[House Hearing, 111 Congress]
[From the U.S. Government Printing Office]
[H.A.S.C. No. 111-90]
PSYCHOLOGICAL STRESS IN
THE MILITARY: WHAT STEPS ARE LEADERS TAKING?
__________
HEARING
BEFORE THE
MILITARY PERSONNEL SUBCOMMITTEE
OF THE
COMMITTEE ON ARMED SERVICES
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
HEARING HELD
JULY 29, 2009
[GRAPHIC] [TIFF OMITTED
U.S. GOVERNMENT PRINTING OFFICE
56-936 WASHINGTON : 2009
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MILITARY PERSONNEL SUBCOMMITTEE
SUSAN A. DAVIS, California, Chairwoman
VIC SNYDER, Arkansas JOE WILSON, South Carolina
LORETTA SANCHEZ, California WALTER B. JONES, North Carolina
MADELEINE Z. BORDALLO, Guam JOHN KLINE, Minnesota
PATRICK J. MURPHY, Pennsylvania THOMAS J. ROONEY, Florida
HANK JOHNSON, Georgia MARY FALLIN, Oklahoma
CAROL SHEA-PORTER, New Hampshire JOHN C. FLEMING, Louisiana
DAVID LOEBSACK, Iowa
NIKI TSONGAS, Massachusetts
Dave Kildee, Professional Staff Member
Jeanette James, Professional Staff Member
James Weiss, Staff Assistant
C O N T E N T S
----------
CHRONOLOGICAL LIST OF HEARINGS
2009
Page
Hearing:
Wednesday, July 29, 2009, Psychological Stress in the Military:
What Steps Are Leaders Taking?................................. 1
Appendix:
Wednesday, July 29, 2009......................................... 49
----------
WEDNESDAY, JULY 29, 2009
PSYCHOLOGICAL STRESS IN THE MILITARY: WHAT STEPS ARE LEADERS TAKING?
STATEMENTS PRESENTED BY MEMBERS OF CONGRESS
Davis, Hon. Susan A., a Representative from California,
Chairwoman, Military Personnel Subcommittee.................... 1
Wilson, Hon. Joe, a Representative from South Carolina, Ranking
Member, Military Personnel Subcommittee........................ 2
WITNESSES
Amos, Gen. James F., USMC, Assistant Commandant, U.S. Marine
Corps.......................................................... 6
Chiarelli, Gen. Peter W., USA, Vice Chief of Staff, U.S. Army.... 3
Fraser, Gen. William M., III, USAF, Vice Chief of Staff, U.S. Air
Force.......................................................... 7
Lefebvre, Maj. Gen. Paul E., USMC, Deputy Commanding General, II
Marine Expeditionary Force, U.S. Marine Corps.................. 37
Lynch, Lt. Gen. Rick, USA, Commanding General, III Armored Corps
and Fort Hood, U.S. Army....................................... 35
Walsh, Adm. Patrick M., USN, Vice Chief of Naval Operations, U.S.
Navy........................................................... 4
APPENDIX
Prepared Statements:
Amos, Gen. James F........................................... 79
Chiarelli, Gen. Peter W...................................... 56
Davis, Hon. Susan A.......................................... 53
Fraser, Gen. William M., III................................. 90
Walsh, Adm. Patrick M........................................ 67
Wilson, Hon. Joe............................................. 55
Documents Submitted for the Record:
Two articles from the Pacific Daily News of Guam, dated March
25, 2009 and July 4, 2009.................................. 101
Washington Post article, ``Crime Rate of Veterans in Colo.
Unit Cited,'' July 28, 2009................................ 105
Witness Responses to Questions Asked During the Hearing:
Mr. Jones.................................................... 109
Ms. Shea-Porter.............................................. 109
Ms. Tsongas.................................................. 109
Questions Submitted by Members Post Hearing:
Mr. Loebsack................................................. 115
Mr. Wilson................................................... 113
PSYCHOLOGICAL STRESS IN THE MILITARY: WHAT STEPS ARE LEADERS TAKING?
----------
House of Representatives,
Committee on Armed Services,
Military Personnel Subcommittee,
Washington, DC, Wednesday, July 29, 2009.
The subcommittee met, pursuant to call, at 2:07 p.m., in
room HVC-210, Capitol Visitor Center, Hon. Susan A. Davis
(chairwoman of the subcommittee) presiding.
OPENING STATEMENT OF HON. SUSAN A. DAVIS, A REPRESENTATIVE FROM
CALIFORNIA, CHAIRWOMAN, MILITARY PERSONNEL SUBCOMMITTEE
Mrs. Davis. The meeting will now come to order. Thank you
all for being here, and welcome to our new digs. We are
obviously refurbishing the House Armed Services room in
Rayburn, and so we are using this room today. We hope that
everybody is going to be comfortable here.
The mental health status and needs of servicemembers, their
families, retirees and their families relate to most, if not
all, hearings held by this subcommittee. Whether we are
discussing post-traumatic stress disorder (PTSD), family
support programs, frequency of deployment, access to health
care, missing in action (MIAs), prisoners of war (POWs), or the
aftermath of a sexual assault, the importance of mental well-
being is always involved. We also dedicate one hearing a year
solely to mental health issues.
This year's hearing on mental health was originally
intended to examine the increased incidence of suicide in the
military and to review what actions the Office of the Secretary
of Defense (OSD) and the military services were taking to
address this troubling trend. However, we know that suicide is
not a discrete occurrence or problem. It is the final step an
individual takes when they can no longer deal with the
stressors in their lives. And, therefore, in order to determine
why the suicide rate has increased, the entire spectrum of
stressors must be considered.
Further, there is zero-sum-gain aspect to mental health.
Neither the Department of Defense (DOD) nor the country in
general have enough mental health providers. Any resources
directed towards suicide prevention will have to be directed
away from your current allocation. So it is important to
examine what is going to be shortchanged in order to resource
any new suicide prevention program and to consider if this will
have any negative unintended consequences.
For today's hearing we will have two panels. In the first
we are fortunate to have the four vice chiefs of the services
here to talk about what they are doing to deal with the
psychological stress on their soldiers, sailors, marines and
airmen. We have the Vice Chief of Staff of the Army, General
Peter Chiarelli; the Vice Chief of Staff of Naval Operations,
Admiral Patrick Walsh; the Assistant Commandant of the Marine
Corps, General James Amos; and the Vice Chief of Staff of the
Air Force, General William Fraser.
Gentlemen, we look forward to your testimony and hope to
leave this hearing with a clear understanding of how each of
your services is addressing the issue. It is important for the
headquarters of each military department to acknowledge and to
address this issue, and it is also just as important for
individual commanders to understand the problem and take
positive actions at their level.
For our second panel, then, we have chosen to highlight the
positive actions taken by commanders of their own accord to
address the psychological stress experienced by their command.
We have Lieutenant General Rick Lynch of the Army, Commanding
General of III Corps and Fort Hood, to participate in our
hearing. General Lynch has used his command authority to make
fundamental changes to the way his installation is run with the
goal of providing soldiers and, just as importantly, their
families stability and predictability in their schedules.
From Marine Corps we have Major General Paul Lefebvre,
Deputy Commanding General of II Marine Expeditionary Force.
General Lefebvre created the Office of Suicide Prevention
Training Program and the Operational Stress Control and
Readiness Extender Program.
The problems that we are discussing today cannot be solved
today. We wish they could, but we know that is not possible.
But we must continue to understand and confront the
psychological stress that our servicemembers and families have
to deal with every single day. We must continually evaluate
actions taken, gauge their effectiveness, and then press to
determine what must be done.
[The prepared statement of Mrs. Davis can be found in the
Appendix on page 53.]
Mrs. Davis. Mr. Wilson, I turn it over to you for your
comments.
STATEMENT OF HON. JOE WILSON, A REPRESENTATIVE FROM SOUTH
CAROLINA, RANKING MEMBER, MILITARY PERSONNEL SUBCOMMITTEE
Mr. Wilson. Thank the Chairwoman Davis. And thank you for
holding this hearing today.
Today's hearing continues our commitment to work with the
Department of Defense to find ways to address the psychological
stress that our servicemembers are struggling to overcome and
to continue to improve mental health services for our military
personnel and their families. I am encouraged by the direction
that the Department and the military services are taking to
recognize and alleviate psychological stress experienced by our
troops, particularly our combat veterans.
From my own service as a veteran in the National Guard and
Reserves, with four sons currently serving in the military, I
understand the responsibility for finding the right answers to
this problem does not lie solely with the military medical
departments. This is also a leadership challenge, and I commend
the military service for making the mental health of our
military and their families a leadership priority.
With that said, as the former president of the Mid-Carolina
Mental Health Association, I remain concerned that the programs
that each of the services are implementing to address
psychological stress are disjointed and are not well
coordinated or communicated. I am anxious to hear from our
military senior leaders on our two panels what steps have been
taken to develop a comprehensive multidiscipline approach to
addressing psychological stress.
I would like to welcome our witnesses, thank them for their
services, and I am particularly grateful to see persons who
have served at Fort Jackson Marine Air Station/Beaufort, at
Parris Island/Beaufort Navy Hospital that I have the privilege
of representing. And I want to thank you for participating in
the hearing today. I appreciate your providing young people the
extraordinary opportunity of military service which protects
American families. I look forward to your testimony.
Mrs. Davis. Thank you very much.
[The prepared statement of Mr. Wilson can be found in the
Appendix on page 55.]
Mrs. Davis. And we will begin, General, please.
STATEMENT OF GEN. PETER W. CHIARELLI, USA, VICE CHIEF OF STAFF,
U.S. ARMY
General Chiarelli. Madam Chairwoman, Ranking Member Wilson,
distinguished members of the subcommittee, I thank you for the
opportunity to appear before you today to provide a status on
the United States Army's efforts to reduce the number of
suicides across our force. This is my first occasion to appear
before this esteemed subcommittee, and I pledge to always
provide an honest and forthright assessment. I submitted a
statement for the record, and I look forward to answering your
questions at the conclusion of opening remarks.
As all of you know, it has been a busy time for our
Nation's military. We are at war. We have been at war for
nearly eight years. That has undeniably put a strain on our
people and our equipment. Unfortunately, in a growing segment
of the Army's population, we have seen increased stress and
anxiety manifest itself through high-risk behaviors, including
acts of violence, excess use of alcohol, drug abuse and
reckless driving. The consequence in the most extreme cases has
been an increased incidence of suicide.
Earlier this year I visited six posts in eight days in
order to conduct sensing sessions, collect data and evaluate
suicide-prevention efforts and programs. It became clear to me
after leaving the third installation that our mission extended
far beyond suicide. Simply stated, we must find a way and ways
to improve the behavioral wellness of soldiers and their
families after repeated deployments in the context of eight
years of war. And that is why Secretary of the Army Pete Geren
and our Chief, General George Casey, consciously made the
decision to expand our efforts to improving the overall
behavioral health and well-being of the force.
Ultimately we want to get left of this very serious
problem, and to do so we must improve the resiliency of our
soldiers and their family members. In the past the Army's
approach was primarily reactive. That has changed today. It is,
in fact, proactive, to identify or assess and mitigate issues
early on before it becomes significant concerns; to educate
soldiers in order to ensure they are aware and have access to
resources and support programs that can provide them with the
most benefit; and to assist and treat individuals who are
struggling and may need help. We are confident by doing so, by
improving the overall resiliency, behavioral health and well-
being of soldiers and their families, we will also ultimately
reduce the number of suicides across our Army.
Our approach is based on two big ideas: the Comprehensive
Soldier Fitness program, which is really the big idea that
moves us to the left, and a campaign plan for health promotion,
risk reduction and suicide prevention. We are also taking steps
to eliminate the stigma that has frequently kept soldiers from
seeking and receiving help.
The reality is in all cases there is no simple solution,
and we must resist any attempt to generalize or oversimplify
the challenges we are facing. Improving the overall health and
well-being of our force will require a multidimensional
approach to identify effective programs and mitigation
strategies. And it will take a total team effort across all
Army components, jurisdictions and commands, as well as in
cooperation with the Department of Health, Congress, National
Institute of Mental Health (NIMH) and other willing civilian
health-care providers, research institutes and care facilities.
I can assure you, the members of this subcommittee, that this
challenge remains a top priority for the United States Army.
Madam Chairwoman, members of the subcommittee, I thank you
for your continued and generous support and demonstrated
commitment to the outstanding men and women of the United
States Army and their families. I look forward to your
questions.
Mrs. Davis. Thank you very much.
[The prepared statement of General Chiarelli can be found
in the Appendix on page 56.]
Mrs. Davis. Admiral Walsh.
STATEMENT OF ADM. PATRICK M. WALSH, USN, VICE CHIEF OF NAVAL
OPERATIONS, U.S. NAVY
Admiral Walsh. Madam Chairwoman, Congressman Wilson,
distinguished members of the subcommittee, thank you for the
opportunity to testify about the organizational and command-
level efforts to prevent suicides in the Navy. Suicide ranks as
the third leading cause of death in the Navy. It is a loss that
destroys families, devastates communities and unravels the
cohesive social fabric and morale inside our commands.
While the symptoms of those who contemplate suicide are
unique to each person, a common thread to all victims is a
sense of psychological emptiness that leaves individuals
impaired and unable to resolve problems. Therefore, the steps
that leaders take to find solutions to this tragedy must
address the underlying causes that affect the ability of an
individual to recover from change or misfortune and regain
their physical and emotional stamina. So the target of our
policy and practice is the resilience of individual sailors and
their families. This means that leaders must look for and
connect to those individuals challenged by seemingly
intractable troubles with relationships and work, financial and
legal matters, deteriorating fiscal health, as well as mental
health issues and depression.
We must eliminate the perceived stigma, shame and dishonor
of asking for help. This is not simply an issue isolated to the
medical community to recognize and resolve. Commands have a
critical role to play in setting a supportive climate for those
who need to admit their struggle and seek assistance.
Some of the more noteworthy policy and programmatic actions
that leaders have taken include the Chief of Naval Operations
(CNO) directed establishment of a preparedness alliance, which
is a consortium led by our Chief of Naval Personnel, our Chief
of Naval Reserves, Bureau of Medicine and our Commander of
Installations Command, to address a continuum of care that
covers all aspects of individual medical, physical,
psychological and family readiness issues across the Navy.
Additionally, the CNO instituted an Operational Stress
Control Program, which is a comprehensive approach designed to
address the psychological health needs of sailors and their
families. It is a program led by operational leadership,
supported by the naval medical community, and provides
practical decision-making tools for sailors, leaders and
families so they can identify stress responses and problematic
tension.
By addressing problems early, individuals can mitigate the
effects of personal turmoil and get the necessary help when
professional counseling or treatment warrant. Through training,
intervention, response and reporting, the Navy executes
prevention programs for all sailors that focus on operational
commands to take ownership of suicide training initiatives and
tailor them to their unique command cultures.
Feedback is an important element of policy development. The
Navy polls extensively and tracks statistics on personal and
family-related indicators such as stress, financial health,
command climate, as well as sailor and family support. We use
this data to monitor the trends in the force and make
recommendations for adjustments in deployment practices, as
well as track all suicidal acts and gestures.
In conclusion, on behalf of the men and women of the United
States Navy, I thank you for your attention and commitment to
the critical issue of suicide prevention. By teaching sailors
better problem-solving skills and coping mechanisms for stress,
the Navy will make our force more resilient. We will do
everything possible to support our sailors so that in their
eyes their lives are valued and are truly worth living.
Thank you.
Mrs. Davis. Thank you.
[The prepared statement of Admiral Walsh can be found in
the Appendix on page 67.]
Mrs. Davis. General Amos.
STATEMENT OF GEN. JAMES F. AMOS, USMC, ASSISTANT COMMANDANT,
U.S. MARINE CORPS
General Amos. Thank you, Chairwoman Davis, Ranking Member
Wilson and distinguished members of this subcommittee, for the
opportunity to report on the Marine Corps suicide and
psychological stress prevention efforts. On behalf of the more
than 242,000 active and Reserve marines and their families, I
would like to extend my appreciation for the sustained support
Congress has faithfully given to its corps.
As we begin this hearing, I would like to highlight a few
points from our written statement. The tragic loss of a single
marine to suicide is deeply felt by all of us who remain
behind. We lost 42 marines to suicide in 2008, up from 33 in
2007 and up from 25 in 2006. This is unacceptable, and we are
taking action to turn this trend around. The Commandant cares
deeply about this and is committed to work with the leadership
of the Marine Corps to fix it.
The data shows that the marine most likely to die by
suicide corresponds to the Marine Corps' institutional
demographics. He is a Caucasian male. He is 18 to 24 years old,
between the ranks of private and sergeant E-1 through E-5. The
most prevalent common thread is a failed relationship. Male
marines are significantly at greater risk of suicide than
female marines. The most common methods of suicide within the
Marine Corps are gunshot or hanging, similar to our civilian
counterparts.
Suicide prevention is required training for recruits in
boot camp and for all our new officers at The Basic School. It
is part of the curriculum at our staff non-commissioned officer
(NCO) academies, our commanders courses, and at other
professional military education venues. Simply put, suicide
prevention training is incorporated into our formal education
and training at all levels of professional development and
throughout a marine's entire career.
Regretfully, there is no single solution that will likely
turn this trend around. Rather, we believe it will be a
combination of efforts whose consistent themes are value-based
training, behavior modification and leadership. At a planning
session this past November, some of our Corps' very brightest
and best young non-commissioned officers asked us to provide
them with the additional training so that they could take
ownership of suicide prevention for their peers and for their
marines.
Our NCOs have the day-to-day contact with these marines,
and as such have the best opportunity to see changes in
behavior and other problems that can mark marines in need of
help. As a result, we have developed a high-impact leadership
training program focused on our non-commissioned officers and
our corpsmen. It is designed to provide them with additional
tools to identify and assist marines at risk for suicide.
Additionally, I directed the Marine Corps Combat
Development Command to take an independent look at our suicide-
prevention training throughout the Marine Corps. A special task
force began their work earlier this month on how we are
specifically training our marines. It will explore how we can
modify training at all levels to improve resilience, decrease
stigma and reinforce the themes that marines thrive in
hardship, that marines persevere through the strength of our
fellow marines, and that marines don't quit when the going gets
tough. In other words, we want to get to the left of the
suicide.
To rapidly raise the level of awareness across the Marine
Corps, 100 percent of all marines received additional training
in suicide prevention during the month of March this year. The
training package was delivered by Marine leaders and educated
all marines on warning signs, engagement with their buddies,
and how to access the variety of local and national support
resources. With support from the Navy, we are increasing the
number of our mental-health professionals, embedding more of
them in our deploying units where they can develop close
relationships with our marines all in an attempt to reduce the
stigma of seeking help and to identify potentially affected
individuals earlier.
While there is no single answer that will solve this crisis
of rising suicides, we are committed to exploring every
possible solution and using every resource we have available. I
promise this committee that I will not rest until this is
turned around. I thank each and every one of you for your
faithfulness to our Nation and your confidence in the
leadership and commitment of our Corps.
