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The Army's Suicide Prevention Efforts

Presenters: Vice Chief of Staff of the Army, Gen. Peter Chiarelli, Brig. Gen. Colleen McGuire, and Brig. Gen. Rhonda Cornum
November 17, 2009
                COL. GEORGE WRIGHT (Army Public Affairs): Good morning, ladies and gentlemen. My name is George Wright. I'm with Army Public Affairs. Welcome to today's media roundtable. 
 
                We're joined by General Peter Chiarelli, vice chief of staff of the Army; Brigadier General Colleen McGuire, director of the Army Suicide Prevention Task Force; Brigadier General Rhonda Cornum, director of the Army Comprehensive Soldier Fitness Program; and also available for questions is Brigadier General Richard Thomas from the Office of the Surgeon General of the Army. 
 
                Let's first cover the ground rules for today's event. We're on the record and recording news devices are permitted. The event will end at 11:45. We will not discuss the shooting at Fort Hood nor matters related to the accused, as these are being considered as part of an ongoing investigation. At the end of the event, General Chiarelli will not be available for individual interviews. And during the Q&A, please state your name and news organization, and I'll try to accommodate one follow-up question. 
 
                General Chiarelli? 
 
                GEN. CHIARELLI: Okay. Thank you. Thank you very much. 
 
                Ladies and gentlemen, thank you for attending this morning. 
 
                When I started to oversee the Army's suicide prevention efforts in February, I told you that we'd be transparent in our processes. It is in that promise of transparency that I'm here today. 
 
                As of 16 November, the Army has reported 140 active-duty suicides, which is equivalent to our total in 2008, with a month and a half remaining in the year. In fact, when we laid this on, we were at 141 and had one of our suicides that was non-confirmed, was declared an accident. So we are at 140 today. We've also had 71 suicides by soldiers not on active duty, which is14 more than our total in 2008. 
 
                I felt it was important to relay this information now and not wait until our normal monthly release, because I know many of you watch and frequently report on this topic. I also believe it is important to put these numbers in context and to talk about why we believe, despite these numbers, that we are making some progress. 
 
                If you look at the aggregate total to date, there have been 140 active-duty suicides. We are almost certainly going to end the year higher than last year.   
 
                Obviously we would prefer not to have another suicide this year or in the years that follow. But we know that will not be the case. This is horrible. And I do not want to downplay the significance of these numbers in any way.   
 
                We talk about these incidents of suicide using figures and percentages. However the grim reality is, each case represents an individual, a person with family and friends and a future ahead of him or her.   
 
                Every single loss is devastating. But our goal since the beginning has been to reduce the overall incidents of suicide. And I do believe we are finally beginning to see progress being made.   
 
                In January and February alone, we experienced 40 suicides, nearly one-third of the total suicides so far this year. If you were to simply consider these months or the total number for the year, you could erroneously conclude that the Army's efforts are not working.   
 
                However as I said, I believe, we're making progress. In fact since March, the general trendline, with the exception of a couple of months, has been down. And we attribute this reduction in the number of suicides to the many actions we have taken, since February, to inform and educate leaders and soldiers on this important issue.   
 
                If you were to ask me the single reason why I think we're starting to make progress, it's leader involvement across the entire force. I cannot emphasize enough, the challenge of suicides is without a doubt the toughest that I have had to tackle in 37-plus years in the Army.   
 
                Simply stated, it is not a single problem with a defined set of symptoms or markers. There are no easy answers or solutions. Over the past eight months, every suicide has been briefed to me. And although we have made changes to Army policy based on many of the lessons learned, we still haven't found any statistically significant causal linkage that would allow us to effectively predict human behavior.   
 
                The reality is, there is no simple answer. Each suicide case is as unique as the individuals themselves. That being said, we are very concerned with the increase this year of suicides at Fort Campbell, Fort Stewart and Schofield Barracks; while at the same time, we're studying why suicide rates are down at Fort Hood, Fort Bragg and Fort Drum. 
 
                Fortunately, we've come to better -- to a better understanding of some of the specific symptoms that may indicate high-risk individuals, and we continue to focus on the related areas of undiagnosed mild TBI, PTS and mental illness, risky behavior and other stressors. Almost everywhere I go, in nearly every speech I deliver, I speak about TBI and PTSD being real injuries, no different from a bullet wound or a broken leg, that require treatment by a doctor. 
 
                We are also working very, very hard in the Army to eliminate the stigma long associated with seeking and receiving help. This is a matter of life and death, and it is absolutely unacceptable to have individuals suffering in silence because they're afraid their peers or superiors will make fun of them or, worse, it will adversely affect their careers. 
 
