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Office of Public and Intergovernmental Affairs

Remarks by Former Deputy Secretary W. Scott Gould

DoD-VA Suicide Prevention Conference
Boston, MA
March 15, 2011

First, let me thank Secretary Gates for joining Secretary Shinseki in sponsoring this year's conference on suicide prevention.

Let me also thank Dr. Samuel Kleinman, Deputy Under Secretary of Defense for Readiness; Dr. and Brigadier General Jonathan Woodson, Assistant Secretary of Defense for Health Affairs; and everyone else who has supported and organized this conference, including VA's Dr. Agarwal, Dr. Sonja Batten, Dr. Toni Zeiss, and Dr. Jan Kemp.

Together, DoD, VA, and our community partners have accomplished a lot of late in suicide prevention, and this conference is a much needed opportunity to share what we've learned. I'm pleased to have the opportunity to be here.

You know, we often use the word tragedy rather loosely, describing any great misfortune as a "tragedy." Theater folk use the word very differently. In drama, a "tragedy" is a play with a sad ending, and not every misfortune has a sad ending. People often learn from their misfortunes. They grow stronger. They find other opportunities and sometimes new meaning in life.

Death itself is not always a sad ending — but suicide is. Suicide is a true tragedy: It ends sadly for everyone. It's perhaps the ultimate tragedy — never necessary, always avoidable, absolutely final, and permanently painful for those left behind.

At VA, we care for millions of Veterans with sick or broken bodies. We help Veterans live better lives. We sometimes even save lives.

But those of you involved in suicide prevention do even more than that. You don't just save lives — you save souls. You pull spirits back from the brink of despair, saving them from the worst possible outcome, and sparing others lifetimes of grief and shame.

Your work could hardly be more urgent, more honorable, or more deserving of the Nation's support and encouragement.

I know that's how Secretary Shinseki sees it. That's why one of our three main objectives at VA is breaking that downward spiral of defeat and despair that too often ends in homelessness and suicide. One in five suicides in America is a Veteran — over 6,000 per year — 18 per day by some counts.

Five of those 18 are Veterans receiving care from VHA. For every Veteran in the VHA system who dies by suicide, at least six more attempt suicide. One third of Veterans who commit suicide have attempted suicide before.

The suicide rate among male Veterans is almost twice that of the general population. Older Veterans account for most Veteran suicides. These are often men and women overcome by age-related depression. Some are also burdened with disabilities and psychic trauma from their time in service.

But young male Veterans of Iraq and Afghanistan have seen some of the highest suicide rates in the past decade. They are still more prone to suicide than Americans just like them who have not served in Iraq and Afghanistan.

The suicide rate for young male Veterans of Iraq and Afghanistan spiked in 2004. That same year, VA developed its Comprehensive Mental Health Strategic Plan, with a special focus on suicide prevention efforts. In FY 2007, we added a Suicide Prevention Hotline and began hiring Suicide Prevention Coordinators, fully implementing the strategic plan in FY 2008.

Since then, funding for VA mental health programs has risen from $3.9 billion to over $5.2 billion dollars in FY 2011 — a one-third increase. With the extra funding, we have hired more than 3,500 mental health professionals, and our mental health staff now totals almost 21,000.

With all that extra firepower, we're turning the battle around. We're starting to see evidence of a decrease in suicide rates among Veterans in VHA's care — in the critical age group of 18 to 29 — compared to similar Veterans not in VHA's care. This decrease translates to about 250 lives per year.

Make no mistake: One suicide is too many, so we're not stopping there. The President's 2012 budget request includes $6.2 billion for mental health programs — $1 billion dollars more than this year — a nearly 20 percent increase. Of the requested $6.2 billion, $68 million are for suicide prevention.

Our basic strategy for suicide prevention involves providing ready access to high-quality mental health care, with special attention to Veterans suffering from Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), or other psychological and cognitive health conditions.

The strategy also involves energetic outreach to educate people on what to look for and how to access the available care.

One of our most successful initiatives is our Suicide Prevention Hotline. Veterans can call the hotline — 1-800-273-TALK — and then "push 1" to reach a trained VA professional who can deal confidentially with an immediate crisis. Nearly 400,000 people have called the hotline, including over 5,000 active-duty Service Members. We have made over 50,000 referrals for care, and close to 14,000 actively suicidal Veterans have been rescued.

In 2009, we added an on-line Chat Service for people who might feel uncomfortable talking to someone in person. To date, we've made contact with almost 4,000 people through on-line chat. Many of them have been referred to the hotline for immediate personal care.

