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Special Defense Department Briefing from the Pentagon Arlington, Virginia

Presenters: Vice Chief of Staff, Army Gen. Peter Chiarelli
July 29, 2010

                 I'm here to try to put in context a report that we posted online today at 10:00; and just want to tell you that, as you all know, in May of 2008, both the secretary of the Army and the chief of staff of the Army initiated a full-scale effort to understand and mitigate suicide trends within the United States Army.  

                In January of 2009, after the Army, for the first time ever, exceeded the civilian ratio for deaths-per-100,000 due to suicide -- we were close to 20-per-100,000, as opposed to civilian deaths of 19- per-100,000 -- the secretary and the chief asked me to lead a task  force to try to drive down the rate of suicide in the United States Army.  

                In early spring, we went out to six installations in seven days, with a team that split up and talked to soldiers and family members -- family members of deployed spouses.  

                And as any operator going out to solve a problem, I was totally focused on driving down suicide but came to understand after about the third installation we went to that this is an issue that's much larger than that.  It's about the health of the entire force, and it also includes families.  They are a critical piece to this whole thing.  

                We came back, published a campaign plan, which we have been executing for the last year, and began the process of pulling together this report.  We thought it absolutely critical to get this report out as soon as we possibly can so we can go about doing -- making the fixes that we know we have to do.  

                It represents 15 months of rigorous effort by government, military, medical and behavioral health-care providers, researchers and others.  It identifies indicators of high-risk behavior that are reflective of the stress and strain on the force after almost a decade of persistent conflict.  It also identifies gaps in policies, processes, procedures pertaining to the surveillance and detection and mitigation of high-risk suicidal behavior.  

                Now, the truth is that some of you are going to get stuck on chapter three, but we felt it absolutely important to lay out what the problem is and some of the indicators we see, because the rest of the report take -- report takes on how are we going to fix that.  And it's important that our leaders understand the issues that we saw as we looked at the data -- some 32 databases that we pulled together to provide some of the statistics you see in chapter three.  

                But I would hope that the report would be looked at holistically, in all 10 chapters.  There's 10 chapters.  It not only says where we are today and what we've done so far to try to fix it, but it also lays out a way ahead for how we're going to get us back to where we need to be.  And that is absolutely critical.  It has to be reviewed in context -- and understanding that you're looking at, after a decade, a force that's been stressed and strained for that decade.  

                Now, the United States Army is a fully capable force comprised of 1.1 million men and women, totally capable of doing whatever mission the country gives it.  What you're going to see in this report is a focus on 700,000 of those soldiers, because the databases I have are only for that portion of the soldiers that are serving as Title 10.  It includes reserve and National Guard soldiers who are mobilized.  But once a soldier is demobilized, it gets -- the fidelity of the data that I have here is almost impossible as they go back to posts, camps and stations.  

                And I just want to stress this represents a very small portion of the population.  The subset of the population we're looking at is divided into two groups of people.  First are "at risk," a sustainable population who need and are seeking help.  And it's absolutely critical that we understand that, because that's one of the things we have been trying to stress, is the need for soldiers who have behavioral-health issues and other issues to get the help that they need.    

                But there's another subset of high-risk soldiers, which is a smaller population that need -- needs help but will not seek help.   

                And it is continuing to engage in high-risk behavior.  And because of some of the policies that we used to apply across the force that, because the force has been so stressed for so long, have not been followed, we've lost track of some of those high-risk soldiers.  

                The report has over 250 recommendations to identify and mitigate some of these problems.  It is a report.  It is only a report.  It is not a regulation.  And it will now go into a staffing process where we will take those recommendations and make a determination on which ones we're going to put in place.  

                To my left you see the first chart, and I asked to have my folks put that up there.  That is basically the table of contents that lays out for you the 10 chapters of the report.  The first four chapters of the report basically lay out the problem, where we are.  Chapter three talks about some of the issues we see in the force today.  Chapter four introduces a new piece that I will talk about today called the composite life cycle that we think is very, very important to understanding the stress that's been put on the force.  Five lays out our campaign plan, where we went on our campaign plan.  And then six through 10 lay out for us where we want to go in attacking the problems laid out in the first four chapters.  

                Next slide, please.  

                Now, in the report you're going to see charts like this.  And I just put this up as illustrative.  If they're not -- if someone doesn't take the time to read what is in the text, you can walk away with what I think would be incorrect perceptions.  But this is a good example of recruiting waivers.   

                I think you've all reported, at least in the last couple of years, the high number of waivers that we had in the United States Army, which peaked in 2007, as you can see by this chart.  It has gone significantly down in 2009.  This report covers only 2009.  The data I have is not for the entire period:  We are focused on 2009 data here.  

                You can see that the number of recruiting waivers in 2009 was 6,000, almost half as many as we had in 2007, and that number continues to go down today.  We are down to 10.1 percent.  And a majority of those waivers are very, very minor waivers, mainly health waivers, none of the more serious waivers that many of you talked about before.    