                As a part of our efforts to improve the health and wellness of the entire force, we are educating soldiers about risky behavior, from the most benign things, such as poor diet and sleep deprivation, to more serious behaviors, such as substance abuse, aggression and recklessness. 
 
                Most of you are already aware of our five-year study with the National Institute of Mental Health. I will be taking an initial briefing from them in early December, and we will feed their recommendations into our current processes and initiatives. And those briefings will be constant over the next five-year period. 
 
                Already, we have instituted several pilot programs related to telemedicine, our Army substance-abuse self-referral and behavioral health counseling upon redeployment. And we have another pilot on TBI and PTSD education and protocols that will start next month at Fort Campbell. Also, in October we implemented a new screening questionnaire, through Military Entrance Processing Command, to determine preexisting or current mental health issues that warrant further evaluation as part of the enlistment process. 
 
                Initial data on the value of this new tool looks very promising. 
 
                As I said at the start of my remarks, this challenge of suicides is without a doubt the toughest I've had to take and tackle in my 37 years in the Army. Each event is unique and complicated, and there are no easy answers or solutions.   
 
                But I can assure you, the Army leadership at all levels remains absolutely committed to the overall health and wellness of our force, our families and our communities, and we will continue to work hard to help soldiers see that they are not alone and that there are other options available.   
 
                In the meantime, we're continuing to conduct a holistic program review on all programs related to health promotion, risk reduction and suicide prevention. That has allowed us to take a two-pronged approach. We're examining our legacy programs to ensure they are coordinated, streamlined, properly resourced and appropriate for today's soldiers, Army civilians and family members. 
 
                The biggest step that we have taken to enhance wellness in the entire force through prevention, rather than treatment, is the Army's new Comprehensive Soldier Fitness Program. It is an investment in the readiness of our force that gives the same emphasis to psychological, emotional and mental strength that we have previously given to physical strength.   
 
                And I'd like to have Brigadier General Rhonda Cornum talk briefly about this great program and the master resiliency trainer course she just returned from, and then we'll take your questions. 
 
                General Cornum. 
 
                GEN. CORNUM: Thank you very much, sir. 
 
                Well, Comprehensive  Soldier Fitness was really developed -- started about a year ago. It has taken a year to really roll out to this force, but it was developed in recognition that we have spent a lot of time, historically, on the training physical fitness and technical excellence in the Army, but not psychological fitness, and that all three are really essential in this era of persistent conflict.   
 
                And we recognized that people come into the Army with a wide spectrum -- normal people with a wide spectrum of physical fitness, and for example, experience with firearms. Well, they come in with that same wide spectrum of psychological strength as well: decision- making abilities; coping skills, with whatever adversity they might come up to; communication skills, which are essential in the Army, and insight into how things affect what they feel, what they think and what they do. 
 
                Now, those things together -- roughly lumped together we describe as, if you improve them, we are increasing resilience and psychological fitness -- and happily, these are all things that can be taught -- and that we need to give everybody an education so that we bring everybody up to a higher level than they came. 
 
                We need to -- just like we do physical fitness, we need to bring them up to their psychological potential. And if people are already good at those things, that's great, and we then will teach them how to instill them in other people, how to be an example, how to have an organization that is more open to other people's development.   
 
                Well, the program really is modeled -- because the Army does things well this way -- it's modeled after how we do physical fitness training. First of all, it's applied to everyone, so it's not just applied to people who we think are, quote-unquote, "at risk." There is an assessment and a reassessment at appropriate intervals, just like we do PT every six -- do a PT test every six months.   
 
                There's institutional training. Just like we do PT in most units Monday, Wednesday and Friday or five days a week, we have developed or are in the process of developing resilience training at every leadership development school, from basic officer leadership and basic training up through the sergeant major academy and the war college. 
 
                Individual training: Just like PT, most people have an individual training program. They run on the weekends, they do cross- fit, they go do weightlifting. So we have individual training based on how you did on the assessments, and that will lead you to a menu of modules that would improve you in whatever domain you are not as perfect as you could be in. And everybody has to do it. So even if you are great, it'll just be a little bit harder and you'll have to learn how to instill it in other people. 
 
                And lastly, the fourth pillar is master resilience trainers, people who get extra training on how to instill these thinking skills in their subordinates, primarily noncommissioned officers and junior officers, captains and majors who go through this, because they're the people who actually interact on a daily basis with soldiers. And that's much like we have master fitness trainers for PT. 
 
                We brought together the nation's experts from civilian academic institutions and within the military to help with the development both of our assessment tool and the training. So we are very confident that what we are deploying to the force will actually accomplish the intent.   
 
