a comprehensive, public health approach. fourth, service members well as and fitness, total fitness -- mind, body and spirit -- is essential to mission accomplished an and suicide prevention. fifth, recommendations of the task force should reflect the best available practices and sign to the government as well as the expert consensus -- and scientific evidence as well as expert consensus. and sixth, the recommendation should be consistent with the culture of the armed forces and catalyze on the strength of the armed forces. the title of our report is "the challenge and a promise: strengthening the force, preventing suicide and saving lives." while there is still much not understood about suicide and suicidal behavior and effective approaches to prevent it, in the

collective wisdom of this task force, the four focus areas already mentioned constitutes of what we consider a comprehensive suicide prevention strategy. they're not only considered lines of defense in suicide prevention, but they inform and build on one another and cover the entire range of activities. those focus areas, as you can see, are listed on this chart over here. i mentioned already, organization and leadership. it is important to be organized for success and leaders must be involved at every level. well this enhancement and training -- wellness enhancement and training, the pinnacle of primary prevention is and well- being, or fitness. and training is key. training needs to be accomplished throughout the force, not only with service members and families, but also with personnel. another is access to end

delivery of quality of health care. while health care, and behavioral wild carrot -- health care is an important component for the strategies, we need to keep that in mind and make sure that people have access to that quality care and that is comprehensive and communicated and coordinated amongst the various interventions services that we have. and finally, surveillance, investigation and research -- obviously, any public health approach needs to have a solid grounding in surveillance, a unity of effort in servin is to inform suicide prevention programs in the future when -- the unity of effort in surveillance to inform souza prevention programs in the future. suicide is extremely complex

with a multiple rehr with -- array of was factors and prevention factors. there is no single solution. suicide prevention programs must be multidimensional in their approach and work to decrease risk factors while simultaneously increase productive factors. these multifaceted solutions, as contained in the task force recommendations, the 76 recommendations, are intended to achieve the taskforce reason -- a vision. a military force, fit in mind, body and spirit, that can destinations call. at this time, like to introduce ms. bonnie carroll -- to ask ms. bonnie carroll to the podium and she will list mortar board recommendations and then we will open it up to questions.

>> a nation reveals itself not only by the men it produces, but also by the men and honors -- it honors, the men id remembers. those were the words of president john f. kennedy and they echo here today. general build troy, then commander of the army in alaska, spoke about this honor and courage, when you do a memorial service in a different way for a suicide victim, i think you are adding to the stigmatization of a sold through have a behavioral health problem. you do not mean to, but -- of a soldier who had a behavioral health problem. if you do not need to, but you are making it look like it's his fault. we should be memorializing his service to the nation, his service in combat. he is a volunteer, a member of a free nation that came forward and join our ranks to defend this country and that is what we

should be memorializing, not passing judgment on the manner of his death. the tide is turning. leaders are listening. stigma is fading. the military has led the way to eliminating racial discrimination and sexual harassment. in the military -- and the military we saw over the past year is dedicated to strengthening the force, preventing suicide and saving lives. the foundational recommendations of the report are critically important to the success of developing a comprehensive department of defense suicide prevention model. the task force saw best practices in each of the services and recognize the urgent need to share these success stories across the service lines. a primary recommendation is to create a suicide prevention

policy division within the office of the secretary of defense. to standardize policies and reece -- and procedures with respect to resiliency, mental fitness, life skills, and suicide prevention. the office will provide standardization, integration of best practices, and general oversight, served as a change agent and established an ongoing external review group of non-dot group experts to assess -- of a non-dod experts to assess progress. we see success when leaders take charge. a key recommendation of the task force is to keep suicide prevention programs with leadership and will leaders accountable at every level for insuring a positive command

climate that promotes the well- being, a total fitness, and health of their service members. a significant focus on better tools to assist in suicide prevention must be undertaken. it is as though the essential that efforts are focused on this being,e member's well- total mind, body and spirit, and increase productive factors and a decreased risk factors. this is the pinnacle of primary prevention. we must reduce the stress on the force by ensuring the quality and quantity of the well time as the force is reconstituted over and over again. this will allow service members to reestablish relationships and

find connected this. stigma kills and caring leadership saved lives. it is vital that the armed forces develop a comprehensive stigma reduction campaign that attacks the issue on multiple fronts to encourage health seeking behavior and normalize the care of the hidden wounds incurred by service members. during our site visits we've repeatedly heard from service members who told us they had almost died from borden, listening to yet another suicide prevention -- from boredom, listening to get another suicide prevention briefing. they felt this was done more to fulfill a requirement and to give them the tools they need. we must develop skills based training for suicide prevention, especially among buddies, family members, first time line supervisors, clergy and behavioral health personnel.

those on the front line who recognize a service member in distress. community health and access to quality, competence and services are essential to suicide prevention. we recommend that the services coordinator and leverage the strength of installation and local community support services for both active and reserve component service members. maintaining wellness and mental fitness is vital to suicide prevention. military life, particularly in wartime is inherently stressful on individuals and presents a unique challenge to maintaining wellness.

physical, psychological, spiritual, family, social, financial, vocational, and emotional well-being are protected factors against suicide. -- protective factors against suicide. our comprehensive approach will mitigate risk factors and at the same time enhancing productive factors. therefore, dod and its services must support programs that strengthen these protective factors, including resilience, total fitness, connected this -- connectedness, sense of purpose, loving relationships, stable environment, and leaders of the respect and values its troops. -- leadership that respects and

values its troops. when individuals exhibits signs of suicidal behaviors everyone around them must be quick to recognize their stress and ensure their referral to deeper prevention services. peers, as first-line supervisors, and especially the members must be trained to recognize suicidal behavior is and know how to get the person to the appropriate intervention services. we must ensure continuity and management of quality behavioral health care, especially while in betweenon periods duties. the key to understanding

suicide is to go below the surface, far below the snowflakes on the iceberg, which a soldier wrote about on his journal just before he ended his life. standardize a suicide investigation and expand their focus to look at the last days, the last weeks, the last two years preceding a suicide or attempted suicide. patterned it suicide to -- pattern suicide investigations on aviation accident investigations and use that as a model to standardize suicide investigation protocol. considerable effort has been expended by dod, numerous individuals across the world in support of service members across the world -- are of service members and their families. it is to enhance the work

already being done to insure and already fit and ready force for meeting the demand of serving in the military. it is our belief that implementation of the task force recommendations and strategic initiatives will save lives and further propel the dod as a national leader in suicide prevention. abraham lincoln brought him into a nation in the midst of our country's civil war with these words, "with malice toward none, with charity for all, with firmness in the right as god gives us to see the right, let us strive on to finish the work we are in, to bind up the nation's wounds, to care for he who shall have borne the battle and his widow and his orphan, to do all which may cherished and

achieve a just and lasting peace among ourselves and with all nations." and this is our challenge and our promise, to care for him who shall have borne the battle by strengthening the force, saving lives and preventing suicides. thank you. >> thanks, bonnie. at this time, let's open it up to questions. >> thank you. paul corston from cnn. witnessing today suicide problem from the result of prolonged wartime past -- we have been long wars in the past, and yet, the problem of suicide only just

now seems to come to the attention of task forces like these. what has changed? >> i think along the topic, i mean, first off, it is very difficult to compare today with yesterday because, quite frankly, the data was not collected on a lot in the past on previous conflicts or in their aftermath on service members. there is not a lot of comparing and contrasting that can be done because data is deficient. data focusing on a lot of now in this current conflict because it is recognized that this is a particular issue and challenge throughout the department of defense and we see it in the rising number of rates of suicide by service members. our report focuses specifically on this particular problem at this particular time and

particularly, the rising rate and number. did any of the members want to have to that? >> one of the things that has changed is just like with prophetic -- prosthetics and other medical of vances, there are a lot -- there is a lot more awareness than in vietnam or korea or world war ii. there's a lot more understanding of how to approach a suicide prevention. much of the attention, i believe, is it because we are in a different place today than we were at the end of world war ii, or korea or vietnam. >> [inaudible] inyes, i flew b-52's vietnam. >> [inaudible] >> is different.

if vietnam, as i recall, was just about as long as the double, we have been in ladley. the obstacle he -- the services became very intense about not only collecting of data and defining data, but also a suicide prevention in the 1990's. for about 10 years they have been doing a tremendous amount of research and investigation and prevention work that had not been true in previous eras. >> i would like to know, do you already have all the facts to understand what are the main

situations where the soldier had taken their lives, for example, the average age if they are in the theater or when they come back, if they are married or single, if they have experience. do you even know what is causing this problem? >> the armed services have been quite good and thorough in collecting that sort of data that we would describe as an epidemiological data. we know a lot about the age, marital status, gender obviously, rank. one of the recommendations in the report is to better understand of the demographics, but the dynamic nature of suicide and the fateh -- and

particularly the pathways that lead in individual that is reasonably functional of one. down a path toward suicide. -- who is reasonably functional at one. down a path toward suicide. the focus that we think is most important is move from demographics to a dynamic understanding of the suicidal individual. >> to add to that, i think it is also important -- because this goes down the line of your -- we cannot really develop a profile of a person at risk. it is very complex and the risk factors and causal relationships are extremely complex and very individualized in very -- in each suicide case and in each

case where someone risks suicidal behavior. it is therefore important that we have a collection of multiple programs that attack this from all different avenues, from prevention to early identification and intervention and altering behavior to strategic messaging to leadership involvement so that no one will fall through the cracks. there is a basket there and someone to catch the individual. it is extremely complex, no simple solution. >> [inaudible] there are some manifestations or maybe some symptoms that could allow you to detect a person about to commit suicide. is that possible?

>> i'm not sure if a member is able to answer that. again, if you look at the chart on risk factors, any of those respecters which will supply or occurred in any order. a lot of them all of one's will increase the risk for suicide. and this is true because the culture. the big ones are failed relationships, overwhelming financial indebtedness, and the legal problems. you mix that with a little alcohol and you have a deadly mix. not everyone is going to resort to suicide with that same mix, but those are the major risk factors here on this chart over here. part of what we are recommending is to try to moderate those risk factors across the board for everybody and to increase the productive factors on the right-hand side of this chart.

-- protective factors on the right-hand side of this chart. >> tom fitzgerald from fox television. in the focus area, it in this report you refer to the discriminating and humiliating treatment of service members who sought help for psychological problems. could you expand on that and tell us what environment you found in regards to attitudes toward members who sought out psychological treatment? also, is one branch of the armed forces more susceptible than others? and in your looking at the different services that each individual branch created, is one branch doing a better job than the other branches? >> during our site visits, we saw examples of and we're in

were told of examples of humiliating behavior and rosset will of many examples of exemplary leadership. we visited installations across all of the services and heard similar stories across all of the services. the really, what it boils down to his unit leaders. some are very effective and mature and support their troops and others might not necessarily have the skills to support their troops as well as others. that being said, i think leaders through the ongoing efforts across the dod to raise suicide prevention awareness, reshape the fourth, a decrease sigma are really getting the -- decrease the stigma, are really getting the message of how to take care of them effectively. >> they are getting the message now, but what was going on?

>> we heard several stories of humiliating type behavior in ranks formations where single -- soldiers were singled out and identified as someone who was suicidal, publicly ridiculed, things along that nature. we saw other attempts to provide a safety net for service members by bringing them under the wayne of the command structure -- under the wing of the command structure and charging them with the cq desk where they are under the watchful eye of officers, but unwittingly identified as someone who is suicidal. more needs to be done.

>> there are many cases were saves are being done every day and leaders make a difference in saving lives. we have heard stories about that over and over, but they're clearly also is the occasional leader that has a negative command climate that has to the stigma and/or will prevent the individual from seeking help. we have seen cases like that. i do not think it is any different than what you would find out of the world in general in any organization or institution, but it is out there. those leaders need to be held accountable for that. it is mostly at the first line, frontline, supervisory level leadership that we are talking about. the bigger part of that, those that have a negative command client -- climate unknowingly because we are asking some very young noncommissioned officers and officers to now lead to other people, really, for the

first time in their lives. the question that we have to ask ourselves -- are we giving them the skills to manage and take care of the whole person? are we giving young, noncommissioned officers and officers the skills on how to deal with a relationship problem when one of their people in their charge has a relationship problem? are we teaching them how to deal with a financial problem? are we teaching them how to deal with a situation where a service member, be it a soldier, sailor, airman or marine, isn't quite fitting in with the rest of the team. how do you approach that as a leader and make him feel valued and respected and included as part of the team? and not sure that we are teaching the skills to all of these young leaders and by default, that creates a climate that makes these particular service members more susceptible for suicidal behavior.