                But at the same time, if you follow back to FY '97, you see the number of chapter actions that we have taken to move soldiers out of the service have gone down over that time period.  That's the kind of data we provided in chapter three.   

                Next slide, please.  

                Now, this is a model, and it's not to be taken out of context. It's our attempt to try to show to our leaders some of the issues we see.  And it is in the form of a maze.  As I indicated before, this is all fiscal year '09 data.  And some of you who follow this very closely will look immediately to the center of the chart and see the 160 suicides and say, well, wait a second, I thought you had 162 suicides last year.  We did in the calendar year, but we had to correct this data for the fiscal year, because all our databases are in fiscal year.  So that's why you see that number of 162 (he meant 160).  

                In addition to that, you see high-risk deaths of 146.  This model demonstrates the complex relationships that we see between stresses associated with high-risk behavior and the increasing severity of outcomes.  

                You must understand that outside that model is our baseline population, the large majority of soldiers who never enter into the maze.  And being in the maze is not necessarily a bad thing.  In fact, we are encouraging soldiers to come into that maze.  And I'll explain that in a second.  

                A soldier can enter the maze in two different ways, one to the far right, and you could enter and make your way to the first area, which is outpatient behavioral health care.  And to give you an example, what we're talking about here is anyone seeking outpatient behavioral health care or anyone screened for -- by a behavioral health specialist.    

                So I am hoping that this number, when we take this data for 2010, quite frankly, doubles.  As many of you know, we're working -- virtual behavioral health care is one method of ensuring that every soldier that comes back gets a good evaluation, not just the filling out of a form, but a good evaluation from a behavioral health care specialist. And those numbers are included in that outpatient behavioral health care.  

                So that's a very good thing.  Many people will enter the maze, get that particular care, whatever it might be, or that screening, and they come right back out into the base population.  

                It is important to increase and improve our surveillance and detection systems to better monitor and intervene the deeper folks get into the maze.  And one of the things that has been very difficult for us to understand, and some of you have been at the suicide review groups that we do, is that there are some people we see walk in this maze and make their way toward the center, but there are other people that go directly to the center.  And that's what's represented in the upper left-hand corner.  And I will give you an example of that in a second.  

                The goal is to get folks out of this maze as quickly as we possibly can.  And the two different colors you see here, the light colors are those individuals who are at risk, who are seeking behavior, which is a good thing; and then the darker colors are individuals who are displaying some kind of high-risk behavior, not seeking help, that require intervention.  

                Our intensity of effort increases in the inner-three rings, and I'll explain that in a second.  And of course, the blue center is where we don't want anybody to go.  And as you see, we've broken this into two groups, not only suicides but high-risk deaths.  

                Now, let me give you a couple examples, vignettes.  And for those of you who've looked through the report, you'll see some pretty stark vignettes that we've put in there for our leaders to take a look at. Again, they are (inaudible) of one in a force of 1.1 million, but we thought it important to lay out some real-world examples of what can happen when sometimes we don't do what we should or don't follow our policies the way we should.  

                An example of a soldier who enters in the left-hand -- right-hand side of the maze:  This is an individual who will be represented in many of these rings here.  So one of the things I want to tell you is, you can't add up these numbers and say, "Ah-ha, there was X number." The numbers do not add.  

                Let me give you an example here.  We have a 28-year-old private with four years in the Army, separated from his wife, deployed twice, history of suicidal and homicidal gestures; assigned to a WTU, received treatment for PTS; under investigation for marijuana use; financial difficulties, recently lost their -- his home and his car. As you can see, he's represented in many of these rings here.  Command referred to mental health; diagnosed with a personality disorder and a deep depression, prescribed several medications, including sleeping pills, anti-depression and pain relief; failed to report to duty, suicide note found in his room. 

                He was found dead four days later from an apparent self-inflicted gunshot wound to the head.  This is an individual that touched just about every single one of those rings.  That's why the numbers are not additive.  

                Now, these are the cases -- these are the -- this next example is an individual who enters at the top, and it's a direct entry.  And these are the ones that are so perplexing and difficult for us to understand.  Twenty-eight-year-old female staff sergeant, with eight years in the Army, on her third deployment.  Married; she and her husband deployed together, and were allowed to cohabitate.  And those of you who've been downrange know that that is what we do; our married couples are allowed to cohabitate if they're on the same forward operating base.  This female received a Bronze Star on her first deployment for saving another soldier's life.  Found dead from a self- inflicted gunshot wound to the head.  No history of alcohol or drug abuse; no evidence of previous suicidal ideations or attempts; no clearly identified stressors; strong marriage, no issues there; no evidence of prior planning of suicide or pre-suicidal signals or indicators.  Again, very, very perplexing.  And as I get briefed on 20 to 25 cases every single month, there always seems to be two or three that are just like this.  