                And then additionally, we do have a robust assessment program of the plan as we do it to make sure that we were correct and it's -- validate that it is, in fact, quote-unquote "working." Historically this has been done with resilience training of teachers in middle schools, in high schools and in colleges.   
 
                And the assessment was, how did the students do, and demonstrated that the students' performance was better and their rates -- even two years after they were exposed to that teacher, their rates of depression and anxiety were half what the rates were of the students whose teachers did not get this training. 
 
                We feel confident that these same thinking skills, when you talk to soldiers, will improve performance, also lessen anxiety and decrease the catastrophic thinking that leads to the person feeling that a problem is a crisis without a solution. 
 
                Thank you. 
 
                COL. WRIGHT: Let's recall the ground rules. We'll now move into the Q&A phase.   
 
                Barbara Starr. 
 
                Q     Let me ask you two things. I specifically am not asking about the incident at Fort Hood or the criminal investigation.  What I want to ask you, General Chiarelli, is, several -- pardon me, sir -- several days ago General Casey and, I believe, Secretary McHugh have spoken publicly about the Army's desire to take a hard look -- General Casey's words -- at itself to see what it could do and what it should study to ensure that such an incident never happened again. Can you tell us what progress has been made by the Army in taking this hard look at itself, exclusive of the CID investigation or the incident? And what programs do you have in place or are you thinking about putting in place to identify people in the Army with mental illness? 
 
                GEN. CHIARELLI: Well, first of all, I'm going to let both General Casey and the secretary of the Army speak to the hard look we're going to do at Fort Hood.  
 
                But I think the Army has -- the Army has already begun the process of collecting information to begin that hard look. And I think you'll hear more about that in the days ahead. 
 
                Q     Well, am I correct that the hard look is Army-wide, not just Fort Hood, of course? 
 
                GEN. CHIARELLI: Oh, it's Army-wide. 
 
                Q     Nothing about the progress you've made? 
 
                GEN. CHIARELLI: Not at this time I can't. 
 
                Q     And tell us about any programs -- the second part of my question -- that you have or -- I mean, General Cornum spoke about resiliency, but what do you have to identify people that may have a mental illness? 
 
                GEN. CHIARELLI: Well, one of the programs I talked about in my opening statement is through the Suicide Prevention Task Force and the work that we did this last year, we've come up with a new questionnaire that is being used at the MEP stations. This is brand- new. It's only been in place for a couple of months. I've been talking to Lieutenant General Ben Freakley about its implementation and the results that we're getting.   
 
                And he feels that they are in fact -- this is a huge improvement over anything that we've had in the past.   
 
                I am very, very heartened by what we've just accomplished out of Tripler.  We took a battalion returning from theater and gave 100 percent of the soldiers in that battalion mental health evaluations.   
 
                That's the very first time we've ever been able to do anything like that. And I mean real mental health evaluations, with mental health providers, by supplementing our doctors on the ground and at Tripler with a network of mental health care providers that were provided online.   
 
                So we had a portion of that population, of that battalion, do face-to-face. And we had a portion of that population do it online. The most exciting thing about this is, the doctors that did it online are convinced that they can do it online and have tremendous success.   
 
                It's very, very interesting some of the results that have come out: a higher reference rate for mental health issues that we believe we've caught earlier, because of a 20-to-30-minute evaluation, the fact that younger soldiers prefer the online method of evaluation, more than they do the face-to-face, and the fact that older soldiers, and some of you might not find this so surprising, find face-to-face more to their liking.   
 
                But the key here is to be able to supplement our behavior health care providers for the return of a battalion. We want to increase this to a brigade and provide everybody, early on in the process, that evaluation and to come back at the 90-180-day mark and do it again, to identify those individuals who may be having trouble with reintegration.   
 
                It's these kinds of things that we're doing, that I think have great promise, for getting at this problem.   
 
                GEN. MCGUIRE: I also wanted to just add, on the program pieces, that we've expanded our scope, just not on some of these behavioral -- the suicide programs and the like but all programs in the Army that were designed to alleviate chronic soldier stressors.   
 
                And so even before what happened at Fort Hood was in place, we had already started looking at all programs, to include family programs, because we know that they are all interlinked to some degree in alleviating soldier stressors. But a lot of these programs were developed 20, 30 years ago; and so are these legacy programs still relevant to the needs of the soldier today and their family? 
 
                So we're looking at that holistically as well, to ensure that there is a component or an element of an assessment, an education training component, an intervention and a treatment component, when it comes to linking all of these different programs; that they're all nested and complementary of each other. Right now, I couldn't tell you if that was the case. 
 
