Good morning Chairman Mitchell and other members of this distinguished subcommittee. I truly appreciate the privilege of your time to offer my perspective on veteran’s mental health and suicide prevention.

I am currently serving as an Army Reservist while I attend the George Washington University here in DC. I am a combat medic in the military and have served two tours in Iraq, the most recent as part of the Surge in Baghdad, and I returned to US soil on Memorial Day of this year after ten difficult months.

As a medic, I am responsible and intimately connected to the health and well being of the soldiers in my unit, which is increasingly revolving around mental health. The Army has begun placing much greater emphasis on the mental health and welfare of its Soldiers, with the placement of combat stress teams on most bases in theatre, and much more required training and briefings for Commanders, medics, and Soldiers alike. These efforts have paid great dividends in reducing the stigma associated with seeking mental health care, and I believe that leadership at all levels are now much more supportive and encouraging in this matter. This not only enhances the level of care available to most soldiers in theatre, but also makes identification and treatment of issues more rapid and effective. These efforts should be encouraged across the military.

Obviously, however, this fight does not stop upon leaving the battlefield. Even more important than the availability of mental health care in theatre is the availability and usage of such care at home. There are some key differences between these environments that I would like to outline for you briefly before I go on.

In country, your average service-member has daily interactions with their chain of command, as well as with their peers who are experiencing essentially the same stresses. Therefore, it is significantly easier for an aware leader to be able to identify “at-risk” individuals by comparing how he or she is handling their stress compared to everyone else. Along these same lines, it is also much easier for a health care provider or commander to track the development of a condition over the course of a tour because, for the most part, everyone entered theatre at the same time, and therefore their exposure to trauma and stress is essentially equal.

In these conflicts, especially at this phase, where the theatres are so mature and rich with resources, service-members have many more stimuli affecting their stress levels than ever before. It is not uncommon to have Soldiers talking to their families or friends on phones or online hours or even minutes before leaving the wire on a combat patrol, as the time difference lends convenience to that time of day. Now imagine for a moment if that short albeit critical conversation does not end well for that service member, be it a fight with a spouse, a sick child, an unexpected expense, or just tension from the other line. That soldier now has significantly more on his or her mind than their peers, yet still must be able to handle the same stresses of their mission. I am not a psychologist, but I can say from experience that stresses from home can significantly amplify the stress of combat.

Upon redeployment after the tour, the homecoming experiences run the gamut, from good to bad. For the most part, the excitement of reuniting with families and the real world takes precedence over all else, and whatever issues that service member was facing are pushed down. As we now know, this is not only dangerous and unproductive, but it is normal. “What happens in Vegas stays in Vegas” does not apply here, yet many service-members wish it did. Maybe they think their buddies don’t want to talk about it any more, and that their families and friends wouldn’t understand, but for the most part, in those first few weeks, elation and relief is perceived for progress and a cure. The veteran selects the middle of the road answers on the mental health survey, and is released from the out-processing center. After all, he just wants to get home! He doesn’t want to stay away from his family any longer, or hold up his buddies’ demobilization, so he skimps on details with the health care provider and goes on home.

In most units, this is the time where the most issues begin to occur. A family or lifestyle is not as he remembered, and he no longer has his battle buddies around to talk to, to keep track of him. He may have a few months off now, with a regular paycheck and no one accountable for him. As a Reservist with multiple tours, I had almost 70 days of leave accrued, which was kindly tacked on to the end of my tour as part of my terminal leave. During this time, I reached out to the friends and family that I had missed while I was gone, and to my close friends from the tour. At no time, however, did my chain of command, or anyone else, contact me to see how I was doing. The rationale for this, at least in my experience, is that Soldiers don’t want to be bothered with Army business during this time, so they are not.