                Now, let me put the numbers in context for you, so you understand those a little better.  I already talked about outpatient behavioral health-care numbers.  As you see here, it's over 216,000.  This is a good news story.  This, I think, is the Army's attempt to try to break down the stigma associated with seeking that help.  And quite frankly, if that number increased to 400,000 next year, that means that virtual behavioral health is out and being worked.  Because soldiers are seen by a behavioral health specialist, they are given a good look at, and they will be included in those numbers.  

                Prescription drugs.  The kind of drugs we're talking about here are indicated.  They're anxiety medications, pain medications and antidepressants.  Some of these will be for behavioral health issues; others will be pain medicine.  Every single one of these prescriptions is someone who received a prescription for three weeks or more -- or is it 15 days? -- 15 days of pain medication.  Okay?  So this isn't the individual that goes in and has his wisdom teeth taken out and you give him five Percocet for pain relief.    

                But these are not necessarily all behavioral health issues.  And we can't parse the data as fine as we would like to, and this whole exercise has been important for us because we will start doing that. But if you have a soldier that has a knee problem after 15 months in Afghanistan, humping a ruck at 10,000 feet, that's an example of an individual who may come in and get pain medication and be included in that number.  

                Inpatient behavioral health care is someone who cannot just be seen as an outpatient, is put into a facility.  As you know, most of our facilities are contract facilities, and we had just over 9,000 soldiers in our fiscal year '9 data who had inpatient behavioral health care.  

                Other criminal offenses.  This is not 57,000 soldiers.  Let me give you an example.  If you're an individual who's picked up for DWI and titled for DWI and reckless driving, you represent two of those numbers.  And many -- some people, as you well know, are titled for many, many more than two or even three offenses, depending on how serious it was.  So that number there is not a number you can look at and say we had 57,000 soldiers with criminal offenses.  

                Drug and alcohol offenses, just short of 17,000, and you can see those numbers.  That's probably a pretty pure number, but somebody could have had two drug and alcohol offenses.  And we saw some recidivism out there in fiscal year '9.   

                Suicide attempts, 1,713, if anything, that number is probably a little lower, I've got to tell you that.  That does not account for the individual who takes a bottle of aspirin, doesn't think they're going to wake up, wakes up the next morning, and we never hear about it.  But those are the suicide attempts we know of.   

                High-risk deaths are those individuals that are not considered suicide.  But that may be the individual who gets behind a car, wraps that car around a bridge abutment at 2:00 in the morning and has a blood-alcohol level of 1.5.  Next slide, please.    

                Now, what we tried here to do is to show you that in perspective. If you take the big blue dot as a force of 700,000 folks, and if you look at the number of folks that are in outpatient behavioral care, that's the red dot you see there.  Those are two good dots.    

                I like that red dot, because we've got folks that are listening to what we're saying about stigma.  Then if you look at the prescription drugs, that is a good dot, because at least these are drugs that are being prescribed by a doctor.   

                And I think you know that there's a companion volume to what we're doing here that many of you have read about, that was done by the Pain Management Task Force, to take a look at how we can decrease our reliance on some of these pain medications and other kinds of medications.    

                And the surgeon general has come out with a way to do that and a campaign plan to do that, which is also a good thing.  As I explained, the purple dot shows people with criminal offenses.  But that's the number of criminal offenses.   

                That does not represent the number of people, nor does drug and alcohol offenses in every single incidence.    

                Then you see inpatient behavioral health care at just over 9,000.  And if we had not shadowed in suicides and high-risk deaths, you wouldn't even be able to see those dots on this chart.  

                We are, in fact, expending much, much effort on a very, very small portion of this population in order to drive down the incidence of high-risk deaths, high-risk behavior and suicides.  

                Next slide, please. 

                Final chart I want to talk to you about from chapter four -- and this is exciting for me.  And this is some of the things that I think are going to come out of this report that are going to help us get at this problem.  And it was one of these things that, when they laid it out for me, was a blinding flash of the obvious.    

                We tend to look at ARFORGEN [Army Force Generation] and the effect of ARFORGEN and the Army Force Generation model and the fact that our soldiers are on the BOG/dwell rate that they are today -- we still have not gotten to 1:2. We still have an Army that's out of balance.  It is better today than it was four, five months ago, but I still have aviators that are going out at 1:1 -- one year home, one year deployed, one year home, one year deployed.  We are approaching 1:2 with some of our MOSs, and we expect to be there with many of them in FY '12.    

                But no one has 24 months at home until they've spent 24 months at home.  The mere fact that you tell them they're going to spend 24 months at home doesn't really have an impact until they've had that 24 months at home.  

                But you all know about that.  You know we have soldiers that go, in a period of eight years at three different units, they go through a cycle of resetting their equipment, getting trained and ready and then going ahead and deploy and starting it all over again.  A soldier up in that particular line, that ARFORGEN line, may have gone to three separate units; he may have stayed in the 101st the entire time.    