                GEN. CHIARELLI: And General Cornum is always schooling me on the fact that they need to be evidence-based. And we have become believers that they need to be evidence-based. 
 
                Now, let me give you one where we're having a problem, since I gave you ones that I think show great promise. I think there's a link to substance abuse in some of the issues we're seeing, particularly with mental health. And one of the areas where I'm having a problem is getting substance-abuse counselors. And those numbers do not come out when we look at the totality of behavioral health. They are a separate group of individuals. And I'm having one heck of a time getting the numbers I need at the different posts, camps and stations, that I need to handle what I think is a higher rate of substance abuse today than eight years ago. 
 
                I think it's only natural you're going to see that as soldiers come back, you know, with the dwell time that they have, that we're going to have a higher rate. And I need more substance-abuse counselors in my posts, camps and stations. 
 
                I don't know how many of you know, but the -- the substance-abuse program -- if an individual self-referred, that was reported to the chain of command.  And although leaders didn't particularly care for it, we kicked off a pilot program in three different locations where we allow an individual to self-refer and not notify the chain of command. We keep those substance-abuse counseling services open late at night and on weekends, so people can make those appointments without the -- their chain of command knowing. And we've had tremendous success. I think that even evidence-based, it will prove to be a great success of a -- of a soldier, male or female, saying, "I think I have a problem. I need some help." 
 
                The issue I've got is enough substance abuse counselors so that when Chiarelli self-refers himself, that Chiarelli can be seen and not told, "Well, good, come back in three months and we'll take care of you." And that's the issue I've got in substance abuse counselors. I need more of them so that I can expand this program to other posts, camps and stations. 
 
                MR. WRIGHT: Let's recall the ground rules and the focus of our meeting today. The generals have been very gracious with their time to talk about suicide prevention. 
 
                Tony, you're next, please. 
 
                Q     Tony Capaccio with Bloomberg News. To what extent are the suicide rates a valid, accurate indicator of stress on the force? 
 
                GEN. CHIARELLI: I wish I could give you an answer to that. And I scrub the numbers every way I possibly can. I told you about the higher suicide rate at Fort Campbell, but I think it's fair to say Fort Campbell, the higher number of those suicides are soldiers that have never deployed. Our numbers remain as they remained last year. We've got about a third of the force that are incorporated in that 140 number -- okay? -- that have no deployment history whatsoever -- okay? -- who have committed suicide.   
 
                As I look across all the factors, from the number of deployments individual brigade combat teams have gone through, to everything else, I cannot find a causal link that links anything, other than what the Army Science Board gave me that said that soldiers who are in geographically separated locations -- okay? -- have a higher incidence of suicide. I guess the statisticians can prove that. But I can't find it. 
 
                Now, I am really hoping -- and, you know, we are always looking at this, but we believe that the National Institute of Mental Health study is going to help start to provide some of these answers. And I have great promise in the team that we've put together and the outcomes of that study. 
 
                Q     Just one quick factual follow-up. To be clear, of the 140 this year, last year, and the numbers from the last four or five years, roughly how many of the suicides occurred in theater versus in the United States? 
 
                GEN. CHIARELLI: I'd have to double-check that number. I think it's less than a third in theater. I believe the numbers are a little bit down in theater this year, but we can provide you those numbers. 
 
                COL. WRIGHT: Next question. Gina. 
 
                Q     Gina Cavallaro from the Army Times. 
 
                Do you have the numbers of suicides at -- that you mentioned at Campbell, Stewart and Schofield -- do you have that breakdown, and also at Hood, Bragg, and Drum? And can you say -- you said you're concerned about substance abuse and getting enough health care -- enough substance-abuse counselors. Does that substance abuse include prescription medications? 
 
                GEN. CHIARELLI: We're looking very, very hard at that.   
 
                Q     What else can you tell us about the substance abuse? 
 
                GEN. CHIARELLI: Well, I mean, the normal substance abuse, the fact that there are prescription drugs and there are more prescription drugs being used today for behavioral health issues, means that there are more out there. Some people are using them as prescribed, and other people are getting ahold of them and not using them as prescribed.   
 
                And I think that, although I have no numbers that I could give you, the incidence of alcohol abuse is up at our posts, camps and stations. So all these areas of substance abuse concern me. And we've looked at it from every possible angle we can. 
 
                As far as numbers, we have had 18 suicides at Fort Campbell, Kentucky in this calendar year. Now, if -- when I look at those suicides, 11 of them occurred in the first four months of the year. And as I go down all these locations, at Fort Stewart we've had a total of 10 suicides. Six of those suicides took place in the first five months of the year. And at Schofield Barracks, we have had seven suicides, and five of those suicides -- and some of those are not confirmed yet, okay, Gina? But I'm giving you the total number. And five of those suicides took place in the first five months of the year. 
 
