Introduction

Chairman Mitchell, Congressman Roe, distinguished Members of the Committee; thank you for the opportunity to appear here today to talk to you about the Department of Defense’s (DoD) suicide prevention programs and related outreach efforts.   

On behalf of DoD, I want to take this opportunity to thank you for your continued support and demonstrated commitment to our service members, veterans, and their families. 

Over the last nine years, a new era of combat emerged where our service members are constantly challenged by the demands of a high operational tempo.  Despite these challenges, they continue to meet the increasing demands placed upon them with resilience, dedication and remarkable ability.

However, the constant stress placed upon our service members is taking its toll.  The loss of even one life to suicide is unacceptable and of deep concern at all levels of DoD leadership.  DoD has developed many resources and tools for service members, veterans and families; however we realize utilization of these resources is dependent upon prevention education and communication about their existence. Therefore, continued outreach to service members, veterans and families is an essential part of the Department’s overall suicide prevention strategy.  Today, I will share with the Committee our current suicide prevention outreach efforts.

Suicide has a multitude of causes, and no simple solution.  Recognizing this, DoD is using a multi-pronged strategy involving comprehensive prevention education, research, and outreach. We believe in fostering a holistic approach to treatment, engaging the community, leveraging primary care for early recognition and intervention, and, when needed, providing innovative specialty care. This includes a proactive preventive approach addressing multiple stressors.  Some of these stressors include relationship failures, legal/work/financial problems and substance misuse.

Outreach is only one part of DoD’s overall strategy, but is an essential part.  As we shift to a culture focused on building resilience and improving the well-being of the force, we need to educate our service members, veterans and families on the available resources to achieve and sustain a healthy lifestyle.  DoD conducts outreach through a variety of mechanisms to disseminate available resources, promote awareness and encourage service members, veterans and families to seek help when they need it.

Collaborative Outreach Efforts

Continued collaboration and coordination with the Department of Veterans Affairs (VA) and other federal, private, and academic organizations is the key to ensuring we reach our military community in the most meaningful way.  We collaborate with the VA on many outreach initiatives to ensure that service members, veterans and their families receive resources and access to services on a continued and consistent basis. 

In November 2007, the DoD established the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) to offer a central coordinating point for activities related to psychological health concerns and traumatic brain injuries.  DCoE focuses on the full continuum of care and prevention to enhance coordination among the Services, federal agencies, and civilian organizations.  DCoE works to identify best practices and disseminate practical resources to military communities.

DCoE works closely with the VA to coordinate information and resources with the National Suicide Prevention Lifeline (1-800-273-TALK).  This partnership facilitated  a modification to the introductory message on the Lifeline, by pressing the number 1, that enables veterans, service members, or callers concerned about a veteran or service member to access a crisis counselor who is knowledgeable about the military and has access to resources designed specifically for this community.

The DCoE Outreach Center is staffed by health resource consultants (licensed mental health and traumatic brain injury clinicians) who are available to listen, answer questions, and refer callers, to a wide range of resources. These consultants include licensed nurses, social workers, and doctoral-level clinical psychologists.  In March 2010, the Outreach Center health resource consultants attended and completed the American Association of Suicidology (AAS) “Recognizing and Responding to Suicide Risk” two-day training program.  Since then, the Outreach Center utilized AAS’ best practice methodologies and constructed a lethality assessment document as well as a safety plan document to further assess suicide risk and need for intervention.  Since its launch in January 2009, the Outreach Center has been utilized by approximately 5,000 people.

DoD and VA collaborate to educate and train regional suicide prevention coordinators each year on innovative programs, best practices and new platforms for outreach.

DoD and VA are collaborating annually to promote suicide awareness week, creating common theme materials such as factsheets and coordinating with the Services and other relevant organizations to disseminate messages to the widest audience possible.

The Suicide Prevention and Risk Reduction Committee (SPARRC) has served and will continue to serve as the venue for inter-Service and interagency collaboration on suicide prevention activities.  Members include Suicide Prevention Program Managers from the Services and representatives from the National Guard Bureau, Office of the Assistant Secretary of Defense for Reserve Affairs, VA, Office of Armed Forces Medical Examiner, National Center for Telehealth and Technology (T2), Substance Abuse Mental Health Services Administration (SAMHSA), and others.  This committee is the main forum for ensuring coordination and consistency in system-wide communication related to suicide, risk reduction policy initiatives, and suicide surveillance metrics across the military.

DoD Outreach Initiatives

Each of the Services has a variety of suicide prevention programs and outreach efforts tailored to their specific population. They utilize multiple communication avenues to increase awareness of available resources. In addition, DoD has many efforts currently in place to raise awareness and increase leadership involvement in promoting healthy choices.  The initiatives listed below are not dedicated solely to suicide prevention, but they feature a variety of resources for psychological health, including suicide prevention, and offer the opportunity to increase outreach to service members, veterans and families.

Real Warriors Campaign

Stigma is a toxic threat to our service members, veterans and families receiving the care they need.   We recognize that outreach is essential for combating stigma, encouraging help-seeking behaviors and promoting awareness of resources.

In May 2009, DCoE launched the Real Warriors Campaign, a multimedia public education initiative designed to combat the stigma associated with seeking psychological health care and encourage service members to reach out for the care they may need.  Under the theme “Real Warriors, Real Battles, Real Strengths,” this effort provides concrete examples of service members who sought care for psychological health concerns and are maintaining a successful military career. 