                But it's representative -- and each one of those red dots indicates a stress point that that soldier goes through.  

                In addition to that, every soldier is a soldier.  And individual soldiers have stress points, as you can see here.    

                One of the ones that we point to in the report, that's absolutely critical, is exodus leave and reception: that soldier that leaves basic training and goes to his first unit, leaves a group of individuals that he's very, very comfortable with, that he's gone through a very rigorous training regime with, and then is shipped off to a unit where in fact he doesn't have those same friends and he has to make his own way and make friends.    

                It's a new experience for him.  And as that soldier increases in experience and rank, he has other stressors, everything from promotion to his first noncommissioned officer course to his first leadership position.    

                I don't think there's a soldier in the Army that hasn't had no- pay-due at some time, a promotion, a temporary profile.  You can read those.  Each one of those is a stressor.    

                And then finally there's the one that we often forget, and that is in fact the family strand.  The soldier gets married, makes a major purchase, has financial difficulties, birth of child one, and birth of child one while that soldier is in fact deployed.    

                This chart shouldn't be looked at horizontally, it should be looked at vertically, because these are the stressors the soldiers go through.  And they accumulate down here at the bottom in these stressor windows.    

                Now, what are some of the things we're able to draw out of this? We know that 60 percent of the suicides that we have today are first- term soldiers.  Those are soldiers who are in their first enlistment. And the most dangerous year to be a soldier is your first year in the United States Army.    

                We see more suicides in that first year than in any other years. Most soldiers who enter the Army are 18, 19, 20 years old.  They have that highest rate of suicide.   

                But I can also tell you that if we look at another cohort, and that's soldiers who enter the Army when they're 28 or 29, their suicide rate is three times that of a soldier who enters the Army at 18, 19 or 20.    

                Now, I'm not trying to typecast a soldier that enters the Army at 28 or 29 years old, but I think it's fair to say in some instances it would be a soldier that’s possibly married, couple of kids, lost his job, no health-care insurance, possibly a single parent, okay, coming in the Army to start all over again, and we see this high rate of suicide -- three times the rate that we see in an individual 18, 19 or 20 years old.  

                Now, why is that important?  Young lieutenant gets a new soldier into his unit, sits him down -- 29-year-old private.  We hope through this report that young lieutenant will know that maybe it's time to spend a little more time talking to that 28- or 29-year-old, understanding what his financial situation is, maybe getting him over to AER [Army Emergency Relief] if he needs it, getting him or her the financial counseling they may need, and paying a little more attention to him.  

                We also know, by the statistics I just gave you, that 79 percent of our suicides are soldiers with no deployment history or one deployment.  And the most dangerous time in that first deployment is the first six months.  That's adjusting to the theater.  

                Now, how is that important?  As busy as our units are today, if sponsorship programs are not doing what they're supposed to be doing, it's probably not important to concentrate on the majors, the colonels, the lieutenant colonels and the senior non-commissioned officers.  If young leaders are doing anything down there today, they ought to be focusing their sponsorship programs on young soldiers coming into the unit, that soldier that just comes out of basic who's trying to make friends, who is new to the unit.  

                These are the kinds of things and lessons that you draw from this data that we believe are going to be absolutely essential for us getting a handle on this.  

                And as many of you know, what's really interesting is that the bottom part of the chart -- we all know that as we get older, we get more mature; at least, hopefully, most of us do.  But what we haven't understood until the advent of Comprehensive Soldier Fitness and the inculcation of that program into the Army is that we find that younger soldiers coming into the Army -- and I think the Global Assessment Tool shows that -- have a much lower rate of resiliency, much less resiliency than older members.  That's not to say that everybody who's old has high resiliency.  

                But we know through evidence-based training that we can teach soldiers to have a high rate of resiliency.  And through this data, we have focused our effort, with our master resilience trainers, at basic training.  Now, this may not mean anything to you, but it means something to me.  And in basic training today, in a very short period of time we've added 10 hours of resiliency training for young soldiers entering the Army.   

                That's the kind of thing that comes out of data like this, and it allows us to focus our efforts to make sure that we're expending resources where we need to expend resources, and getting a very valuable resource to us, the master resilience trainer, to the place that he needs to be.  And if you have a choice, it's a great place to have him -- him or her, in basic training, beginning the process of making soldiers more resilient before they go to their first unit.  

                Next slide, please.  

                Now, I'll just put this one up here again because I know there's a lot of interest in Chapter 3.  But there are 10 chapters here.  I hope you'll help people see this report in context, an attempt by the United States Army to take a really, really hard look at itself, see some things that maybe we're not doing as well as we should before, put it in the context of a -- of a force that's been fighting for 10 years and has a plan on how it's going to fix those things that it needs to fix. 