yes, sir? >> my name is carl osgood. i write for executive intelligence review. i would say that most of these instances in relation to military service after those individuals leave this service. i realize your recommendations are aimed at dod, but i'm wondering if they might have a positive long-term effect after people leave the service. for example, there are vietnam veterans dealing with ptsd 40 to 45 years after their dramatic experiences. i wonder if you could talk about that as well. >> i'm glad you asked that. the v.a. was very fortunate to be a part of this task force, not only from a perspective where hopefully we were able to contribute we have learned and the lessons that we have learned over the past several years in dealing with suicide, but also

to absorb some of the needs and changes that we see coming. if we look forward to partnering with the dot in the implementation of some of these recommendations, to really learn from people's experiences in the department of defense, and to carry some of this new and exciting training and their opportunities -- training and opportunities into this. is a good program and we are excited to be part of that. >> developing cultural values that support held seeking, that support the pursuit of mental and psychological fitness, but also helps support training people in these skills, prevention skills. all of these things will carry with them when they leave the

service into the civilian community. we certainly think this should have affect outside the military, and actually, even in the communities as people go back to their civilian communities. >> my name is steve robinson. i made better and advocates -- i am a veteran advocate and former service member. first, thank you for the report. it is refreshing to see that the complete picture of suicide prevention is being addressed, which includes looking at us as leaders in the military and how we play a role. thank you for that. i'm wondering if it's time for the panel of experts to ask themselves if the word stigma is too soft a word and we ought to start calling in to flat out discrimination for mental health issues. it would be the same as someone hit with a roadside bomb and had no legs on the side of the road

to abandoning someone with a mental health care injury. i'm wondering if the word stigma is too soft. perhaps it is discrimination in its highest form. >> one of the problems with the word stigma is that if envelops several different concepts, so when you use the word, no one is really sure what you mean. but also, every time we say the word stigma, we are reinforcing that there is a bunch of stigma there and it is a big problem. i think we agree completely that we should tease this apart. sometimes it is prejudiced, sometimes it is discrimination. sometimes it is self discrimination. in talking about these things we need to talk about exactly what we need in -- and mean in this context and then we will be able to address the core issues involved. >> and that is the reason why an are foundational

recommendations, we recommended a campaign plan that addresses and teases this apart, takes a strategic approach to tackling all of the types of the stigma. but i do want to make something very important, of that we recognize that these services are doing something very important. soldiers today have the of your health care needs for whatever reasons, and because of that stigma, we create anonymous sources for them to get care because it is important for them to get care. we need to be sure that the stigma is not so great that they are not going to get care so that we have to overcome it. but at the same time, we have to reduce sigma over time in order to move. -- reduce the stigma of overtime in order to move into behavioral health care.

it is okay to ca behavioral health person. you could be the strongest warrior in the world and you are still human. you still have challenges and ups and downs. the messages that need to go up our that while you are resilient and a top warrior, you may need some additional services and interventions at different times. there is plenty available. it is okay to seek those services, and guess what, they work when you do see them. that needs to be the message that goes out in these strategic communications at the same time as that -- as tackling the stigma for the future. >> and carol pearson. i'm with the voice of america. since there is no profile of a person likely to continue -- to commit suicide, did i understand that right? would you rule out recruits

that maybe had a history of depression or took lexipro or something like that? people in you rule out t the armed services who might be at risk of committing -- of committing suicide? and how would you look at the service members who may be on anti-depressant drugs or into anxiety? how would you assess their mental health call-in not just their needs, but the mental health situation? -- not just their mental health, and not just their need, but the mental health situation? >> there is a lack of coordination among various services and individuals who would identify risks, higher

risks in individuals. when someone sees the real health care, that is one stowe bought. community services, our call and is the absence of use -- all call and substance abuse programs. first of all, the communication and coordination across so the leaders have a common operating picture of what is going on with their service members and they can identify who is at risk and who is nad. right now, that information is not shared as well as we would like it to be. this is particularly important in transitions when people are eager deploying or redeploying for changing station, moving to another installation, were being released from active duty and going to the civilian world. there is a loss of those protective factors during the time -- during that time and

there is not a lot of oversight. one of the things we have to do is effectively manage transitions in order to make sure that people are covered during those transitions, which appeared to be a vulnerable time for suicidal behavior. the other answer to your question is, there are tools out there and current research going on on a lot of these tools. and in our report we talk about a lot of that research going on. but this is clearly an area where there are some knowledge gaps and the only we can close those knowledge gaps and identify better tools for the high-risk individuals, because there is no one set profile for identifying someone at risk is through ongoing research, screening tools and those types of things.

anyone else? >> i think, too, it is important to recognize that there are different types of risk factors. there are risk factors that we referred to as predisposing risk factors and they have to do with things we can i do anything about -- age, gender, all sorts of things. there are other risk factors that are more precipitating risk factors, more situational. those are the ones that we really can make an effort to identify and change. you have heard some of those already today. people who are having severe financial difficulties, severe relationship issues, perhaps some problems with substance use and abuse. of all of those things -- all of those things would affect someone who has predisposing factors already in play.

paying attention to those situations and really working hard to provide training programs to offer those -- alter those, to change someone's response in these stressful situations will go along way in helping people find these risk factors and build protective factors around them. and i think he will be in trouble if you start identifying people and putting labels on them. we will not only missed lots of people who are having trouble, but we might put the labels on the wrong people. paying attention to those precipitating issues is important and i think we talked about that in the report. >> let me just add one other area that i was speaking to before speaks to acute risk factors. those observable beaters, symptoms, signs, cues that are displayed by the individual in

the last 30 days to one week of their life. we now know a lot about what describes individuals in the armed services who died by suicide, we know practically nothing about those last 30 days, which is the window of opportunity for intervention, for years to observe, for referrals to be made, obviously country and to be instituted. that is the area where we most need to understand -- obviously, treatment to be instituted. that is the area where we need to most understand. outhouldn't we just screen people with health needs and reduce the risk that way either in our interest in screening or in the active forces, in answering that question, what

we've learned in this task force is that the vast majority of a people who died by suicide did not have a diagnose mental illness or a diagnose behavioral health care. another thing that we know and was reinforced by the task force is that the vast majority of people who have behavioral health needs and are engaged in clinical care do not suffer suicide -- suicidal ideation and do not commit suicide. the vast majority continued to get well and served in uniform. it is important for us to aware -- to be aware that taking care of the metal helmets -- the mental well as of the troops actually increases the total

wellness. >> there's a lot more research than we think there is. effective suicide treatments in a handful of states are very effective. we do not know a lot about how to effectively treaty. it seems amazing that we do not know. that being said, and effective warrior may not necessarily translate into being an effective patient. that is something that we looked at with this task force. there is so much focus on mental fitness. if we can make mental fitness commensurate with physical fitness for warriors, then we can make a lot of progress. there is a cultural consideration in all of this. but the assumption that there must be obvious ways to handle this is not the case from the larger perspective. but there is no one doing more

for suicide prevention then the dod and v.a. system. i can say that unequivocally. we are after it. i think the military is in a position to take the lead not just for the military, but for the nation. >> with respect to -- it has long been felt that any request for mental health services because you have some mental health issues is a career stopper if you are career military. how do you address the perception, or how you change that? >> there is evidence that is not necessarily the case, but it is a common perception. in the air force program there has been data shown that when someone identifies and six mental-health treatment, a very small percentage had a career impact. but that is one of the

challenges, that there are perceptions that need to change and this task report directly addresses those perceptions. >> i think also, there are many of us in senior leadership positions that have sought mental health intervention in the past. we always talk about the tragedy of suicide and the loss of suicide and what are the actions the services are taking, you know, strategic and indications. but clearly, we need to change the conversation that seeking help is ok. there are plenty of resources out there. it is okay to seek them. it does not affect your career and it helps. you get better. there are plenty of examples out there of individuals who have had many successful careers who

have sought services. on the same token, there are aspects of this -- i think many of you may have seen the nationally televised talking point by some of our medal of honor awardees who give the message, do not let the enemy defeated you at home. you are facing these enemies abroad all the time. there are some scholars that you bring back -- some scars that you bring back from deployment, from services. do not let the enemy defeats you. there are services that it is okay to seek those. many say, i wish we have those resources after vietnam, or after the conflict they got back from. i think those services are very helpful, too. >> if we interpret mental health care has something to take a deficit and return it up to

normal. if we refrain that to a performance enhancement approach, i seek mental health care, i go to the chaplain, i go seek some financial counseling all in the name of the improving my performance as a human being and as a soldier, sailor, mingan, marine, that refrainin will begin to tear down barriers as well. >> bar. with mcclatchy newspapers. you have all described a lot of the services that were put in place since the conflict began. and yet, looking at the statistics, the numbers almost at every year almost steadily continue to rise. where those numbers continuing to rise and when are we going to -- why are those numbers continuing to rise and when are

we going to turn those are around? >> i think that is one of those situations where we do not have enough data to answer the question. it is so complex. there are so many different things going on at the same time that i do not believe we draw a conclusion on that question in that -- in the report. >> any hope on when those numbers might start to a turnaround? >> we do not. in 2005, the department of defense, there were 189 suicides and the raid was about 11. something. it was the rate for 100,000. in 2009, there were 309 suicides in the department of defense and the rate is like 18.4%.

it has clearly gone up since 2005 year after year. right now, we are seeing no relief in the numbers in the current trend. but we believe there is a great opportunity to implement some recommendations that will change the face of what we're doing with suicide prevention, tackle lot of these risk factors that we are talking about that are below the level of suicidal behavior is, but obviously, just tackle in the well-being and wellness and life skills of the individual, resiliency, and balancing these risk factors with protective factors is key. again, it pays to be a comprehensive approach -- it needs to be a comprehensive approach.

and leadership is involved at the strategic level tremendously in all of the services. we believe they are some optimized and could be further enhanced -- sub-optimized and could be further enhanced. these offices are there to help standardize policy, standardized procedure, in order to achieve better surveillance. better surveillance means more information to modify a suicide prevention programs. that is what we need. we need a unity of effort in the department of defense to standardize policies and procedures, standardize surveillance, learn from everything we are doing, including all of these risk and productive factors, and leverage in these programs.

we feel very confident that will make a difference in tackling the trend and the rate you are describing. >> when we compare the military population with the civilian population, being in the military has consistently been a protective factor. that is, this was the greatest -- the suicide rate is substantially lower in military than in civilian. when the rates started going up, we paid attention as sort of working with it. -- and started working with it. we cannot compare on a wee sing your basis with the civilian population -- on a recent year basis with the civilian population because it takes about two years to collect all of that data. the right now we are running about two years behind on civilian reporting.

but still, at the last direct comparison, the military raid was still lower than the same demographic among civilians. in talking to parishioners end others, it seems like it is much worse than in dealing with their neighbors. that is simply not the case. but the military and employers are doing all began to coordinate and keep the rate as low as began. -- dahliwal de cantu chordata and keep the rate as low as we can. -- they are doing all they can to coordinate and keep the rate as low as we can. >> one of the initiatives is to reduce stress on the force and

directional -- actionable recommendation is to decrease operations. i'm wondering if that is realistic given the current wars. >> yes, we believe there needs to be reduced stress on the force. there needs to be a very high operational tempo. i cannot speak for we can speak on this particular one, and it is the feeling of the task force there is stress on the force. there is a significant amount of fatigue, fatigue among leaders. it really comes down to the amount of time we have to reset the person and apply all the time that is needed for better training, skills-based training, teaching life skills, taking care of the whole person.

that time commitment seems to be narrowed down because of the operational commitments we have. even those not deployed, they are going at a fairly rapid pace, too, and significant demands at our cans and installations. of reducing stress is important. we also believe there is some research, evidence that talks about dwell time to reset an individual. when we say we said an individual, when we talk about is a -- it is amazing how resilient as service members are. these men and women deployed over and over again and are taking on missions in service to our nation. that has to be done.

at the same time, those repeated separations, the difficulty of putting your life on hold while you are deployed, knowing that you are going to deploy it again without having this reset level to some state of normalcy, it is critical to the long-term health and wellness of the force. the mental health advisory team -- the army has conducted six of those. we looked at the data from the mental health advisory teams and stuff, and they showed evidence for a year-long deployment, there needs to be 20 months to 24 months of 12 time. -- dwell time.

we also have to be careful with that because it is not the quantity, but also the quality. how do you recall to to the protective factors that are lost by some of the service members when they return? how do you reestablished good, strong, loving relationships? how do you get me connected again? this loss of connectedness with the people in your community, family, friends, has to be reestablished again for your long-term well-being. so the quality of that time to reestablish mazed connections is a very important. we believe there are things that can be internally done in the defense department, and we also believe strategic leaders of the nation need to look at the supply-demand of the force, and balance that out. clearly, there is a mismatch in

the way the current force is operating, and that is creating stress on the force. >> the difference between resilience and stress, that we are talking about here, if we can enhance resilience to reduce the stressors, then that provides additional protection against suicide and other things that happen that are not pleasant. all the work that the services are trying to do to build up strength, to enhance family life, strength and our troops, then we will have better protection. so the differential of stress and bad of resilience can be reduced, so we the military, can do our job without the effect of

suicide. >> [inaudible] from los angeles. i have been speaking with hispanic soldiers that have pointed out there are some cultural differences in hispanics, latinos, that makes it difficult for them to come back and adapt to their regular family life. i wonder if there was any part of the report that addressed these cultural challenges that hispanics or latinos have, and if race plays any significant role in the rate of suicide. >> i will let the members answer in the second, but the difficult part is we do not have good enough surveillance. that is why one of the recommendations is to maturity dot suicide prevent report --

dod suicide prevent report so that we can standardize the reporting and get into the details on the impact of culture onto his side, particularly with service members. i do not believe we have the data that sorts that out right now, with the current surveillant method. >> since some suicides take place after someone has left the military, is the military concerned about providing health? also, how easily is mental- health help it possible for someone who has left the military -- accessible for someone who has left the military?