Mrs. Davis. Thank you, General.
[The prepared statement of General Amos can be found in the
Appendix on page 79.]
Mrs. Davis. General Fraser.
STATEMENT OF GEN. WILLIAM M. FRASER III, USAF, VICE CHIEF OF
STAFF, U.S. AIR FORCE
General Fraser. Chairwoman Davis, Representative Wilson,
distinguished members of this committee, I want to thank you
for the opportunity to appear before you today. It is a
privilege to join with the other vice chiefs of our sister
services in addressing this very important issue. I want to
echo their sentiments and believe we must continue to develop
and implement programs to maintain the psychological health of
our servicemembers.
Your Air Force is heavily engaged in worldwide operations.
The demands of frequent deployments and increased workloads at
home station, compounded by other external factors such as
economic pressures, continue to place a heavy burden on our
airmen and their families. Under these conditions the Air Force
does not take a business-as-usual approach to monitoring the
physical and the psychological well-being of our force. The Air
Force Suicide Prevention Program requires the personal
attention of every airman. Secretary Donley and General
Schwartz, our Chief of Staff, have led the charge in making it
clear that whether you are on active duty, Guard, Reserve or
civilian, leaders across our force must deal with this problem
head on.
Through a total force approach, we are strengthening our
focus on the suicide preventions. We are working diligently to
heighten awareness and reduce the stigma of seeking help. Our
goal is to ensure that every airman is as mentally prepared for
deployments and redeployments as they are physically and
professionally.
We continue to institutionalize our Air Force Suicide
Prevention Program, focusing heavily on 11 program elements
that enhance the psychological and health treatment and
management programs. Recognizing the importance of
collaboration in this effort, we are bringing together key
representatives from across the Air Force in working groups to
ensure that we anticipate, identify and then treat the
psychological health issues that are before us.
We are also working closely with our joint teammates to
capitalize on best practices as seen in the other services.
While there is some comfort in the impact these programs are
having, even a single suicide is one too many. Individually and
collectively, the Air Force is committed to taking care of our
most valuable asset, that is our airmen.
I want to thank you for your continued support of America's
airmen. I look forward to your questions and further discussion
on how we can best serve those that serve our Nation.
Thank you.
Mrs. Davis. Thank you.
[The prepared statement of General Fraser can be found in
the Appendix on page 90.]
Mrs. Davis. I want to thank all of you. And I know from
your statements that you have submitted, as well as your
comments today, that you take this very seriously, and we
certainly appreciate that. I wonder if you could just expand on
your statements a little bit and share with us what has been
the most frustrating part of trying to deal with these issues?
What would you like us to know as you have had to deal with
this?
General Chiarelli.
General Chiarelli. Well, the most frustrating thing is
trying to find the cause. And that is why we have asked the
help of the National Institute of Mental Health to do a study.
And we feel that this could be huge, huge for the Army,
Department of Defense and, quite frankly, for America, because
I think many of the lessons that are going to be learned in
this study, where we have combined the resources of the
Department of Defense, Harvard, Columbia, University of
Michigan and put together a world-class team, that it is going
to have the Army and the Marine Corps to use, to gather the
data that I think are really going to unlock some of the
mysteries of why this happens with some individuals. And I
think it will get us out of the speculation of someone who
spent 36 years with troops trying to figure out and look at
statistics and determine a cause, it will get me out of that
business and into the business of finding out what the real
cause is, what works and what does doesn't work, so that we can
provide for our commanders that which I think will help them in
helping to prevent suicide.
Mrs. Davis. Have they shared how you might make real-time
use of that data as they are developing their study? Is that
something that you have been able to move forward on?
General Chiarelli. They realize this is not business as
usual, as General Fraser said. We are into this, and we are not
going to wait for the results of a study or anything else. And
the National Institute of Mental Health understands that. And
we rolled out the study team a week ago, and we already have
calendared their first comeback to us of initial study results
in early November of this year. They will do that every single
quarter. So we will learn as they are collecting the data and
analyzing the data, and that is exciting.
I think the other thing that is frustrating to me is I
really think the thing that will give us a leg up on this that
will help us out so much is to increase the amount of dwell
time that our soldiers have at home. There is no doubt in my
mind that this reduced dwell time, turning it around in
rotations every 12 to 15 months, is causing a tremendous amount
of stress on the force, on soldiers, families, and I have to
believe that the National Institute of Mental Health will
identify that early as one of the stressors that is affecting
us.
Mrs. Davis. Thank you.
Admiral Walsh, did you want to comment?
Admiral Walsh. It is actually hard to organize our thoughts
when it comes to that question because there is so many
different ways to approach this at so many different levels. So
on a very personal note, I would like to play a constructive,
impactful role. And in this particular area, because you are
dealing with so many unknowns and variables that are very hard
to even describe and grasp, it is hard to come forward asking
for more resources and programmatic solutions to something that
requires a connection to take place between people.
And so that is why we try and take a balanced approach to
this that really pulls on the command and operational sorts of
roles that need to be played in trying to carve out time and
space to look at people and see what people need. And what I
have heard across the panel here is absolute consensus on a
climate that allows for that kind of dialogue and feedback;
absolute consensus on we will leave no good idea on the table;
shared best practices between the services in terms of how they
will adapt initiatives to their particular culture and domain.
What is frustrating for us is not to find the correlative
data that we are looking for. In one sense you would think that
more deployments would be indicative of those that would be
more inclined to go down this path, and that has not been the
case for Navy. In fact, what this conversation provokes is
really an inward look inside our own cultures to see where are
the checks and balances, where is the accountability, where are
the authorities, and how do we look after people. And what we
find is that we have built our culture on our deployment model,
and that while there may be some exceptions, the problems that
we find in the case of suicide is that our folks, while they
are deployed, generally do okay. We have some vulnerable
pockets within the general population of sailors.
But the area that we really need to focus on is when all
those checks and balances and that sort of cocoon that they
live in on deployment is now taken away, and they come back off
the deployment. And so the first six months for those who
return from deployment are those who are in the area that is
most vulnerable, as well as those who have never deployed. And
so what that does is it sort of strikes in the face of what
many in the general population think, is that we are handcuffed
off to deployment, and that we have to do this, and therefore,
it is more stressful for us.
The reality of it is the target for this needs to be the
assimilation of those who have served back into the general
population dealing with the day to day, whether it is families,
their kids, their education, their bills and the relationship
stressors associated with it.
Mrs. Davis. Thank you.
General Amos and General Fraser, if the panel doesn't mind,
if Members don't mind, we are going to go ahead and finish our
panel. Thank you.
General Amos. I share my colleagues' exact sentiments here.
It is interesting because the Marine Corps, like all of us,
have been deployed in some pretty tough conditions for the last
seven years and have done quite well. And when you visit, and I
know probably all the committee members have visited them
forward-deployed in combat, they are a happy lot. Even though
they are full of stress, and there is an awful lot going on, it
is very dangerous, they are a happy lot. And when they come
home, that is typically when we have issues.
The Marine Corps is unique in that 70 percent of the
marines, actually about 71 percent of our 204,000 marines we
have on active duty today are on their first enlistment. So we
are the youngest of all the services. We have got 42 percent of
our marines are lance corporal and below; 24 percent of that
204,000 aren't even of drinking age yet. So this is a very,
very young population that we have.
The frustrating part for us in the Marine Corps, and I know
it is shared by my brothers here, is trying to find those
common threads that you can actually put your fingerprints on
and try to do something about. I mentioned in my opening
comments that one of the typical threads is a failed
relationship. That seems to--that seems to be for the marines,
the young men, that 18 to 24 that are taking their lives, seems
to be a common thread, but it is never the thing that seems to
push it over the edge.
There are a pile of stressors that in many cases, if taken
by themselves, and you could carve them out and set them aside,
they can deal with them quite nicely. And the fact of the
matter is most marines do deal with them. But it is the
compilation of those stressors and all of us trying to figure
out, okay, how do we identify those ahead of time, and how do
we do something about it to kind of stop this chain of events
that finally leads somebody to take their lives. That is the
frustrating part, Chairwoman. And we are working very hard, but
we have only found a couple of things that seem to be common.
Mrs. Davis. General Fraser.
General Fraser. Thank you. And I, too, would echo the
comments that have already been made. But let me just say that
most frustrating is the fact that there is no one single
answer. But even above that, I would say it is more
frustrating, for everything that we provide, given the
resources that we have in the programs that are in place, is
when an individual does reach out and they seek help, and we
are seeing that happen. Actually our numbers are going up where
I think we are seeing that the stigmatism is--we are getting
past that, that people are reaching out for help. And so you
begin to provide that help. And then it gets very frustrating
when all of a sudden they go along a path, and then they are
successful in executing suicide.
To me that is very frustrating because you have provided
programs, you have provided mental health care providers or
chaplains or whatever else it may be that they were reaching
out for, but for some reason it wasn't enough, and to me that
is the most frustrating.
And we do have some rather small numbers from 2003 to this
time period here. About 25 percent of those have actually been
receiving care of some sort, but yet something wasn't good
enough, and that is disappointing. And so we go back and we
take a hard look at that, but I would say that is the most
frustrating is when you provide things, and then still it is
just not enough. And you never, ever really know what else
could I have done or could we have done to help them to not
lose hope and despair and then commit that fateful act.
Mrs. Davis. Thank you. Thank you all for responding.
Mr. Wilson.
Mr. Wilson. Thank you very much.
And again, thank you for your participation today.
General Amos, I want to particularly thank you for pointing
out the morale of our troops who are serving overseas. I have
had the privilege of visiting 10 times in Iraq, 8 times in
Afghanistan. Actually I visited with my former National Guard
unit in Afghanistan. And I have had two sons serve in Iraq.
They are proud of their service. And we go over to actually
encourage them. Every time I go, I come back inspired by the
young people serving our country.
For all of you today, each of you have described a broad
spectrum of programs that cut across many disciplines within
your respective service aimed at preventing, recognizing and
treating psychological stress in military personnel. How do you
identify which services are most appropriate for a particular
servicemember and then coordinate the use of those services
between the servicemember, the command and the multiple
organizations that offer the services?
In addition, when I look at the continuing incidence of
suicide, even with the number of mental health programs each
service has available, I can't help but wonder if your programs
are working. What are your thoughts and how effective are your
programs for reducing psychological stress and suicide, and how
are you measuring whether your programs are effective? And this
is for each one of the panel, and beginning with General
Chiarelli.
General Chiarelli. Sir, last year the Army Science Board
did a study for us as they looked into the increasing number of
suicides in the Army, and they found 14 pages of programs. So a
young commander going to look at what he needed to do to work
this issue would be faced with 14 pages of programs. And it is
clear to all of us that this is not a problem of having too
many programs, it is not knowing which ones are the ones that
actually have an effect.
We feel that we were very successful in getting the focus
on this problem with the stand-down we conducted in the March-
April time period where we used the Beyond the Front video
followed up by a chain teach. But we know the National
Institute of Mental Health is going to help us to identify
which programs in that 14 pages work. And we also feel that the
Comprehensive Soldier Fitness will move us to the left of this
problem as today we have young non-commissioned officers who
are taking training at the University of Pennsylvania in
resiliency training that will go back to their units and begin
to work with soldiers from the time they enter the Army until
the time they leave the Army. And we hold great hope that that
is going to move us to the left.
Admiral Walsh. Sir, I would put it in the category of
mental welfare and the programs associated with that. For Navy
we really focus our energy around a concept of operations here
that involve line leadership. We feel that we cannot just
develop something in the medical community and have it stand in
isolation, which may or may not actually connect to people.
So the focus of our effort that is now under way today,
that is too early to assess but instinctively and intuitively
tells us we are on the right path, is our Operational Stress
Control Program. The way we are going to track this is really
relying heavily on assessments and feedback. And the question
that that then promotes is what do you do with that feedback
once you get it.
We have learned over the course of this war that we have to
have the ability to get mental-health professionals on site,
and we have direct examples of this, where we have looked at
detainee operations, for example, in Afghanistan, where we were
looking at the rotation rates, the dwell time, and just the
amount of effort that it took for sailors to take on that duty
and responsibility. When we had the flyaway team get boots on
ground and actually take a look at it, the feedback that we
got, the surveys that we used to target that particular
population, then influence, then policy changes in terms of who
we identify for those types of billets, how long they have
those billets, the dwell time that they need to have after
having a job like that, and then whether or not they are good
candidates for returning to the area of responsibility (AOR).
So in response to your question, whatever program that we
come up with has to have an understanding that unless we are
able to assess it and measure it, then we have no idea whether
or not it is taking any traction. And that is the spirit in
which we are unveiling the Operational Stress Control Program
this fall.
Mr. Wilson. Thank you.
General Amos. Sir, I think the programs that we have had in
the past, if you go back and look at history, the Department of
Defense hasn't kept, didn't start keeping accurate records on
suicides until post-Vietnam. That was probably sometime in the
1980s. But I remember looking at a chart. In 1996, the
Department of Defense began to focus on suicides, and across
the services you saw a drop. So I think the fact that this
subcommittee, our Secretary of Defense, our service secretaries
and our service chiefs are putting this much attention to it is
going to have an effect.
It is too soon to tell. Certainly if you ask me today, how
are you doing today, I will tell you we are doing abysmal, we
are not doing well. But the programs that we have had have
worked up, I think, until probably just the last couple of
years. It has--this generation, this--where we are in kind of
the state of the Marine Corps with the consistent persistent
deployments and, I think, the young men and women we are
bringing in, which are the best we have ever seen by far,
requires a different approach. It requires an approach that is
more meaningful to them. And we are going back to what the
basics of the Marine Corps is, which is leadership; not just a
platitude, not a plaque, but fundamental leadership.
Leadership, the same leadership we had while we are deployed in
Iraq. And we watch them, and we know everything that goes on in
their brains when we are together on the ground, and yet we
come home, and we don't have a lot of time at home, and we are
not spending that detailed leadership and attention to detail
and attentiveness to those young men and women back home.
We are changing that. We are instituting the NCO leadership
panel or training period, which I was telling you about in my
opening statement.
And then this final thing that I think is going to take
root, and it may have the most significant effect, and that is
to go into entry-level training, to Parris Island, South
Carolina, and to Marine Corps Recruit Depot in San Diego, and
with those senior drill instructors and those other two junior
drill instructors, and they look at those young men and women,
and they are making them marines in 12 weeks, they change their
behavior for life. We are working right now to figure out what
those precise messages are so that when that senior drill
instructor who they will never forget tells them that marines
endure hardship well, we don't take the easy way out.
That is where we are going, sir. So it is too soon to tell,
but we are working fervently on this thing right now.
General Fraser. Sir, one of the things that we are doing
and continue to do is build upon the program that we instituted
back in the 1997 time period as far as our Air Force Suicide
Prevention Program goes. It has 11 different elements within
it, and we take a holistic look across all of our programs all
the time. And this integrated delivery system that we have
brings together different elements from different
organizations, from the medical community, from the chaplaincy
I mentioned earlier. We have also got Office of Special
Investigations (OSI) for investigations. We also have the Judge
Advocate General (JAG) Corps that is a part of that, and also
our personnel, and we have recently integrated safety as a part
of this. And what we do with this type of holistic approach is
look across all of our programs at the wing, the numbered Air
Force, the Major Command (MAJCOM) and even at the headquarters
level. And so we are able to look across all of our programs
and see what can we do better.
We are also participating in the Suicide Prevention
Awareness Risk Reduction Committee that is now a part of OSD
across all the services. And I think that goes to the point
that you were trying to make is how are we reaching out and
getting best lessons from others, best practices, so that we
can integrate them in. And so not only at the wing, Numbered
Air Force (NAF), MAJCOM and headquarters level, but even across
the services we are trying to take this approach to see what
can we do better.
We have learned some things. In March of this year, I
instituted a Suicide Prevention Working Group. And just in the
short time that they had been meeting every single week, just
recently they outbriefed me with 33 different initiatives that
we are going to be looking into that go across training,
policies and other types of programs that we can actually
institute. So we are seeing some positive things come about to
ensure that we are maximizing everything that is available to
us and to our troops.
Mr. Wilson. We look forward to receiving your updated
reports. Thank you very much.
Mrs. Davis. Thank you.
Mr. Jones.
Mr. Jones. Madam Chairman, thank you very much. And I sit
here listening very carefully. And thank you, gentlemen. You
have got one tough damn job, truthfully, because of the war in
Iraq and Afghanistan. And I am looking at an article in Marine
Times, and, General Amos, this is not a criticism, this is
praise really. At least seven marines are believed to have
killed themselves so far in July, officials said, putting the
Corps on a record pace despite broad-based efforts introduced
to reduce suicides.
I think you and those who work with you got an impossible
situation, but I want to thank you for accepting it not as
impossible.
I guess you know when you really want to look at this, this
Nation continues to wear out and break the military. And no
matter how tough that marine is or that soldier, airman,
seaman, whatever, a tough human being is a human being. And I
guess my question, if I have one, I want to know, these seven
marines, and it could have been seven soldiers, when you get
the report that Sergeant X or Private X has committed suicide,
where does that report go? Does it come all the way up the
chain?
My point of what I am trying to ask is what I would love to
know, just one tragedy, the history of that one soldier or that
one marine, and wanting to know that if he or she had been
there--let us say that it is because of frequent deployments.
You said sometimes it is not, and I understood, and I agree
with that. It could be family situation, it could be financial
situation. But I really would like to have a briefing from the
Army or the Marine Corps or the Navy just taking one soldier or
one marine and give me a classified briefing of what was his
life like, what signs did you see or not see; and I don't mean
you individually, but that lieutenant or that captain or that
major. Did they see any signs? Because I truthfully--I don't
think you all could be doing any more than you are doing, and
that is my own personal feelings. But I have sat here, and I
want to thank the Chairlady and the Ranking Member. We have had
numerous hearings, and I have sat here, and I think you all are
doing the very best job you can do. And I commend not only you,
but the organization, the service that you work with. But I
don't know if we can get a handle on, unless we had several
classified briefings about it, Chairman, and let you give us a
soldier or five soldiers or five marines or five seamen or
airmen to tell us what was that person's life like, why was it
not--why was it missed? I am not sure that would help us give
you any better direction, to be honest with you, but I think it
would better help us understand.
Does that make any sense to you that we could be briefed
individually if not as a committee to try to understand?
General Amos. If I could take that. I think it makes
complete sense. And you need to know, and the committee needs
to know, that in our organization we have a thing, and it is
not a fancy term and it is a heartbreaker, but it is called a
death debrief. And you go to visit General Hejlick down at Camp
Lejeune, and General Hejlick gets a brief. It doesn't matter
whether it is an airplane accident, or whether it is a marine
who takes his life, or we have an accident out there and a kid
has a single-vehicle accident and loses his life. That thing is
dissected at the lowest level, the Lieutenant Colonel command
level, all those people in his chain of command or her chain of
command, sergeant major right down to platoon sergeant right
down to the squad leader. Everybody comes into General
Hejlick's office, to include all the generals in between, and
he will sit down for probably about a 2\1/2\- to 3-hour debrief
to include pictures, to include family history, all the things
that you had mentioned. All that is peeled back at General
Hejlick's.