                Now, I -- you know, I flip that and I say, wow. And I look at all the factors that I have at Fort Campbell, and from special forces, primarily infantry, a tremendous op tempo; and I go to a place like Fort Bragg, okay, with almost double the population, and I've had a total of six suicides this calendar year. I go to Fort Drum, with over 21,000 soldiers, I had two suicides this year. So everywhere I try to cut this and look at it to try to find out what the causal effect is, I get thwarted.   
 
                And that's why we think that we've got to look in its totality at a whole bunch of different issues. And it's going to take time.   
 
                Q     (Off mike.)   
 
                GEN. CHIARELLI: Yes. Fort Hood has had a total of 11 suicides this year. And you know the population of Fort Hood, almost 60,000, almost 60,000.   
 
                COL. WRIGHT: The next question goes to Nancy Youssef from McClatchy.   
 
                Q     Sir, you mentioned that a lot of these suicides are happening in places where there aren't as many forces deployed and that a lot of these involve suicides of people who have never been deployed.   
 
                Are you looking at programs -- looking at soldiers who are stressed about the possibility of going on their first deployment? Is that potentially a contributing factor from the research that you've looked at so far?   
 
                GEN. CHIARELLI: I think that's really where NIMH is going to be able to give us a hand, in doing that whole piece, because I think you know. They're going to start tracking soldiers from entry into the Army all the way through the first five years -- I mean, they are literally -- those that are willing.   
 
                And I think now we're going to start to see if there is a portion of that that can be attributed to that. I mean, that's definitely something we've looked at. I just want to make sure that I was clear.  
 
                I think what I tried to say is that soldiers who are in geographically separated areas -- we define geographically separated as really kind of away from the post, camp or station -- I mean, I would argue that a soldier in the center of the New York City is probably geographically separated, because it is very, very hard for him or her to get to many of the services that are on posts, camps and stations, because there just aren't any nearby.   
 
                I think that's some of the argument. We had the problem in Houston. Although in a major metropolitan area, many of those recruiters were in geographically separated areas.   
 
                That's one of the things that concerns me so much, with National Guard and reserve component soldiers, because they in fact mobilize. And then they leave the service and go to, for a soldier, a geographically separated area.   
 
                And that's why I am so excited about what's going on at Tripler. I mean, the vision is that if we could, to provide that kind of counseling that would be on call, to a soldier and more importantly their family, if in fact they feel that they need to talk about something.   
 
                And that could be done over the Internet. And you can do that face to face using Skype technology.   
 
                We've got to work through some of the issues, across-state-line kinds of things, but I think they can be worked through. 
 
                Q     If I could follow up, is there a correlation between the number of mental-health professionals you have -- I know there's been an emphasis of putting more at places like Bragg and Drum and Hood, and the suicide rate -- 
 
                GEN. CHIARELLI: I haven't looked at that. I know there's a natural tendency when you have an issue to ensure that your behavioral health-care specialists are -- we've got all that we need. And that's what we've done in every instance where we've seen an elevated suicide rate. But I will tell you that 40 percent, or over 40 percent of the suicides we've had this year are individuals who have seen a behavioral health-care specialist. 
 
                So like I said, there is -- doesn't seem to be any single answer or anything that will say that, if this happens, the incidence of suicide will go down, except the only thing that I can point to -- and again, it's not totally evidence-based, but it is leadership; and that is, leadership involvement, and looking for the signs that an individual is stressed. 
 
                GEN. MCGUIRE: And we don't know how many of those suicidal ideations or attempts we're -- we're -- we're catching, you know; and that, in fact, seeking behavioral health, that that could be a success story, but we have no means to capture that type of information either. 
 
                COL. WRIGHT: Ma'am, your next question? Your name and your organization, please. 
 
                Q     Mary Louise Kelly, with NPR. Thank you. 
 
                I wanted to ask about the October suicide numbers, which I'm guessing were not numbers that were where you wished they had been. They were more than double September, as I recall. Have you -- do you have the information yet to assess whether that was a blip, I mean an unfortunate blip, or whether the trend line is still going in the right direction despite that, or whether this indicates a new, you know, shift in the wrong direction? 
 
                GEN. CHIARELLI: I'll let Colleen comment. I will tell you that it -- I hope it was an aberration, but it was definitely higher. I won't call it a blip. It was higher than what we had seen. 
 
                But now I've rolled into November. I'm -- what? -- 17 days into November, and we've had five suicides in November. So I think by all accounts, we're -- we're going to see, hopefully, those numbers go down in November, when we reach the end of the month. And I can't explain, necessarily, what happened in October. 
 