>> dod has been working relentlessly to run the war to improve transition times between the time when people leave the military and enter the community and are eligible for v.a. services. especially for this newer group of veterans, we are making hard to make that transition even before people leave the military, so there is a seamless transition into v.a. mental health services. that being said, one of the things that the report addresses as there are huge groups of people who fall in between deployment and active duty and discharge. those are the people that we stress really need more attention.

we need to concentrate on programs that reach out to those people, people in ready reserves, in the guard and reserve groups, who are not in an active duty status at the current time. we have cited some best practices in the report of organizations doing a good job -- out and providing not reach -- providing outreach. >> well this is necessary in our country, at some cost, there are few people anywhere that are trained in suicide consultation. one of the hero and his assumption that people make is that date -- hero aeneas -- erroneous assumptions that

people make that is not the case. down the road, long separated from the war, the number and on other issues, it is no longer just up to the department of defense. national care is a matter of national responsibility come as the current health care bill is trying to make -- responsibility, as the current health care bill is trying to make the point. someone becoming suicidal is not a normal part of our society, and that is a change that we need to make, beyond the dod and

v.a. >> 10 years ago, dod and v.a. did not court made in this way at all. it is just three said that they have they do inside joint -- a joint suicide conference. coordination in the last five years have been significant. the other piece that i would like to take with this idea is that we see on this task force suicide prevention should not be relegated under mental health. it should be across the board, across command, a solution that is multi-focal, not just a mental health issue. best practices need to be provided, but this is a much larger scope. this should not be housed

exclusively under mental health, but should cut across each of our branches. >> norway. do you know how big of a percentage of suicides you have reported have been during deployment, while the person was in the army? what is the impact of suicide during deployment on the people close to the person who committed suicide? >> i think a good way to understand this is the role of stories. as we looked at the data, one- third of the data that we completed happened to troops who were deployed in a theater of combat. one-third had a history of the plan went -- but were in their home station. the other third in troops that

had never deployed. that is roughly how the statistics break down with regard to suicide. to enter the second part of the question, suicide -- >> to answer this -- to answer the second part of the question, suicide has an effect on everybody. but we do not have a good way to reconcile that. there was some discussion in early on about the rituals involved in memorializing a death. if people are still struggling with how to recognize and greed in the face of suicide. it has a wide and profound effect on the survivors. >> and you deliver your recommendations -- a veteran advocate. as you deliver your recommendations, i have participated in other meetings

and reviews, the freedom commission, other recommendations that have been delivered. what will you do to ensure your recommendations are inculcated, what kind of commitment to you have from the secretary of defense to undertake these initiatives? if i could make one recommendation, having served 20 years, if you want the army, for example, to adopt something, you need to rate them on their oer and they are held accountable for knowing in or not knowing it. just a suggestion. >> the task force is turned to make recommendations to the secretary of defense on the report committed today. the secretary of defense, with

office and staff, has to provide a cover and implementation plan. this report will go back to congress, so i believe the accountability will be at the secretary of defense level. having said that, we included an appendix in the report for each of our recommendations for what we were recommending level of responsibility to address the implementation under recommendation. some of them were under service, summer osd, occasional ones at the congressional level. we have made recommendations on implementing that, but the report is now owned by the department of defense.

they will have to provide their response and implement that. ok, thank you again for being here on this most important topic. while we are thrilled to release the report, year-long deliberations on providing this report, we are also reminded that the real benefit of this is actually in saving lives and the actions we follow will be important. in this report, task force members presented their findings and recommendation for restricting the force and preventing suicide in members of the armed forces. the task force is confident implementing the recommendations in this report will make a significant difference to the total fitness of the force, strengthening the force, the well being of service members, and prevention of suicide. effective action must proceed in

the context of strategic planning as a consistent standard us policy. this report is the bulk of our assessment -- and effective action. suicide is preventable. thank you all very much. we appreciate it. guest: caller: [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2009]

>> now more on military suicides from this senate hearing. we will hear from high-ranking members of the military. carl levin chairs the armed services committee. this is from june, about two hours. the committee meet today to report on the status of military suicides and the protection and treatment and mannequin of the so-called visible wounds of war, which we consider to include a traumatic brain injury, compulsive events, post-

traumatic stress, and other combat-related psychological health concerns. a hearing on military suicide was requested by senator inhoff several weeks ago and we all appreciate the request. due to the committee markup schedule, we were unable to schedule a hearing until this week. this hearing was meant to focus on suicide -- excuse me, on service suicide prevention policies and programs. but given the recent does concern a report alleging poor diagnosis and treatment of service members suffering from traumatic brain injuries, post- traumatic stress, i felt it important to broaden the scope of our discussion today to include those topics as well. especially given the fact that day can often occur concurrently, making a diagnosis of any or all of the illness is difficult.

the increase in two was signed by military personnel in the last few years is alarming. in 2007, 115 army soldiers committed suicide. in 2008, the number increased to 140. 162 in 2009. similarly, 33 marines committed suicide in 2007, 42 indiana 2008, and 52 in 2009. i understand there are a number of additional cases where a armed forces medical examiner has not yet concluded whether the deaths are by suicide, so the 2009 numbers will likely be even higher. these increases indicate this by the service's efforts, there is still much work to be done.

we must improve our suicide prevention efforts to reduce the number of service members taking their own lives. i am greatly concerned about the increasing number of troops concerning -- returning from combat with post-traumatic stress and traumatic brain injuries and a number of those troops who may have experience compressive injuries that were never diagnosed. studies indicate that mild traumatic brain injury or concuss said is associated with ptsd, depression, and anxiety. these conditions, in turn, may contribute to the increase of a number of suicides. one key to suicide prevention is to make greater efforts and to and the stigma that too many perceive that attaches to when they receive mental health care. another key, of course, is the proper diagnosis and treatment of brain injury, posttraumatic

stress, an increasing awareness of access to mental health care resources, as well as leadership support for those seeking such care. we hope to hear from our witnesses today, the approach that each service and department of veterans affairs is taking to detect, treat, and manage psychological health problems to include posttraumatic stress and traumatic brain injury. the numbers of suicides have increased and every service, but significantly more so in the army and marine corps. the two services most heavily engaged in ground combat in iraq and afghanistan. congress has recognized the strain on the ground forces and has, over the past several years, often by significant increases in the active duty in strengths or the army and marine

corps. it is our intent that the increases will relieve the stress of those forces, but we also have to make sure that we provide the assistance that our troops need to help them stress -- cope with the stress they are experiencing. professional tells us that, an issue of needing to suicide our relationship problems, financial problems, as well as mental health issues. each of the services, as well as the v.a. have programs to address those as well as suicide prevention efforts. undoubtedly, deployment and lack of dwell time have contributed to these underlying problems linked with suicide. the army in working with the institute of mental health on a five-year longitudinal study to help identify and identify -- and prevent strategy is to decrease the number of suicides in the army. while this is an important

effort, we cannot wait a full five years to occur for these results. we must identify actions and take them now to reduce suicides. in general, we look forward to hearing the interim findings in the study and how the army might use those findings to better target suicide prevention efforts. he must learn more about traumatic brain injury and concuss lift the events and their relationship to post- traumatic stress and suicide. unfortunately, these brain injuries remain relatively unknown territory in both the military and civilian military environment. i look forward to learning more both on policies and programs, each service has in place to handle incidences of dramatic brain injury and concussive events both in theater and at home. we also look forward to learning

what policies, programs, and initiatives, each service and the v.a. has identified and implemented to ensure our service members in both the active-duty and reserve components, military veterans and their families receive all of the support we can provide, and that our all volunteer force can provide -- continue to perform its mission with the help of other services they need, and deserved. i am pleased to welcome our witnesses we have with us. general peter reilly, chief of staff panetta states army. jonathan green, the vice chief of naval operations of the united states navy. general james amos, assistant commandant of the marine corps. general carol chandler vice chief of staff. dr. robert jesse, the acting

under principal deputy secretary for the veterans health administration, department of veterans affairs. in general -- general amos, i know that we all offer our congratulations in becoming the next commandant in the marine corps. senator mccain. >> thank you. let me think the witnesses for joining us today. i would also like to acknowledge senator inhoff who requested this hearing in april. i am pleased and thank you for your initiative, senator. i am pleased that we are having this hearing. it is our privilege to distinguish -- serve the distinguished men and women of our armed forces, that after nine years risk everything to defend their country.

we have the greatest admiration and appreciation for them and their families and we will always honor their courage and sacrifice. the burden of our missions in iraq and afghanistan are tremendous, and so are the consequences to those who served. many of our service members have entered their country pasquale with multiple plumas to combat and little respite for recovery at home. the enemy signature weapon, the improvised explosive device, causes multiple injuries to parts of the body and brain. as is the case with every word, many of the deepest wounds are the ones that wracked the minds and souls of our citizens and soldiers, wounds that continue to plague them long after returning home from the field of battle. the department of defense had documented nearly 2002 sides found to the house and oneto 2009, and data services has reported more than 140 during 2010. although the air force and navy

have previous experience rates higher than those presented today, rate for the army and marine corps are historically high levels. these are casualties that our nation cannot accept an armed services much a part to protect -- percent among troops that have deployed, and those that have not. we must devote cultural barriers and attitude from peers and leaders that may cost soldiers who need care to turn away from it. we must conquer any bureaucracy that stand in the way of compassionate care for a man or woman who seeks it. since the attacks of september 11, we have devoted billions of dollars to caring for wounded children and their families, provided not just by the the that the defense department and veterans administration alone, but by many government agencies. one example is the national suicide prevention lifeline.

responders speak to former serving military members every day. as a nation, we can be proud of this effort but not to contend with the results. teaching our service members to navigate complex pathway to care is necessary but leaving them there is essential. the quality of leadership will determine our quality of success and bill year. several of our witnesses report military service members continue to distrust in forming a chain of command, that they have a brain injury or that they're experiencing stress, considering harm to themselves or others for fear of bringing a sense of shame to themselves and their unit. this is unacceptable. there is no shame in a minute you are struggling with the hidden wounds of war. those would are every bit as real as those that are visible on the surface. the service must increased focus on transforming their transformed -- cultural leadership, train more leaders

to understand the emotional and physical health are critical factors in military readiness, and hold them accountable, if they fail. americans expect high-quality health and mental health care matched by compassionate involvement of military leaders can and will make a difference that is capable of saving lives that would be lost to suicide. to me this rifle the high expectation, leaders must exercise their sacred obligation to take responsibility for their subordinates, know about their lives and families, have conversations with them, listen to their concerns. these powerful interactions, which are the essential character of the core military dollars of trust and cohesion, can save lives. our service men and women and their families deserve nothing less. i think you and i look forward to hearing your testimony. >> thank you, senator mccain. we will start with the general

chiarelli. >> thank you for the opportunity to appear before you today to provide a status of the army's ongoing efforts to reduce the number of suicides across our border. also to carry the tag for cylinders suffering from post- traumatic stress, traumatic brain injury, and other issues. i have submitted a statement for the record and i look forward to answering your questions at the conclusion of my remarks. as you are aware, in a mandate is a time for our military. we are in the night wore of our -- my dear of the war. patience is increasingly high. i am proud to report the men and women serving in our army today are doing an outstanding job. they are well-trained, highly motivated, and deeply patriotic. our nation has asked a great deal of them and their families,

and they have exceeded expectations by a long shot. however, the prolonged if demand continues to put a significant strain on the force. one of the symptoms of this, although -- albeit the most severe, it is the high number of suicides we have experienced. fortunately, we have seen a significant reduction in suicides for active duty soldiers this year compared to last. however, we have expected -- seen an increase in our soldiers have not been active duty, in particular, the army national guard. needless to say, the loss of any soldier, armies of million, or family member to suicide is tragic and unacceptable. each represents an individual and a family that has suffered an irreparable loss. we have learned a great deal about suicide in the past four months. we now know that soldiers with one or more to plymouth

represent 71% of all suicides. first termers represent 60% of all suicide. i have worked closely with my colleagues in the navy and particularly, my good friend jim, our ground forces share a similar mission, and we are working on similar issues. you have my word we will continue to work diligently in an effort to learn more to reduce suicides in our force. in the meantime, we have learned a tremendous amount of the broader challenges of behavior health issues challenging our soldiers, family members. after eight years of war, multiple planets, many are suffering from depression, anxiety, a traumatic brain injury and traumatic stress. often referred to as the invisible wounds of war. these and other highly complex injuries in conditions involve the brain pos he needs -- you need challenges

} â" in particular, the co morbidity of symptoms can make diagnoses especially difficult in many cases, a fact not well understood or appreciated by many. the reality is the study of the brain is emerging science and there is still much to be learned but we are making progress. over the past 12 months, the army's commitment to promote suicide prevention has changed army policy, structure, processes. we have realigned programs, increase care services, refocused redeployment integration, and enhanced treatment of ptsd and tbi and behavioral medicine. notwithstanding, we have more to do. we have an army-one problem that can only be solved by the coordinated efforts of our commanders, leaders, soldiers, program managers, and health providers. this is a holistic problem with

holistic solutions, and that is how we are approaching it. we are investigating ways to promote resiliency, reduce stress, and increase soldiers' ability to identify when their friends need help and take advantage of the resources and support available to them. i can assure the members of the committee there is no greater priority for me and other leaders in the u.s. army and the safety and well-being of our soldiers. the men and women who wear the uniform of our nation are the best in the world, and we owe them a tremendous debt of gratitude for their sacrifice. members of the committee, thank you for your continued and generous comport reduce support for your commitment to the outstanding men and women of the armed services and their families. i look forward to your questions. >> thank you. >> testing which members of the committee, thank you for the opportunity to testify about the

ongoing efforts to prevent suicide in our navy and to discuss what would have been referred to as the invisible wounds of war, posttraumatic stress, a traumatic brain injury. each suicide is a dramatic loss that can destroy families, devastated community, and impact you need u --nit the cohesiveness. a common thread is a personal, perceived inability to cope with stress. our focus and effort is to better understand the stressors that sailors and their families face and equip them with positive methods to cope with stress. we want to foster a resilience in our sailors and their families, increase family level vigilance and encourage early intervention and care. our acronym in this is act, to ask about a ship date, care for the shipment, and to help get they should make get treatment.