That happens across the Marine Corps for the very reasons--
and parts of that comes to me within eight days. That is the
Assistant Commandant. It comes up. I get to see it, I see the
pictures, I get the preliminary reports. And for the very
reasons that you were asking, Congressman Jones, is because we
just--I don't ever want it to be just another statistic. I want
it to be a face, a name. He belongs to somebody. Some mother
and father loaned him to the Marine Corps, or her.
And so we can do that. We would be happy to do that.
[The information referred to can be found in the Appendix
on page 109.]
General Chiarelli. Sir, I sat in a video teleconference
this morning with commanders from all over the United States
where 11 suicide cases were briefed to me. Those cases took
place between February and March of this year. Every single
suicide is briefed to me this year. And we go through them in
great detail; 11 cases in about 2 hours and 15 minutes. We
learn. And that is what this is all about. It is learning. And
as a commander briefs, another commander in another part of the
United States, Iraq, Afghanistan, Hawaii or Japan is on that
video teleconference being able to apply the lessons learned
from each individual case to situations that he might find
himself in with the smaller population that he commands. And we
could very easily provide you with that information.
Mr. Jones. Yes, sir.
Admiral Walsh. Typically I will see the information either
the day of or the night after in terms of the summary of what
happened, which then will prompt a series of questions, because
we know where our pockets of vulnerability are typically with
our individual augmentees who are serving apart from deployed
units on their own in support of the ground fight. While our
statistical evidence suggests that we have not had a problem in
that area, that is one of the first areas we start looking for.
Then we look for deployment history. That briefing will go up
to the Chief of Naval Operations so that everyone is aware.
I am happy to provide you that information. It is
unsatisfying because it will leave you with more questions than
answers. The approach that we take today, the questions that we
ask, the emphasis and the focus that we place on leadership,
beginning with the question of why didn't you know, you should
have known, actually are not our words. Those words were
written in 1995 by Mike Boorda months before he committed
suicide.
So we are a service that has lived with these lingering
questions and no answers for many years, and this is something
that we can't put enough focus and emphasis on.
Mr. Jones. Madam Chairman, I guess my time is about up. I
want again to say I don't really want to see the reports. I
know you are doing your job. And I guess I want to bring that
point up just to say I think you are doing everything that you
can possibly do in a situation that is just unbelievable,
because these young men and women are being stressed beyond
belief. And you cannot--again, in closing, you cannot be--I
don't care how strong you are, there comes a time that the body
just says, I cannot do much more. And this country needs to
face this. This is not your problem. This is the problem of
this Administration as it was the past Administration, and we
need to face the facts that we are in a bad situation.
Thank you.
Mrs. Davis. Thank you, Mr. Jones.
And we have been a little loose with the time today because
I know that it takes a while sometimes to even express how some
of these programs and concerns are moving along. And so I
appreciate taking a little more time.
I wanted to just ask unanimous consent for Mr. Coffman to
be able to participate and ask questions. Hearing none, I move
on to Mr. Murphy.
Mr. Murphy. Thanks for that, Madam Chairwoman.
Gentlemen, thank you for your candor and tact on such a
difficult issue with suicides in our military and the
psychological stress that our heroes are going under during
these times.
General Chiarelli, I appreciated your comments regarding
being more proactive than reactive of a change in philosophy,
and we do appreciate that; and also your partnership with the
University of Pennsylvania, that resiliency training classes
that your folks are going through.
General Amos, I appreciate your comments, too. As far as we
all know, in the Army this is the year of the non-commissioned
officer and your leadership program with the NCOs and making
sure that they break through those barriers, and that
leadership, I think, is very much welcome as well.
I know today we also talked about as far as the stress on
deployments and the stress going home. I know when I was in
Iraq 6 years ago, 1 of our 19 paratroopers committed suicide
over in Baghdad, and that weighs on my heart. And I know my
colleague that I served with over there, Captain John Soltz, he
talked about when he came home the hardest thing about
deploying was coming home and that stress there.
I represent the Eighth District of Pennsylvania, and I can
tell you that we have had three young heroes in the past seven
months this year alone, three young heroes who came home from
either Iraq or Afghanistan that committed suicide, and that has
been really tough, that has been really tough. In each of these
cases we heard similar stories from their families. They knew
that their loved ones were having problems, but they just
didn't know how to help or where to turn.
So my question, I think, are--you know, I know the earlier
testimony about there was 14 different programs and making sure
that we are syncing this up and getting it straight. But how
are the services working with the families before, during and
after their loved one's deployment so they can spot the signs
of either post-traumatic stress disorder, traumatic brain
injury or depression and know how to take action? If you can
comment about that, I would be very much appreciative.
General Amos. Sir, two years ago the Commandant got ahold
of our family team--what we call our family team-building or
family readiness focus and said, let us put this on a wartime
footing, when it became apparent that we are going to be at
this for some time. Not that money is an indication of focus,
but it does give you a sense of prioritization for our
Commandant. And it is $400 million in 2008, $400 million 2009,
and just about that, in fact a little bit more than that, in
2010. And the whole purpose is to build those, of all those
awareness programs, all the predeployment efforts, the
briefings, bringing in the health advisors, bringing in all the
folks that pull a family together as a unit, to prepare them
for their deployment.
Now, there is a host of things that the young marine goes
through, all the combat training, as you know. I am talking
about the family readiness part. I am talking about getting the
spouse prepared for the deployment, what is it like, what can
you expect, how is it as you get closer, and what it is like
when you are in the middle of it; and then what is it going to
be like, as you said, sir, when you come home, what is that
like? I mean, that is a different set of dynamics.
We have looked at all three of those periods of time, and
without getting into just huge details, we have put a lot of
effort in there to include communications tools, to include
staying plugged into them with volunteers and paid workers to
help us stay plugged into those families. In there are all the
different ways. You can bring your children and get them help
if they are in school and they are struggling with it. We
worked very hard at that, sir. And it is all begins six months
before the deployment and comes back when they come back home.
Mr. Murphy. Thank you, General Amos.
General Chiarelli, could you comment.
General Chiarelli. The most successful program we have seen
in recent years is the military family life counselors. They
have been absolutely fantastic, and we are pushing them down to
battalion level. Prior to having that asset that you could use,
the only thing you found down at the battalion level, that
formation of anywhere between 500 and 800 individuals, was the
chaplain. We have always had one chaplain, but, you know, in
today's world, after eight years of war, we need two chaplains,
I would argue, down at those battalion headquarters along with
the military family life counselors.
Substance abuse counselors. What I found when I went to
visit seven installations in eight days was that we still had
the same authorizations for substance abuse counselors in 2009
that we had in 2001. And there is no doubt in my mind that the
incidence of substance abuse has increased in the United States
Army, and it is part and parcel to the deployments we are
under. So we are today hiring as quickly as we can to provide
the additional substance abuse counselors we need.
And you all know the problem with mental health counselors
in trying to get enough. We are looking for new and innovative
ways. And we really believe that being able to provide mental
health counseling on line, and one day, I hope by November or
December, an individual will be able to do that at his or her
home. We made available to all families as well as soldiers in
the privacy of their own home, and we think that this is one
way we can get around a national shortage we have by being able
to bring them together in an on-line capability that will
service all the Department of Defense.
Mr. Murphy. Thank you.
Gentlemen, I think my time is up. I don't want to get
reprimanded by the Chairwoman, but I would appreciate the next
round we can further discuss. Thank you.
Mrs. Davis. Thank you.
Dr. Snyder.
We actually have some votes coming up. I think we can
probably work for at least another Member asking questions and
maybe a second.
Dr. Snyder.
Dr. Snyder. Thank you, Madam Chair.
General Amos, when you were talking about Marine Corps
Recruit Depot (MCRD) in both the east and west coast, it is 42
years next month I began, and I don't remember much in terms of
the teddy bear counseling quality of my drill instructors. On
the other hand, I think I remember everything they ever said,
so I think your point is probably a good one.
I wanted to direct my questions to you, General Chiarelli,
if I might, since you have the study going on by the National
Institute of Mental Health, and more in the spirit of just open
questions. We are focused here today on suicide rates. That may
or may not be the thing that we need to be measuring or looking
at. I don't know what is under the water out there. I think of
all those soldiers that you have right now who are in misery
and their family is in misery and perhaps children who witness
a lot of this are in misery, and yet because they don't ever
actually take the act of some violence towards himself, we may
not know about it. And I don't know what that is for every
completed suicide. Is it 5 families, is it 20 families, is it
200 families? But I think that is--you know, what do we
measure, and what do we look at? And I think that your study
from the National Institute of Mental Health may point to what
we look at. Do we measure the suicide rates of spouses or the
suicide rates of children of military members?
General Chiarelli. We collect as much of that data as we
possibly can, and we track it. It is the most difficult of all
the data gathered not when it takes place on a military
installation, but when it takes place off of a military
installation. But we do our best to collect as much of that
data as we can.
And, sir, I think you are 100 percent right. Suicide is a
the extreme indicator. And by the time I hit the third
installation, I realized that this wasn't about suicide
prevention, this is about the mental wellness of soldiers and
families. That is what this is about. And what our programs
have to be directed at is that mental wellness, not at the
extreme. And if we get at that, I really think we are going to
see the incidence go----
Dr. Snyder. I think that is right. When you talk about the
factors, failed relationships, I think, was one that you
specifically mentioned. Again, the causation is what you are
looking for; what is causing this out there along the chain? I
was surprised that a diagnosis of depression was not one of the
factors. Where does that fit into this?
General Chiarelli. Depression is an indicator, but when I
talked to spouses on that tour, what I found from them was
their spouse was coming back off of a deployment going through
that first 30-day period where everything is wonderful, but
then getting down into that training period as he is getting
ready to go out or she is getting ready to go out in 9 to 11
months. And the whole process of reintegration, if you have
ever tried to do that, spouses were telling me their husbands
were not reintegrating with the family. They just realized that
that was too hard to do in the short period of time they had,
and they would back off from the family, which creates the
relationship problem, which you know spirals out of effect.
Dr. Snyder. Is there--you all--I think all of you talked
about the fact that we haven't talked about this for some years
now, that I think we are doing a better job both in our
American civil culture, but also the military culture, of
acknowledging that seeking mental health counseling should not
be stigmatized. In your Army culture what about couples who
seek help for marital problems? Is there a stigma to
acknowledge as a couple that they are having problems, or do
you think that that is also recognized as better accepted, that
it is okay to go ahead and acknowledge to your folks that you
are having difficulty?
General Chiarelli. I think marriage counseling is better
accepted, if there is such a way to put it, than the stigma of
seeking mental health help. And one of the focuses of what we
are trying to do is to do everything possible to get rid of
that stigma. That is one of the reasons why I am so excited
about being able to deliver mental health counseling on line.
It has been done in Australia. They have had tremendous
success. The people are more willing to open up on line. And
that gets the geographically separated people who don't have
the cocoon of a military post to fall under.
Dr. Snyder. Are there any duty assignments that a person
can't hold for a while, such as flying or air traffic
controller, if they are placed on an antidepressant or a
medicine for depression or a mental health illness?
General Chiarelli. There are, and flying is one for sure.
Dr. Snyder. So that can be a factor in how we deal with
some of these signs.
General Chiarelli. It can. But I worry about something
other than that. I worry that we are overprescribing. I worry
that we are having such a rough time determining the causal
effect of this that in many instances I fear that our own
doctors, at least I will state Army doctors, at times are
throwing prescriptions at soldiers because they are either
overworked or just don't know what to do, and there is enough
evidence-based information to indicate that in some instances
drugs do----
Dr. Snyder. Do you track allegations or confirmed episodes
of child abuse in military families, in Army families.
General Chiarelli. We do and those numbers are available
also.
Dr. Snyder. Do you know what the trend is in that?
General Chiarelli. I believe last year we were down.
Dr. Snyder. I think my time is up, Madam Chair. Thank you.
Thank you all for your service.
Mrs. Davis. Thank you. We are going to go vote and then
come back. We are certainly hopeful that you all will be able
to stay, and I certainly hope that the members will all come
back, because this is a very important hearing and we would
like to have everybody's input.
So can I count on members to come back, hopefully? Thank
you.
[Recess.]
Mrs. Davis. We want to thank everybody for your patience.
It always takes longer than we think it will. I want to turn to
the next member, Mr. Loebsack.
Mr. Loebsack. Well, thank you, Madam Chair. Speaking of
chairs, I will allow everyone to get in their chairs.
I really appreciate your being here, all of you. Thank you
so much for your service and for what you are doing on this
particular issue. I guess I might just mention a couple of
things at the outset here before I ask specific questions.
The whole issue of stigma, I am glad that that was brought
up. You know, obviously whether it is mental health in the
civilian sector or the military sector, I think stigma is
probably maybe the most important factor in all of this and
doing all we can to overcome the stigma of mental health.
I have some personal connection to this. My mother as I was
growing up and throughout my whole adult life, as long as I can
remember, there has been a struggle with mental health and
stigma was a huge issue. And we had Rosalyn Carter speak before
the Education and Labor Committee on Mental Health Parity and a
number of folks, including her, focused on that particular
issue. And never having served in the military, but I can only
imagine that that issue may be even more significant in the
culture of the military, and you can correct me if I am wrong,
if I am wrong about that. As I said, I have never served.
Also the issue of multiple deployments, I think that just
seems to be coming up over and over again. And clearly that is
just an important issue with not a lot of dwell time in
between. I know we are trying to improve on that in all the
services. And I really hope that we can continue to do so.
I want to also maybe focus on or drill down a little bit
more on the families and the children. It was mentioned, I
think General Amos is the one who mentioned that predeployment
there is a lot of work done with the families. Obviously
postdeployment. This is a very important issue. There was a
National Public Radio story recently about children of the
Guard, Reserve Components. We do not have a lot of big bases,
we have none in fact in Iowa, but we have a lot of National
Guard folks. I like to mention that every hearing I possibly
can. And clearly I think it is just absolutely critical we do
everything we can for the families, not just of the active
service folks, but also those Reserve Components. And I am just
wondering if you folks, one or all of you, whatever number
would like to could speak to the Reserve Components, especially
those Guard folks and their families, those folks who have had
these multiple deployments. And everyone is trying to balance a
lot of different things when they are deployed and when they
come back, but those Guard folks in particular. Whoever wants
to start, please do.
General Chiarelli. Well, sir, that is definitely a focus of
ours. It is how you can take a disbursed population. When you
take a look at the United States Army today, we have 710,000
folks on active duty, they are active duty soldiers, Title 10
soldiers. With about 400,000 who were in the Reserve
Components. Their total numbers are greater, but 200,000 of
them, close to 200,000 of them are on active duty. When they
come off of a 12- or 15-month deployment within 3 or 4 days
they are back in their community. And that community won't have
the support base of a Fort Hood or a Fort Bragg. And that is
why we are so excited about being able to provide mental health
care on-line, because we will be able to move into remote areas
and provide Reserve Component soldiers who are part of the
TRICARE, who join TRICARE, and they can do that today with
TRICARE Reserve Plus. They and their families will have access
to that on-line mental health care counseling. And I think you
all know the tremendous impact the Yellow Ribbon Program has
made on Reserve Component soldiers in bringing them back and
giving them the opportunity to go through some reintegration
training at different periods after they return home from
deployment.
So definitely a focus and concern of the Army, one of the
toughest things we have to try to get at.
Admiral Walsh. If I could speak to the multiple
deployments, we don't have correlative data that with more
deployments we have more suicides, but intuitively,
instinctively, I think what we have learned in the course of
these discussions is that what multiple deployments do, often
time under voluntary conditions where the member elects to go
back, sometimes sooner than required, is it puts off the family
integration challenge, and it just allows this to take more
time and to fester in some cases. This is personal opinion.
This is sort of an insight that comes with time, trying to
dissect what the data is really telling us.
On the family and the children issue, I think I can offer
an example here where our collaboration with the Marine Corps
has provided insights that now apply across the Navy in the
case of needs addressed in Pendleton about trying to target
families who have gone through multiple deployments and
specifically the needs of children.
The Marines, with Navy Medicine, piloted a program and
worked with local universities to come up with a program called
FOCUS, which is really a program for families that are under
constant stress from continuing deployments. Took that idea,
Naval Special Warfare saw that, liked it and piggybacked on it,
and now we use that Navy-wide.
What it does is it is another set of antenna that get us
out inside our own population to understand what the stressors
are and what people's needs are. We know that the stress is
more now than it has been before. We know that there are a
number of factors that contribute to it. To look at the service
culture and isolation is not fair to the problem, nor is it
accurate.
So our reintegration efforts with folks who return from
deployment who empirically we know are at risk need to take
into account these factors of trying to plug people back with
their families and help them assimilate into problem solving
for their families, because that is really an issue.
And then finally on the Guard component, for us it is the
Reserves, you have given me an opportunity to highlight. We
couldn't be where we are without the help of Reserves. The
Reserves have been a tremendous force multiplier for us in
terms of the skills they offer and the patriotism they bring to
the mission.
The challenge that we have in this particular area is not
so much those who affiliate, it is those who then choose not to
affiliate after they have served and then we lose track of
them.
Typically the way things work in the service culture is
that if we have got our eyes on it, we will fix it, we will
work with it, we will support and we will find ways to help.
But if we are not looking so then we don't see it. So this is
an area of concern for us.
General Amos. Sir, we get to the children through the
parents. That is how we touch our children, both on active duty
and on our bases and stations where we have DOD schools, like
Lejeune and Pendleton, and overseas where the children live on
the base. That is actually the easiest of how we get to them.
In fact most of those, if not all of those DOD schools, they
have added counselors, because of deployments. The teachers are
seeing the results of the deployments on the behavior of the
children in the school.
So it is not quite as easy outside in the public school
systems, which is clearly where the majority of 100,000
children reside. But to the Reserves--we don't have Guard in
the Marine Corps, we have Reserves, and they have been very,
very effective. We have deployed the socks off them in the last
four or five years. Every unit has deployed at least twice, and
so we are resetting many of those units right now.
Eighty plus percent of our Reserves are in what we would
call whole cloth units; In other words, an infantry battalion,
Marine wing support squadron. And when they go what has
happened with the Reserve side is we have mirrored all the
family readiness programs, all the things I talked to
Congressman Murphy about. We have mirrored all that for those
units that are in the Reserve. So they had the benefit of all
the training, everything. The ones that are troublesome are the
individual log meds, what we call the IRR, the Individual Ready
Reserve that kind of goes out onesie, twosie. They come out of
your state, they come out of my home state. They deploy and
they come back. That is what Chiarelli was talking about, this
Yellow Ribbon Program, this reunion effort which is fantastic.
So the focus effort that came out of University of California
Los Angeles (UCLA) that was just talked about, Web-based
opportunities. We call now every single one of the families. We
are doing our best to stay plugged into them. Through them the
parents we can get to the children, but there are programs
available for our children and our families that are out there,
even if you are an individual log med. It is just the level,
degree of difficulty of that is significantly higher.