                What I am totally struck with is, sitting and listening every single month to approximately 20 suicide cases being briefed to me by commanders around the world -- and we, as some of you have seen, go down range to Korea, Iraq, Afghanistan, Europe, and commanders brief me. 
 
                This isn't an attempt to try to point fingers. This is an attempt to try to find whatever things we can find and learn from the unfortunate circumstance that some commands have -- go through in that month. 
 
                And what just strikes you is, every single one is an individual case. Although we can't -- we think we're starting to pick up some things, such as substance abuse -- it's being an issue that we've got to ensure that we've got everything in place to tackle -- and some other things, I can't with any kind of -- I can't tell you exactly why the numbers went up in October or why they're down in November. 
 
                COL. WRIGHT: Yes, ma'am. Your name, please. 
 
                Q     Peggy Holter, Al-Jazeera English. In your opening statement you said that one of the things you were working on was the stigma of reporting, and of course anecdotally people often say that they feel isolated, that they feel it will harm their career, their future, which leads to the despair of suicide. And I was wondering what the specifics might be of working on the stigma. 
 
                GEN. CHIARELLI: Well, first of all, everywhere I go, I'm talking -- and I'm disappointing a lot of people. I have -- I am talking about TBI and PTS. I am trying to change what I believe is the culture of an Army to look at these invisible wounds as something less than a broken bone or the loss of an arm or a leg. There are very, very serious physical things that happen to the body.   
 
                And I think we're starting to make some progress. We have a pilot we're going to kick off at -- with a brigade at Fort Campbell who's in the midst of a train-up in December, where we're going to go down and hopefully, using both Army professionals and some civilian professionals, begin to change the culture of that brigade as it prepares to go into theater. We're going to go to the training center they're going train in and make sure that we are interjecting into their training that they're going to get at the Joint Readiness Training Center some requirements to work these issues. And then we're going to follow up with training for doctors and medics in the areas of TBI and PTS, and make sure that they are fully trained and understand what they can do to help us out here. 
 
                But I am very hopeful in some of the things that I'm seeing that are coming out of science that indicate that the further to the left, the further to the incident that we can move the treatment, the more likely we are to get at some of these things. 
 
                COL. WRIGHT: Ann Scott Tyson, Washington Post. 
 
                Q     Hi. I'd just like to follow up on three statistical things, really. You mentioned that the battalion at Tripler, you had identified more -- you know, these evaluations had identified more people with problems. Could you quantify that? Also, on substance abuse, just how many people you are short?   
 
                And then, with the suicide numbers, is there any sort of seasonality to it that could play into the change in the numbers you've seen? 
 
                GEN. CHIARELLI: If I were to lay out the seasonality answer to your question, it would go in the face of everything you believe. And that's what we look at when we look at the numbers. All I can say on seasonality is that I've been told my entire life that at the holidays the suicide rate is higher. The army has not seen that. We just haven't seen that. That's not to say we won't see it this year, but we have not seen that across the board. 
 
                I will tell you I -- most people, I think, would make the argument that the springtime -- 
 
                GEN.     : Spring and summer. 
 
                GEN. CHIARELLI: -- is the number -- where we see numbers go up. Yet that doesn't answer why in January and February this last year we had 40. So -- and what was your other question, Ann? You asked for some statistical help. 
 
                Q     How many substance abuse counselors are you short? And then, you said the battalions -- that the online and the beefed-up screening you did of that battalion identified more people, perhaps -- 
 
                GEN. CHIARELLI: I'm going to let Doc Thomas get you that afterwards, okay? He did it and he can give you the exact numbers. I can recall them. 
 
                Now, we didn't see anything abnormal here. What we're really pleased with and what the doctors are really pleased with is what they believe is, other than the normal PDHA or -- PDHA that is administered in the post-deployment time period, the fact that they were able to do a face-to-face counseling allowed, again, them to identify folks much earlier in the process and begin to provide them the counseling or treatment that they need. 
 
                But most exciting, because I've learned that working with doctors is a challenge for a guy like me, most exciting is the fact that doctors believed that they could do this online. And to me that is critical. That is the population we had to convince that we could put together a network.   
 
                And just imagine this. I mean, rather than go out and hire 200 doctors, okay, I have the ability to bring aboard 200 doctors to take care of a battalion or a brigade or to do that initial counseling, okay, or evaluation, to do that evaluation, and at the -- at the end of using those 200 doctors, I say thank you very much. And we now turn those folks we've identified over to the folks we have at our posts, camps and stations who can provide the further follow-up treatment. 
 
