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Submission For The Record of Richard F. Weidman, Vietnam Veterans of America, Executive Director for Policy and Government Affairs

Chairman Filner, Ranking Member Buyer, and other distinguished members of this committee, Vietnam Veterans of America (VVA) thanks you for the opportunity to present our views on suicide and PTSD among our nation’s military personnel and veterans.  We also want to thank you for your consistent concern about the mental health care of our troops and our veterans. I should note that Dr. Thomas Berger, Chair of VVA’s National PTSD & Substance Abuse Committee made substantial contributions to this statement, as did Ms. Marsha Four, Chair of VVA’s National Committee on Women Veterans.

The subject of suicide is extremely difficult to discuss.  It is a topic that most of us would prefer to avoid.  Accurate statistics on deaths by suicide are not readily available because many are not reported or are misreported for insurance reasons as well as the desire of local officials to avoid the “stigma” of suicide in a family. Many of us, as veterans of the Vietnam War and as comrades and caregivers to our brother and sister veterans, have known someone who has committed suicide and others who have attempted to take their life.  Unfortunately I have personally known many Vietnam veterans who were overtaken by despair induced by their deep and intractable neuron-psychiatric wounds from the war.

But as uncomfortable as this subject may be to discuss, it must be confronted. It is a very real public health concern in our military and veteran communities. A 12-year study published in the June 2007 issue of the journal Epidemiology and Health clearly demonstrates that the risk of suicide among male U.S. veterans is more than two times greater than that of the general population after adjusting for a host of potentially compounding factors, including age, time of service, and health status.  A report released this past May by the VA Inspector General noted that “veterans returning from Iraq and Afghanistan are at increased risk for suicide because not all VA clinics have 24-hour mental care available . . . and many lack properly trained workers.”

Media reports of suicide deaths and suicide attempts among active duty OEF and OIF soldiers and veterans began to surface back in 2003 after a spate of suicides in Iraq during the first months of the war.  Since then, both the military and the VA have stumbled and fumbled in their attempts to answer questions about the severity of this malady.  For example, while all the military services maintain suicide prevention programs, the Army in its August 2007 Army Suicide Event Report acknowledged that soldiers committed suicide last year at the highest rate in 26 years, and more than a quarter did so while serving in Iraq and Afghanistan.  The report noted “a significant relationship between suicide attempts and number of days deployed in Iraq, Afghanistan or nearby countries where troops are participating in the war effort.”  The report added that there also ''was limited evidence to support the view that multiple deployments are a risk factor for suicide behaviors.''  It might be noted here that this report which was released only after a FOIA request. 

VVA believes that these deaths are among the most extreme failures by the U.S. military to properly screen, treat, and evacuate mentally unfit troops.  Even a report by the Army released this past October suggests that the quality of care, as much as the number of providers, is a factor in the rising incidence of suicide among active-duty service members.  This report notes that more than half the 948 soldiers who attempted suicide in 2006 had been seen by mental health providers before their attempt -- 36 percent within just 30 days of the event.  Of those who committed suicide in 2006, a third had an outpatient mental health visit within three months of killing themselves, and 42 percent had been seen at a military medical facility within three months.  Among soldiers who were deployed to Iraq or Afghanistan when they attempted suicide in 2005 and 2006, 60 percent had been seen by outpatient mental health workers before the attempts.  Forty-three percent of the deployed troops who attempted suicide had been prescribed psychotropic medications. 

The report offered no details on the type or duration of mental health care that troops received before they tried to kill themselves.  A June 2007 Pentagon task force on mental health report, however, specifically notes the issue of quality of care, recommending that the military develop core training for all medical staff in recognizing and responding to service members "in distress."  This task force also concluded that mental health providers needed additional training in treating depression and combat stress. 

To its discredit, the Department of Defense has managed to keep what has clearly become what CBS News called a “hidden epidemic” under the radar of public awareness by concealing statistics about soldier suicides.  They have done everything from burying suicides on official casualty lists as "accidental non-combat deaths" to outright lying to the parents of dead soldiers.  Meanwhile the Army officially insists that they have yet to find a connection between PTSD, between the stresses of combat and the type of combat waged in Iraq and suicide.

It may be true that, as Will Rogers once said, there are lies, there are damn lies, and there are statistics.  But even the statistics the Pentagon admits to are telling. Unfortunately what is told is a grim story indeed, one of willful ignorance and recalcitrance to the point of malfeasance on the part of senior officials who do not move to correct these problems in both access to mental health care and quality of care when access is gained.