General Fraser. Sir, we look at it from a total force
perspective and so all the programs that we have for the active
duty are certainly available for our Guard and the Reserve. We
have a very active Yellow Ribbon Program in every state and
territories now, and it is funded and we are actively engaged
in that.
We do also have some new positions with respect to the
Guard, there is psychological director that has been
established, a directorate, and is being manned. There is also
seven regional teams that are able to reach out and work with
the folks in and the families.
The other things that we have also made sure that we do for
the non-collocated locations where there may not be active
duty, or other types of care, or programs provided is how to
reach out to them, and what can we do. If somebody has a need,
has a requirement for some mental health care, then we make
sure that we get that to them or we will bring them to a
location where they can receive health care.
The other thing that we have done is utilizing our
Preventive Health Assessments, PHAs, before they deploy. That
then gives us a baseline. We then do a post deployment health
assessment. Then there is another mandatory one after that, 90
to 180 days after the deployment for a reassessment. Then that
gives three looks at the individual so that we can see are
there any other indicators so that we can be proactive. Where
they may not be coming forward but we see something through
these assessments, that allows us then to reach out to the
individuals or to the families if we are seeing things, too. So
that has been very hopeful.
Mr. Loebsack. Madam Chair, I would like to submit a
question or two for the record to our witnesses because I am
going to have to go to another meeting.
Mrs. Davis. If you can submit those, that would be fine,
Mr. Loebsack.
Mr. Kline.
Mr. Kline. Thank you, Madam Chair. Thank you, gentlemen,
for being here and for your outstanding service.
Looking at the testimony of all of you and the numbers, I
think it is interesting to note that while both the Army and
the Marine Corps have suicide rates in the 19 to 20 per
thousand and the Navy and the Air Force about 11 per--per
100,000, I am sorry--per 100,000, that puts you at or near the
national average or just barely above half of the national
average. And so one could say you could potentially say well,
we are really okay, we are doing as well as the country as a
whole or we are doing a little better than the country as a
whole, but you are not saying that. You are not satisfied at
any suicide rate and you are digging in, and we all ought to be
grateful to you and your leadership and the service for digging
into that because we share your concern that it is not okay.
But I think it is also important to recognize that this isn't
an extraordinary suicide rate. This is very much in keeping,
sadly, with what is going on in the Nation as a whole.
I would like to address questions to all of you, but I am
not going to do that. I am always tempted to go directly to
General Amos for the Marine Corps tie, but I am not going to do
that.
General Chiarelli, I want to chat with you for just a
minute and pick up on some of the conversation we have had
here. We have been active in a Yellow Ribbon Reintegration
Program in Minnesota for the National Guard, and the Marine
Reserves there have been actively participating in that. We
think it is working very well. Part of the program is to bring
those soldiers back on a regular schedule, 30 days, 60 days and
90 days, so that they can get some marriage counseling, there
is a marriage retreat program in Minnesota. You can go to up
with of the finest hotels in the Twin Cities, quite a nice
event. There is counseling and a chance to reunite, and so
forth. So I think that has been a great program. I am glad that
it is expanding and the states are picking it up, and it seems
to be working for the Reserve Component.
The question is when you look at the active component, I
think that for a long time we have sort of made the assumption
that because you are back with the family, if you will, you are
back on a big post or station, you have got medical facilities,
you have got resources there, that we don't have to worry about
that periodic checking. And I am just wondering particular for
the Army, and perhaps the others could take it for the record,
are you looking at that set period, we are going to look at
these soldiers, the active soldiers on purpose at 30 days or 45
days or some time and again at 60 and again at 90, specifically
looking at the how are you doing, you know, are there signs of
undue stress?
General Chiarelli. Well, if I am not mistaken sir,
Minnesota led with the Yellow Ribbon Program, it is true.
Mr. Kline. Thank you, I didn't plant that question, but
thank you very much.
General Chiarelli. And it was always a frustration to me
that we brought active component soldiers home and made them go
to 14 consecutive days of reintegration training, we brought
mobilized soldiers home and got them demobilized in two days
and that was success. It never made any sense. That is exactly
in my opinion the right template to use, to bring them back.
The Army force generation model has provided us a brigade
centric force. We don't deploy divisions anymore, all we deploy
is brigades. There are some second and third order effects that
our task force is finding. One of them is we normally change
out commands and leaders at the 30- to 60-day mark upon return
from a deployment. And when you do that, you break down that
leadership knowledge where you knew that Private Chiarelli had
a rough time in that last deployment, and if you don't have a
handover to someone who is taking over the platoon or battalion
where you tell Chiarelli's story, he can very easily get lost
in now a desire to get ready to go on the next deployment as
quickly as you possibly can, with the new leadership team that
is totally focused on not only what you have done, but what you
are getting ready to do. So this is something that we are going
to have to work very, very hard to make sure we are bringing
soldiers back at the 90- and 100-day period, that leaders are
passing off good continuity books to ensure that they know who
had problems and who didn't.
I know for a fact that one of the biggest issues I have got
is I don't have the number of mental health care providers I
need. I send a psychologist on rotation, he comes back within
30 days, he comes back to the military treatment facility where
his practice is and we leave a unit without someone who was
with the unit doing those kinds of things.
So you are spot on.
Mr. Kline. Thank you, General. My time is about to expire.
I very much appreciate the answer, and I hope that all core
services are looking at that issue, because there is leadership
turnover, there is personnel turnover. And we need some
continuity, which ironically we now have the Reserve Component,
Guard and Reserve, that I am afraid we may not have in the
active component.
Again thank you very much. I yield back.
Mrs. Davis. Thank you. Ms. Tsongas.
Ms. Tsongas. Thank you all for being here today to talk
with us about this most difficult issue. I was recently in Iraq
and Afghanistan with Congressman Wilson where a young soldier
had been lost to suicide, and I know how hard the commanders
took it. So this is not a simple issue by any means.
I have a question more directed to what happens after
somebody has chosen to take their life and you learn of it,
what is in place? Are there protocols in place to deal with
family members? And also how do you deal with it within the
unit of the military, because all you have to do is look, for
example, when a young high school student is lost to violence
or whatever and the way in which schools come together to
provide counseling and understanding and try to move people
forward. Is there any attempt to address the unit after
something like this happens? And also do you track data to see
can it become viral, can the issue of suicide and the existence
of suicide become viral so it travels within the unit once it
takes place, unfortunately takes place?
I direct that to all of you. I don't know who wants to
begin.
General Amos. Ma'am, if we lose a Marine through a suicide,
that family member is treated just as if that Marine fell in
the battlefield in Iraq or Afghanistan. That great sense of
dignity and care of the family is precisely what happens. The
casualty assistance officer is assigned, the whole unit from
that unit all the way up to Headquarters Marine Corps turns its
spotlight on that family to provide all those things that
family members have happen to them after the loss of a loved
one.
So there is zero stigma, it is not a matter of we are not
going to take care of you because you did something that--you
know, it is precisely with the same dignity we would do with
the fallen Marine. So I want you to know that all the way from
the family members all the way to the burial, and the staying
reconnection typically between that unit and that family
member. So I want you to feel good about that.
Ms. Tsongas. Is there an effort to identify that it may be
different for a family member in the instance of suicide and
something different might be required to be supportive?
General Amos. I don't know. I suspect probably our there
are cases where that might be. But I would also opt just about
every time a door is knocked on at 2 o'clock in the morning and
the casualty assistance officer is there or the notification,
each family, each one of those situations are always different.
We have the way we do it, but each one of them has probably 20
percent of the entire effort is different because family
members are different. So I would say that if there are
differences and things that had to be handled as a result of a
suicide instead of a Marine that was lost in combat, they would
do that. They would know how to do that.
The issue within units by all means. What typically
happens, we lost a Marine last week. The report I got was the
unit stood down. We brought all the leadership to the unit, it
was an infantry battalion, brought all the leadership of the
unit together, to include the entire unit in pieces and
companies as a battalion, and they sat down and talked about
it. In other words, the last thing we want to do is hide it. We
want the Marines to know about it and we want them to
understand there is an obligation that they have to the family
if they are close to that family, and that we talked about it.
We bring the chaplains in, and that is where it begins. And
then from that point if there are issues, like best friend kind
of issues, then we are sensitive to that and we will route that
young man or young woman to the right help that we do. We pay
very close attention to that.
The final thing I would tell you is that I am always
nervous about when a unit has a suicide it might then make
somebody else think that this is an option. And I worry about
that. I can't tell you that I have seen that, but I will tell
you I am always concerned about that.
Ms. Tsongas. So there is no actual data around that?
General Amos. We actually have data, we can certainly tell
because we have tracked all the suicides since the early 90s,
so we can tell precisely what unit and where they are.
Ms. Tsongas. I would be curious to see that from all the
services if that was possible.
General Amos. Okay.
[The information referred to can be found in the Appendix
beginning on page 109.]
General Chiarelli. I have some pretty strong feelings about
that. The literature that I have read indicates that there is
not a tendency for suicides to multiply through a unit or an
organization because of a single or a second suicide. And I
think sometimes out of frustration people want to go there. And
I think it is exactly the wrong place to go. I totally agree
with Jim, in the requirement to sit down and talk about this
from every single incident.
As far as the stigma, I would like to say we are as good as
our Marine brethren, but I fear we are not, because stigma
still exists in the United States Army. I know that for a fact.
We are making great strides at trying as hard as we can to
change that, but stigma not only resides in the United States
Army, it resides in the civilian world. And I would hope that
some day the family and parents of suicide victims would be
treated exactly the same. We will do everything we can from the
Headquarters Department of the Army (DA) level to be able to do
that, but I fear that it is not the same across the board in
every single unit in the United States Army.
Mrs. Davis. Ms. Tsongas, I am going to move on because we
have a few people who have not had an opportunity yet. I also
want to ask unanimous consent for Mr. Kennedy to be able to
participate and ask questions. Hearing no objection, thank you.
Next we move to Ms. Bordallo.
Ms. Bordallo. Thank you very much, Madam Chairman, and
thank you to all our witnesses here today. General Amos, a
special hello to you, and I hope that all things are still a go
with the Marines coming to Guam and that the community on Guam
will receive the full and uncompromised support of the
Commandant and the Marine Forces Pacific as we go forward with
the realignment and the buildup. Thank you.
I am very concerned about the mental well-being of the men
and women in the Army and Air National Guard, since we have
such large numbers of guardsmen and reservists, the highest
number per capita of any State in the Union. Given their
increased assignments over the past six years, we have seen a
significant stress on their force from equipment availability,
to training, as well as psychologically on the servicemembers
themselves.
There was an article in the Pacific Daily News of Guam
recently, our local newspaper, that reported on the
psychological stress on our National Guard force. And Madam
Chairman, I will ask that these articles be entered into the
record.
Mrs. Davis. Yes.
[The information referred to can be found in the Appendix
on page 101.]
Ms. Bordallo. In the article one woman soldier stated,
``There is incidences where my daughter would say something to
me and I would snap. And she'd come back and say, mom, we are
not the enemy, you are at home now.'' And this woman soldier
goes on to say, how do I adjust? How do I adapt to the changes
that I am bringing home?
So my question is for General Chiarelli and General Fraser,
what are the Army and Air Force doing to ensure that our
guardsmen and women have access to appropriate mental care when
they return from deployment? Now I am particularly interested
to hear your perspective on how you are working to ensure a
home station mobilization and demobilization for the National
Guard. I believe that the home station demobilization, known to
some of us as the Yellow Ribbon Program, and that was referred
to earlier here, helps in identifying these symptoms early, but
additionally after demobilization what specific steps are being
taken to watch for any symptoms that may develop over time? And
is there a program in place to monitor this type of activity?
And is there any follow-up with individual soldiers beyond the
30-, the 60-, the 90-day checkup periods after demobilization?
General Fraser. Yes, ma'am. With all of our Reserve
Component, and more specifically with the Guard, we do the same
thing with them as all of our programs for the active duty. And
so they have access to all of those programs. They have also,
as you mentioned there, the Yellow Ribbon Program, we have that
and we are very much in favor of it. We see a lot of positive
things coming out of it, and so we have ensured that that
program continues to be viable.
And the other thing that we do is our surveys, that we do
before individuals deploy, give us a baseline. That is the
Preventive Health Assessment. And so now they complete those.
And to go to your point about follow-up afterwards, that is
the reassessment that is done between the 90 to 180-day. And so
you are able to take a look at predeployment, postdeployment
before they return home, and then another reassessment to see
if there has been any change, which allows us then to be
proactive in providing them any help that they may need. And
that is an indicator.
The family members are all briefed, too. And so they know
the programs that are available. So we continue to reach out to
all the family members to make sure they are aware of the
various programs that are available.
For those that are non-collocated though, we still have
work to do. And that is the hardest one that we are trying to
make sure that we accomplish now, because they don't have
everything that is available to them. So we keep working it as
hard as we can, we are not perfect yet, but we will stay at it.
Ms. Bordallo. Thank you.
General Chiarelli.
General Chiarelli. Initially counseling happens as a
soldier returns from deployment and the demobilization time
period. Then I have indicated to you that we are very excited
about being able to provide mental health care on-line. That
will be kicked off in a test program in three States that I
know of in the National Guard armories, where soldiers will be
able to go to the armory and go on-line and get that kind of
care. And then Military One Source also offers the opportunity
for up to 10 appointments to an individual feeling that he
needs to see a mental health care professional in person.
Ms. Bordallo. Thank you.
Mrs. Davis. We are going to have another vote. What I would
like to do, we have three individuals, three members who want
to ask questions. If we can get through those three in the time
before voting, and then we are delighted that some of you may
be able to stay. We would love it if you could all stay for the
second panel in case there are some additional questions, and
we will return after the votes. They are the last votes. So we
wouldn't be interrupted again.
So if I could go on to Ms. Shea-Porter and then we will
have Mr. Coffman and Mr. Kennedy. If you could all try to keep
your questions really brief so they can respond in the time,
that would be helpful.
Ms. Shea-Porter. Thank you. And General Chiarelli, thank
you for your comments. Your comments were wonderful. I have a
question though. I wondered if you know what percentage of your
suicide victims had drug or alcohol problems.
General Chiarelli. I can't give you that number off the top
of my head right now. I know it is lower than one might think,
but definitely an issue that we are really working hard at
right now, because we know that drug abuse and alcohol abuse
has increased since the start of the war. There is no doubt
about it. I will get that number to you.
[The information referred to can be found in the Appendix
on page 109.]
Ms. Shea-Porter. Thank you. Because I know a lot will self-
medicate to ease some of the pain. So first of all, what is the
process for discovering that someone has drug and alcohol
problems and how do you treat them?
And I am going to say it all at once so you will be able to
answer it in one question. Can you describe the treatment you
do after diagnosis, do you have intervention, and what is the
length of your treatment, and do you work with the family as
well?
General Chiarelli. The length of the treatment depends on
the soldier. There are two major ways. There used to be only
one. We were very reactive before. We waited until an incident
occurred, and you were command referred either because you came
up hot on a urinalysis for some kind of drug abuse or you did
something like get picked up for driving while intoxicated. It
kicked off a pilot program at three installations, only at one
right now, where we are allowing soldiers to command refer
themselves, to literally self-refer themselves, self-refer
themselves for drug and alcohol counseling, and their command
is not informed. So you can go in, we have set up special hours
that are after duty hours on Saturdays and Sundays where these
appointments can be made where a soldier who self-refers can go
in, get the care and the counseling he needs, and hopefully
head off a problem before we end up in the reactive mode.
Ms. Shea-Porter. I think self-referral and being able to
keep their privacy is absolutely critical for soldiers to step
forward for treatment. But again, if you recognize them--the
length of time that they are in treatment is critical. A lot of
the programs that fail in the general population, like three
days inpatient and then they don't have the support around them
when they are discharged. So if you find somebody and you
recognize that they do have to be hospitalized and treated for
this, what is the range of the program, is it available to all?
General Chiarelli. My problem is counselors right now. I
don't have enough counselors. We are really focused on hiring
as many as we can. But it is up to the individual counselor to
determine the severity of the case and make a determination on
whether it can be handled as an outpatient or whether inpatient
care is required. If inpatient care is required, we have a
number of facilities we use throughout the United States where
we will send individuals for the requisite amount of time to
handle the substance abuse problem that they have.
Ms. Shea-Porter. And do they have to wait for the referral
because of your backlog?
General Chiarelli. That is exactly the problem I have got.
When you don't have enough substance abuse counselors and you
get a series of command referrals, what I found with the
recidivism rate that I had, where the number of soldiers who
had come up hot on a urinalysis for drugs, the time it was
taking to get them referred and get them seen by a counselor
was so long because of a higher incidence rate and not enough
counselors. So that is an issue that we have had to attack and
we are attacking it as hard as we can. I couldn't kick off the
pilot program because it wouldn't do anybody any good to self-
refer yourself for an alcohol problem to be told well, come
back in eight weeks and we will take care of you.
Ms. Shea-Porter. And sadly the same problem exists in the
general population.
Thank you, I yield back.
Mrs. Davis. Thank you.
Mr. Coffman.
Mr. Coffman. Thank you, Madam Chairman. First of all, I
want to compliment you on something you are doing and encourage
you maybe to enhance that or certainly stress that, and there
are two things that I think are very effective. One is I guess
the postdeployment briefs prior to leaving the theater of
operations. I found during the Gulf War, in leaving Iraq in
2006 of the United States Marine Corps, that those briefings,
those postdeployment briefings were extremely helpful in
readjusting, in my case, back to civilian life. So I want to
obviously I was an individual augmentee and I think that
certainly the Marine Corps was covering everybody, and I want
to encourage everybody that that is extremely helpful.
And the second thing that is being done that I want to
certainly stress that you continue doing, if not enhance, and
that is the decompression period, particularly for the Guard
and Reserve, that they come back somewhere and that there is a
period of time where maybe they are processing out, but it is
extended a little bit prior to sending them back out to
civilian life. I think that is another important feature that
you all do.
Last is a question that I have in terms of a preventative
tool. I was in Army in between a Marine Corps infantry, combat
training and combat is tough stuff. It requires people that are
physically and mentally tough. And you can't sugarcoat that.
That is just the way it is. And what tools have you developed,
or are you looking at, or I would hope that you would look at,
that when you are looking at that intake, when you are looking
at that potential recruit, people have varying thresholds to
stress. And there are people that by the nature of their makeup
are going to break a lot earlier than other people. Are you
being able to look at those recruits, potential recruits, and
develop tools to say, you know, this person just isn't going to
make it, they are going to fall apart, and this person has the
characteristics to be successful. I think that is absolutely
important to try to address this problem preemptively instead
of dealing with it after the fact.
So if you all could address that, I would appreciate that.
General Chiarelli. Well, that is why I am so excited about
comprehensive soldier fitness, because it has such a robust
assessment tool on the front end. It will not only be used when
a soldier comes into the Army but will be used throughout his
career to evaluate his resiliency and his ability to do exactly
what you are talking about. So from the Army's standpoint, that
is our big idea and what we are looking at to get at the exact
problem you are talking about, sir.