the first death in this is providing an awareness to the trainers. to that end, in 2010, training workshops for leaders, first responders, and suicide prevention coordinators was conducted at 20 locations in five countries, with five more being planned. a new training video called a suicide prevention was distributed just this april. interactive training programs such as peer to peer training have been distributed, aimed at strengthening a culture of support. we have trained about 120,000 people so far in operational stress control. a key in all of this is taking control of stressors. stress is a fact of life. we want to be framed the issue in terms of comprehensive stress control, something that will help.

it is a program designed to be implemented by leadership all levels, providing them with practical decision making tools for sailors, leaders, and family, to build resilience and improve their awareness of stress response, and to take every action to mitigate the effects of stress as part of a healthy lifestyle. our sales deployed to iraq and afghanistan faces a dynamic environment with unique experiences and the preponderant of the best i could manifest posttraumatic stress. we are currently focused on preventing ptsd, building resilience, and eliminating stigmas associated with treatment after deployment. provision efforts include incorporating our personal stress control continuing and the stress for state principles for all our sailors, from basic training to fly up to development. when-based information resources and navy career courses. our project focus, families overcoming stress, is an example

of intervention of families responding to the challenge of the women and related stresses. it has reached a tangible results and is being instituted dod-wide. connaught and operational first- aid training is designed to give our caregivers the support the ability to overcome the stigma of requesting help. while there are several injured hundred in theater, an important area for all bus terminal traumatic brain injury. the diagnosis and treatment of tbi is a top party. there is still much we do not know about the injuries and their long-term injuries on the lives of our service members, but through a collaborative effort, defense centers, the department of veterans affairs, academia, we are committed to a full assessment of blast injuries, attention injuries, and making sure that every sale

affected receives the best medical treatment available. surveillance for injuries across the debt limit continue and it is critical to the early indication of tbi. screening, monitoring, and treating sailors involved in the blast event, and instituting tracking mechanisms for follow- up care are key elements. i want to thank you for your attention and commitment to the critical issue of pre suicide prevention. by teaching sailors to navigate stress, our navy will make our force more brazilian. by assisting in treating those with tbi, pts, we can potentially eliminate a cause of depression and suicidal behavior. we honor the sacrifice and service of our members and their families and we will do everything possible to support our sailors so they recognize their lives are truly value and

truly worth living. on behalf of the men and women of the united states navy and their families, thank you for your attention and commitment to the issues. >> thank you, admiral. >> thank you. speakers, thank you for inviting me to invite me to discuss suicide, posttraumatic stress. on behalf of the more than 240,000 active brains and their families, i would like to extend my appreciation for the sustained support congress has faithfully provided. as we begin hearing, i would like to highlight a few points from our written statement. you have rightly focused on three of the most difficult challenges facing our court today. let me interview the leadership of the marine corps recognizes this early -- series this of the challenge we face with tbi, ptsd and suicide, and we're doing all we can to protect our men and women. we have learned much in the

several years about the effects --concuss this co --n concussive events. we have made progress in training to develop resiliency in diagnosing and treating tbi, pts, and and getting out marines to prevent suicide. we also realize we have much more work to do. research that has been done by several organizations will help to improve our diagnostic tools. the tragic loss of a seminary to suicide is deeply felt by all those who remain behind. we have experienced about the same number of suicides this year as we did last year at the same time, and we recognize our considerable efforts to prevent suicides must continue if we are to turn the trend of the last few years around.

we are building on the training program that we launched late last year to reach the rest of our marine corps and we continue to examine each suicide carefully and frantically and disseminate the lessons learned from that across all marine corps leadership. i have personally been involved, along with others in the army, in the development of guidelines for the detection and treatment of mild traumatic brain injuries. the newly established protocol and regulations we have in place for marine deployed in afghanistan are squarely aimed at the leaders and the medical personnel, all in an attempt to further care for our wounded marines and sailors. it will enter those exposed to concussive events will receive immediate attention, and that this information will have been properly recorded for future reference. the long-term objective with this protocol is to reduce the

chance of bad memory or a sailor will suffer the effects of the blast injury at some later date, perhaps years later. as you know, ptsd is a real injury that is often difficult to diagnose. many marines are reluctant to recognize the fact that they are injured, and even more reluctant to come forward. our efforts to reduce this injury began early on in our training regiment by training read to be more resilient to the stresses of combat. we have embedded mental health professionals in our combat units to reduce the stigma and barriers to seek help. we are exploring new ways to ensure new ways have access to care, including the establishment of a new crisis hot line aimed at marines, four marines, and their families. partnering with the medical community, we are making sure every marine struggling with stress get the support it needs. while there is no single answer

that was all the challenges of rising suicide, trying brain injury, and posttraumatic stress, we are committed to exploring every potential solution and using every resource we have available. we will not rest until we have turned this around. thank you for your concern on these important issues. i think each of you for your faithfulness to our nation and your confident in leadership. i request that my written testimony be expected for the record. >> thank you, general. the testimony of all the witnesses will be made part of the record. thank you for that. general chandler. >> distinguished members of the committee, thank you for the opportunity to address suicide in the air force as well as protection and prevention of our arab and suffering. the air force is strongly committed to the physical, emotional, and mental health of our chairman. we appreciate all the good of

help in the force and mission readiness. the number of their men taking their own lives have been rising, despite our efforts to prevention. similarly, ptsd is an area of increasing concern. finally, our ability to treat tb i continue to be challenging. the mental state of individual companies to sign an actual condition of suffering ptsd and tbi are similar in that they often do not manifest themselves invisible ways. therefore suicide rate recently reached slightly more than 142 was 5 per 100,000 total force members. nearly two-thirds were not receiving assistance from mental health professionals, despite concerted efforts to reverse a long-held biases against seeking mental-health assistance. well no section of the air force is a need to suicide, there are no high-risk populations and no common risk factors, like relationship problems, financial troubles, and a history of mental health diagnoses. the air force recognize a suicide as a public health concern that requires active and

persistent and often from commanders, supervisors, and peers, often referred to as women, but off lows of organization, and there involvement is making counseling service more effective and focused training. all part of our improved resiliency program. total forest and the air force initiated the total force was a and 2 program this year to ballistic we address the root causes of suicide. air force program affect a broad based approach to support and airmen and their families, recognizing physical and emotional health are critical to the quality of life and readiness to the force. airman resiliency is critical. immediate family and all that and wing man support arcing components.

there is no substitute forairmen knowing their subordinates, co- workers, well enough to recognize changes in attitudes, behavior, and personality, and intervene when something is not right. part and parcel to the programs is an effort to expand the availability of professional counsel. community action information board, which provides cross review and resolution of individual family installation and community issues is now chaired by the vice chief of staff to provide adequate oversight in light of increasing suicide rates. professional counsel is not available now more than ever through clinics, and the readiness center, dod military referrals. complementing this increase capacity or training programs to better prepare our individual

airmen. resiliency training is delivered in a tear-fashion based on risk factors. those most at risk receive the greatest trading. basic education and training is now available to low risk audience the unit briefings, chaplains' services, financial fliers, and computer-based training. additionally, the air force's identify strategies to include all sections are included to prevent suicide early on. additional and ,airmen will receive additional training before deployment. a traditional center in germany will open next month to revive training to assist in the transition from the plan to home station for airmen how exposed to a regular combat death. goals of the center include providing reconstitution,

wingman support, and fostering individual skills for those exposed to a traumatic situations that may lead to ptsd, tbi. in 2003, more than 600 united air force personnel were diagnosed with ptsd. in 2008, that number increased to 1500, with over 78 percent stemming from deployment-related events. efforts to identify, treat ptsd begin at home with screening and education, the use of forums like the community actions board, dramatic stressed response teams at each installation, all intended to foster resiliency through education and psychological first aid. " while the stress control teams seek to minimize the adverse effects of combat on our men. of note, even non-deployed, even

those two pilots and aircraft, an intelligence personnel must be monitored for posttraumatic stress symptoms that well. where it may not be possible to pinpoint the incident p.s. tape -- ptsd has on to an individual, this is really the case with dramatic brain injury. tbi is recognized in the air force as a physical condition that can cause lifetime sentence. from 2001 to 2009, 1000 airmen were diagnosed with tbi, accounting for 4% of department defense cases. baseline testing of the players and education of commanders in the medical personnel is increasing as we were to apply best to and practices to prevent, identify, and treat tbi. the goal is simply to provide the best possible treatment, minimize the impact on long- term health and maximize rehabilitation recovery, and reintegration. in conclusion, the people are our greatest asset.

a key component to partnering our fight. there is a commonality among suicide, ptsd, and tbi, beyond the obvious impact on the individual and mission. they all require a heightened awareness and understanding if we are to understand, prevent, and treat them effectively. again, thank you for your continued support. thank you for your -- the opportunity to discuss these issues today. i look forward to your questions. >> thank you, general chandler. dr. jesse? >> good morning, ranking members. thank you for inviting me to discuss the department of veterans affairs response to treat and minimize the impact of dramatic brain injury, a posttraumatic stress disorder, and veterans suicide. written testimony for us greater detail about our programs and about our cooperation with partners at dod, but i was like

to highlight a few key factors for the committee. before doing so, i would like to express my gratitude to the committee for their insight to the importance of these issues and for their ongoing support of all the initiatives that are intended to mitigate this. v.a. has developed and implemented a range of programs to ensure it provides a world- class care for veterans and service members which remember an injury. we offer services at 108 facilities across the country. to remember that brings together some of the best minds in medicine. we deliver comprehensive rehabilitative services to members of our teams of providing patient and family education and training, psychosocial support, and advanced rehabilitation and prosthetic technologies. v.a. nurse liaisons' in

treatment facilities support for medicare, patient transfers, and chair of patience. in terms of the population, between march 2003 and march 2010, v.a. has seen an hour centers almost 1800 patients, more than half of whom were active-duty service members. second, the federal record record mission program is a successful joint v.a. dod initiative that provides injured veterans and service members with access to the benefits and care that they need to recover our recovery coordinator to work with military liaison to, members of the service would wars program, servers recovery care corp. nader's contractor coordinator, and various staff members to bridge the transition from v.a. to dod. each client has a specially tailored plan based on the goals and needs of the veteran and

based upon input from the client and his or her family. this plan serves as the basis for returning our wounded warriors to the highest level of functionality and independence they can achieve. third, v.a. has implemented a robust screening for -- we screen every veteran from iraq and afghanistan for brain injuries enemies can every individual for ptsd and problem drinking. if ptsd is positive, we request a and i wish to pursue. any positive screens lead to further a valuation in the primary care setting, all of my specialty care services as needed. v.a. has established that the standard for mental health that require prompt contact of patients within 24 hours of the referral by a commission to

address their needs. if the veteran has an urgent care or need, we make appropriate arrangements, including an immediate admission to one of our facilities. if the need is not urgent, the patient must be seen for a full diagnostic about a wish and of the apartment treatment plan within 14 days. across the system, v.a. is meeting the standard over 95% of the time. suicide prevention efforts are having a meaningful impact on those veterans coming to us for care. suicide for any service member is a tragedy for the individual, friends and family, and to the nation. we have initiated programs that push the va and the forefront of suicide prevention programs. the return on investment for

these efforts is significant. a suicide prevention hot line has saved the lives of more than 9000 veterans and service members since its inception. other data demonstrate younger veterans are come to the va for healthcare services were 30% more likely to die from suicide when those who do not come to us for care. more broadly, the rate of suicide has declined steadily since 2001. from a public health perspective, this decline is significant. these are considerable accomplishments that both va and congress can be proud of, but it is imperative that we reach even more service members. in conclusion, va and dod shares a partnership with best practices and workers aboard the brave men and women who support -- who wear the uniform.

thank you for the opportunity to discuss these issues with you today. i am happy to answer any of your questions. >> >> thank you very much. >> we are lucky that the chairman of the veterans affairs committee is also chairman of the armed services committee. that has allowed us to do much better coordination in these matters. it is a real break for us, more importantly for our troops and our veterans. he is a member of this committee. let's try seven minutes before the first round here. general, let me start with you. a couple of weeks ago, national public radio reported that the military is failing to diagnose brain injuries in troops who served in iraq and afghanistan, that the injuries were not documented on the battlefield, the soldiers do not always get

the best medical treatment. interviews with soldiers at fort bliss revealed that some soldiers were crying out for help and still had to wait more than a month to see a neurologist. also, they reported that many military doctors failed to accurately diagnosed tbi. can you give us your response to cox those reports? >> i've provided a complete response to national public caught radio in which i detailed my copper problems with the report. i have three basic problems. number one, it criticized the leadership for not caring and not doing anything about it. i think that is far from the truth. i take great exception with a report stating that our doctors will not seem to care, do not properly diagnosed these injuries, without explaining the real issue here.

you cannot isolate traumatic brain injury without talking about posttraumatic stress. as i mentioned in my opening statement, it is very difficult for doctors to make that diagnosis. of of whatof my army wounded warrior population, the most severely wounded population i have, as 60% have either tbi or pts. for the -- 43% ptsd, an 17% tbi.

i really believe that when you fail to talk about both in this issue, you are doing a great disservice. to stated flatly, our science on the brain is just not as great as it is in other parts of our body. researchers are struggling today to find the linkages and to learn everything they can about the brain. because of this, we are going to see some misdiagnoses. i can tell you that the people at national public radio had over 200 appointments -- the people that national public radio talked about had over two hundred appointments a piece. you can go anywhere in the world hawke and find soldiers who are struggling because of our inability to nail down and determine exactly what treatment they need for these issues, but i promise you, it is not for lack of trying, or a lack of caring on the part of our doctors. our leadership is completely committed to this. >> one of the soldiers claim the month to more to see a neurologist.