During these months, however, other Soldiers reached out to me. Even though we were off-duty, and in some cases no longer in the same unit, my guys from downrange still felt comfortable calling “Doc Hawthorne” to chat about what was going on, as they had while we were in Iraq. Mostly, they wanted to know what “normal” was. “Should I be having trouble sleeping?” “Is three beers a night too much?” “My wife isn’t as interested in sex as she used to be, is it me?” and so forth. As I said, I am not a psychologist, and I know the limits of my capabilities. I would help as I could to talk them through these issues, but mostly I referred them to Military One Source, which was heavily advertised to us both downrange and during our post-deployment briefings. For the most part, they received outstanding treatment from this system, and are continuing to see one of their assigned therapists with great success.

The question then becomes, hence this hearing, what about the veterans who don’t have a Doc, or who do not know about Military One Source? Or what about the family member who has concerns about their recently returned veteran, and does not know who to call? That, I believe, is where the VA Suicide Hotline plays the most important role. By advertising its availability and convenience, not only where the veterans are, but also where their families and friends are. By making this service public knowledge, we are infinitely increasing the likelihood that a veteran will end up using it, either through his own discovery, or the peer pressure so to speak of a concerned family member or friend.

If this is indeed our objective, then there should be no limit to the creativity applied to its distribution. While it could be argued that a veteran is not likely to be sitting at home at noon on a Tuesday watching soap operas, it is very possible that his mother or grandmother could be, and having just had a conversation with him about his difficulties, has been empowered with information that could save his life. On the opposite end of the spectrum, his or her teenager may not fully understand what their parent has been through, but they understand that they are different now, maybe more irritable or withdrawn. Well, soap operas may not be the way to reach this demographic, but certainly ads in arenas such as Facebook, Myspace, Google, etc may register enough with them to prompt a conversation or intervention. We cannot afford to forget the influence of such mediums.

To speak specifically on the ads that are currently running here in DC, I would like to make the following comments. First, it is imperative to emphasize the confidentiality of such services. Bearing in mind that many veterans are still in some kind of government service, career progression is a major consideration when seeking help. I personally know soldiers who refrain from seeking any sort of official mental health care due to the fact that they do not want a “black mark” in their record so to speak. This is not an official or institutional issue, this is a personal one, in that in the military, we promote our own image. Take for example, a friend of mine who is a young infantry Lieutenant who served as a platoon leader in Iraq and then comes home and seeks mental health care. How likely is his unit to send him to an arduous course such as Ranger School, after seeing that he struggled with combat stress? What about when he is up for promotion to Major, or eligible for Battalion Command as a Lieutenant Colonel? Are the General Officers on the board likely to give him that Command, with his history of mental health issues? Again, we must allow for this soldier the opportunity to talk through some of these issues without hurting their career opportunities down the road, and I believe that the VA is the agency for that..

 Secondly, the “strength of a warrior” quote is an excellent one, and I agree with it wholeheartedly, however, it is pretty exclusive to the Army and the Marine Corps, and does little to reach out to our water- and sky-borne brethren. We cannot afford to have this service seem exclusive in the least. Lastly, and probably most importantly, basic market research must be done to decide who the VA is trying to reach with each ad, and then tailor the ad for that demographic. A quote in front of a flag is great, but the marketing industry spends billions of dollars every year researching how to best convey a message to a certain audience, and we must tap into that expertise so as to expand the appeal and digestion of our message.

In closing, I would like to reemphasize the fact that the military is currently making great strides in caring for the mental health of our service-members while they are deployed and when they return home. There is still much to be done, especially for Guard and Reservists who are essentially cut to the four winds upon return home, but even in the two years between my demobilizations, much had changed for the better. The VA, therefore, has big shoes to fill for those who are no longer in and must transition from the military to their services. I would highly recommend collaboration with Military One Source and other such services for best-practice examples.

Secondly, these initial efforts of advertisement are to be commended, and I would ask that the VA expand on these initiatives for all of their benefits, particularly education and the new GI Bill and other health services. What often keeps a veteran from achieving their full potential with earned benefits is sadly just ignorance of their entitlements. Again, it may be an observant family member that sees an ad and can drastically change the life of one of our nation’s heroes for the better.

Thank you for your time, and for your service to our veterans and their families. I welcome the opportunity to answer any questions you may have.