                That is what I'd like to say to you today.  And I will open it up for questions. 

                Sir.  

                Q     If I could make a leap of faith for a moment that probably the people who you're dealing with who are at risk of suicide probably brought issues into the Army with them, that's not something they picked up there, necessarily.  How does this relate to -- you know, to your recruiting efforts and things that you try to do to try to flag some of those issues and folks before -- you know, before they come in?  

                GEN. CHIARELLI:  One of the things that we asked for and NIMH [National Institute of Mental Health] managed to do for us when they started the 50 million dollar -- the study, the big study they're doing for us on suicide was to go down and see what our screening process was for new recruits coming into the Army.  We redesigned that entire program.    

                And one of the very positive things we've heard from the National Institute of Mental Health is that we've got it about as fine as we possibly can.  I think you all know we can't force anybody to turn over their medical records to us at a recruiting station.  It's basically the honor system.  We can't access those medical records. We have to look for other indicators that they have problems.  

                And we have -- we have -- we have -- we have increased our screening.  And NIMH told us point-blank that if you want to reduce suicides by your screening methods into the Army by two suicides a year, you'll have to disqualify such a large population that, quite frankly, you couldn't meet your recruiting goals, and you would have a very, very small return on the number of -- you would be denying a whole bunch of folks the opportunity to serve their country in the Army, and you would have very little effect on your suicide rate.  

                Now, I think you all know that the Global Assessment Tool is something we require all soldiers to take.  And we're right in that process now of finishing that out.  But some of that data has showed us that young soldiers coming into the service have a lower rate of resiliency; much the same as maturity.  And that's why we have focused our efforts at that particular level.  

                Yes, sir.  

                Q     General, you've been looking at this for a long time now. You've overseen this report.  The Army today, your bottom-line assessment:  How good a job is the service doing at preventing suicides?  Are they doing a better job today than they did 15 months ago when you started this task force?  

                GEN. CHIARELLI:  Well, I happen to believe we are.  I believe we've got leaders engaged in doing the kinds of things that they need to do.  This report is the next step in putting together all the databases that never before have been put together.  We pulled together some 32 databases.  And I don't know if you've ever tried to get somebody's database from them, but information is power, and it becomes very difficult at times to get folks to give you that data.  

                But we pulled together all the databases to put this report together, and it pointed out some things that we think we need to work on.  We've included most of those in chapter 3, with a series of recommendations.  That chapter is written for the force.  I've got to help leaders understand how things have changed in almost a decade of war.  

                I mean, you need to understand that we've got platoon sergeants -- E-7s in the United States Army today -- who joined the Army after September 11th, 2001.  They've known nothing other than the OPTEMPO that we're under today.  Their life has been constantly:  reset, train-ready, deploy; and begin that process all over again.   We have families:  that's all they've ever experienced.  

                And the real exciting portion of this report -- which is a yawn for you -- is chapters 6 through 10, because now we lay out a plan for how we at Department of the Army are going to find the gaps in our programs.  

                We're going to eliminate the redundancies, make sure that we're spending the taxpayers' money in a way that supports evidence-based ways of getting at this problem and not somebody's good idea that they think works, okay, and begin to tackle this problem.    

                But in order to do that, we had to have chapter three to lay out for leaders some of the things that our data shows us.   

                Q     But in chapter three, but in -- of the problems today, of the ones that you can fix, what's the most important recommendation? You can't change the op tempo until it changes.    

                GEN. CHIARELLI:  I can't tell you what the most important -- there's a lot of important recommendations in there.    

                I mean, one of the things that I think is very, very important is the 4833, something that I grew up with as a brigade commander.  And I'll never forget after 30 days in command, I got a call from the deputy corps commander wanting to know where my 4833s were, the commander's report of disciplinary action.    

                I have a soldier that's picked up for DWI.  That is in fact given to the commander to take the action that the commander deems he's going to take.  But no commander is forced.  That commander makes a judgment on what he's going to do.    

                But you're to report back.  Nobody's grading your paper.  But what you're doing is, you report back that I took no action, because there was a reason why this occurred, or I took the following action.    

                We used to have a compliance rate on a 4833 of 99 over 99 percent.  And in the force today, it's less than 65 percent.  It's that kind of thing and getting that in.    

                And that helps us to understand so that when a soldier makes a mistake -- goes on deployment, does wonderful things on deployment, comes back and makes a mistake again -- that we've captured that data and know the history of that data, when that soldier goes to his next unit.   

                Those are the kinds of things that we've got to get back to doing in the force today.  

                Q     Sir, how did the Army get so far behind the curve on all of this?  

                GEN. CHIARELLI:  It's not -- you have to understand that we prioritized what we were going to do, and that we prioritized, I think, the way you would want us to do, and that is to fight our nation's wars and to be ready and tactically sound to go and do the mission we were given by the country.  But when you come back and you're in the BOG:Dwell ratio that we were in, commanders prioritized those things that they were going to do.  And they rightly prioritized the number-one thing that they were going to do is to prepare their soldiers to go into harm's way.    