While primarily focused on combating stigma, the Real Warriors Campaign addresses the issue of suicide in a number of ways:

• The website, www.realwarriors.net, prominently displays the National Suicide Prevention Lifeline on every page.
• Two video profiles of service members involved in the campaign openly discuss their struggles with thoughts of suicide by demonstrating that they reached out for care, received it and that action has enabled them to continue to lead a fulfilling personal and professional life.
• The site allows service members, veterans, families and health professionals to confidentially reach out to health consultants for assistance around the clock through the Real Warriors Live Chat feature or by calling the DCoE Outreach Center. 

The Campaign's message boards include numerous posts from service members who share their coping strategies for dealing with suicidal ideation.  The site includes content that focuses on suicide prevention and substance abuse, which is a potential contributing factor to suicide.  Short, documentary-style videos illustrate the resilience exhibited by service members, their families and caregivers. 

The Real Warriors campaign has reached thousands since the Campaign launched in May 2009.  The website, www.realwarriors.net, which service members can access globally, has reached 72,239 unique visitors, with more than 110,000 visits and 781,600 page views.  The campaign is featured in the Army G-1 Suicide Prevention Program and the Air Force Surgeon General’s Office used the campaign in a Suicide Prevention Stand Down in May 2010. In addition, the campaign has partnered with more than 100 organizations to increase their visibility and reach among service members, veterans and military families. 

Military OneSource

Military OneSource, the “go-to” resource for service members and families, prominently features the National Suicide Prevention Lifeline on its home page and provides suicide prevention information.

Yellow Ribbon Program

DCoE is an active contributor to the legislatively mandated Yellow Ribbon program and working group, which provides suicide prevention information, services, referrals and proactive outreach programs to service members of the National Guard and Reserves and their families through all phases of the deployment cycle. The intent of the program is to proactively prevent suicide by reaching out to National Guard and Reserve members and their families to prepare them for deployment; sustaining their families during the deployment; and reintegrating the service members with their families, communities and employers upon re-deployment or release from active duty. The Yellow Ribbon program also conducts outreach to help service members and their families navigate through the numerous DoD, VA, and State systems to ensure they receive information and assistance regarding all the benefits and entitlements they have earned as a result of deployment. The working group is conducting a gap analysis of existing suicide prevention programs specific to the National Guard and Reserve populations.

Afterdeployment.org

DoD is leveraging technology to conduct outreach in real time and connect service members, veterans and families to resources. Web-based resources such as afterdeployment.org provide a safe platform to better understand and increase awareness of substance misuse, depression and other mental health related issues. In August 2008, the National Center for Telehealth and Technology (T2) launched the website afterdeployment.org to support service members, veterans and families with adjustment concerns that often occur after a deployment. The website provides interactive, self-paced solutions addressing post-traumatic stress, depression, relationship problems, substance abuse, and several other health issues including mild traumatic brain injury and spirituality concerns. Site features include quick health tips, self-assessments, e-libraries, self-paced workshops, warrior and family stories, community forum, RSS feeds, and daily topical quotes. Additionally, a Google map locator helps users find providers close to home. Visitors to the site can benefit from a sense of community by joining the Facebook group, receive Twitter messages, and download podcasts from iTunes or Zune depicting warrior stories. Afterdeployment.org surpassed the 100,000 visitor milestone in April 2010. 

Telebehavioral Health

T2 is developing and testing multiple technologies that will provide ways to supply timely telebehavioral health services to enable a broad telehealth network for service members and their families across the deployment cycle of support.   Populations with access to care barriers such as geography, mobility, and stigma can benefit greatly from telebehavioral health services, which refer to the use of telecommunications and information technology for clinical and non-clinical behavioral health care.  Leveraging these technologies enables DoD to reach out to a broad array of populations and provide service members, veterans and their families access to patient-centric behavioral health care even in the most extreme and/or remote circumstances. 

Caring Letters

An outreach effort that has shown significant promise to reduce suicides in the civilian sector is the Caring Letters Program.  In a randomized clinical trial, sending brief letters of concern and reminders of treatment to patients hospitalized for suicide attempts, ideation or for a psychiatric condition was shown to dramatically reduce the risk of death by suicide following their hospitalization.  In an effort to determine the applicability to military populations, T2 is piloting a program at Ft Lewis, Washington.  Efforts are currently underway to plan a multi-site randomized control trial.

Way Forward

DoD has made much progress in suicide prevention outreach, but we recognize that there is still much to be done. 

DoD and VA are currently developing a strategic action plan for the next three years. This plan will: create consistent communication of suicide data between DoD and VA; improve communication to service members, veterans and families on available suicide prevention practices, programs and tools; continue resource and information sharing between VA and DoD; and coordinate training efforts to educate community members, suicide prevention coordinators and medical staff throughout both agencies.

Families play a vital role in preventing suicides among service members and veterans.  A current Suicide Prevention and Risk Reduction Committee (SPARRC) initiative is focused on identifying available resources for families and dissemination platforms used throughout DoD in order to increase outreach efforts targeted to families.

In addition to numerous existing DoD web-based resources, the SPARRC is developing a website to serve as the clearinghouse for suicide prevention information, contacts, innovative approaches, and tools. This website will be open to anyone looking for suicide prevention information specific to the military and will leverage existing resources. The website will provide a platform to increase awareness and streamline access to current suicide prevention initiatives and resources.

Conclusion

The Department of Defense is aggressively pursuing new ways to address suicide prevention in collaboration with our partners at the VA. Outreach is a crucial part of DoD’s multi pronged suicide prevention strategy which emphasizes education, early recognition and intervention, and providing the best treatment possible. 

On behalf of the DoD, thank you for the opportunity to address this vital issue.  I look forward to your questions.