Mr. Coffman. Are you doing it in terms of looking at
potentially saying, you know, you meet all the standards, but
we think that given there are some behavioral characteristics
here, based on assessment tools, that maybe you are not meant
for the United States Army, certainly you are not meant for
ground combat?
General Chiarelli. That is an excellent question. We can do
the assessment. I have asked the same question. Once we get
this totally in place, there will be some legal issues that we
will have to, I know, maneuver our way through to show that the
assessment tool has that degree of accuracy that we could make
that kind of call.
Admiral Walsh. From the Naval perspective, we have sailors
serving on the ground. The assessment tools that we have rely
on the judgment of leaders, and that is where we see this
warrior ethos passed from one generation to the next. We see it
in the training pipeline for Naval Aviation, we see it in the
Recruit Training Command, we see it in Special Warfare Command.
The way we have been able to tailor our training command
pipeline so that we do put stress on folks to see how they
react and respond under stressful conditions, however
artificially induced, gives us a preview of how they will react
over time in the duress of combat, not perfected.
Mr. Coffman. Thank you.
General Amos. Sir, at recruit training, in the next session
we will have maybe General Lefebvre up here sitting in this
spot and he commanded the recruit depot at Parris Island, so he
will be able to give you precisely. But we specifically and
very purposely put an enormous amount of stress at boot camp
for a 24-hour period of time. And what we want to do is find
out those young men and women that can't handle it. This isn't
machoism, it is just a function of the unit, you know, what the
Marine Corps is. And after 24 hours they get what they call the
moment of truth, that is where the drill instructor takes his
hat off and says, okay, it is now time, those of you that have
now figured out that you're in the wrong spot, no harm, no
foul. You can leave the depot, and of course we do that. So
that is how it happens entry, in the early entry. We rely on
those drill instructors, and as you know, they are pretty
doggone good.
A little bit farther down the pipeline for bona fide card-
carrying Marines, we have immersion training that we put them
in, where the sights, the smells, the sound, the fear, the
noise builds their level of stress while they are doing their
training up to the point where the guys that are combat vets,
if they have any issues in some cases that comes out during
this immersion training. So we give that. We have a combat
fitness program now that the Commandant started about a year
ago which actually gets us in shape to do the kinds of things
we find in Iraq, and then we finally rely on small unit
leadership, those NCOs and those staff NCOs and those young
officers paying very close attention.
Mr. Coffman. Thank you.
General Fraser. Some of the exact same processes are used
as far as our troops go too. Early on using some of the tools
that are available to us to ensure they get into the right
career fields. As they are stressed in their comprehensive
training program, some are actually dismissed and possibly then
retrained in other areas because they still want to continue to
serve. Part of going into theater though, it is a
comprehensive, realistic training environment to stress them as
best we can and then relying on those leaders to make that
assessment if they are ready to go.
Mr. Coffman. Thank you, Madam Chairman.
Mrs. Davis. Thank you.
Mr. Kennedy.
Mr. Kennedy. Thank you, Madam Chair. Thank you for the
honor of able to participate with this panel. I appreciate my
colleagues agreeing to let me speak.
I first want to thank all those members of the armed
services who are here for their service to their country. It is
an enormous sacrifice. You are not in it for the money, that is
for sure. You are in it for your service to our country, and
for that on behalf of my constituents I want to thank you for
your service, especially at this time while we are at war. You
never know when you serve, when you will be serving, whether it
is at peacetime or wartime, or where you will be serving and
whether you will be in a place where you might be called upon
to put your life at risk. And all of us want to say thank you
for your service to our country and to say thank you to your
families as well for the sacrifice they make on behalf of our
country.
It is really in that regard that I wanted to ask all of our
panel what they think of the opportunity for us to get
treatment for and really for our soldiers by helping support
our family members, because really the family is our first line
of defense in helping those returning servicemen and women when
coming back. And we found with the Veterans Committee the
benefits all go to the veteran, but it might be good if we kind
of broaden the definition of beneficiary to include the spouse
and the kids in terms of reimbursement for services, because,
you know, they are suffering from secondary post-traumatic
stress disorder when they see their family member overseas and
in harm's way, and of course they are away from their family
member for so long that is a stressor. But when their family
member comes home, would you not agree that if it were up to
us, it would be good to get them ready to know how to identify
and be ready for and support their loved one so that they can
help them reacclimate to family life, and don't you think we
need to be kind of helping to reimburse for whatever services
that may be needed for those family members?
Can we start with you General Chiarelli.
General Chiarelli. Well sir, the military family life
counselors I think has been a huge, huge improvement in the
last few years to provide that kind of a service and care for
families down to that battalion level. They are working inside
the battalion. But I am very proud of the fact that all family
programs that we have put so much into these last years, they
have all been put into the base budget in everything from child
care to all the services available to families are there and
available throughout the deployment and once soldiers come back
home. So I really think the emphasis has been placed on this
has been emphasis well placed, and it has had a huge impact on
the United States Army.
Mr. Kennedy. If I could follow up, I know my previous
colleagues, Representatives Coffman and Carol Shea-Porter, both
asked about how to screen soldiers before they come in to make
sure that they are adequately prepared for the stresses of
combat and military life and then how to best treat a soldier
who might be suffering from substance abuse disorders and the
like.
I have introduced, along with Walter Jones, the SUPPORT
Act, Supporting Uniform Personnel By Providing Oversight and
Relevant Treatment, SUPPORT in short, and that is to oversee
basically all of the substance abuse and treatment programs
that are out there within DOD to assess what are working and
what aren't and bring some coordination and see to it that we
are using the best practices in our treatment efforts.
And in regards to making sure our servicemen and women can
be prepared for any situation, I wish we didn't have to have a
stigma, because when I was first elected to Congress I was
asked to go down to the John F. Kennedy Special Warfare Center,
and there our elite Green Berets have available to them
psychiatrists 24 hours a day, 7 days a week. And you might ask
why would the elite of the elite have psychiatrists available
to them. Well, it was believed by the commanders that it made
them better at what they do to have a clear head and a healthy
state of mind when they were called into combat duty.
Now if that was the thinking for our elite forces, why
isn't it the thinking with the rest of our forces if they are
now being called in to all kinds of dangerous situations to
have a healthy state of mind? Why do we look at this as a
weakness? Why don't we look at this as proactive, as my
colleague Representative Coffman said, and think of this as a
strengthening tool rather than as a reactionary tool to only
treat people who may be looking as though they are falling
apart? We look at this as strengthening. They can better be
resilient, and they can better make decisions under combat in
stressful situations, and they can be better soldiers in the
process.
So what would all of you like to say about that?
Admiral Walsh. We have mental health specialists that
deploy with our services, with our units, with our carrier
strike groups. So it is viewed as an asset that helps to
sustain the force. So the capability is there no matter what
happens, under what conditions, to help servicemen, regardless
of their rank or their rate or gender or background, whatever
help that they need. And so we see it as the embedded concept
works at sea and helps sustain the force.
Mr. Kennedy. What troubles me is that with the Marines
having just in 2006 put the suicide prevention program in
place, I mean, this is many years after the war started and
then the funding for suicide preventions remain relatively
stagnant in spite of the fact that suicide has gone up. Am I
right or did I not get the testimony correct?
General Amos. Sir, the funding is not an issue. We have
never had an issue with funding, both from the perspective of
if we ever asked for it we can get it. Quite honestly, the
Services are more than willing to realign programs to get the
money to do it. So funding is not an issue.
Honestly, I think this has been an evolutionary process.
Prior to stepping across the border in March of 2003, we had a
military that hadn't been to combat since the Gulf War, for all
intents and purposes. So now we spent probably the first two or
three years not in denial, but this effort of combat stress,
the issue of what is this doing to our force, because quite
honestly I think everybody thought well, this war will be over,
we will be able to come back and reset, and we are going to be
okay.
Now we are coming at this from my perspective probably a
little bit late within the last three years I would say,
certainly in my service the last three years, have been huge
efforts put towards this thing. I will tell you there is not
enough mental health folks right now. What you have described
with the special forces is exactly what we would like to have
happen. We have got 24 mental health folks in Afghanistan with
our 10,600 Marines right now. We want more, we want to get them
there. In a perfect world you would want to have as many of
those kinds of folks as you possibly could get and higher down
with those units for the very reason you have talked about.
Quite frankly, they are not there.
Mrs. Davis. Thank you, Mr. Kennedy. We are going to have to
close.
What I would ask you to do, I think, is you have spoken
about the need. Is it necessarily money? It is obviously
trained people who would be available and either in the service
or in some cases, whether it is TRICARE or family care, help
for our children. It is through the health programs that their
families are engaged with. Thinking about what would it look
like if we actually were covering these issues at a better
level, what would that mean? How many personnel are we really
looking for and what areas particularly might they be, the full
spectrum in terms of our servicemembers and their families. I
think trying to maybe see ideally where we ought to be, that
might help us. If we think in terms of strategically where we
need to be, we wouldn't want to even think out five years,
maybe even three years for that matter. Because I think looking
at the mental health work that is being done, the research,
trying to follow up, go through the data and understand it
better, we know that that is in the future a little bit before
we have all of that information.
You have great information. I think you all are doing what
needs to be done, and it may be that some of the concerns that
we have had over the years haven't necessarily been met because
it has been hard to figure out what you really need. And now we
have an opportunity to perhaps see that clear. And we would
certainly hope that with those budget requests that we were
able to at least understand the extent to which we are able to
meet the most critical needs. And if we can help with that, we
would certainly like to know what does that picture really look
like.
Mr. Kennedy. Madam Chair, there was an article in the
Washington Post I would like to submit for the record about the
crime rate on base at the 4th Infantry Division in Fort Carson
being 114 times higher than the surrounding Colorado Springs
community, and the issue here is how are we going to deal with
the servicemen and women dealing with their stress and getting
caught up in the criminal justice system and even the court-
martial system.
Are we going to make special allowances to the fact that
much of this is due to their post-traumatic stress? How is the
military going to deal with this? Are we going to end up
locking up all of our soldiers because of the crisis they are
facing emotionally as a result of their service?
[The information referred to can be found in the Appendix
on page 105.]
Mrs. Davis. Thank you, Mr. Kennedy. Thank you all so much
for being here. If you can stay a while for the second panel we
would certainly be grateful for that. We will return after
several votes, and then there will be no more interruptions.
And we really do look forward to hearing the second panel.
Thank you so much.
[Recess.]
Mrs. Davis. Thank you. We are pleased to start with our
second panel. And we are delighted to have you here. Lieutenant
General Rick Lynch and Major General Paul Lefebvre. Thank you.
Please.
STATEMENT OF LT. GEN. RICK LYNCH, USA, COMMANDING GENERAL, III
ARMORED CORPS AND FORT HOOD, U.S. ARMY
General Lynch. Thank you, ma'am. Chairwoman Davis and
Ranking Member Wilson, thank you for this opportunity to talk
about what has happened in III Corps and Fort Hood, but
candidly, more important, thank you for your continued support
for our soldiers and their families and your demonstrated
commitment. Just having the opportunity to watch the engagement
with the service vices shows me how dedicated you are to truly
helping us take care of our soldiers and their families.
I am privileged to command III Corps in Fort Hood. That is
63,000 soldiers, over 10 percent of the Army, and one-third of
the Corps is currently deployed fighting and winning our
Nation's wars, one-third of the Corps just recently returned
from a deployment, and one-third of the Corps is preparing to
deploy. That is the new normal in an operational force here and
one facet of the Army Force Generation (ARFORGEN) model.
I am personally responsible for the lives and well-being of
125,000 family members and 200,000 retirees in the central
Texas area, and I take that responsibility very personal. I
believe that engaged leaders love their soldiers and their
families like they love their own children, and indeed that is
the approach we take at III Corps and Ford Hood.
I don't spend a lot of time at Fort Hood talking about
suicide prevention, but I spend all my time talking about
stress reduction. Because I am convinced that the stress of the
force can indeed be reduced by positive affirmative actions.
And if you don't mind I would like to highlight four of those
things for you now and then take whatever questions you would
like towards the end.
The first thing is we have declared III Corps and Fort Hood
as the family first Corps. If you are assigned to III Corps,
you are home for dinner every night by 6:00 because that is
where the family unit forms and functions. If you are assigned
to III Corps, you leave Thursdays at 3:00 in the afternoon.
That allows you more time with your families, that allows you
to be home when the kids get home from school, that allows you
to have some additional family activities. And if you are
assigned to III Corps in Fort Hood, you don't work on weekends
without my personal approval.
Because the only thing you cannot do once you deploy is
spend time with your family. So what we have to do is mandate
quality family time. It was only three days in the command of
the Corps, this is now over a year ago, when a family member
came and said, General, you all are lying to us. I said, ma'am,
what? She said, you say that you brought our husbands home in
this thing called dwell time but we never see our husbands. He
comes home after the kids go to bed, he is working on weekends,
you take him off to the national training center, and she
looked me in the eye and said, you might as well just keep him
because we are not seeing him anyway. That is why we are the
family first Corps. And that has indeed had great effect in
reducing the stress on the families.
As part of that what we have done is emphasized the
maintain balance and have fun. What I found when I returned to
the Corps is we lost the ability as an Army to have fun. So
what I have done is implemented a lot of things that allow
folks to have fun. We have reopened the club systems, we have
rejuvenated family programs because I want the youngsters and
their families to enjoy life at Fort Hood.
The second thing we did is we took an entire city block at
Fort Hood, Texas and made it the resiliency campus. See, I
believe we spend too much time addressing issues with soldiers
and their families after we broke them and not enough time
keeping them from breaking, and I think that is the essence of
resiliency. So at the resiliency campus we took a chapel, which
happened to be the chapel my wife and I were married in 27
years earlier. We took this chapel and turned it into a
spiritual fitness center. It is manned 24/7 by chaplains and
counselors, so if a youngster or a family member has a problem
late at night and they need someplace to go and somebody to
talk to they can go to the spiritual fitness center. They can
go there to pause and reflect, they can go there to meditate,
they can talk to people with shared experiences, they can
indeed grow spiritually. It is not about religion, it is about
a spiritual foundation from which to turn to.
We turned a gym into the wellness center, and it is not
about how much push-ups you can do but how truly well you are.
So we do diagnosis of the individual, of the soldier and their
family, we determine their level of wellness and then we take
them into the wellness center and improve their wellness.
The primary issues with suicide in a III Corps perspective,
we have had four completed suicides since the first of the
year. It is about strained relationships, and it is about
financial issues. So on the resiliency campus we put our
military family life consultants that General Chiarelli was
talking about so you have immediate access to counselors, and
we have a national assistance center which allows us to improve
the financial readiness of our soldiers, which reduces the
stress on the family, so so very important.
So this resiliency campus indeed found a life of its own,
and people come there not because they got a problem, but
because they want to avoid having a problem. It is all about
getting in front of the problem and not reacting afterwards.
We are all concerned at the stigma related to mental health
issues. So the way we approach this at Fort Hood is every
Friday--correction, every Wednesday at 3:00 I personally greet
every new arrival to the great place. And normally that is
about 300 to 400 new soldiers and their families. And I explain
to them how important they are, their self-worth, how important
they are to their families, to our organization, and make it a
point to tell them how important they are. And then I tell the
group that I have cried more in the last three years than I
have cried my entire adult life. One hundred fifty-three
soldiers died on the place in the battlefield that I placed
them as I was commander of the task force as part of the surge,
and I got to live with that the rest of my life. And I am
personally responsible for 882 gold star families, these
families who have paid the ultimate sacrifice, and that has an
emotional drain. But I share with the larger audience that I am
indeed affected and I am getting help, so if they got a problem
raise your hand, so we can get you the right kind of help to
reduce the stigma. The stigma is still out there, but it is
something we approach on a daily basis.
And the last thing, it is all about engaged leadership. I
personally chair a suicide prevention review board once a month
where every commander and command sergeant major and I review
all the suicidal trends across the Corps from the previous
month. I thank God and I thank engaged leadership we have only
had four completed suicides. But three times a day my phone
rings with a youngster who has got a suicidal gesture, an
ideation or an attempt. And what we do as a group of leaders is
we dissect each case and try to learn from those cases. We
empower our leaders with information on how to deal with
suicidal ideations. And we find ourselves in a situation now
when a youngster who has a problem he feels free to tell his
battle buddy or his leader that I got a problem, that I need
some help. That has significantly driven down the completed
suicides at least at Fort Hood, Texas.
So again I think it is all about reducing stress, and we
continue to take action at Fort Hood to reduce stress. And
ma'am, with that I am happy to answer any questions.
Mrs. Davis. Thank you very much. We will go on and come
back to questions. Thank you.
General Lefebvre.
STATEMENT OF MAJ. GEN. PAUL E. LEFEBVRE, USMC, DEPUTY
COMMANDING GENERAL, II MARINE EXPEDITIONARY FORCE, U.S. MARINE
CORPS
General Lefebvre. Thank you, ma'am, Chairwoman Davis,
Ranking Member Wilson, distinguished members of the committee.
On behalf of all marines and sailors and the II Marine
Expeditionary Force (MEF), I would like to thank you for having
us here today to let us talk a little bit about what we are
doing down in the Carolina Marine Air-Ground Task Force
(MAGTF).
Just by way of reference, as the Commandant of the Marine
Corps said, I was Commanding General at Parris Island for two
years. So I had recruiting duty east of the Mississippi, and I
also had recruit training. And for the last year I was the
Deputy Commander for the 18th Airborne Corps, largely an Army
unit in Iraq, and I chaired their Suicide Prevention Board. And
I am currently serving as the Deputy for II MEF, and I am
headed to a Marine Special Operations Command shortly.
I also have personal knowledge of the General's command and
leadership philosophy as it was exhibited in Iraq, and I can
tell you that it doesn't get any better than what the General
does in terms of leadership. You can have all the programs you
want, but it is the commander and what he does to make all
those things happen that are important. And his impact in Iraq
was felt long after he left on many, many soldiers across the
theater.
In reference to II MEF as a combat unit supporting both
Iraqi Freedom and Enduring Freedom, we very deeply feel the
death of every marine and sailor, whether combat loss,
accidental fatality, or suicide. I would reinforce General
Amos' statement when he said that when a marine or sailor dies
by suicide the needless loss of life is a tragedy. We take
every opportunity to ensure our marines and sailors know how
important they are to the Nation and to the institution.
II Marine Expeditionary Force is grateful for your support,
that of OSD and from our service in dealing with this issue. In
our analysis of factors affecting suicide we have identified
trends that may contribute to a tragic suicide; however, the
majority of our suicides this year appear to be impulsive
responses to a short-term issue, often a troubled relationship.
We are trying to determine how cohesion is affected in certain
units that continually regenerate for combat.
As marines we seek to build a strong sense of commitment
within our platoons, companies, battalions, and squadrons to
foster the feeling of an extended family so our warriors know
they will always have someone to turn to immediately when
confronted with problems. It is imperative that in an era of
instant communication where personal issues boil quickly that
we are there to intervene and to mitigate. This task has proven
to be challenging given the increased and extended operational
tempo resulting from the war.