                COL. WRIGHT: Next on the list is Luis Martinez, ABC News. Please note that we've got about 10 minutes left. Luis? 
 
                Q     Sirs, you spoke earlier about the reserve component, about the National Guard and the reserves, the concerns that you had there. Are the suicide numbers comparable to last year's? Have they gone beyond that? And when you speak about leadership being a potential solution with that component, how -- what are the difficulties when you have them mustering not as often as -- obviously as the active-duty? What are some of the things you can do to the leaders there to train them to see what visible signs there are? 
 
                GEN. CHIARELLI: The numbers are higher this year. And I want to make sure that you understand the numbers that I'm kind of throwing out at you here. I think you normally consider the active component force, whatever our active component force is, at 525, 47-4 or whatever. When I speak active component force in these numbers, I'm talking about those soldiers who are on active duty. And that number during this time period is about 700(,000) to 710,000 folks at any one time.  So that 140 number is not that number that goes into what you would normally -- it is all the soldiers who are on active duty. 
 
                Now, when we say soldiers who are not on active duty, this is a soldier who, in fact, may have been downrange 15 days ago, has come back, demobilized, okay. He's gone back to his local community and commits suicide. He may have only been back less than 30 days, less -- quite frankly, less than two weeks in some instances. And that number is, in fact, higher this year than we saw last year. 
 
                Q     Can you quantify that, sir?   
 
                GEN. CHIARELLI: I believe we're at about 10.   
 
                GEN. MCGUIRE: It was in your opening statement.   
 
                GEN. CHIARELLI: Ten more.   
 
                GEN. MCGUIRE: Right, yes, sir.   
 
                GEN. CHIARELLI: Thirteen. Fourteen more.   
 
                (Cross talk.)   
 
                Okay, 14 more.   
 
                Q     So then it's 140 plus the 71.   
 
                GEN. CHIARELLI: That's exactly right.   
 
                GEN. MCGUIRE: But the total Army.   
 
                GEN. CHIARELLI: Yeah, right. Right. We break them into two separate nodes.   
 
                Now, we have -- as you understand, when a soldier dies on active duty, a medical examiner goes out and makes a determination. When a soldier who's off active duty dies in his local community, a medical examiner does not go out.   
 
                That's done by the community, the location that he or she is in. And we've really put a focus not only on that population. I would argue our numbers in the past, on that population, were not as good as they are today.   
 
                I mean, we have really drilled that population, to make sure that we're capturing as many as those as have occurred. Plus we've expanded our look to family members and that absolutely critical portion of our force, which is our civilians, civilian employees.   
 
                Q     (Off mike.)   
 
                GEN. CHIARELLI: Now, again, and I hate to keep harkening on this. But one of the things that we've got out of -- out of Health Affairs is a program that I'm really excited about that is in fact online counseling.   
 
                We can provide today, to anybody who's a member of TRICARE and, you know -- TRICARE has been made available to our reserve component soldiers, to be part of TRICARE. Even after that six-month initial period after deployment, they can be part of TRICARE. We have available today, and the network continues to grow, 24/7 counseling.   
 
                Now, that counseling falls short of two things. Prescription management online cannot be done at this time, okay, nor can psychotherapy be done at this time. But they can get ahold of a counselor. And what I find exciting about this is, now I have opened this up to the family.   
 
                I've opened it up to a spouse, who particularly doesn't like some of the behavior being exhibited, by someone who's returned or been returned for 90 days, can go online 24/7 using this TRICARE network, in our three regions, and get that kind of counseling and explain what he or she is seeing and find out if there's reason for concern.   
 
                I have hope that I can expand that to include much more than that in the future and we can grow this network. And that's the way -- the best chance I have -- I believe we have at being able to deliver that kind of mental health provider help to those who are geographically separated. 
 
                COL. WRIGHT: Courtney Kube, NBC News. 
 
                Q    Well, Ann kind of asked my question, but this is about substance abuse counselors. How short are you? And then also, how many total you have -- or how many are deployed, do you have deployed? Is that a problem, that you're seeing substance abuse in theater as well? It's just here in the U.S.? 
 
                GEN. CHIARELLI: We're seeing it here in the United States. 
 
                Q     Okay. And then also, do you have the total number of mental health professionals that you still are short Army-wide? I know that was a problem -- (off mike). 
 
                GEN. CHIARELLI: This is one of those great numbers, okay?   
 
                GEN.     : (Chuckles.) 
 
                GEN. CHIARELLI: You know, we are an Army that is based on authorizations that were prior to eight years of war. And I have been pounding the system to say we have got to sit down and determine what we need after eight years of war. And if I was to look at substance abuse counselors that I feel that we need today, I would up the number that currently are on hand about 300, 270 to 300 more that we need today. That is what I believe we need at our posts, camps and stations across the Army. 
 