If you haven't already heard, we'll be making one significant improvement to our hotline in the weeks ahead. After studying its effectiveness, we've decided to strategically rebrand the hotline as the Veterans Crisis Line. Research suggests to us that this should lower the threshold for Veterans and their families, so they'll make that critical first call for help sooner. We'll be doing a formal roll-out of the new brand in a few weeks.

Let me tell you about some of our other successful initiatives:

  • We now have a Suicide Prevention Coordinator or team in all 153 VA Medical Centers. These coordinators and their teams take referrals from the Veterans Crisis Line, to arrange care needed for Veterans in danger.

  • We've set up screening and assessment processes throughout the system to help identify patients at risk of suicide. Charts of at-risk patients are now flagged so that every care-giver is aware of the danger and of the need for special care.

  • High-risk patients receive an enhanced level of care, including safety planning, regular follow-up visits, and care plans that directly address the danger. If they miss an appointment, someone contacts them immediately to find out why and to keep them on track.

  • We've established reporting and tracking systems to learn more about at-risk Veterans. From what we've learned, we've issued three information letters to the field concerning increased risk for patients suffering from PTSD, TBI, and chronic pain.

  • We've put together employee education programs, including a Web-based clinical training module that's mandatory for VA employees and a briefing on recognizing and helping Veterans at risk called

      Operation SAVE —
    • S for Signs of suicidal thinking,

    • A for Ask questions,

    • V for Verify the experience with the Veteran, and

    • E for Expedite or Escort to help.


  • We've established to two centers devoted to research, education, and clinical practice in suicide prevention:

    • VISN 2's Center of Excellence in Canandaigua, NY, develops and tests clinical and public health intervention strategies for suicide prevention.

    • VISN 19's Mental Illness Research Education and Clinical Center (MIRECC) in Denver focuses on:

      1. clinical conditions and neurobiological underpinnings that can lead to increased suicide risk;

      2. implementation of interventions aimed at decreasing negative outcomes; and

      3. training future leaders in the area of VA suicide prevention.

    • You'll hear more about the work of both Centers during this conference.

    • VA researchers make sure participants in studies have undergone standardized risk assessments and have safety plans in place that are coordinated with the Veterans Crisis Line.

    • We've also begun a clinical demonstration program to explore the impact of safety planning in VA emergency departments. This program includes the use of Acute Service Coordinators, who help Veterans negotiate the transition from urgent to sub-acute care.

    Of course, the biggest challenge in suicide prevention is getting help to the people who need help before they attempt suicide. That means raising awareness among VA employees and reaching out to Veterans and their family members.

    Our outreach and awareness efforts include —

    • Suicide Prevention Days to increase awareness within VA;

    • Public service announcements, Web sites, and display ads to publicize the Veterans Crisis Line;

    • Brochures, wallet cards, bumper magnets, key chains, and wrist bands to inform and remind

    Veterans, their families, and VA employees of the signs to look for and the help that's available. Our Suicide Prevention Coordinators also do outreach activities in their local communities and provide Operation SAVE training to returning Veterans, family groups, Veterans Service Organizations, or other community groups as needed.

    Challenges remain.

    • We need more research, particularly on the effectiveness of screening programs, cognitive therapies, and educational efforts.

    • We need to keep fighting the stigma attached to seeking mental health care. War is not normal. Veterans see things no man or woman was ever meant to see. They suffer unseen wounds in no ordinary way. There is no shame in having suffered such wounds — and no shame in seeking help in dealing with them.

    • Veterans perhaps understand this better than others, but many Veterans and non-Veterans still need to be taught that those who do suffer in this way can still lead stable, productive lives while receiving care.

    • Finally, we need to continue and extend where possible the collaboration we have begun between the Departments of Defense and VA in providing mental health care. We've made significant progress already in meeting the milestones set for various deliverables required by the DoD/VA Integrated Mental Health Strategy. These conferences are a part of that effort, as are several other initiatives I've mentioned. A few educational products are still in the works. We need to continue what we've been doing, while also completing the deliverables that still remain.

    • Our collaboration must also include pushing forward with the President's goal of establishing a common DoD/VA Virtual Lifetime Electronic Record for everyone who enters service, to ensure those Service members needing mental health care continue to receive it — without interruption — as they transition from active duty to Veterans status. I am very pleased Assistant Secretary of Defense Woodson has seen the need for a new electronic health record and made it a priority. I look forward to working with him on it.

    We can't allow our Veterans to languish without hope. As Secretary Shinseki has said many times, "At VA, we don't accept hopelessness — not among the injured, not among the ill, and not among the homeless."

    By sharing your insights and experience, both the Departments of Defense and Veterans Affairs will be better able to restore hope to those suffering without it. On behalf of Secretary Shinseki, thank you for taking part in this conference and for all you do daily on behalf of our men and women in uniform and our Veterans.

    Thank you.