Whether deployed or at home station, the day-to-day
activities to either conduct or support requisite training keep
our leaders at full steam and almost in perpetual motion. The
challenge for our leaders is to balance the preparations and
execution of war with team building, mentorship and the
development of a war ethos for their subordinates while
maintaining their own families and personal relationships.
It is the sense of team among peers, unit esprit, and the
approachability of leaders that provide the safety net when the
individual marine lacks the resiliency to handle a flash point
personal issue or extended period of stress. Our operational
tempo has stretched the safety net on a number of occasions.
Our Commandant acknowledged the effect of operational
stress when he gained congressional approval to increase the
size of the Marine Corps from 182,000 to 202,000. We had a 5-
year period in which we had hoped to do that, and we actually
accomplished it in 2\1/2\ years, and this year we hope to see
the benefit of that buffer so to speak that we have established
here now with the force. His intent was to break this 7 months
deployed, 7 months home cycle--and as you know it is not really
home, it is preparation for the next deployment--and to put a
14-month buffer in there which allows the concerned leadership
that we require at the individual level to identify these flash
point issues that often lead to a negative consequence.
We believe a key issue in this suicide rests with smart
young leadership. I would tell you that--I would emphasize what
General Amos said in that we have put all our marbles, so to
speak, in the NCO basket because they are closest to this
particular problem. And they are young themselves, as General
Amos talked about, probably the youngest of all the force. So
how does a young corporal who succeeds in combat, how do we
give him the skills to both understand the issue and to be able
to deal with it. So that is our focus of effort as we speak
today.
My boss, Lieutenant General Denny Hejlik, the Commanding
General of MEF, recently addressed all lieutenants and captains
who had been very focused on the operational aspects of this in
order to enhance the concerned leaderships required by junior
officers, in particular to understand what the signs are here
within operational stress both in the families as well as
within their marines. And our Sergeant Major has done the same
with all our staff NCOs in the force. We will continue to
create and maintain an environment where marines and sailors
are cared for even though we maintain the tempo that I have
talked of.
Our marines and sailors must know that they are integral to
the success of the Marine Corps and to the expeditionary force,
and sometimes we forget that. In the heat of the moment as we
prepare for the next training piece or the next deployment it
is important to remind them from a resiliency standpoint what
we have accomplished and what role they play in it from a self-
worth perspective.
Most importantly, we want our young marines and sailors to
have the confidence that they can reach out and embrace the
support they need from the leadership without any stigma
attached. Our way forward is to continue integration of service
level programs with local initiatives that meet our
circumstances.
The NCO program that I talked about is extremely hard
hitting. It starts with a 30-minute video. And this video takes
you through a marine from combat that starts to experience the
stress of the post-stress environment, to include the financial
piece, marital issues, and marines can see for themselves what
it is to witness this as it occurs even when it has not
happened in their own lives. This video also takes a marine
corporal who attempted suicide and talks to nine of his
supervisors that intervened in the suicide and talks to what
they saw. And significantly, it includes one of our Navy Cross
winners who actually attempted suicide also, and it talks to
how he got to that point from a relationship standpoint, and it
walks you back to where he started to and then how he got there
and concludes with three family members that have experienced
suicide.
And then the Socratic method is used by NCOs with NCOs to
talk about the video in terms of the vignette as to what the
lessons learned. And we think this will enhance the skills at
the NCO level. As a matter of fact, this past Friday General
Hejlik with all the general officers in the MEF, all the
leaders and the staff NCOs, witnessed the instruction for the
purposes of making sure that we understood we had the best NCOs
in here to be the best teachers for this as we really focus
down at that particular level.
Additionally, we are implementing the operational stress
control and readiness. We talked a little bit about that in the
previous session. What that does, it provides mental health
professionals provide instruction to our doctors and our
chaplains and our leaders at the battalion level to give a
connecting thought to these NCOs that we are training. So we
are pushing down the capability down to the battalion, down
actually down into the company level. That training is going on
now and will be implemented here within the next 90 days. So
greater awareness, as well as greater response capability.
Lastly, I would like to conclude by saying that we are not
accepting this. You have acknowledged our great effort. There
is still tremendous work to be done. I very much appreciate the
efforts of this committee to look at this and to help us. Also
very much appreciate the sharing of ideas with our sister
services here on this because no one has the answers.
Again, thank you very much for the opportunity to express
my thoughts today. Thank you.
Mrs. Davis. Thank you very much. It is good to have you.
General Lynch, if I could just start by asking a few
questions. How has your new program, if we call it, been
received, and do you find that there is work that is not
getting done because of the schedule? Have the exercises of
time management sunk in and are people utilizing them? People
must be watching what you are doing and wondering what is going
on.
General Lynch. You know, I went so far as to bring in the
Franklin Covey Institute for Time Management to give classes to
all my leaders, because what I found is we are indeed wasting
time during the course of the day which caused them to have to
work late at night which caused them to be away from their
families. So I just took away that option. If you got to be
home for dinner by 6:00, you got to manage your time better.
And I gave them the skill sets so they could manage their time
better.
It is well received across the installation. It is
embarrassing to me the number of family members who come to me
to tell me thank you. When I ask what are you thanking me for,
they say we are thanking you because you gave us our husbands
back. They should never have to do that. That is something we
should do all the time.
So it really is a function of effective time management,
take away the options to work late at night, work on weekends
and we are as prepared for war now as we were when we found
ourselves working seven days a week.
Mrs. Davis. And are you able to evaluate that? Is there
something in particular that you are looking for in that
evaluation that would be helpful for others to know?
General Lynch. Yes, ma'am. We continue to work all of our
training regiment in preparation for combat operations. That is
indeed what we are trying to accomplish. Number one is prepare
for and win our Nation's wars. So there has been no degradation
in our capability. And since I have been the corps commander we
have deployed multiple units, and in the deployment they are
doing extremely well. So I know we didn't lose anything there.
And I do know now the stress on the families has been
reduced because when the husband is home or the wife is home
they are truly home. And I am seeing all indicators go down;
domestic violence go down, substance abuse go down, suicide
ideations, gestures, attempts go down as a result of reducing
the stress.
Mrs. Davis. One of my colleagues, and I think it was Dr.
Snyder who mentioned earlier that we are not just focusing on
those who actually commit suicide, but people that are in pain,
that are hurting in a whole host of ways. And I am wondering if
you have a sense that--you mentioned that things are looking
better.
What about acting out? What about people getting into
trouble in town? We know that there are a number of problems
that a number of our military men and women are experiencing
that may really be of great concern as we look at the numbers
soon. What are you seeing? Are people not getting into trouble
as much? I like the fact that you took everybody on a
motorcycle run. I saw that.
General Lynch. Yes ma'am. What we found is----
Mrs. Davis. Are you tracking that, are you tracking those
numbers.
General Lynch. Yes, ma'am, we are. I get briefed routinely,
as all commanders do, on statistical trends. And one of the
things I am working and looking at is crime rate on the
installation and off the installation, and it has been
significantly reduced over the course of the last year, to the
point of about, I think it was half of what it was this time
last year. So the kids are indeed, the kids being my soldiers,
I refer to them as my kids because I love them like I love my
children, the kids are indeed as a result of having reduced
some stress and emphasizing to having fun--I mean, you talked
about my motorcycle run. I happen to be a Harley Davidson
aficionado. So we take these runs, but it is all about reducing
stress. And the result of them being less stressed they are
less likely to hurt themselves, hurt somebody else and do
something bad, and we are seeing those trends.
Mrs. Davis. General Lefebvre, you had mentioned working
with the commanders and really trying to educate them as well.
And I am just wondering if you have had much pushback? You know
do--are you seeing that people are saying, well, you know, I am
not a psychologist, you know, what do I need to know this stuff
for. Or did you start out with those kind of conversations that
have changed and trended, and what could you tell us about
that?
General Lefebvre. Yes, ma'am. First of all, because suicide
is pervasive and it is not to a specific unit, military
occupational specialty (MOS) or element in the MAGTF, everyone
has experienced it. So there is no question or problem at any
level of leadership inside the Marine Corps as to how big an
issue this is. And I think the traditional pieces of let's just
be a little more concerned about this, those ideas went out the
window a long time ago. Now it is how, as you asked your
question earlier about frustration, how do we actually figure
out where the causative factors are and what do we actually put
our arms around. And commanders are asking those questions and
they are looking for help.
So you can proliferate programs, and yes, you are right
about the fact that some of them may not be coordinated, but
right now they are very interested in every asset they can put
their hands on in order to get at aspects of the program until
we get our arms around the larger piece.
So there is no bad idea, so to speak. So when we come
forward to them with a new way of looking at this, and
especially when we emphasize at the NCO level what we are going
to do, it is part and parcel to our leadership style and it
fits our culture perfectly in terms of where we are going to
go.
So I think the commanders are absolutely on board with
that, and I think the forum probably is more to get a give and
take with the commanders on better practices and ideas than it
is to sell a particular idea to them.
Mrs. Davis. What part of the culture though makes this
difficult?
General Lefebvre. The part of the culture is that we are
all tough guys. But I think we are by that. And I will use how
we approach boot camp. One of the members today was talking
about the fact that he went to boot camp and he remembers what
his drill instructor said but he doesn't remember the soft side
of things. Well, I wouldn't exactly say it is the soft side of
things. What I would say is that we have embraced this idea of
values-based training.
So now you have 80 hours where a drill instructor stacks up
a couple of locker boxes and he gets in front of his platoon
and they talk about sexual assault. I mean, it is not a
lecture, it is a back and forth on what is this, it is a back
and forth about stress, it is a back and forth about, for
instance, the power of prayer and what part that plays inside
the development of a marine.
So it is not just about the mental and the physical. The
moral aspect of it is now a big piece of recruit training. And
you cause kind of some--you cause kind of a new area. So out in
the fleet sometimes when we start to talk about these things
people are, what are you doing in boot camp now, why are you
having these sessions where you are talking about these issues.
And the bottom line is that is how you recognize whose
resiliency locker, so to speak, is low or high and who you have
to focus on in the boot camp stressful environment in order to
put some tools in that particular marine's bag in order to
allow him to be successful as he moves out.
So those have been very, very positive developments, but
they have not necessarily been part of who we have been in the
past, but clearly where our Commandant wants us to go.
Mrs. Davis. Thank you. Mr. Wilson.
Mr. Wilson. Thank you, Madam Chairwoman, and thank both of
you for your heartfelt explanations and pointing out of
something that I believe, and that is the military service of
the servicemembers, their families, veterans. It is like
extended family. And I particularly--General Lynch, I
appreciate your past service at Fort Stewart. I spent 25
summers with the Army National Guard at Fort Stewart, so I know
the capable people who are there. And then also very
significant, my oldest son was trained there for his deployment
to Iraq for a year and returned to Fort Stewart before he
resumed his legal career.
Also, General Lefebvre, thank you so much for your service
as commanding general at Parris Island. I am very grateful.
That is part of the district that I represent. It has already
been identified that all males east of the Mississippi River
are trained at Parris Island. I am also very grateful all
female marines in the world are trained at Parris Island. And I
have been there to see the training, I have been there for the
graduations to see the bearing of these young people. It just
makes you feel so good to know how they have faith in
themselves and know what they are doing. But it is also even
better to see the families, to see the moms, dads, the
grandparents, the siblings, the other relatives who are
present, and there is not a dry eye in the house. Everybody is
just so proud of their military.
And so thank both of you for providing the opportunities
you do.
General Lefebvre, as we consider this issue could you tell
about the Marine Corps programs that are specifically focused
on reducing stress on the personnel most affected by suicide?
How do you plan to measure the success of these programs? In
your estimation, what other resources are needed to address
psychological stress in the Marines?
General Lefebvre. The measurement piece, sir, as expressed
in the last panel is one of the causative factors and how do we
put a capability against it and then wait to see how we are
being successful.
The two programs that probably have the most benefit, one
is the NCO program I just talked about. The other one is this,
is the OSCAR program, this Operational Stress Control and
Readiness program that we are developing with the Navy, where
we are adding mental health professionals at the higher levels
of command and providing mental health professionals at the
regimental level, which we have already done in combat. And
because there is a shortage of those we have taken mental
health professionals and we are now going to train battalion
commanders and normal doctors, medical doctors, and chaplains
in a couple of areas.
One is in this issue of resiliency that we talked about
here today. And I think resiliency, mentioned by every member
of the panel, is one of the keys, but a tough thing to define
and a tough thing to measure in the individual servicemember.
But for sure when resiliency is low they are prone to suicide.
So the key is how will they measure what is in the tool bag
so to speak to include what we are doing at boot camp, how we
sustain that through their training and how do we refresh that
in the fleet.
But the OSCAR extender program that we call it will give us
capability down into the battalions, actually down into the
company level as a peer kind of a capability with specialized
training. The goal in the long term is to provide the health
professionals at that level, but that will take time and we
don't have time.
So I think, ma'am, in particular your question to the
previous panel about what the ideal is, that is apropos and one
that we can really get our arms around because we have been
looking at that in terms of numbers of professionals. I think
when we made this decision to go to 202,000 and as we studied
family readiness the Commandant did a couple of other things
also. He put a family readiness officer in each one of our
battalions. We had a family readiness program for an awful long
time, but it was volunteer. And we asked our families, the
senior wives in particular, to handle a lot of those
responsibilities at the expense of a lot of other personal
issues. As a matter of fact, the kinds of issues you deal with
today are so complex that a volunteer wife would have
difficulty being smart on those issues.
So this family readiness officer who is now with the
reserve units, as well as with the active duty units, is a one-
stop shopping as a resource into the number of programs that
are there. As a matter of fact once referred there or once
there they can sort out the programs for you, whether that is a
family program or an individual program, has proven to be
hugely successful to this point for units that are getting
ready to deploy, and they remain at home station with the
families while we are gone.
So, sir, those are the programs. The measurement of those I
think, given the NCO program, the combat operational stress
program, as well as what we are doing in family readiness, I
think over the course of the next year, as well as we have
achieved this, about to achieve this 14-month buffer because of
our increase in our forces, are going to pay dividends for us
in our ability to spend more time from a leadership perspective
around those who are most at risk.
Mr. Wilson. Thank you very much.
General Lefebvre. Thank you, sir.
Mrs. Davis. Thank you. We appreciate that. You are talking
about the family readiness counselors, and I know having met
with key volunteers and the ombudsman how critical they are.
When I first came into Congress and started working with HASC,
and even though I had obviously been living in San Diego for
many, many years I wasn't aware of the role that they played.
And I was also aware that they were all volunteers and they
handled such complex issues 24 hours a day. And I really
wondered how they do that. And without any recognition.
We tried to change some of that, but I know that we have
moved from that role for a number of individuals. And I was
going to ask you whether you felt that in order to deal with
the shortage that we have in mental health providers if there
are individuals that we could or should be training, utilizing,
that are in the services today that perhaps are doing very
important jobs but could be doing even something more critical
to the mission. And if you thought about that and where you
might want to go to think about bringing more of those
individuals, whether they are--we think of them in terms of
practitioners at a physician assistance level or how we might
do that in the future.
General Lynch.
General Lynch. You had asked the question to the earlier
panel what is the biggest source of frustration. My biggest
source of frustration is indeed the lack of behavioral health
professionals. That is the biggest frustration. I am short
about 44 of what I am convinced I need at Fort Hood that I just
don't have. And that includes reaching out to the community to
see what the community can do to help. But candidly, what I
found is the Nation is short these behavioral health
specialists, not just the military. So when we try to bring
somebody on the installation we are taking away from the
community which expands the problem.
So what General Chiarelli talked about earlier, we are very
excited about, this idea of on-line counseling. Because if the
youngsters or their families can go on a computer, which is
what they do most of the time anyway, and can access a
behavioral health specialist and have individual counseling,
that would be powerful. It wouldn't rob from the community but
it would be a nationwide asset to allow us to be able to
access. And what I understand from the Army's perspective we
will be able to do that in the fall. That is very important.
What we have found is the number one issue with suicidal
ideations is failed relationships, and these failed
relationships are a lot of the function of deployments around,
it just is. I mean you can't continue to go away, come back, go
away, come back without strain in a relationship. It can't
happen. You have got to focus on those family counselors.
So when General Chiarelli talked about these military
family life consultants, that is so very important. These are
licensed professional counselors with at least a Master's
Degree of education in counseling that are now embedded in our
units at the battalion level that allow soldiers and family
members to say hey, I need some help, and they can have that in
a confidential forum.
We also take those military family life counselors and take
them off the installation in a program we call Operation Store
Front. So if somebody wants to go get help but doesn't want to
do it on the installation, they can do it off the installation.
Many of the local hospitals have reached out as well with
their licensed professional counselors to give my soldiers and
their families access.
So, ma'am, we are doing all we can do there trying to make
sure we get the right professionals helping us address the
problem. We try to empower our leaders with how do you deal
with grief, tragedy and loss. We try to empower our leaders in
how do you identify suicide or ideations and what do you do
about it, but you really need to be able to turn to those
professionals.
Mrs. Davis. Are you finding that families who have
experienced a suicide in the family--in most cases they would
be leaving the base fairly within a year's time, is that
correct, or how does--what happens after a period of time?
General Lynch. We treat our fallen heroes who fell as a
result of suicide with the same dignity and respect that we do
those soldiers who fell on the field of battle, to include
their families. So we do everything we can do to ensure the
families are helped through these difficult times.
I talked about the 882 gold star families that we deal with
in central Texas. Many of those are gold star families from
suicides. So we make sure that those families know about it.
They stay on the installation as long as they need to up to six
months, and they can extend that if they need to. We make sure
they are given the same kind of resources and access to
resources that those soldiers who fell in combat do.
Mrs. Davis. And you are saying that it is six months but it
can be extended if that would be in the best interest of the
family?
General Lynch. Yes, ma'am. It is all about concerned,
caring, compassionate leadership. And what we try to do is
handle each case on a case-by-case basis and look at the
situation to see what is appropriate.
Mrs. Davis. Thank you. I certainly appreciate that. And
just in terms of waiting times to get help and assistance, are
you aware of whether it takes a family several weeks to have a
child in, for example, to see somebody as opposed to the
servicemember who may be seeking help? What do those wait times
look like to you?
General Lefebvre. At Camp Lejeune, ma'am, we have five
family counselors with a full docket. But to get in there for
an additional appointment for assessment is actually pretty
quick. It is based on how deep is the problem and what is it
going to take. So we don't think four is enough. We think the
number is probably about 10 to handle just the families and the
children.
The FOCUS program that we talked about a little while ago
with the help of UCLA is the program that we developed, and it
has been very, very successful. What we don't know based on the
stigma that you have talked about is how many people would not
come to this.
But again I would go back to the 14 months now between
deployments. I think commanders will be more aware of what, for
a fingertip feel, what their issues are. They are embracing the
counseling pieces that are required, and I think you will see
more advocacy of that as we turn more attention to those
pieces.