-- reclaimed the weight of a month or more to see a neurologist. -- claimed a wait , of a month or more to see a neurologist. >> i will tell you that and neurologist is not necessarily the answer to these issues. i have a total of 52 neurologists in the united states army. 40 of them are currently practicing. 40. that is when i include my child. 18 new works of behavioral health issue is a team of a near rolla -- the team who works on a behavioral health issue is a team, a neurologist, a psychologist, and behavioral health specialists. even the medications for pts and tbi are totally different. if we might miss in as been the beginning, the medications are going to be different -- if we misdiagnose in the beginning, the medications are going to be different than what they need.

there are also anxiety issues, depression issues, other issues that are the product of these wars that are causing us so much difficulty in this area. i have 79% of the psychiatrists currently assigned to the united states army, and i know that authorization is lacking, but i only have 79%. it is not just an army problem. this is a national problem, the shortage of behavioral spell health specialists. -- health specialists. >> is this a matter of funding, of finding people? >> i think it is a matter of finding people, of getting them to move to some of the places where the army is stationed. when you have shortages, it may be because a psychiatrist

prefers to be in nashville banner in clarksville, tennessee. -- than in clarksville, tennessee. >> is the delay because of a lack of resources, or because of the complexity that you just described? >> i would argue that it is the complexity. i really would. i would not say that in every instance we are getting soldiers in exactly when we want to, but soldiers have a primary care manager at the rate of one per two hundred, a primary care manager of where you or i would have a primary care manager at a ratio of one to 1200 or 1500. they have a nurse case manager at a ratio of 01-20.

have a squad leader at a ratio of one to 10 or less. we have done everything we can to forecast -- to focus our resources in this area, but i will tell you,we are short behavioral health specialists. >> but again, that is not a funding issue. >> it is not a funding issue. >> the va, you testified, screens all of our iraq and afghan veterans who receive care from the va for traumatic brain injury. does that screening indicates that there is a routine failure in the military to properly diagnose traumatic brain injury before you see that veteran, when they're still on active duty? >> i do not think we can say that. the problem with traumatic brain injury is that there is no hard, fast diagnostic test. it is not a lab test that you can send off and get a solid answer back. this is one of the temporal issues that often takes time to

manifest some of the effects. i do not think that it is a failure on the department of defense side to find these people. i think it may just be the complexity of disease, as you have heard, takes time to manifest in ways that we can then identify. >> first of all, it was called to my attention, oddly enough, of all the committees i have never served on, one is personnel. it was called to my attention the propensity of these suicide and i made a request the restarted looking into it. -- that we start looking into

it. general, i know the you have really made a study of this thing. you said something to the effect, i did not see it, i was told it was in your written testimony. on active duty, we have actually had a reduction of the number of suicides, is that correct? >> that is correct. >> in the 1990's, we were downgrading the size of the military and all of that stuff. after 9/11, we had all of these appointments. -- these deployments. we all hear from people back home, our garden reserves. they say it is not livable. that goes all the way across the services. i would think that perhaps the up-tempo might be some leading cause of these, in that it is

much higher. do you see that relationship? >> i see that as one of the factors. we have had an increase, it is really interesting. we have had at decrease of the active component suicides. it is about 700,000 person force. once a reserve soldier is made an active-duty soldier, he is counted in my active component number. we are down 50. -- 15. we are up 21 in our national guard soldiers who are not on active duty. that concerns me greatly. a think it is multiple deployments.

i do not think we are getting enough time with them to give them the kind of checkups that they need, behavioral checkouts. third, i think senator mccain said in his opening statement, this lack of human interaction with other soldiers when they leave the service after a 12 month deployment is a real issue here. >> that is. that is what you're talking about. you implied with the public radio think that it was not totally accurate and i agree with you. there was another article on the 14th of june in usa today that talked about -- it was pretty critical, because it talk about a law that was passed in 2008 which said that there have to be both pre and post, and apparently we are short on the post and a bit.

-- end of it. can you elaborate on that? >> the law stated that we had to use a screening tool in pre and post deployment. and we still use that in pre deployment to the baseline on cognitive and skill. -- to get a baseline on cognitive skills in our soldiers. on a post -- we found that when we used it on post we are getting a high number of positives, a false number, way too high. we had a number of specialists working their way through these false positives. we still use the test if a soldier demonstrates any of the symptoms of traumatic brain injury or cognitive issue. we're still using it, but we're not making it mandatory for

every soldier so the we do not make our limited number of behavioral specialists have to wade through all of these tests. we have other things to analyze virtual behavior health. we can give every soldier a 30- 40 minute riyadh session with a behavioral health specialists using -- triage session with the behavioral health specialists using the internet. this allows providers to put everybody from a brigade commander to everybody in that unit through a 30-40 minute thing. this is the kind of thing would like to be able to provide to reserve components soldiers when they get back, but i do not necessarily have the time necessary to do that. >> do any of the rest of you want to comment on that in terms of how relates to the law that was passed? >> we still use the test pre and post.

we are fortunate in a way that we can do that based on the numbers we are dealing with, even with the false positives. we have had a fair amount of success with a post deployment health assessment that takes place in the theater shortly after return. six months later there is a reassessment. that assessment has yielded 16% of those chairmen that we are trading for -- those airmen that we are treating for posttraumatic stress syndrome. we think that six months' follow-up is extremely important as well. >> we're in agreement with the army and the other services. we used the test with 100% of our marines prior to deployment. we are not doing that when they come back. it is used occasionally by our mental health professionals if they do not have anything better, but the issue of false positives and the lack of

reliability on the post leads our navy doctors, our mental health professionals, to seek other ways. we are doing that. we screen 100% of the marines as they are coming out of theater, and then at 90-100 days later we do it again. 15% of those that are screened coming out of theater answer some questions positively which would lead you to further screening. of that further screening, 7% see mental health professionals. by the time you whittle it down, about 2% of the marines actually need mental health care when they come out. it is just not that reliable on the backside.

>> that is very helpful. my time is expired. but i want to rescue a question -- ask you a question. another article talks about tying an up-tempo with families, with deployment, and apparently the new england journal of medicine did a study. i read this article and then did a little more research about the findings they're having in terms of these families, the wives, the kids. nothing was really said during the opening statements about that, so i would like, for the record, to have the four of you address what we might be doing in terms of the wives and children at that might have the same problem and the same ratio that the troops in cells -- troops themselves are having. >> i have made reference to a

bill that was introduced by a congressman who was the co- founder and co-chair of a task force. we have received a statement from him which we will make part of the record. >> thank you for scheduling this hearing on these vitally important topics. i want to thank my brother and friend, senator inhofe, for helping to bring this about. i want to recognize our distinguished group of witnesses and thank you for your dedicated service to our country. i also want to thank the men and women that you leave for their outstanding service. -- that you lead for their outstanding service.

the topics that can today are -- the topics at hand today are ones that i cared deeply about. in continuing to work with you and my colleagues, we can continue to refine efforts to prevent military suicides and look for better ways to treat, detect, and care for those suffering from the invisible wounds of war. generals, suicide prevention is difficult and challenging, and for all of you in our panel, this has come across because of what we call combat stress. as was mentioned, that includes ptsd, tbi, and behavioral health issues that we are facing here.

as was previously stated, there has been a rise in suicide since the wars in iraq and the afghanistan started. there is a need to look suiciding get to a point where -- to understand suicide and get to a point where we can prevent it. how can the dod and be a better collaborate -- dod and va better collaborate on suicide prevention research? this has been mentioned as a great need here, and i would

like to have the three of you give your perspectives on this. >> i would argue that i believe that cooperation has never been better. we are running a pilot at different installations that is proving to be a great success for the united states army. the wonderful thing about this is that when a soldier goes through, we ensure that if they are leaving the service that they are in a v.a. system. this is something that is never happened before as far as i know. it is a wonderful benefit of desperate -- benefit of this, that when a soldier makes a decision to leave the service, he is in the system. before, we would have soldiers separate and it would be their responsibility to work their way through the process of getting into receive both their medical benefits and other

benefits through the system. i think that you have hit upon a key piece, and that is stressors. it is not only combat stress, it is individual soldiers dressed -- individual soldier stress and family stress. when we look across the continuum, we're seeing that a soldier in at the first six years that he or she spends in the united states army has and the accumulative stressors of an average american throughout their entire life. that is when you combine high up-tempo, individual stressors, and family stressors. this is an area that we're looking at very hard. when you realize that 79% of our suicides last year word -- were soldiers, 50% in in their first term, 79% one a deployment or no deployment, i think it points to doing everything we can to mitigate those stressors

whenever possible and, as we're doing so hard in the army, worked to increase the resiliency of our soldiers, particularly in their younger years. >> senator, i would be happy to talk about not only the relationship of the hand of -- handoff between the military and the veterans' association. i have never seen it better. the entire organization is a well lit from the top down. they are passionate and compassionate about the men and women to enter our system. i have travelled around and visited a lot of our hospitals and our wounded, and i am very moved by what i see. there is a systematic handoff. in the marine corps, and this is done by our recovery care coordinators'. we take summer rains we have around the nation, u.s. marines

-- we take some marines we have around the nation, u.s. marines whose job in a life is to everything they can -- whose job in life is to know everything they can about the va system. that recovery care coordinator contacts the recovery care coordinator federally. we have a network to put our arms around a guy. i have seen it firsthand where the actual hand off foreign needy marine, in some cases two years after the initial diagnosis of the injury, i just saw this last month. a young marine diagnosed two years ago, his wife as unravelled right now, and their

-- his life has unraveled right now, and the federal recovery coordinator and the care coordinator in san antonio, we were able to plug this marine back into a hospital right now to get some care. i've never seen a better. -- seen it better. >> thank you, senator. i think the general hit the nail on the head. i think cooperation is very good. we rely on them to streamline the system. what we are finding in our study of suicides is the transitional period seems to be a spike in stressors. this is something we need to watch very closely to ensure that our sailors have the social support network that they have had as they move through their career. that is an area to watch out for.

>> we have about 700 men and women in our wounded warrior program. their lives have been changed forever, and we are dedicated to taking care of them from the time they're wounded until they no longer need our services in the air force and they make a transition to the federal system. if in fact that is required and we are not able to bring them back to the air force. we use much the same system that was described with a recovery care coordinators around the nation. we are very comfortable with our relationship with the va and the way that is working. >> i am glad we are working on a seamless transition, and that we are moving along in that

capacity. >> so as not to reiterate things that have already been said, i would just like to point out a couple of areas where this level of integration has really become manifest. first, the reassessment exercises. the va generally has a presence at those exercises, not to administer the exams, but to be present to ensure that those service members are aware of all of their benefits that the va can provide, but also, if there are immediate health, particularly mental health issues that arise, that they are there and can literally make an appointment on the spot. and if we need to take them into our care at that point we can do that. so we participate in that. the second is the pauley-trauma networks, which really are -- poly-trauma networks, which

really are a great thing. third they are part of the wounded warrior networks in bethesda. i had a chance to look at the seamless way that both patients and their information moved through those networks. we ensure that any movement of a patient is a one handoff, and not just being sent to another place. finally, in the mental health area, i think there has been an extraordinary collaboration going on for some time. there was a joint conference in the fall of 2009 that led to an integrated strategic plan.