Much of the problem that the VA will in fact be inheriting is caused by the failure of the Army Medical Department and the Navy Medical Department to properly address neuron-psychiatric wounds of war. More than four years into this war, one may well ask “how can this be?”

Part is the problem with the military is lack of organizational capacity caused by the questionable decision to downsize the military medical departments as we were going to war. The former Secretary who had overall responsibility is now gone, and the Assistant Secretary for Health brought in because his entire experience was cutting costs by reducing services for HMOs and insurance companies, and who actually did the dirty work is also gone. However, the real architect of this outrageous and irresponsible policy that has cost soldiers their lives and/or their health continues on in his job as Undersecretary of Defense. VVA was asked if we hold LTG James Peake accountable for creating the situation of too many grievously injured soldiers needs chasing too few clinicians and case manager, and we said no, because we do not know how hard he fought on the inside. VVA continued in as communication with the White House that we do question why David Chu still has a job, after all of his public utterances of disdain for injured soldiers, survivors of KIA, and more importantly the total failure of his policies.

While VVA now understands that as of early this calendar year the Army was given 3,000 additional persons/slots in the Army Medical Department, it takes a long time to “ramp up” and we wonder how successful this all will be as long as David Chu is driving this train, aided by his top consultants at the unit of Rand Corporation led by Bernard Rostker, who has already done so much damage to Gulf War I veterans.

There is a solution. It requires data collection, training, leadership and a cultural mind shift from the military, as well as the network of consultants and hangers on that surround the civilian officials who are at the head of DOD.  Military leaders at all levels, beginning with basic trainees, should be taught what their roles and responsibilities are when warriors come home.  This training should be as structured and well thought out as fielding a new weapons system.  This includes Field manuals, training circulars, incorporation of training into Common Test Training (CTT) and Mission Essential Task Listings (METL).

If we change the culture in the military to deal openly and honestly about the rigors of war when service members come home, then we can begin to mitigate the suicide issue.  We don’t have a lot of time. The longer we delay the worse the problem gets, and it becomes more devastating to the all-volunteer military.

We’ve got the training for war part down cold. The missing component is training to come home. If we do it right, retention and recruiting will be high. Soldiers and families will grow and become stronger from their experiences.

However, if we don’t put as much emphasis on coming home as we do in going to war the implications will be felt for the next 20 to 40 years. We can’t continue to try and force the warriors figure this out on their own, with no help from the command structure and a "grateful nation." They have no reference point at which to begin recovery and become strong.

When we begin teaching them how to come home it will become as ingrained as field stripping an M4. It will become reflexive instead of reactive; it will become proactive instead of passive. It will be something that a war fighter has to do as a natural part of going into and returning from battle. This will truly begin to remove the stigma in the military that has led to situations like that experienced by Lt. Elizabeth Whiteside, where the Army is still contemplating whether to court martial her for attempting suicide after 10 months in Iraq treating grievously injured soldiers, and rendering exemplary service, when it all came crashing in on her. Her command structure in Iraq created a hostile work environment as opposed to trying to be supportive, and getting her counseling help. Compounding this is the Command here in the Military District of Washington who even as we speak today is still contemplating whether to be vindictive and try to punish this fine young soldier by means of a court martial, possible jail time, and stripping her of all Army and VA benefits, instead of helping her to receive proper treatment. This case exposes just how far we have to go to change the military culture in order to stop the punishing of war fighters for experiencing psychiatric wounds.

Words alone won’t fix this problem. There is lots of hard work ahead. VVA asks that this distinguished panel partner with the Committee on Armed Services and others in the House to please convince someone in the Pentagon to start listening. 

The Service Chiefs need to launch a Nation wide Anti-Stigma Campaign, for starters.

Active-duty soldiers, however, are only part of the story.  One of the well-known characteristics of PTSD is that the onset of symptoms is often delayed, sometimes for decades.  Vietnam veterans are still taking their own lives because new PTSD symptoms have been triggered, or old ones retriggered, by stories and images from these new wars.  Their deaths, like the deaths of more recent veterans, are written up in hometown newspapers; they are locally mourned, but officially ignored because the VA does not track or count them unless they are part of the VA registry.  Both the VA and the Pentagon deny that the problem exists and sanctimoniously point to a lack of evidence they have refused to gather.