                Now as we come back and we start to see BOG:Dwell increase, or at least we forecast it's going to increase, it's time for the Army to take a hard look at itself, to sit down and say, okay, what are those things that came lower on our priority list that we need to reinstitute, reinforce and start doing to get at this problem? 

                Q     You knew most of this stuff was happening, right?  I mean, you had your figures from '06, '07, wherever, that you were increasing waivers, decreasing separations.  You knew the demographic of your Army was changing.  

                GEN. CHIARELLI:  I'm just saying that -- waivers aren't necessarily bad things.  Okay?  We have lowered the number of waivers that we provide today.  And we knew some of these things were happening, but I don't think we ever put it all together in a place that could help us understand the way we've tried to do with this report.  And that's exactly what the report's trying to do.  

                Ma'am.  

                Q     (Name off mike) -- from The New York Times.  Just to be counter-intuitive, if you say -- you're right that 79 percent of the suicides are soldiers within their first deployment?  

                GEN. CHIARELLI:  Seventy-nine percent of soldiers have no deployment history whatsoever --  

                Q     Yes.  

                GEN. CHIARELLI:  -- okay -- or have one deployment.  

                Q     Seventy-nine percent soldiers who --  

                GEN. CHIARELLI:  Seventy-nine percent.  

                Q     -- of the suicides.  

                GEN. CHIARELLI:  Yes, ma'am.  

                Q     Well, then, how does that -- that means that they haven't been deployed over and over and over again, so how is -- are you -- I mean, there's an incredible stress on the force, obviously, but that doesn't speak to incredible stress on the force over five deployments if it's only -- if most of these suicides are happening in the first deployment.  

                GEN. CHIARELLI:  Many are -- I mean, the average age for suicide is 23.  

                Q     It's sort of -- it is -- your -- this --  

                GEN. CHIARELLI:  That still leaves 21 percent of the force, okay, that we have to take a look at.  

                Q     But you don't see that -- I mean, so maybe it's the waivers rather -- more than the stress on the force over 10 years of deployment?  

                GEN. CHIARELLI:  You can make an argument by looking at this data for just FY '09 that, as you go and have additional deployments and get older, your resiliency may get better and your ability to handle things -- you could look at the data and parse it that way.  I think that would be dangerous to do, just looking at '09.  I think you've got to look in total.  And one thing that NIMH is going to do is help us with that.  

                As we get more -- as we get more experience with the GAT and comprehensive soldier fitness and we start to build that database over time, that too will help us to understand this problem more.  

                Q     But you won't say that -- it seems to be, some of these numbers, that the bigger problem is granting too many waivers.  

                GEN. CHIARELLI:  I don't -- I don't agree with you at all.  I don't agree with you at all.  I do not agree.  We see no relationship whatsoever to waivers and suicide that we were able to pull out of this.  Nothing.  Nothing.  

                I just tried to pull two charts out to show you the kind of thing we lay out that will be very, very helpful in our discussions.  

                I think the most important chart there is to -- is to look at the number of separations, how separations have gone down over time.    

                Sir.    

                Q     General, if the new soldier is the most at-risk soldier, is there some thought to maybe taking some of these soldiers from their basic training unit and sending them to a unit together, so they have a little bit of a network, in terms of a couple of buddies going with them to a unit, for their first deployment?    

                GEN. CHIARELLI:  We haven't looked at -- I think that's the kind of debate that we will have, as we -- as we look through that. Whether or not  we could do anything like that, I can't tell you.    

                We are a transient population by nature.  And it's very, very hard to send us around in groups of individuals and maintain our ability to do what we've been able to do, for the last 10 years.    

                But I think the bigger issue there is that a commander now, a young lieutenant down there, a young captain down there, knows that his high-risk population is that new population that's coming into his unit.    

                So what time he has or she has, they can focus it on that new soldier.  And the data helps them understand that.  That's why we found it so important to get this in the hands of the leaders.    

                They don't have to read 350 pages, believe me.  I know you probably all choked on the size of it.  This is interactive online. And a commander can go in and only pull out those portions very, very easily that apply to a company commander, platoon sergeant, battalion commander or brigade commander.    

                Ma'am.    

                I'll come to you next, Mick, I promise.    

                Q     I wanted to circle back to Julian's question about solutions.  Most Americans are not familiar with Army terminology, report numbers, things like that.  Could you just circle back and describe in your view, after all of this -- explain to Americans what the solution is to all of this?    

                You have laid out a very serious series of problems.  What in simple language does the Army need to do now?    

                GEN. CHIARELLI:  Well, what we -- what we need to do is to take a look at what we have in the first four chapters of this report, look at those things, those processes that, because of prioritization and the way we have had to operate over the last 10 years, that we need to place more emphasis on.  