the real goal is to make sure that there are evidence-based therapies for posttraumatic stress, and that we agree on how we treat those patients, such as treatment begins and then there is a transition, we are not abruptly stopping what form of therapy and then beginning another. i think this is a huge point of collaboration that we have gotten that far. >> thank you. the testimony of our witnesses saying that the integration planning and diagnosis and treatment of our troops and our veterans is going along at a good pace is important to both of our committees. it is something we put a great focus on. our armed services and wounded

warrior legislation was aimed at accomplishing that, so this is important testimony and good to hear. senator collins. >> thank you, mr. chairman. senator inhofe, i want to thank you for suggesting in this hearing, as well as the chairman. in the past year, i have met with retired generals, with returning members of the national guard, and with a whole variety of health care professionals to discuss the mental health needs of our troops and the troubling rise in suicides. to a person, each of them has told me that it is insufficient

dwell time between deployments that they believe is the biggest factor, that there is not sufficient recovery time before deployment occur again. how important do you think that factor is to the increase in problems with mental health and the suicide rate? >> i think for the national guard soldiers it may be higher than we are seeing with other soldiers. as i indicated, 79% of our suicide last year were soldiers that had never deployed or only deployed one time. that would indicate that there is a resilience that grows with an increased number of deployments. that the realeve outpu issue for our national guard

soldiers is that when they come back from a second or third deployment, that we have sufficient time to do the kind of medical tests, such as a virtual behavior health counseling or other things, to ensure the number one, we get a good read on how they are doing , and number two, that they fully in understand the medical benefits they will have when they return to their state. one of the hardest things for any of us is that the benefits for national guard members vary from state to state. we have made great progress. added to the six months of care that you get when you come back, we can provide them fall care until the next deployment. i think this is critical. i think we have to look at this population a little bit

differently and realize, again, as senator mccain said, i am able to help active-duty soldiers for the entire time they're back, but we take these reserve soldiers and their back in their own community within five-seven days of their return. >> even though the va will provide assistance or the national guard will provide assistance, it is often many hours away. that is a problem that is in our society as a whole, and it is mentioned in the shortages you are facing that it is difficult to match the mental health professionals with where bases may be located, but that is an even worse problem when you are talking about national guard members or reservists who are

going back to their home communities, their regular jobs in small communities that may not have any mental health professionals at all. >> we started a program last august that gives counseling 24/72 anyone who is authorized, and it is done on line. it falls short of psychotherapy or prescription pain management. we cannot do that online, but where i really see is making up for this shortage is to really explore what we can do with telling-behavioral help -- tele-behavioral health. it gets to the issue of shortage that you're talking about. i think this is something we should do now, rather than wait until we grow the necessary providers we need over time. i really think we should be

exploring this as hard as we possibly can. >> i completely agree. there is great potential, particularly because so many of these young troops have access to computers in their own homes, because the sick and still is there, despite all of our efforts. -- sickness is still there, despite all of our efforts. even though we have given a lot of attention to the army's rising suicide problem, i was struck tuesday in 2009 that the branch with the highest rate -- struck to see in 2009 that the branch with the highest rate of suicides among active-duty personnel was the marine corps. the army has clearly done a great deal. is the marine corps matching that effort and stepping up your

programs to try to tailor them to the culture of the marines? >> that is a great question. the short answer is absolutely yes. we are joined at the hip with our programs that we mutually shared across boundaries. we are aware of all that each of the other services do. we collaborate. we share best practices. we still get ideas from one another. -- steel could -- steal good ideas from one another. in 2009, we had 25 more suicides a than we did in 2008, a total of 52. we do not have all of the answers on this thing. we are trying to find out and do something about it. interestingly, the marine corps

is the youngest service age wise of all of the other services. for instance, 67% of all of our two hundred two thousand marines are between the ages of 17-25. if you compare that to the other services, we are woefully more -- when i say "immature," i am just talking about years. that in and of itself causes some issues. the population of marines getting themselves is between 17-23. it is mail. it is about half married, have single, white, and the deployment -- for instance, this year alone, we have had nine young marines take their lives that have never seen a deployment. we have had marines come right out of boot camp and having spent 12 weeks in what is arguably a legendary but oot camp, they it c

kill themselves. did they go on leave and they take their lives, and they have never been deployed even once. what causes that? we had a young lance corporal just check into this unit two weeks ago in afghanistan. his very first day, he goes on duty, walks outside the perimeter and shoots himself. he did this -- if you do the forensics on this thing. his girlfriend left him just before he left. he has issues with his family at home, his mother and father. these are the kinds of things we're seeing. so what are we doing about it? first and foremost, in our organization, we are focusing on the leadership in the marine corps. i know that sounds trite, but we

are an organization based on leadership. we start at the very top. the sergeant major of the marine corps and the commandant are adamant about this. it goes all the way down our leadership. we have to absolutely pay attention to this. this is not something to be taken lightly, and it is an issue. that is the first thing where we are focused. we took six months to develop and pioneered last july left non commissioned officers -- and non-commissioned officers suicide prevention half-day course. it is video. it is felt. it is in the vernacular of the noncommissioned officers. looking at the age of the suicide population, that is within the noncommissioned officer jurisdiction. they know them better than anybody. we got high reviews, a great

reviews from the noncommissioned officers. 100% of our noncommissioned officers have gone through this, and they're taking this training down to the young marines below them. interesting, we have seen a drop of suicides this year. even though right now we're on the same plateau was last year, and that is not very encouraging. but if you consider the vector the we have been on since 2005, which has been very steeply vertical, the fact we are even where we were last year is an encouraging sign. a further piece of news that is encouraging is that this course, we think, at to suit -- too soon to tell, but last year 93% of our suicides or in this age group. wising that age group dropped to 84% today. -- we have seen in that age

group dropped to 84% today. so we have said, let's take a look at everyone and build a very similar program. it should be published in the next two to three months, and we're going to do the whole thing for the entire marine corps. we think it has worked. it is too soon to tell. we are trying to make our marines more resilient. i have a list of things down here that i could go through, but i just want you to know that this has got our attention. >> thank you. >> senator udall is next. >> good morning to the panel. general, i want to in particular note to the amount of indention

you have paid to these issues -- the amount of attention you have paid to these issues. i have had the chance to travel with you. i trust my questions will be received in that spirit as well. there is a question earlier about the test used pre deployment for baseline. you said you do not use a post deployment because of the false positives that often result. here is my question. by definition, a bass line is supposed to give us something to look back at in the aftermath. if we are not using close to 600,000 pre-deployment assessments to compare post- deployment assessments, wire redoing them? why use them at all of their not being used -- why are we doing them?

quiet use them at all if they are not being used in a post- deployment situation? >> the baseline is important because it gives the doctor and this additional tool when it concerns are detected post- deployment. we are not doing it is a post- deployment test for every soldier regardless of whether they show the symptoms. we are getting so many false positives, and we just do not have the people, the specialists, to work through all of those false positives and give the care we need to the rest of those who need care. >> that is helpful. we will continue that

conversation. my next question will follow on that. i want to talk about the post- deployment tests that are supposed to catch things that were not caught in theater. a soon-to-be published study shows that the standard screen fails to catch 40% of those who have a problem in the theater. i have been the colorado on a number of occasions to get briefings on how they're handling tbi patients. i think they are doing it right by doing a more thorough exam. there is a concern that the individualized approach would take too much time and too many personnel. but i am told that it only takes about 15-20 minutes to do this. could you speak to the approach

at fort carson? >> i disagree with fort carson. i want them to institute a virtual behavior health screenings so that we can ensure that we get everyone. i do not want to use any form or series of questions that automatically says that a soldier does not have those issues. i think that what we really need to do is to get to us standard that says, we are going to give everyone a post-deployment screening. follow that up 90 days later or 100 days later. here is my problem with the fort carson approach. it focuses on soldiers with the doctors say have assigned when they come back. they may get through a 15-20 minute screening of a select population who have demonstrated on a questionnaire that they may have issues. they may be medium to high risk. but when you do that, you take away the doctors that we have already found because you're

focusing on this group. that is why the virtual network is so important. you can get the number down to those that you can treat with those people that you have on base. i've spoken to fort carson about this, and i have to tell you, until i get doctors to use the virtual method, many of them pushed back. they pushed back because they have never done this before. but what we're finding is that those who go through with, those doctors are the biggest supporters. we find that this generation is much more open to using skype technology or some kind of high- definition, or even more so than sitting across the room like you and diane are right here. they really feel they are able to get at some of these issues and do a good evaluation.

>> let me turn to what is perhaps the difficult conversation tied to the npr story. they used the term "miserable minority" to referred to those who suffer from traumatic brain injury. it is true that many people recover from mild tbi, but others have symptoms the same to recur for months or years. the npr story intercepted an e- mail from a doctor who questioned the importance of even identifying mild tbi. can you help me understand

whether finding ways to diagnose and treat mild tbi is important to the army? >> it is extremely important to the army. that dr. represents a population to, quite frankly, you can find one who will support just about any way of attacking this. i think the dialogue is good. i did not necessarily agree with what that dr. roped -- dr. ropwrote in the new england journal of medicine. i think the great disservice to that npr did was to try to isolate tbi from ptsd. that is just not possible. i also think they did a disservice when they indicated that ptsd is a psychological problem.

it is a physical injury that occurs, and i think it could be best described as a chemical injury. that a frontal cortex does not turn on and stop the flow of the things that could keep people calm. there in an altered state 44-6 our -- they are in an altered state for 4-6 hours. >> thank you. thank you to all of the members of the panel as well. cross is for your service. >> senator mccaskill. >> there are three areas i would like to cover quickly that i think are important. an overarching concern is that of confidentiality. some in the issues surrounding mental health, whether is brought on by a brain injury or

by substance abuse, alcohol abuse or prescription drug abuse, so much of the problem we have been the military is the stigma associated with getting for activeicularly u duty personnel. i am sure you are all aware of the pilot program that is ongoing for the confidentiality of alcohol and substance abuse treatment at three different facilities. these soldiers are not being read third -- referred to the chain of command after they have sought treatment. general, could you address of the program is going and whether you think this pilot program shows potential for allowing people to get help with the negative impact to their careers that some many of them fear right now? >> tremendous potential. we have done it at three

installations. we started at fort carson in august and we are expanding to two others. this was approved a month ago. the only problem we are having is trying to recruit the number of drug and alcohol counselors that we need in order to ensure that when someone suffers from this problem, that in fact they can be seen immediately and not be told, come back six weeks from now. we are seeing great results from the three installations that we have started a pilot at. >> that leads to one of the other areas i wanted to cover today and that is the availability of counselors. as you know, into the asinine comeuppances -- into cells and nine, -- as you know, in 2009, a study was released that counselors should be allowed to practice

without an extra supervisory layer of personnel. with that, do you see the ability for us to staff at a more appropriate level to get at this problem that we see in terms of availability of mental health professionals for men and women who need help? >> this is a wonderful provision. we have done an exhaustive study, and just as we are close to reaching our goal, because of the increased amount of drug and alcohol issues that we have in the army, i am not going to paper them over, we need about two hundred 25 more. we got authorization to hire an 225, and this is five going to be a great help to us.

>> this is just as important as the other tools we give our fighting men and women. our heroes need not just the armor in the battlefield. they need the availability of help when they need it. i know you have made this a huge priority. i know all of you on this panel have. i want to make sure if there is anything we can do as members of this committee to reinforce this of the highest level of leadership in our armed services committee let us know. the idea that we would stand between more help for men and women who are struggling, that we need to get more people on board, is very frustrating. i want to make sure that there are many of us are ready to go to battle over this if necessary. unfortunately, missouri has had one of the highest rates of suicide in our national guard. that is what brings me to the notion of embedding, particularly for our national

guard and reserves, embedding mental health counselors. as you probably know, this has been done in california at a surprisingly low price tags. the availability is for the weekend and the two week training as opposed to 365 days of around-the-clock. but think this could be a huge assistance to our national guard members, and i would want your reaction to that. i know the we do not have a member of the national guard on the panel. >> i look for any way that i can get behavioral specialists down to national guard units, and i think embedding is in a standing idea -- is an outstanding idea. they have not brought the program to maine, but -- they

have not brought that program to me, but i promise you i will look into that. >> this is really important, because in california, they have 40 different guard units, the largest component in the country. the cost for one year was $820,000. that is a bargain, particularly when we see this kind of increase. we have lost five members of the national guard and misery already this year to suicide. that is something that is unacceptable, and i know that the general of the national guard is very concerned and want to move toward some kind of embed program. i think the support of the people on this panel this morning would be crucial for that to be moving forward. >> as i indicated before, we have had an increase of 21 suicides across the national guard at the same time the we are down and all other

categories. this is really gotten my attention and i know the attention of others. >> i will continue to follow-up on that. >> thank you, senator. >> i want to follow up if i can just a few of the comments and responses to some of the questions that were given earlier. first, general, i want to thank you for the work that you're doing. you're definitely passionate about trying to resolve this issue or at least afford and a positive way, and i really appreciate that. -- move forward in a positive way, and i really appreciate that. i know you have been subjected to my conversation on this before. i do believe that this is a huge opportunity for both of them at dod and the va to explore and a positive way with a new

generation of soldiers. when you think back just a few years ago where we work with computers to where we are today, is unbelievable. i hear your comment about some doctors pushing back on this new technology. how are you getting them to see the value? i say this in as polite away as i can. you are in the military. one thing i have learned about the military is that when you want to get something done, you just do it. doctors sometimes have to grow into these things, but time is of the essence. what are you doing to get these doctors on board with tele- madison? in states like mine, -- with medicine.

in a state like mine, people do not have access to behavioral health medicine. what are you doing to get these doctors on board? >> we have seen 1000 flowers blooming, and it is time to move ensuring that wet, look for new kinds of innovation and treatment, but at the same time, ensuring the we have a standard program for soldiers that not only treats them when they come tom, but the 90-100 daymark when we -- when they but also at the 90- 100 day mark when we start to see some of these problems.

>> i saw some technology development done by an alaskan corporation on alcohol screening and alcohol abuse follow-up for those that decide to move forward. i saw that technology and it was impressive. it is reaching into how to get to these young men and women at their world of technology, rather than bringing them to an office to sit down. we think that is unique and i know the va is starting to look at that. could you just let us know what you're doing around electronic element of some of this? >> as you know, we have quite a long history, dating back to the 1980's with hallmark monitoring and pace -- home-monitoring and

pacemakers. as you mentioned, the new technology is using smart phones. you do not even have to invest in something that ties someone to their house. anyone who has a kid in their 20s and know that you do not even bother to call them. you just texting them. they will not call you, but they will texting the back. -- text you back. younger people are much more used to chat lines on the web than they are to having a telephone conversations. that has been an emerging way to contact in under people. as we deploy mental-health technology, along with all of our other capabilities, using new technologies that young people understand and preferred

to use, i think it is going to be vital. >> we just signed a memo that is a key and critical piece here. we want doctors to be part of our virtual behavior health system. that is a real issue when you're trying to provide the same kind of care across state lines, and even within state lines. in the year of behavioral health, i think we really need to look at some of those roles and think about, do they need to be the same for this branch of medicine as they do for, say, a heart surgeon or someone else? . .

what do we need to do to support you? what is the next the? -- step? >> i can go ahead and provide for a referral for a soldier at fort campbell, kentucky, to drive 100 miles to nashville to see a psychiatrist. i cannot help him up over the internet if he is not a military installation and privileged and credentials from that location. i cannot hook into his office in nashville, yet i can put a soldier in a car to send him 100 miles to see the doctor.