                Q     That's for substance abuse? 
 
                GEN. CHIARELLI: That's just substance abuse. 
 
                If I look at mental health care providers, I think that we've -- in the last two years have hired almost 900. But I see a shortage today of somewhere in the vicinity of, I would argue, 800 -- 750 to 800.   
 
                Q     And that sort of begs the question of with these continued shortages of mental health professionals, is there any concern that the quality of your mental health professionals in the Army are -- is going to slip? Is it going to fall? That people are being promoted up when perhaps they shouldn't be in the mental health -- 
 
                GEN. CHIARELLI: There's no -- there's -- I have no data to show that whatsoever. But I think it's really important to understand this. The problem I have isn't my problem alone, isn't the United States Army's problem alone. The reason why I'm having a problem with mental health care providers is, United States society as a whole is having a problem with mental health care providers. 
 
                They are just not available. And it makes it very, very difficult for us to make up our shortage. 
 
                That's why I look to other ways of trying to -- to get that kind of help. And that's one of the reasons I'm so excited about what we just did at Tripler, because if this were to prove that we could do this at posts, camps and stations for returning soldiers, I really believe that delta that we have that I'm giving you right now, that I look at as based on the old way of doing things, if we could -- if this proves to be something we could use, we could lower that number that we needed to have, quote-unquote, on our payroll. 
 
                COL. WRIGHT: And you may be the last question, from the Associated Press. 
 
                Q     General Chiarelli, given the problems that you've identified in trying to figure out who may be a suicide risk, how confident are you that the Army will be able to apply any of -- any meaningful metric to who might be at risk for the kind of violence we saw at Fort Hood? Are you concerned that there may be other time bombs out there, and could you find them, if there were? 
 
                GEN. CHIARELLI: I want to let -- please let Rhonda correct me if I'm wrong, but as I'll say -- that is why I'm really excited about what NIMH is going to do for us. And it's their analogy, not my analogy: When they talk about what they're about to do, they compare it to the Framingham study on cardiovascular disease that began in 1948 in this country, and I believe continues today. 
 
                GEN. CORNUM: Continues today. 
 
                GEN. CHIARELLI: A very long-term study that, I've had doctors indicate to me, has reduced the number of cardiac deaths we have in the country by over 60 percent. It is the reason why old folks like me take a Bayer aspirin every day, why you get your -- I hope everybody gets their cholesterol checked on a regular level, why the doctor asks you to talk about incidence of cardiac issues in your family. So they can come up with a fairly good algorithm that is going to say, "Chiarelli, if you don't do things a little bit different, based on all these indicators, you're going to have a problem down the road." 
 
                Now, they feel that because of the size of the Army, because of the data that we're able to provide them -- their words, not mine -- that they hope that they can provide a similar algorithm that can be used to identify soldiers early on who might be at risk for psychological problems later in life, or not so later in life.   
 
                And I think that's what so exciting about what Rhonda's doing, is because this is the very first time that we, you know, have stopped being reactive and, in my words, are being proactive in teaching people to be more resilient. And that's why her program -- our program that she's spearheading, that the chief has been four-square behind -- I think shows great promise for the future.   
 
                I wish we could snap our fingers, make everybody more resilient today, but we know it's going to take some time and some real effort. 
 
                Q     Are you concerned that there may be others out there that have that same impulse to violence that you haven't found yet? 
 
                GEN. CHIARELLI: Well, I think we always have to be concerned about that. Do you want to add anything?   
 
                Q     General Chiarelli, I'm with -- sorry. 
 
                GEN. CORNUM: I'll just add that, you know, I was -- I think I was at Fort Bragg when there was the person who decided to start sniping at people who were doing PT, and I don't think that studying that one guy would've allowed us to predict this second guy. So I think tragedies sometimes happen. 
 
                COL. WRIGHT: General Chiarelli, thank you so much for your time. You've been very gracious.   
 
                Thank you all for coming, General Cornum, General McGuire.   
 
                General Thomas, thank you, sir, your staff.   
 
                GEN. THOMAS: Thank you. 
 
                COL. WRIGHT: If you have other questions, feel free to send them to me: George.B.Wright -- B as in baseball -- Wright -- w-r-i-g-h-t -- @us.army.mil. 
 
                General, thank you. Closing remarks? 
 
                GEN. CHIARELLI (?): Thank you. No.   
 
                GEN. THOMAS (?): Always get you in trouble.  
 
                GEN.     : (Laughs.)
 
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