In yet another example of dancing around the issue, the VA announced last spring that it was setting up a “suicide prevention hotline” for veterans.  This program is headquartered in Canandaigua, New York, in cooperation with the National Suicide Prevention Resource Center and the Substance Abuse and Mental Health Services Administration.  As part of its anti-suicide effort, the VA announced that it was going to hire “suicide counselors” at each of its 153  medical centers.  According to VA hotline administrators, as of late November 2007, 92 percent of the now-titled suicide coordinator positions had been filled and the national hotline center had handled more than 15,000 calls between July 1 and November 17 – while also admitting that the tracking of calls is voluntary, The VA noted that 4,900 callers self-identified as veterans, 164 as active-duty military; and that 600 calls came from concerned family and friends.  Some 1,600 referrals were made to VA facilities, 100 referrals to Vet Centers.

At first glance, the call data are impressive and the VA is to be congratulated in this endeavor.  Yet real questions remain:  How many suicides have been prevented through this intervention, particularly in light of the fact that the hotline call tracking is voluntary?  And is suicide prevention intervention and care available 24/7 across the VA system, including both community outpatient clinics and medical centers?

Finally, much has been made of the recent CBS News investigative report on suicides of veterans, especially of the data collection and analyses.  VVA’s concern is not that the reported figures are too high or too low.  VVA’s position on suicide, however, is clear:  one soldier/veteran suicide is one too many, and there have been far too many.  Let’s not quibble about how accurate the numbers are; rather, let’s focus on the issues of why veterans take their lives and what we, collectively, can do to get more veterans into the counseling that might save their lives. 

Congress recently passed, and the President signed, the “Joshua Omvig Veterans Suicide Prevention Act,” which mandates better suicide prevention training for VA staff, a referral system to make sure that vets at risk receive care, and the opening of a 24-hour veterans’ suicide hotline.  While VVA lauds this bi-partisan effort, we implore you to revisit the situation with regularity, and ask hard questions that must be answered.  With the exception of the creation of the suicide hotline, how are the other mandates being translated into suicide prevention programs, services, and training?  What agency or entity is accountable for them?  And can DOD and the VA be directed to provide truthful, accurate suicide statistics?

The faceless IED-fueled sniping that is killing and maiming scores of our troops, is part of the root cause of the severe psychological wounds that grips too many of our troops and veterans. Further, far from being nothing like the Vietnam war as alleged by some officials who were too busy with other pursuits to join the rest of us who went to Southeast Asia, the Iraq war is, as one of our longtime members who served as an infantry platoon leader with the 199th Brigade “Red Catchers” in Vietnam: “Iraq is Vietnam without water.” You cannot tell who the enemy is in most instances without an electric scoreboard, and then only after a particular action is finished. This uncertainty and constant pervasive danger causes deep and often chronic stress and often leads to Post Traumatic Stress Disorder later on. It is up to all of us, with your leadership, to do the very best that we can to mitigate the horrors of combat by providing enough help and guidance to the men and women who need it most.  It is our obligation to continue to search for answers, and not utter the empty claims that combat has little or nothing to do with the suicides of troops who have experienced it.

 The Nation now clearly understands the gaps in care as outlined by multiple military commissions.  The service chiefs have ensured that our service members were taught how to go to war and with the right equipment.  What remains missing and what we are identifying as a fundamental gap in suicide prevention and all reintegration training is teaching the force the fundamental skills of how to come home.”

To truly address suicides we must change the way our Nation and the Military respond to the trauma of war and the complexities of deployment.  Moreover, we need to evaluate the way we define and understand stress and trauma large scale. 

No veteran should ever feel so left behind that suicide feels like a viable option.  We owe them so much more than rhetoric, Lets start by training them to come home.  Then they will be resourced to seek out existing service and programs and the stigma of seeking help will be minimized.

The Army’s Creed, the Warrior Ethos, and even VVA’s motto of “Never again shall one generation of American veterans abandon another generation.”– are meaningless without the doing.  And the doing requires that we live by and die by our beliefs and the only thing we hold on to is the knowledge that our country will be there for us if we need them. 

The Warrior ethos: written in Soldiers Magazine, July, 2006 by Peter J. Schoomaker talks about the common thread that has tied us all together throughout 230 years of service to our nation. Since 1775, American Soldiers have answered the call to duty. From Valley Forge to the battlefields of Gettysburg; from the Argonne Forest to the shores of Normandy; from the rice paddies of Korea and Vietnam to the mountains of Afghanistan and the streets of Baghdad; our military history is rich with the willingness of generation after generation to live by the Warrior Ethos.  Service members will continue to live by these creeds, the question is does the creed extend to them when they come home, after the war.

We thank you for the opportunity to speak to this issue on behalf of America’s veterans, and we will work with you to find answers that our mentally wounded warriors desperately need. I would be pleased to answer any questions you may have.