>> my time is up, -- >> if we could look at the age of health care appointments and mandatory retirement. there are a lot of people that want to help that may be over the age of 42, which i understand is the limit for a lot of the health care providers, it would be helpful. >> for us, your continued support for deployment cycles. while we work in between the deployment cycles with programs like the yellow ribbon program, the returning warrior programs, these kinds of things help families. that is a modest investment. it has paid rich dividends. your continued support on that would be great. >> i would echo what my counterparts have set, and also

thank you for the bonuses and special pace. that has allowed us to agree ret almost the support we need. mental health nurses are really the only shortages that are dramatic at this point. we appreciate your support for that. we have had a promising research at the air force base in san antonio which hyperbaric treatment. any area of support in that area would also be very helpful. >> and you very much. -- thank you very much. my time is expired. >> what kind of support you need for that the parikh treatment? >-- hyperbaric treatment. >> we're in the infancy stage,

but we have had a promising results. >> if you could give us an example where there is of funding shortfall on the appropriations ike, we would more than welcome it. we're determined we're quick to get you whatever sending you need to address this issue. senator lieberman. >> thank you. i apologize aldosterone out to another meeting in between. i appreciate very much the work that all of the services are still doing on all of these pro, and i know for each of you this is a deeply personal issue, and i thank you for the time you're putting into it. in my own work on this i have become familiar with some statistics that surprised me, and i want to offer them not to diminish the problem that you

and we are facing among service members, because every suicide is a strategy, and we want to prevent them all, but what is interesting to me is that -- and obviously the most significant factor for all this is the extent to which the suicide rate among active duty personnel has increased over the last decade from 9.1 in 2001 to 15.6 in 2009. the increase is comparison to a rate among the civilian population of 11.11%. what is really striking to me, if you take out the young male population in the country, and the military is still

disproportionately, poore compof young males, the rate of suicide among young 24 year-old males is 17.8%. this suggests a broader societal problem, which was a total surprise to me as i went over the numbers. it does not diminish in any way the importance of the effort to are making and we're trying to support you. what it says is at the rate of suicide among young males and military was significantly lower -- in military was significantly lower among civilian population. i want to suggest in the statements, no attempt to minimize the problem, but to say that cries out for some larger

societal response that deals with young males in our society. i do not know whether any of you want to respond to which. >> if i could real quick, we have run around something that is very interesting. when we look at the number of soldiers who are first termers who joined the army between 28 and 29, they account for three times their expected rate for suicide. in other words, there are only 5% of the first term population, but they account for 15% of the first term as suicides, which would indicate that not only is it you, but also this combination of additional stress.

>> interesting. those are compelling numbers. let me go on to a question, and i apologize -- i gather from staff this does not been dealt with in depth, so i will ask it again -- and this is the question of how the services diminish the understandable human keifear of going for help will be detrimental to the service person's career in the basement? i note the air force quantified that in their study, but my own sense from conversations with members of other services is that this is a pervasive problem. you all are obviously deeply concerned about this and focused on how to make it better, and in some sense my question is, how

you transfer the concern down the chain of command so that individual members of your services feel that if you go for help for a mental problem just like you go to help it your leg is bothering you? >> i would not minimize that problem for the air force quite frankly. i see it still exists, and i think there is a stigma attached to that. the basic answer to your question is it becomes a leadership issue. we have the same demographic issues that you described earlier in terms of young, male pearmairmen that are taking ther lives. our biggest issue is relationships.

70% and all relationship issues of some kind. >> within the military? >> typically personal. second would be legal issues. third would be financial. only 20% of the suicide victims have been deployed in the past year. we deviate from the army and marine corps as we do that. if we look at the elements of this, they are young, male members, primarily in terms of security forces. at the same time, those career fields are under the same amount of ok'd tempo. i would not minimize the way we get at this and the air force, but we have moved and mental healtmental health care personnl

into the same building. you can actually get help with your family members or for yourself. we provide at no cost and number of sixth as it is that you can arrange for yourself to do that. all of these are confidential ways to do this. there are ways to get at it, including the chaplain, who are all trained in suicide intervention as well. we can approach this from a number of different directions, but the stigma issue will be very difficult to work on. >> i wonder if any of you want to briefly comment on this. essentially what you're trying to do is remove the stigma. >> you are right. this is evolutionary. five years ago we would not have been talking about this. we would be slipping this off -- sloughing this off.

we have the marine corps that understand that the stigma is real and we have to set the conditions to get around it. i am not convinced that the middle great staad staff e stafe exposure. this is a leadership issue we are working on. to get around this, we have put mental health officials and the deployment battalions. we have the mental health providers, chaplain's involved in this thing. now we have embedded units with every single deployed unit in afghanistan right now. we're trying to get away from that. the final thing -- we are sneaking behind the back door of this did nothing -- the last thing is that on the suggestion

of young marines, we are establishing right now everything west of them mississippi, a marine express hot line. 21,000 mental health care providers and the whole idea behind that is completely -- family members can use it 24 hours per day. you can call and say i am having serious issues which posttraumatic stress. it is all anonymous. we are working around it, senator. >> how did not want to intrude on senator higgins time. >> that is fine. you can go ahead. >> we have a statistically different situation. our demographics has been spread across the age spectrum. the last three suicide, we had a

40 year-old senior enlisted official, a 50 year-old captain entering retirement, and it 18 year-old sailor just out of boot camp. our focus has been no one is immune to the stressors. it is a leadership issue. we focus on operational stress control and management, and for those that still have the stigma, and it does exist, we have deployed at health centers. there are 17 of them spread around where the fleet concentration areas are. people can go and see a clinician or counselors. the stigma is not attached to the hospital or the support center. it is located away with the steelers feel more comfortable. we find once they go there, they will see there is nothing wrong with seeking treatment and they tend to migrate towards the clinic.

>> think you. -- thank you. >> before i call on senator higgins, let me mention this -- i will have to leave. there is a question i will ask you to answer about the status of the centers for excellence of traumatic brain injury and if senator the bourbon is not able to stay, i would ask the senator higgins to adjourn the committee after she is done. thank you. tender again. half-- senator higgins. >> i think this is a very important hearing. i really appreciate the time that the service is putting into helping address this issue. you have underscored the importance of programs,

transferring the culture of leadership with regard to invisible ones, the strain of the forces, ltd. problems, are certainly among the many challenges that we have to overcome. however, we do have a responsibility to effectively institute mental resilience -- resiliency programs to prepare soldiers for the stresses that will ultimately face. what are the service is doing to institutionalize treatment at the pre-deployment in post- deployment state? >> our program is a comprehensive soldier fitness. we have been working with the university of pennsylvania. we have trained over 1200 master resilience trainers through a very intensive course. our goals is to get into every battalion in the united states

army. we're focusing at the basic entry levels of the soldiers, because we know we have to build their resiliency early on in their career. it is absolutely critical. in addition to that, we have a global assessment tool. it is a requirement for every soldier to fill out and understand where they stand when it comes to resiliency. we have had now over 780,000 bill alpfill it out. plus, on-line instructions based on the results you get to work resiliency. this is something that finally starts to get us to the left, and not waiting until we see soldiers with problems, but try to attack resiliency as part to the left as we possibly can. >> thank you. >> senator, we believe in this

two-part. resiliency is physical and mental. we attribute a lot of our ability to be able to do the things the marine corps does for this nation as a result of the physical strength in training. it begins there. values-based training was instituted a myear ago and the marine corps. it teaches some of these things along suicide prevention, sexual assault prevention, a behavioral health issues. that is where it begins. when the marine enters his first unit and is preparing to deploy, we believe the best thing we can do for them is to not only get them physically fit conditioning-wise, at which we have a combat the illness

regiment we put them through, but the second piece is what we call the emergent training. we want the marines to experience back home before he or she leaves. most of what the fear and anxiety and confusion is part of war. we have started on the west coast going to hawaii. it is inside a building, a huge building. we transmission -- transition from a iraqi community to and afghanistan community. we rerun this scenario over and over again so the young marines become accustomed to the fear and uncertainty of warfare. you take that and put them and and ied lane -- in an ied lane.

you get the idea that our last attempt to build the resiliency is to reimburse them, as much as we can until they know that their training is adequate and they will be ok. we find that if we do that, that when they hit the first fire fight, the kids is up them surviving are greatly enhanced. -- the chance of them surviving are greatly enhanced. that is what we're doing to build the resiliency. we follow up when they come home. >> thank you. you mentioned and response something about the age of 42, and i did not quite get that. could you elaborate on that? >> yes, ma'am. health-care providers who desired to enter service, there is a maximum age of 42. that allows them to have a 20-

year career. if we could raise that age, because there are a lot of folks older than 42 that want to help. >> thank you. many of the burdens associated with the worst has been soldiered by the reserve and the national guard members. when the citizen soldiers are redeployed, they are almost immediately demobilized and return to civilian lives. unfortunately for many, the jobs and lives they left, are not what they returned to, which is compounded by the isolation of not having a support structure that is comparable to what is available on thofor those on ace duty. what efforts are being made to make sure the members have a soft landing when they returne home? >> i would tell you that in redeployment process you need to

go back to the beginning of the sleep before you start your deployments to make it successful. our guard and reserve total force all have access to the same things that active duty people do as well. your point is well taken in terms of how wheat reintegrate those people once they come home. -- how we reintegrate those people once they come home. the yellow ribbon program has been very successful at preparing members of the family for deployment in caring for them to rent supplements and the opportunity to reintegrate the members when they return. my discussion with the commander of the reserve, they seem to be very happy. we are happy at this point with the results we are getting, and we're getting the resources to do that, and for that, we appreciate your support. >> for the marine corps, we deploy -- we do not have the

guard, and we will deploy to types of reserves -- and we will deploy two types of reserves. they go through the entire training program, the resiliency training, and when they come back, they do a unit reintegration. they have access to the same capabilities and hopes that the regular unit does. where we struggle, and where we have been working hard the past year and a half is what we call individual of mates. the young marine in the middle of oklahoma that is pulled out what we call the e right to the reserve and has volunteered to go to afghanistan, and that individual comes on active duty individually, does that have

access to all of these great programs. we do our best. we have a training program for them, but when we come home is where i worry the most about. pat is where the whole idea of the returning warrior, -- that is where the whole idea of the returning warriors, the yellow ribbon program has been such a success. that is how we're trying to accommodate those. >> thank you. my time is up. senator lieberman. >> sink you. i have no further questions. -- thank you. i thank all of the witnesses for what you are doing and for your responses. i know for all of us this will be a continuing focus of concern

for members of the committee. we're so grateful to our military personnel. the surplus that honor and capability and 1sacrifice. the military remains one that has a public respect and trust, but it takes its toll. i think we're getting much more in touch with the toll it takes on the minds and spirits of people who serve and therefore, we want to do everything we can to make sure we prevent the most serious problems, such as suicide and we treat problems before we get to that point, so i hope you will understand that you should feel free to advocate

to us what you think you need from congress to fulfill the goals that you have in this regard, which of the goals that we have as well. i think you very much, and the hearing is adjourned. -- i thank you very much. [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2010] >> a reminder that we have lots

of background information on this hearing in the military suicide issue available online. you can watch hearings and briefings, reed reports and other related web pages. it is all available to you at c- span.org. we have more military program oall this week. tomorrow the focus on military use of drones. thursday, military pay and compensation. friday we will wrap up the series with a look a rehabilitation programs offered to wounded veterans. "washington journal" live every day at 7:00 eastern here on c- span. its florida is among f -- flouridrida is amoamong four sts voting today.

john mccain is battling a former house member j.d. hayworth. see that live tonight at 8:00 on c-span. >> we are all pawns from the chess board and we're playing our part in the drama that is neither picture nor unimportant. >> i come before this body to personally express again my sincere regrets at all the encounter with the capitol hill police. >> i cannot walk away and had you doing the campaign because i am annoying. >> current and former members delivery apologies and explanations on the floor the house. it is washington your way. [applause] john boehner called on president obama to fire his economic team during remarks at the city club

in cleveland. he called on the president to leave the expiring push tax cuts in place. he said uncertainty about the new health care law is keeping small business owners from hiring new workers. >> want to think the city club for hosting me today and for all of you who came here today to take part in the discussion. i know this is a beginning of another long day for you tried to make heads or tails without knowing what the next week or maybe what the next day will bring. working at my dad's are in cincinnati -- dad's bar in

cincinnati, i washed dishes and watched him and others agonize over decisions. i had to do them myself when i ran a small business in westchester before i got involved in the political process. when i travel around the state, i talk to employers who are not only trying to create jobs, but trying to keep the people that have on the payroll. the powers that be in washington did not stop to think of how, for small business, employees are like members of the family. you watch them start a family. you run over to the hospital when someone is sick. and these are bonds that cannot imaginbe measured on spreadshee. it is intangible, and they have been freed up by a struggling economy.