                Q     (Off mike) -- give us any examples, just real-world examples that people can understand who aren't going to be reading this report?  What do you need to do?  What does the Army -- what does an Army commander need to do?  What do troops need to do?  Just some examples of solutions.  

                GEN. CHIARELLI:  Pay attention to soldiers that demonstrate high- risk behavior.  Look at the data that we were able to provide you here, and use that to help you prioritize your time on who you're going to concentrate on.  

                This report was written for our soldiers.  It was not written for us; it was written for our leaders.  And the back part of it is for us on how we can provide them the things that they need to get at this problem.  

                Q     What do soldiers need?  

                GEN. CHIARELLI:  We need more drug and alcohol counselors.  We need more programs like CATEP, confidential alcohol -- drug and alcohol treatment programs, where a soldier that feels like he or she has a problem with alcohol can, in fact, self -- refer themselves for help and their leadership will not be informed -- again, trying to get at the stigma.  We want soldiers to understand the criticality of eliminating the stigma, with an understanding that it's not bad to go into the maze.  In fact, it is exactly what is needed in some instances to get the help that you need in order to solve the problem and the behavior you're displaying.   

                I mean, that's what we want folks to get out of this report.  And we want us to look at what we can provide to commanders to make this easier for them to do; provide them the programs they need to do this. And that's where you get programs like Comprehensive Soldier Fitness. I want commanders to walk away with this with the idea that Comprehensive Soldier Fitness is the Army's attempt to move as far left as we possibly can on this program; not wait to have a soldier display high-risk behavior, but tackle that problem early on, when they join the service, and continue that education as they continue their career.  Those are the kinds of things that we want folks to get out of this report.  

                Ma'am -- oh, Mik.  Mik.  

                Q     I'd like to ask you about the very title of chapter 3.  I think most Americans would be surprised to learn -- or at least believe that once absent the immediate stress and chaos of combat, that it might -- that it would be easier to lead, easier to control the troops.  But by the very title, it sounds like it's more difficult to lead and control the troops once they're back home.  

                GEN. CHIARELLI:  What we're trying to show there is it's very, very difficult, in the short period of time that you come back home, to do all of the different things you have to do to get ready for that next mission, plus take care of your soldiers the way you should be taking care of your soldiers.  And we want to make sure that we're reorienting people, as they have more time at home; that they understand, because they've never experienced it before, some of those things that they need to do to make sure that they're taking care of their soldiers.  

                I mean, that's the whole idea here, is to reinstitute some of those things that we used to do so well, but because we were doing exactly what the American people want us to do -- and that's prepare our soldiers to go into harm's way and prepare the best force we possibly can -- some of those things came lower in our priority list. And we need to reinstitute them.  That is what this is all about.  

                And this is a perfect time to do that now as we start to see soldiers returning from Iraq and start to see the force getting closer and closer to being in balance.  

                Q     And it's been a long time since we've heard about the kinds of numbers of drug abuse and alcohol abuse in the force.  Are there any parallels to be derived here?  

                GEN. CHIARELLI:  Well, you look at those numbers and you say drug abuse.  I don't agree that that's drug abuse in any way whatsoever. The good thing about that number is, those are prescriptions prescribed by doctors.  

                Now, the report points out how sometimes that can be abused.  One of the things we found out in parsing our data is that -- an open-end prescription, an individual that's given a number of pills, let's say Percocet, and told to take as needed.  If you don't close that prescription and that person takes -- comes up hot on a drug test, on a urinalysis, that urinalysis is sent to a medical review officer, a doctor who looks at it, compares what that individual came up hot for against what has been prescribed for them; and if you have an open- ended prescription forever, that person would be cleared by the medical review officer because they have prescribed that.  

                So one of the very simple things that came out of looking at this data is, hold it, let's not do that now; let's make sure that when we prescribe a prescription, that we put an end date on that prescription so that it doesn't remain an open-ended opportunity for someone to be abusing drugs, and the things that we've put in place to catch that become -- they don't work because we have not closed a gap there that we have.  

                Q     You think it would be as simple as that, putting an end date on a prescription.  

                GEN. CHIARELLI:  That would help us tremendously.  It would help us for the individual who is abusing drugs but is covered by the fact that when the MRO [Medical Review Officer], the doctor, reviews that urinalysis test, he looks at it and says, "Wait a second.  This person is prescribed that particular medicine.  He can't -- he's not abusing it."  

                Now, if we put an end date on that prescription and a year and a half from now that person comes up, that prescription that was written for a very specific time will not come into play in the review of that urinalysis.  I mean, it's those kinds of things we are able to pull out of here, that is a gap that we had in our system that we've got to fix.    

                But again, I -- (inaudible) -- emphasize to you, every single one of those individuals, the 106 individuals who have those prescriptions, many of them are not from behavioral issues; many of them are for pain management.  And every single one of those prescriptions was written by a doctor.  