But we suffer from the shortage that we have talked about.
But we also have worked very closely with the Navy to increase
our clinicians. They are kind of a bridge. They are not
behavioral psychologists, but they know enough to help our
leaders to point them in the right direction for help. That is
the bridge to about 2011 before we start to see an increase
from the Navy.
The issue that we do see that is significant with post-
traumatic stress disorder (PTSD) and others is continuity care.
Once a young marine establishes a relationship, when that
psychologist or psychiatrist transfers to the theater, which
happens often because they are on rotations, it is like we
talked about before just a little while ago about changing
commanders after 90 days. You lose visibility, you lose
confidence. So continuity care is as important as the numbers
of doctors that we have to address this issue.
Mrs. Davis. Thank you. Mr. Wilson, did you have any other
questions?
Mr. Wilson. Yes, thank you. General Lynch, you have
identified some programs that are unique to Fort Hood that are
specifically aimed at reducing the stress on your troops. Can
you please tell us more about these programs, such as the
Warrior Combat Stress Reset Program?
I would also like to understand why you felt it necessary
to initiate at Fort Hood unique programs in light of there are
so many DOD and Army programs already in place for mental
health stress issues.
General Lynch. Thank you, sir. We indeed approach the
problem from all aspects. So we established what we call the
Combat Warrior Reset Program, which allows my soldiers who
indeed have difficult times, either PTSD or mild traumatic
brain injury (MTBI), to be seen over a three-week process by
dedicated professionals. And we use every approach to their
treatment that we can, to include acupuncture and Reiki and
massage therapy. And indeed everybody that goes into that
program and comes out the other end benefits from the program.
Those are the kinds of things we look at.
But candidly, sir, what I am trying to do is spend more
time addressing the problem before it becomes a problem. I
don't need to get them into the Combat Warrior Reset Center if
I can indeed make them more resilient. Now, not every soldier
who deploys to combat, and your sons can attest to this, not
every soldier who deploys to combat comes back with PTSD. Not
all of them, they do not. Some of them found it to be an
enriching experience. They were confronted with a difficult
situation, they thrived in that situation, and they grew as an
individual.
So what we are trying to do in line with the Chief of Staff
of the Army's Comprehensive Soldier Fitness Program, which
really is all about resiliency, emotional, physical, spiritual,
family, and social resiliency, is have the programs on Fort
Hood that I described on our resiliency campus. Because I want
the families who are experiencing times, and they all are, they
all are--you know, Sara and I have been married 27 years. I
have been away from her four of the last six years. That is
hard. It is hard on a marriage, on an established marriage. Can
you imagine the strain or the difficulties with a newly married
couple and these deployments? So have programs like Marriage to
Street Retreats and a Strong Bonds Program, which allow
families who are developing their relationships to become more
strong and as a result of that more resilient prior to
deployment.
Mr. Wilson. I want to thank both of you, because the family
support activities, I spent many years working on pre-
mobilization legal counseling. And I have seen advances through
Judge Advocate General (JAG) officers, through the family
support organizations, and the Yellow Ribbon Campaign. All of
these are just so helpful to families. And I appreciate you
pointing out, too, that so many of our young people who have
served, this will be a hallmark of their lives in terms of an
uplifting experience to look back to and to let their families
know about it in the future.
And so again thank both of you for what you are doing. And
Madam Chairwoman, thank you so much for this hearing today.
Mrs. Davis. Thank you, Mr. Wilson.
One follow-up. I just wanted to ask about the families
where the soldier, airman have been wounded, marine, have been
wounded and whether we are providing additional kind of support
to them over and above what you would hope to be provided for
those at Fort Hood.
General Lynch. Yes, ma'am. Engaged leaders know their
subordinates and their families. And what we do is we identify
those families that could indeed be high risk. And they could
be high risk as a result of a wound that was incurred in
combat, or they could be high risk because of strained
relationships or financial problems. And what we do is ensure
that we zoom in on those individuals and lead them to the right
kind of resources so they can be taken care of.
Candidly, ma'am, what I found is you can have the
resources, but if they don't know about them they are not going
to access the resource. So engaged leaders lead their
subordinates to those resources, those programs that we have.
Mrs. Davis. Thank you. We certainly have many families that
are supporting their warrior in untold ways, and I think we do
need to provide that support to them. They are extremely
resilient in many cases, but we can't take that for granted
because they are working so hard to be supportive.
Thank you so much. We really appreciate you being here. We
are grateful for what you are doing, and we look forward to
continuing feedback. And we hope that perhaps some of the
examples that we have heard about here today will be followed
in other places. Thank you very much.
[Whereupon, at 5:57 p.m., the subcommittee was adjourned.]
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WITNESS RESPONSES TO QUESTIONS ASKED DURING
THE HEARING
July 29, 2009
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RESPONSE TO QUESTION SUBMITTED BY MR. JONES
General Amos. Headquarters Marine Corps will coordinate, upon
request, to have a command representative from the Operating Forces
give a detailed ``Death Debrief '' to any interested Member or Members
of Congress. Such a request should be sent to the Marine Corps Office
of Legislative Affairs so that appropriate staff action and
coordination can be made.
In the debrief, information such as the Marine's family history,
photographs of the incident, and circumstances surrounding the incident
will be presented. From the time of death, such a brief may be
available to Members of Congress in as few as 8 days; however, this
timeline is entirely dependent upon the release of information
resulting from the incident investigations. [See page 15.]
______
RESPONSE TO QUESTION SUBMITTED BY MS. SHEA-PORTER
General Chiarelli. Of the 696 Army deaths by suicide from January
2003 until July 31, 2009, 114 Soldiers had been diagnosed with a
substance related disorder (16.4%). This percentage has been fairly
consistent over the past four years, ranging between 13.2% and 20.7%.
In the past year, the Army has initiated two major programs to increase
our ability to provide substance abuse counseling and treatment in the
past year. First, the Confidential Alcohol Treatment and Education
Pilot (CATEP) program allows Soldiers who have an alcohol or drug
problem to self-refer into, and seek treatment from, the Army Substance
Abuse Program without their chain of command notified. The Army will
conduct the CATEP program at three installations: Schofield Barracks,
Hawaii; Fort Lewis, Washington; and Fort Richardson, Alaska. The pilot
program runs through February 24, 2010. Second, the Army has increased
the authorization for Substance Abuse Counselors and increased hiring
and incentive programs. The goal of both initiatives is to increase
access and encourage participation in Army Substance Abuse Program.
[See page 29.]
______
RESPONSES TO QUESTION SUBMITTED BY MS. TSONGAS
General Chiarelli. The Army has been collecting comprehensive
suicide data since 2001 using a formal process that documents completed
suicide events. Army Suicide Prevention Program data analysts monitor
the Defense Casualty Information Processing System, which is managed by
the Army Casualty and Mortuary Affairs Operations Center and captures
the cause of death. Data from the Defense Casualty Information
Processing System and other Army information systems are acquired and
conjoined for a focused review of Soldier data (such as age, marital
status, job specialty, deployment, and other service information) to
assist in identifying possible trends or common factors that may
promote suicidal behavior. The extrapolated data allows Army Suicide
Prevention Program data analysts to gather information to include Army
commands, installations, and unit assignment of Soldiers who die by
suicide. This allows further analysis of potential clustering that may
be evident based on common elements within the command or
organizational structures of units to which Soldiers are assigned and
daily perform their duties. The analysis of data does not infer
contagion of suicides in the Army.
In addition to data analysis, the Army has ``postvention''
activities outlined in Army Regulation 600-63, Army Health Promotion,
and Casualty assistance activities outlined in Army Regulation 600-8-1,
Army Casualty Program. These activities are required when an individual
has attempted or committed suicide. After an attempt, commanders,
noncommissioned officers, and installation gatekeepers (those on our
camps, posts and stations that interact with the general population on
a daily basis--emergency response, chaplaincy, medical, small unit
leaders) must take steps to secure and protect such individuals before
they can harm themselves and/or others. Other ``postvention''
activities also include unit-level interventions following suicides, to
minimize psychological reactions to the event, prevent or minimize
potential for suicide contagion, strengthen unit cohesion, and promote
continued mission readiness. [See page 26.]
Admiral Walsh. The record of multiple suicides at the same Navy
unit within any 12 month period from 1999-2009 is:
----------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
1999 4 units with 2 deaths each
----------------------------------------------------------------------------------------------------------------
2000 2 units with 2 deaths each, 1 unit with 5 deaths
----------------------------------------------------------------------------------------------------------------
2001 2 units with 2 deaths each
----------------------------------------------------------------------------------------------------------------
2002 2 units with 2 deaths each
----------------------------------------------------------------------------------------------------------------
2003 2 units with 2 deaths each
----------------------------------------------------------------------------------------------------------------
2004 1 unit with 2 deaths
----------------------------------------------------------------------------------------------------------------
2005 to 2006* 2 units with 2 deaths each
----------------------------------------------------------------------------------------------------------------
2007 4 units with 2 deaths each
----------------------------------------------------------------------------------------------------------------
2008 none
----------------------------------------------------------------------------------------------------------------
2009 2 units with 2 deaths each
----------------------------------------------------------------------------------------------------------------
* Deaths occurred less than 9 months apart, crossing calendar years
With the exception of the five deaths at Service School Command
Great Lakes in 2000, there have been no instances that qualify as
suicide clusters. In that instance the Sailors were assigned to four
different training programs within the Service School Command.
Although suicide clusters (multiple suicides in the same place in a
short period of time) are rare, there is research in the field that
documents an elevated lifetime risk of suicide for those individuals
exposed to suicide in the workplace or in family or close friends.
Any suicide impacts the members of a unit; consequently, prevention
is key. Navy has trained Suicide Prevention Coordinators at each
command to assist Commanding Officers in implementing a command level
prevention program. Each command is required to have a written crisis
response plan. Navy has a holistic prevention program that ranges from
resilience building to vigilance and early intervention, crisis
response, and ``post-vention.''
In the aftermath of a suicide loss, Navy focuses on ``post-
vention'' activities as critically important to suicide prevention
efforts, and vital to the morale, welfare and mission readiness of
those exposed to the suicide. An assessment is conducted to determine
the requirements for supportive interventions for the unit and its
individual members. The unit then coordinates with all command and
local resources, including Chaplains, Fleet and Family Support
Counselors, and Special Psychiatric Rapid Intervention Teams (SPRINT)
for the provision of individual and unit support, grief counseling and
mental health support. [See page 26.]
General Amos. From January 2007 through October 2009, there were
117 suicides spread out across 108 different units. 8 of the 108
battalion/squadron sized units experienced more than one suicide within
a given year. Seven of the eight had two suicides and one of the units
had three. Most of the suicides within a battalion were spread out
across the year by 3-8 months. Only two of the units experienced two
suicides within the same month.
A review of the specifics of the suicides that occurred within the
same unit within the same month, demonstrates:
The suicides did not occur in the same locations
Battalion I: suicides occurred in Rhode Island and
North Carolina;
Battalion II: suicides occurred in California and
Texas
Communication with commands confirmed that their
investigations concluded that the cases were unrelated. [See page 26.]
General Fraser. A review of Air Force suicides from 2003 through
2008 shows 6 incidents in which two suicides occurred on the same base,
using the same means within a three month period. In all but one of
these cases the method of suicide was gunshot (by far the most common
means of suicide in the AF). There do not appear to be other links
between these cases to suggest that they were ``copy cat'' suicides.
[See page 26.]
?
=======================================================================
QUESTIONS SUBMITTED BY MEMBERS POST HEARING
July 29, 2009
=======================================================================
QUESTIONS SUBMITTED BY MR. WILSON
Mr. Wilson. In a recently published article in Joint Force
Quarterly, author Colonel Drew Doolin discusses military mental health
services and psychological wellness programs that are available to
military commanders today. Colonel Doolin asserts that although the
services have several good programs aimed at helping commanders and
troops deal with psychological stress, the services have failed to get
the word out on each program. How does each of the services publicize
these programs? What are you doing to make sure service members at all
levels and their families know about your programs and know how to
access these services?
General Chiarelli. The Army is making a significant effort at the
national and local levels to inform Soldiers and Families about our
behavioral health programs and to reduce the stigma associated with
seeking help. We have developed a Strategic Communications Plan to
publicize relevant programs and ensure Soldiers and their Families are
aware of available resources. This plan addresses national and local
opportunities to disseminate information to Soldiers and Families. At
the national level, Army Senior Leaders discuss behavioral health
programs in testimony before Congress, in national conferences with
military and civilian audiences, and in media roundtables with national
publications. The Army Home Page, the Army STAND-TO!, and other print
and electronic information venues managed by Headquarters, Department
of the Army, regularly highlight behavioral health programs and
resources available to Soldiers.
In 2007, the Army Chief of Staff directed that all Soldiers in
every component of the Army participate in a chain teaching program on
post traumatic stress disorder and traumatic brain injury. This chain
teaching program detailed the steps Soldiers should take if they
identified concerns about themselves or their buddies. This program has
since been incorporated into the Battlemind Training Program that is
required for all deploying and redeploying Soldiers and is also
available for family members.
At the local level, garrison, hospital, and unit commanders use a
host of venues to publicize behavioral health programs. All newly
arriving Soldiers at Army installations are required to attend
newcomer's briefings as part of their inprocessing. Installation and
unit newspapers are a great source of information, as are billboards,
flyers, and brochures. All hospital and garrison commanders conduct
regular Town Hall meetings that are open to all Soldiers and Families.
These events feature briefings, displays, and discussions concerning
community programs and services. Concurrent with each of our publicity
efforts for specific behavioral health programs, we are sending the
overarching message that seeking help for behavioral health concerns is
a sign of strength.
Mr. Wilson. General Chiarelli, your testimony includes your
assurance that Army senior leaders consider addressing the critical
shortfall of uniformed health care providers a priority. However, I
understand that the Army plans to increase the operating force by
approximately 12,000 soldiers by the end of fiscal year 2010. At the
same time the Army plans to decrease the generating force, which
includes medical personnel, by approximately 6,200 by the end of fiscal
year 2010. Given your testimony, would any of the 6,200 reduction be
medical personnel? Along with your testimony today, the Sergeant Major
of the Army testified last week before this committee that the Army
needs more medical providers. How will the Army maintain the number of
mental health personnel to meet the needs of this larger force?
General Chiarelli. The Army is committed to meeting the health care
and behavioral health needs of all Soldiers and family members. In
order to meet the health care needs of the growing force, the Army is
increasing the number of health care professionals in both the
operating force and the generating force. This includes increasing
military billets and pursuing additional civilian personnel.
Our of our highest priority requirements is for behavioral health
providers. For the operating force, Army is investing over 1,000
Behavioral Health Specialists into Brigades across all three
components. Although the Army is adjusting the generating force, our
medical structure will not be decreased. In fact, as a result of the
recently concluded Total Army Analysis review of the generating force,
an additional
545 military billets have been allocated to the U.S. Army Medical
Command (MEDCOM) to support the increase in medical workload.
Assessment by specialty and location on how best to distribute the 545
is currently on-going. This growth is in addition to the previous
alignment by the Army to MEDCOM of 738 additional military spaces in
FY08 and 554 military spaces in FY09. These increases in FY08 and FY09
included 24 psychiatrists, 19 social workers, 12 psychologists, and 100
enlisted mental health specialists. In conjunction with these increases
in military billets, the MEDCOM is actively recruiting civilian and
contract providers to fill all of the anticipated requirements to
support the growing Army. Current shortfalls in the medical workforce
include primary care physicians (family practice, pediatrics, and
internal medicine), as well as behavioral health professionals
(psychiatrists, psychologists, and psychiatric health nurses).
To retain military behavioral health personnel, we are successfully
employing a variety of special pays and bonuses targeted at
psychiatrists, clinical psychologists, psychiatric health nurses, and
social work officers. Participation among officers eligible to contract
for special pays and bonuses ranges from 75% to 95%. To recruit
military behavioral health personnel, we offer accession bonuses and
participation in the Active Duty Health Professions Loan Repayment
Program, which offers a maximum of $40,000 annually for fully qualified
applicants.
The Army Medical Department Center and School and Fayetteville
State University developed a partnership in February, 2008, to
establish the U.S. Army-Fayetteville State Master of Social Work
Program. The graduate social work program was created as a force
multiplier to offset the decrement of licensed clinical social workers
available in the active duty Army inventory. The program graduated 15
social workers last year and has a class of 13 students this year.
The Army has also made significant efforts to contract for or hire
civilian behavioral health professionals to augment our military
providers. Over the last two years, the Army has increased our pool of
military, civilian, and contract behavioral health providers by 48
percent and we continue to pursue hiring actions. During that same
timeframe, TRICARE, the Department of Defense healthcare program for
members of the uniformed services, their families, and survivors,
increased its network of behavioral health providers by over 25
percent.
Additionally, the Army uses virtual technology to expand our
current capabilities for providing behavioral healthcare. We currently
have a number of telehealth programs and are planning to expand our
capability to support care for warriors with traumatic brain injury and
post traumatic stress via telehealth. A Virtual Behavioral Health Pilot
Program was recently conducted in Hawaii to determine the effectiveness
and technical requirements for virtual BH counseling. Initial results
are highly encouraging and we plan to expand the program to additional
sites.
On August 1, 2009, TRICARE expanded its services to include two new
online video BH programs. The two online video programs are TRICARE
Assistance Program (TRIAP) and Tele-behavioral Health which have both
been developed to help eliminate obstacles to seeking BH treatment.
Both programs are available to active duty service members and their
Families. TRIAP and Tele-behavioral Health have the combined capability
to provide secure online Internet therapy with licensed BH counselors
located throughout the United States. Through these programs Soldiers
and Families anywhere in the world can access licensed BH counselors
for short-term, real-time, face-to-face confidential counseling
utilizing video technology and software such as Skype or iChat.
Mr. Wilson. General Colleen McGuire, who heads the Army's Suicide
Prevention Task Force, was quoted recently saying, ``we have young
leaders who have not been trained in the art of . . . just taking care
of soldiers.'' General Chiarelli, what is your assessment of her
statement? How does the Army balance the time it takes to develop young
leaders with the time it takes to prepare for combat? I am interested
to hear from the other service leadership if they are faced with a
similar challenge.
General Chiarelli. I think the Army does a very good job of
developing leaders even as we prepare for war. However, we may be
neglecting the art of garrison leadership. Our programs that care for
Soldiers have not evolved to keep up with the constant transitions that
are the hallmark of our expeditionary Army, and many of our young
leaders who have spent the majority of their time in a combat
environment may not be familiar with the programs that translate well
to a garrison environment.
We do face some challenges in getting our leaders trained on
leadership skills required for taking care of our Soldiers due to the
operational demands. The foundational education and training on the art
of taking care of Soldiers is normally provided in formal Army schools,
specifically Basic Officer Leader Course (BOLC) for lieutenants and
warrant officers and the Warrior Leader Course for noncommissioned
officers (NCOs). Lieutenants and warrant officers attend the BOLC prior
to being assigned to their first units. The foundation of this training
is aligned with the Army's Strong Bonds, Suicide Prevention, and
Battlemind for Leaders programs.