right now america's employers are afraid to invest in an economy that is stalled by stimulus spending and hamstrung by uncertainty. on the prospect of higher taxes, stricter rules, more regulations as employers sitting on their hands. after the pummeling they have taken from washington over the last 18 months, who can blame them? president obama attended a political fundraiser in columbus, and that is the same exact moment where hundreds of all high ewan's were waiting at a job fair where they will learn once again that companies are not hiring right now. or as the organizer of the job fair put it, employers are scared to death. yes, that is what is happening in america. employers are scared to death. when i met with the president last month at the white house, i

shared my belief that this ongoing uncertainty is hurting small businesses and preventing the creation of private sector jobs. not long after we spoke, he signed a $26 billion stimulus spending bill that funnels money to states in order to protect government jobs. even worse, it is funneled by a new tax that makes it more expensive to create jobs in the united states and less expensive to create jobs overseas. this cannot continue. i have had enough, and i think the american people have had enough of politicians talking about wanting to create jobs as a ploy to get themselves reelected while doing everything to prevent jobs from being created here in our country. today i will propose at actions that president obama should take immediately to break this economic uncertainty and help more americans find an honest day's work.

the president should announce he will not carry out his plan to impose job-killing tax hikes on small businesses. president obama stated he wants to stop some tax hikes, and not others. once again putting government in the position of picking winners and losers, and put the tax payer against taxpayer. according to an analysis by the non-partisan joint congressional tax committee, that is the official scorekeeper court all tax policy and our country, half of small business income in america, half, would face higher taxes under the president's plan. of course, the same washington politicians who spent the last 18 months far wi barrowing in sg the country into the ground, are

now fretting whether we can afford to stop the job-killing tax hikes. we will not solve all our fiscal challenges until we cut spending and have real economic growth, and we will not have real economic growth if we keep raising taxes on small businesses. when will all must -- one of obabm'sobama's predecessor says we will never create enough jobs. the president was john f. kennedy. let me be clear. raising taxes on small families and businesses as a recipe for disaster. both for our economy in deficit. and the story. -- end of story.

second, president obama should announce that he will veto any job-killing bill sent to his desk by a lame-duck congress. the house passed the cap and trade national energy tax, but that bill remains of a sitting in the united states senate. remember this, this plan to raise energy prices in america will as president obama said, raised our utility cost -- i think he said they will skyrocket. also pending is a courtship bill. this is a top priority for the public sector unions that

provide money and foot soldiers for democrat campaigned around the country. it eliminates a worker's right to a secret ballot in union elections, making it easier to organize will putting employers at a firm disadvantage. it is a how-to guide for destroying small-business jobs. when i ask the president about his support in a meeting last month, he accused me of scare tactics. while the rest of the democrat leaders looked at me as if they did not know what i was talking about. the very next week, the president told the union crowd that he will keep on fighting pyridine democrat leaders refused to rule out the possibility of the job-killing bills. they're still year to level with the american people -- their failure to level with the

american people only compounds will level of uncertainty in this country. president obama should announce he will veto these bills. third, the president shall call on democrat leaders in congress to stop obstructed republican attempts to kill the 1099 mandate. the whohealth care takeover is playing havoc to small businesses. by the end of july, washington had already racked up nearly 3833 pages of regulations to direct the law's implementation. one of the most controversial mandates require small businesses to report any total purchase that would run at more

than $600. if the landscaper wants to buy a new lawn mower, they have to report the purchase to the federal government. if you are a mom-and-pop grocery store and to buy $1,000 worth of groceries from 15 different vendors, you have to file 15 different forms. what is the point of making employers spend $17 billion to comply with this lock to send paperwork to washington where it will cost another $10 billion to file it away? last month republicans attempted to force a vote on the house floor to repeal the stop killing mandates. the democrat leaders blocked the vote, and instead attempted to use this as an opportunity to impose another drop killing tax on u.s. job creators. president obama should call on the congress today to repeal this mandate without delay and

without strings attached. korff, president obama should submit to congress for immediate consideration and aggressive spending reduction package. -- four, president obama should submit to congress for immediate consideration an aggressive spending reduction package. ahopresident obama says we shoud wait and talk about a deficit reduction plan next year. i say let's talk about it right now. all of the stimulus spending has gotten us nowhere, but we are now far win 41 cents of every dollar we spend from our kids and our grandkids. think about that. 41 cents of every dollar the government spends this year we will pass on to our kids and grandkids. this spring when power changed hands in britain, one treasury

minister left a note for his successor. the vote sainote said, i am afro tell you, there's no money left. i am not afraid to tell you there is no money left. our debt is on track to exceed the entire size of our economy in the next two yearrs, and the government has no plan to pay this back. without a budget washington will try to get away with spending at current levels, and i do not think we can allow that to happen. we also cannot allow politicians in washington to continue to it trotting out the same tired scare tactics because they do not have the courage to say no

to whatever union or special interests has their handout. that is not governing, and certainly not leadership. this is the last stop of the feeling government -- of the failing government. republicans are ready to work with president obama to take this first step on the path to fiscal sanity. lastly, employers of small- business owners are rightly frustrated by the fact that no one in the white house, not the president, vice-president, economic team, no one is listening to them. part of the reason for this is that virtually no one in the white house has run a small business or created jobs in the private sector. this lack of experience shows in the policy that are coming out of the administration. the american people are asking, where are the jobs?

all the president's economic team has to offer its promises of green shoots that never seem to grow. we have been told the president's economic team is exhausted. already his budget director and chief economist have moved on or they are about to. clearly they see the writing on the wall, and the president should, too. president obama should ask for and except for the remaining members of his economic team, starting with timothy geithner and larry summers, the head of the national economic council. this is no substitute for a referendum on the president's stop killing agenda. that question will be put before the american people in due time. we do not have the luxury of waiting months for the president to pick a scapegoat for his feeling stimulus -- failing put

stimulus policy. our fresh start needs to begin now. today i would like to talk to you about how we go about achieving the fresh start that i think we need. in may, republicans launched the american speaking out project. this gave taxpayers, and families, and small-business owners a direct line to their elected representatives. all mine in that town hall meetings, americans are sharing their solutions with building a more responsible government and a better country. all you have to do is log on to america speaking ospeakingout.c. as we speak, thousands of ideas are percolating. this will culminate next month with the release of a clear and positive agenda focused on getting people back to work

again jobs is the issue. where are the jobs is the question i hear almost everywhere i go quite as this agenda will reject the washington knows best policies. this will help families across this great nation realize the american dream. now, this will not be a document handed down by the washington powers that be, but those of us that think we know little, and the same old same old. it certainly will not be based on the idea that sitting in washington cutting backroom deals on the 2000 page deal represents something like coke. we're building this agenda from the ground up by listening to the american people. never before has the need for a fresh start in washington been more prevalent.

i have discussed what we're up against in terms of the immediate economic uncertainty, and beyond the headlines, washington is gripped by a more entrenched uncertainty. a standstill bread from all of the scar tissue built between the parties. i have said that if i were fortunate enough to be speaker of the house, i would run the house differently. i do not just mean differently than the white democrats are running it today. i mean differently than both democrats or republicans in the past. that means challenging the old ways in washington. getting to the bottom of what drives people crazy and getting to thstopping it once ar all. the common logic is that government spending creates

jobs. we have to remember, even when spending is not at record spending levels, each dollar the government takes is taken directly out of the private sector. this is a lose/lose proposition plain and simple. washington's investment in the economy are not nearly as sufficient because government spending decisions often put a premium on political expediency rather than sound economic policy. as we're learning now, deficit spending always comes due. here is an example how out of hand things have become, and we see this in washington all the time, when politicians take it to relapse for spending billions of dollars to continue to provide unemployment insurance. these benefits are held up as a jobs plan, a stimulus for the economy. keeping workers on the

unemployment rolls instead of fostering small business and private sector growth is not responsible jobs plan. the american people would agree that unemployment insurance is an important safety net, but not the responsible jobs program. the american people know what is going on here. when the bill comes due, they will look to them for a bailout. we need to have an open, honest conversation with the american people about the fiscal challenges. that means everything from short-term commitments to long- term commitments. and as an act of bad faith and bad judgment to start this conversation by imposing job killing tax hikes on families and small businesses. failing to rein in these debts is our fault, republicans and democrats.

pliny to start looking at every government program -- we need to start looking at every government program and ask is a right to force our kids and grandchildren to pay this? mitch daniels said you would be amazed at how much government you never miss. he is probably right. just as we've reevaluate how the federal government spends money, we should also think about how the federal government collects money. washington's backward accounting assumes that tax relief expires while the spending will always continue. setting up a built-in bias, or higher taxes and more spending. that is unless congress extends the tax break.

congress is regularly reverse stamps tax files from yoone-year to the next. this year's taxes extended bill has 71 separate tax provisions in it. totaling $31.6 billion of tax relief. the more provisions get added each and every year, but you ever seen to fall out of the package. -- but few ever seem to fall out of the package. there is a tax credit for the steel industry. how about the-rescue team tax credit? or tax incentives so you can invest in the district of columbia? are they worth it? many of them are. we just go ahead and extend all of them, usually at the last

minute. for washington, that is just business as usual, but is no way to run a business, and certainly no way to run of government. we need to take a long, hard look at the undergrowth of deductions, credits, and carve out stepped the tax bill has become. yes, we need to acknowledge that what washington really calls tax cuts are poorly described spending programs that expand the role of government in the lives of individuals and employers. jack kemp said not all tax cuts are created equal. we need to bring simplicity and certainty to our tax code so we can make it a vehicle for sustainable progress growth policies, not transfer payments to the favored few. by trying to build a recovery on government stimulus spending, washington has kept the private sector and bust, while the

public sector has had a boom. since february 2010 the private sector has lost millions of jobs while the federal government has grown by hundreds of thousands of workers. federal employees now make more on average than double what the private sector workers are paid. what is more appalling is the fact that this gap has more than doubled in president obama's first year in office, during a time when millions of american workers in their lost their jobs or took a pay cut just to keep the one they already have. it is nonsense to think that taxpayers are subsidizing the salaries and pensions of federal bureaucrats who are out there making it harder to create private sector jobs.

ko'that is 191 new layers of red tape waiting in the wings, 191 taxes on employers and consumers that keep people out of work and hamper innovation and investment. small businesses cannot plan for the future with ever-changing rules. i wish i could tell you exactly what the new rules are, but there is no transparency. last week i sent a letter to the president asking him to provide a full disclosure of these regulations so we could share them with the american people. we received a response, but still no details on what all of the new regulations really are. no matter who is in charge, the federal government should not be able to issue job-threatening rules, on a whim without public warning or proper scrutiny. no more spending sprees and

tangled tax structures. now more than ever we need a fresh start to put power back in the hands of the american people. as one citizen on america speaking out said, just get out of the way. republicans on the house budget committee led by paul ryan have already identified 1.3 trillion dollars in specific spending cuts that could be implemented immediately. these are common-sense steps like canceling the unspent stimulus funds and the target bailoutp bailout. they have also propose strict budget gaps to limit federal spending on an annual basis. if we reduce spending from current levels and impose a hard cap on future growth, we can save taxpayers more than $340 billion and make sure that this

is the last washington spending spree of its kind. to restore balance between the federal government and the public sector, republicans have called for freezing government pay and government hiring. last month as part of our america speaking out project, republican lawmakers met with some of america's employer community to gear their concerns and talk about ways to end this economic uncertainty. one of the ideas that was mentioned was a freeze on new job killing regulations, some in washington could do to get the private sector a little breathing room. right now republicans are fighting for common-sense legislation that would require congressional approval of any new rule that imposes a cost of more than $100 million on our

nation's economy. i think this initiative would serve as a much-needed restraining order against unelected busybodies who overstep their boundaries and make it harder to create new jobs. president reagan said there should be a law against saying there should be a loaw. i cannot agree more. once businesses get up off the sidelines, we need to keep them in the game. one idea that david can proposed as part of the stimulus plan was to allow small businesses with fewer than 500 employees to take a tax reduction similar to 20% of their income. this would free up capital and allow for new investment and higher rank, and was a better solution when we offered it last

year. it continues to be what we think is a better solution. we have heard a lot of talk in washington about the manufacturing sector. no action. congress has yet to act on the pending trade agreements with colombia, panama, and south korea. these agreements would level the playing field for american workers, farmers, and businesses and pave the way for creating hundreds of thousands of new jobs right here at home. and passing the free trade agreements was a critical point in the johns plabs plan that we presented to the president. the best case i can make for the solutions is that they worked, and some of them are working right now. last year republicans launched as the solution project.

it's promoted better solutions to the everyday challenges that the american people deal with. let's look at what republican governors who have been in office a matter of months have been able to accomplish. in virginia of mcdonald entered office facing an unprecedented $4.2 billion deficit. his predecessor proposed closing the shortfall by imposing the largest tax increase in the state's history. he refused to balance the state budget by making it harder for virginia families and business owners to balance their own budgets. in new jersey, he entered office facing an $11 billion budget deficit. both governors forged a bipartisan cooperation, set

priorities, cut spending, closed this and did so without taxes. iour engine of economic growth, the states, will continue to face difficult choices year after year. for 20 years now i have watched leaders in both parties look at the big issues, the tough issues, and then i watched them go away. now we're just out of time. we have run out of bread to kick the bucket down. it is time to put grownups in charge in time for people willing to accept responsibility and time to do what we say we're going to do. these are the values that i learned growing up with my 11 brothers and sisters. the values that i passed on to my daughter's, and i also told my girls how i was raised, to

never accept an asbestos thing for myself or my country. -- to never accept the next best thing for myself or my country. we will confront these hard truths together, and we will tackle these challenges together. i want to thank you again for the opportunity of being here today, and i look forward to your questions. [applause] >> today at the city club of cleveland we're listening to a special forum featuring john boehner. we're going to return to our speaker momentarily, but first we have a couple of letters to remind you of. remind you of.