The reality is that many of the Army's junior NCOs are serving in
leadership positions without having received formal leadership
education because of the operational requirements.
The Army is striving to balance training, education and experiences
for our leaders. In the relatively short periods of time spent in
Professional Military Education provide theory, conceptual information,
doctrine, policy, and lessons learned. The actual application and
mastery of leadership skills are achieved during operational
assignments while preparing for combat or while deployed for combat.
______
QUESTIONS SUBMITTED BY MR. LOEBSACK
Mr. Loebsack. What steps are the Services taking to assure that
military kids, including those whose parents are in the Reserve
Components, have access to mental health care?
General Chiarelli. The Army is currently working to eliminate the
barriers that exist for providing timely, convenient, and appropriate
behavioral health (BH) services for all military children of active,
Army Reserve (USAR) and Army National Guard (ARNG) Soldiers. Current
initiatives include the Military Child and Adolescent Center of
Excellence (MCA CoE), school BH programs, and the opening of Child and
Family Assistance Centers. Although the Army is leaning forward with
these initiatives, we recognize that gaps remain, especially for
children of those in the Reserve Components (RC).
The Army Medical Command (MEDCOM) approved the development of the
MCA CoE, a center that focuses on interventions, programs and policy to
combat the impact of being a military child with a parent deploying,
wounded, or killed in action. MCA CoE will execute a plan that provides
support for the development of direct BH support for Army children and
their families at large deployment installations.
The MCA CoE concept for the delivery of BH care is to: (1) provide
a diversity of BH resources/services for Army children and Families,
including school BH, integrated under a single umbrella organization;
(2) facilitate the coordination of services and improve capacity and
access to BH care; (3) reduce stigma associated with behavioral
healthcare; (4) provide Outreach Community Services/Programs to promote
resilience and well-being throughout the Army community; and (5) train
pediatricians and family practice providers in early identification and
treatment of common BH concerns. The MCA CoE will also develop a
database of current standards of care for use by other military youth-
serving professionals across the country. Emphasis will be placed on
following military youth longitudinally over deployment cycles and
beyond to comprehensively describe deployment impact, parental injury
or death on children and adolescents and to discover unique protective
and risk factors among military Families.
The Army is also working through the MCA CoE to streamline existing
BH support services for children by funding five school BH programs.
The programs are family-centered and will provide support for children
attending schools on military posts. The current locations are
Landstuhl Army Medical Center, Germany; U.S. Army Medical Clinic,
Vilseck, Germany; Tripler Army Medical Center, Hawaii; Walter Reed Army
Medical Center, Washington, DC; and Blanchfield Army Community
Hospital, Fort Campbell, Kentucky. Madigan Army Medical Center, Fort
Lewis, Washington, is on track to begin a program in the coming year.
The programs in Germany are just beginning, but the other three are
already well established.
Children of RC Soldiers may be eligible for BH services through
TRICARE, the Department of Defense's healthcare program for members of
the uniformed services, their Families, and survivors. Through
enrollment in TRICARE Reserve Select (TRS) or the Transitional
Assistance Management Program (TAMP), children of RC Soldiers may
receive BH services.
TRS is a premium-based health plan that qualified ARNG and USAR
members may purchase. TRS, which requires a monthly premium, offers
coverage similar to TRICARE Standard and Extra. To qualify for TRS, RC
Soldiers must be a member of the Selected Reserve of the Ready Reserve
(participate in monthly drills).
TAMP provides 180 days of transitional health care benefits to help
uniformed services members and their Families transition to civilian
life. Generally, TAMP coverage is available to ARNG and USAR service
members who are separating from the ARNG or USAR after a period of
active duty that was more than 30 consecutive days in support of a
contingency operation.
Additionally, dependents are authorized 12 sessions of BH from the
Military OneSource, which is provided to all dependents regardless of
the Soldier's service, component, or duty status. All dependent
behavioral health services are contracted with a licensed therapist in
the family member's local community. Dependents are entitled to 12
sessions per concern, so if the family member is experiencing
depression and later on becomes fearful of an upcoming parental
deployment, he or she could be seen for 12 sessions per issue.
The MCA CoE has dedicated a section in their organization to
outreach in support of military children of ARNG and USAR Units. Short
term plans are to provide educational programs to parents and school
staff serving these children, on issues such as ``The effects of
Deployment on Children,'' ``Children and Reunion,'' ``Rumors During
Deployment,'' etc. Tripler Army Medical Center already has begun
reaching out to the Guard/Reserve on the islands neighboring Oahu. The
MCA CoE is also developing a video tele-health program to evaluate and
treat children in remote areas. Efforts are being made to develop this
program in the State of Washington and expand into other areas as the
program develops.
Mr. Loebsack. What, if any, efforts are being undertaken to address
the correlating impact on children when a servicemember is determined
to be suffering from PTSD or when they are recovering from a
significant injury?
General Chiarelli. The Army provides inpatient and outpatient
behavioral health (BH) care as well as medical treatment by healthcare
professionals who have been trained to address the impact of post
traumatic stress disorder (PTSD) and significant injury on military
children and Families. These services are provided through installation
medical treatment facilities (MTF).
The Army has instituted PTSD training for health care providers so
they can accurately diagnose and treat combat stress injuries as well
as address the impact on children and Families. The Army additionally
leverages local healthcare providers in the surrounding communities
through the TRICARE Network system, which includes professionals who
specialize in trauma, family, and child BH issues.
In addition to the behavioral health programs for military children
and adolescents, Walter Reed Army Medical Center Child and Adolescent
Psychiatry created Operation Brave Families in 2003. The program aims
to build resilience, value, and empower Families. Operation Brave
Families assists military Families with communicating to children about
wartime injuries and illnesses, emphasizes optimal parenting and family
communication, and facilitates optimal adjustment to changes due to
physical injuries and/or psychological conditions.
Operation Brave Families offers a full range of services for any
emotional problems children and parents may experience. Services
include therapeutic art sessions, therapeutic play sessions, education,
individual and family supportive therapy, case management assistance,
and referrals as needed. Treatment is provided by a multidisciplinary
team that includes a psychiatrist, psychologist, social worker, art
therapist, and a child activity specialist. In addition, the program
offers flexible and mobile services allowing staff to provide support
at hospitals, lodging facilities, Fisher Houses, or Child and
Adolescent Psychiatry clinics. A similar program has been modeled at
Fort Sam Houston and other installations.
Mr. Loebsack. What steps are the Services taking to assure that
military kids, including those whose parents are in the Reserve
Components, have access to mental health care?
Admiral Walsh. Meeting the mental health care needs of military
children is a priority for Navy Medicine. In order to meet this need
services are provided by Military Treatment Facility (MTF) providers,
TRICARE network providers, contract providers working specifically with
the Reserve Components, and counselors working for Navy, Marine Corps
and Joint Family Support programs.
Navy MTFs work closely with the Managed Care Support Contractors to
optimize provision of child mental health services for active duty and
retired family members when the indicated services are not available in
the MTF. Additionally, case managers and social workers are available
to assist in finding network services to provide mental health care.
There are several TRICARE/TMA mental health specific programs. Most
recently, TRICARE Assistance Demonstration Project (TRIAP) and Tele-
Mental Health programs have been developed and marketed. Under TRIAP,
licensed professionals assess and deliver short-term, non-medical
counseling that consists of one-on-one private, non-reportable
conversations. This is a free service for beneficiaries (no billing for
the service).
Navy Fleet and Family Service Centers and Marine Corps Community
Service Centers also provide professional counseling for children and
families. Additionally, Commander Navy Installations Command, the Navy
Reserve Forces Family Support Coordinator and the five regional Family
Support Administrators work closely with Ombudsmen at each command to
ensure families are aware of these services. Together they facilitate
the connection of reserve families to each other, to supportive
military and community resources and improve community awareness of
military families' experiences and needs. The primary focus of these
efforts is to support families living apart from military
installations. The Family Support Administrators liaison with their
assigned Navy Operational Support Center (NOSC) staffs to ensure
families are supported by Navy and other services' family support
programs, including the Joint Family Support Assistance Programs
(JFSAP). All of our Fleet and Family Support programs are designed to
provide high quality service to both the Active and Reserve components
of the Total Force.
The Navy Reserve Psychological Health Outreach Program (PHOP) was
established in 2008 to provide early identification and clinical
assessment of Navy Reservists returning from deployment who are at risk
for not having their stress injuries identified and treated in an
expeditious manner. This program also provides outreach and educational
activities to improve the overall psychological health of Navy
Reservists and to identify long-term strategies to improve
psychological health support services for the Reserve community. The
PHOP facilitates access to psychological health support resources for
Reservists and family members.
Mr. Loebsack. What, if any, efforts are being undertaken to address
the correlating impact on children when a servicemember is determined
to be suffering from PTSD or when they are recovering from a
significant injury?
Admiral Walsh. Mental Health Providers in Navy Military Treatment
Facilities (MTFs) address the specific needs of our wounded warriors,
including those suffering from PTSD. In the Navy tertiary care centers
consult teams meet regularly with these families. These teams consist
of a health educator who assists in training the families of wounded
service members, and a child/adolescent social worker who is trained to
deal specifically with children.
We also have counseling services for children by licensed
professional counselors in our Navy Fleet and Family Service Centers
(FFSC) and Marine Corps Community Service Centers. Navy Command
Ombudsmen are also trained to refer families with concerns about the
impact a parent with PTSD or other injury has on children to these
counselors for services.
Additionally, FFSC staff work closely with the Navy Reserve Forces
Family Support Coordinator to facilitate the connection of reserve
families to supportive military and community resources including the
Joint Family Support Assistance Programs (JFSAP). All of our Fleet and
Family Support programs are designed to provide high quality service to
both the Active and Reserve components of the Total Force.
Although FFSC deployment staff have always worked with families
through the cycles of deployment, a growing awareness of the
significant challenges of these deployments on military family life and
child and family well-being prompted a recent initiative by the
Department of Navy Bureau of Medicine and Surgery called FOCUS
(Families OverComing Under Stress). FOCUS provides state-of-the-art
family resiliency services to military children and families at
selected installations.
Topics including PTSD and other injuries impact on families are
addressed during Returning Warrior Workshops to assist returning
Sailors with reintegrating with their families and communities, and to
better understand the resources available to them. Additionally, the
Psychological Health Outreach Program (PHOP) workers ensure
coordination of access to psychological health support resources for
Reservists and their Family members.
Finally, in an ongoing effort to fully understand the Navy and
Marine Corps family, Navy Medicine has embarked in a collaborative
effort with the Military Family Research Institute of Purdue University
to assess the needs of our Navy and Marine Corps families and to ensure
that programs, policies and practices fulfill the needs of all
families.
Mr. Loebsack. What steps are the Services taking to assure that
military kids, including those whose parents are in the Reserve
Components, have access to mental health care?
General Amos. Meeting the mental health care needs of military
children is a priority for Navy Medicine. In order to meet this need
services are provided by Military Treatment Facility (MTF) providers,
TRICARE network providers, contract providers working specifically with
the Reserve Components, and counselors working for Navy, Marine Corps
and Joint Family Support programs.
Navy MTFs work closely with the Managed Care Support Contractors to
optimize provision of child mental health services for active duty and
retired family members when the indicated services are not available in
the MTF. Additionally, case managers and social workers are available
to assist in finding network services to provide mental health care.
There are several TRICARE/TMA mental health specific programs. Most
recently, TRICARE Assistance Demonstration Project (TRIAP) and Tele-
Mental Health programs have been developed and marketed. Under TRIAP,
licensed professionals assess and deliver short-term, non-medical
counseling that consists of one-on-one private, non-reportable
conversations. This is a free service for beneficiaries (no billing for
the service).
Navy Fleet and Family Service Centers and Marine Corps Community
Service Centers also provide professional counseling for children and
families. Additionally, Commander Navy Installations Command, the Navy
Reserve Forces Family Support Coordinator and the five regional Family
Support Administrators work closely with Ombudsmen at each command to
ensure families are aware of these services. Together they facilitate
the connection of reserve families to each other, to supportive
military and community resources and improve community awareness of
military families' experiences and needs. The primary focus of these
efforts is to support families living apart from military
installations. The Family Support Administrators liaison with their
assigned Navy Operational Support Center (NOSC) staffs to ensure
families are supported by Navy and other services' family support
programs, including the Joint Family Support Assistance Programs
(JFSAP). All of our Fleet and Family Support programs are designed to
provide high quality service to both the Active and Reserve components
of the Total Force.
The Navy Reserve Psychological Health Outreach Program (PHOP) was
established in 2008 to provide early identification and clinical
assessment of Navy Reservists returning from deployment who are at risk
for not having their stress injuries identified and treated in an
expeditious manner. This program also provides outreach and educational
activities to improve the overall psychological health of Navy
Reservists and to identify long-term strategies to improve
psychological health support services for the Reserve community. The
PHOP facilitates access to psychological health support resources for
Reservists and family members.
Mr. Loebsack. What, if any, efforts are being undertaken to address
the correlating impact on children when a servicemember is determined
to be suffering from PTSD or when they are recovering from a
significant injury?
General Amos. Mental Health Providers in Navy Military Treatment
Facilities (MTFs) address the specific needs of our wounded warriors,
including those suffering from PTSD. In the Navy tertiary care centers
consult teams meet regularly with these families. These teams consist
of a health educator who assists in training the families of wounded
service members, and a child/adolescent social worker who is trained to
deal specifically with children.
We also have counseling services for children by licensed
professional counselors in our Navy Fleet and Family Service Centers
(FFSC) and Marine Corps Community Service Centers. Navy Command
Ombudsmen are also trained to refer families with concerns about the
impact a parent with PTSD or other injury has on children to these
counselors for services.
Additionally, FFSC staff work closely with the Navy Reserve Forces
Family Support Coordinator to facilitate the connection of reserve
families to supportive military and community resources including the
Joint Family Support Assistance Programs (JFSAP). All of our Fleet and
Family Support programs are designed to provide high quality service to
both the Active and Reserve components of the Total Force.
Although FFSC deployment staff have always worked with families
through the cycles of deployment, a growing awareness of the
significant challenges of these deployments on military family life and
child and family well-being prompted a recent initiative by the
Department of Navy Bureau of Medicine and Surgery called FOCUS
(Families OverComing Under Stress). FOCUS provides state-of-the-art
family resiliency services to military children and families at
selected installations.
Topics including PTSD and other injuries impact on families are
addressed during Returning Warrior Workshops to assist returning
Sailors with reintegrating with their families and communities, and to
better understand the resources available to them. Additionally, the
Psychological Health Outreach Program (PHOP) workers ensure
coordination of access to psychological health support resources for
Reservists and their Family members.
Finally, in an ongoing effort to fully understand the Navy and
Marine Corps family, Navy Medicine has embarked in a collaborative
effort with the Military Family Research Institute of Purdue University
to assess the needs of our Navy and Marine Corps families and to ensure
that programs, policies and practices fulfill the needs of all
families.
Mr. Loebsack. What steps are the Services taking to assure that
military kids, including those whose parents are in the Reserve
Components, have access to mental health care?
General Fraser. Within the continental U.S., the vast majority of
mental health care for Air Force family member-children is delivered
within the TRICARE network. TRICARE service delivery is managed by
regional contractors who determine the number of network providers of
any given type within their region and work to maintain the adequacy
and quality of the panel of providers. Family members enjoy the unique
benefit of being able to seek mental health care for eight sessions of
outpatient behavioral health care without prior approval or a referral.
Active duty service members (including activated National Guard/Reserve
members) and their families enrolled in TRICARE Prime or TRICARE Prime
Remote can get assistance in setting up behavioral health appointments
by calling the regional contractors' Behavioral Health Provider Locator
and Appointment Assistance Service:
North Region: 1-877-747-9579 (8:00 a.m.-6:00 p.m.)
South Region: 1-877-298-3514 (8:00 a.m.-7:00 p.m.)
West Region: 1-866-651-4970 (24 hours per day)
Family members of the Reserve and Guard have these same benefits
when their sponsor is activated and up to 90 days prior. Resources
available to Reserve and Guard families are essentially identical to
the families of active duty Airmen if their sponsor purchases TRICARE
Reserve Select.
There is a nation-wide shortage of qualified mental health
providers for children. In many rural locations the situation is worse.
This is why the Services' special needs identification programs are so
important. Once a family member is identified as having a need for a
particular type of specialty care, those needs are reviewed before a
family is given a new assignment.
TRICARE has recently expanded its telemental health network and has
launched a particularly interesting pilot program known as the TRICARE
Assistance Program (TRIAP) web-based counseling and referral
initiative, which permits eligible family members to receive counseling
services from a licensed professional mental health provider and be
referred to formal mental health care if such care is indicated.
Parents could use such a service to discuss behavioral problems arising
in their children to better understand the need for further care.
Other resources available to families include counseling through
Military OneSource, Chaplains, and Military Family Life Consultants--
all of whom may refer the family to seek more formal mental health
treatment if necessary through consultation with their primary care
manager or by contacting a TRICARE mental health provider directly.
Mr. Loebsack. What, if any, efforts are being undertaken to address
the correlating impact on children when a service member is determined
to be suffering from PTSD or when they are recovering from a
significant injury?
General Fraser. The Air Force offers a variety of programs and
services to meet the needs of children of wounded warriors.
Airman and Family Readiness Centers (A&FRCs) have many resources
for families of deployed or injured Airmen and their family members.
Information may be delivered in an individual, family or group format
and may cover such issues as deployment, grief and loss, daily life
issues, marriage and relationship issues and parenting. Through the
A&FRCs, Military and Family Life Consultants (MFLCs) meet
confidentially with service members, spouses, family members and
children.
The Air Reserve Component's Yellow Ribbon Campaign provides
informational events and activities for the members of the reserve
component, their families, and community members to facilitate access
to services supporting their health and well-being through the phases
of the deployment cycle.
Depending on the injury or illness, an Airman may have a Family
Liaison Officer (Survivor Assistance Program), Recovery Care
Coordinator and/or Medical Case Manager; these individuals frequently
help the family identify issues and suggest care for a family member.
The Air Force actively collaborates with its sister services and
the Defense Center of Excellence for Psychological Health and Traumatic
Brain Injury (DCoE). One recent initiative of the DCoE has been its
project with the Sesame Workshop to produce the ``Family Connections''
website with Sesame Street-themed resources to help children cope with
deployments and injured parents. In addition, DoD-funded websites, such
as afterdeployment.org, provide specific information and guidance for
parents/caregivers to understand and help kids deal with issues related
to deployment and its aftermath.
In consultation with parents, a child's physician (primary care
manager) frequently is able to identify issues and refer the child for
care when necessary. Typically, formal mental health treatment is
delivered through the TRICARE network--families can seek up to 8 visits
without a referral or the need for prior approval.
Other sources of counseling available that could benefit children
of wounded Airmen include support through a chaplain, counseling
provided through Military OneSource providers, and the TRICARE
Assistance Program, offering online counseling and referral.
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