                Now, that doesn't say we are not trying to get at alternate ways of coming after pain, and that's why I brought this with me and the work that MEDCOM [Army Medical Command] has done to get at this issue that we see out there, because we want less reliance and look for alternative ways of controlling pain.  And that's what this lays out.  

                Anything else, Mik?  

                Okay, ma'am.  

                Q     General, you talked earlier about how many of your soldiers only know OPTEMPO, that they've only been deployed or training for deployment.  I'm curious:  With the drawdown happening in Iraq, with some sort of drawdown starting in Afghanistan in July of 2011, is that population the one that you feel you need to watch next, the one that has the time to sort of absorb what they've been doing for the last decade, and that be an opportunity for things like depression and things to set in?  Is that -- is that a population you're looking at?  

                GEN. CHIARELLI:  That's exactly the population we're looking at. As soldiers come back and have more dwell time back home, we want to reinstitute some of the policies that will help us identify high-risk soldiers who are not seeking help but who are engaging in high-risk behavior.    

                We want to do everything we can to get them before they get to that blue circle in any way whatsoever.  

                Q     But I mean, like, as you look at 2010 statistics, is there anything that suggests that soldiers who have -- who have been in that op tempo, who've never known the military outside of that, are having trouble dealing with being home, not preparing for war?  Is that becoming a growing population that you have to look at?  

                GEN. CHIARELLI:  I can't -- I can't make any generalization like that.  I know we have soldiers that come back from deployments, whether they're home for one year, two years or three years, that will develop reintegration problems.  That is what our whole virtual behavioral health program is aimed at, at getting at that population and trying to find those individuals that are going to have reintegration problems and are going to begin to display high-risk kind of behavior.    

                And we want to take as hard a look at every soldier that comes back so that we cannot wait until they demonstrate that high-risk behavior, but try to identify those that are going to have a rough time early on so we can get them the help that they need.  

                I mean, that's -- that is the whole idea behind what we're trying to do here, and to reinstitute many of those things that we used to do very, very well that, because of the high op tempo we've been on, we just haven't been doing.  

                Q     I know you've had a lot of statistics.  I'm curious, do you have any that -- of what percentage of suicides are by soldiers who have been back for more than a year?  

                GEN. CHIARELLI:  I'm sure that's somewhere in the data, but I don't have it at hand right now.  

                Q     Can I just go back to Elizabeth's question?  Because I'm still confused.  If so many suicides are either first-time deployment or those who have never deployed --  

                Q     Right.  That's what's confusing.  

                Q     -- how -- right.  So if they're first-time deployments or never deployed, how do you square that with the notion that so many of these problems are because of stress and strain on a heavily deployed force?  

                GEN. CHIARELLI:  Let me try one more time.  A soldier comes in the Army with less resiliency as a youngster than he does as he gains experience.    

                What we're trying to do is to increase the resiliency at basic training.    

                We know that there are soldiers that come in with stressors. That's why I tried to point out to you the 28- or 29-year-old soldier. That is a soldier that's a brand new private who makes a determination at 28 or 29 to join the United States Army.  Again, I'm not trying to typecast him.  And we know that that individual has a higher suicide rate than even a youngster coming into the United States Army.  

                So, many of the stressors that people have are not just caused by deployments.  And that's what the whole composite lifestyle chart is supposed to show you.  It is supposed to show you that there are three strands here, that are not looked at horizontally, but they're looked at vertically.    

                It is not -- let me just try to finish.  It is not just the deployments that's causing this problem.  It is all the stressors that you see, and particularly when you add that to an individual who does not have the resiliency to cope with those problems.  That's why we believe we're seeing a large percentage of the suicides are occurring with youngsters, or folks who have built up a number of stressors over time and it just becomes too much for them.  

                Q     But for the majority, it's not the war at all.  

                GEN. CHIARELLI:  We have -- well, I think 21 percent of a population, 160 -- 40 deaths is a population we also want to get at. I mean we're still seeing -- and again, this is 2009 data.  I mean, since we started this whole thing, we have always talked about the fact that a third of the soldiers who committed suicide have no deployment history whatsoever.  We've talked about that before many, many times.  And this is showing many of the things we've seen.  For us to blame this thing just on the war would be wrong.  That's not what we're trying to do here.  

                Q   The perception has always been that it's because of the strain of continued --  

                GEN. CHIARELLI:  That's been your perception, and I have always backed away from that.  

                If you go back and look at everything I've ever said, we don't really know.  But we know a heck of a lot more today, and with the publication of this report, than when I sat in front of some of you in January of 2009.  We know a lot more today.  

                And it goes back and it shows that the ARFORGEN strand, this deployment -- redeployment strand, is only part of the problem, and there are other things we've got to do if we're going to really get at this problem.  That's what we're trying to do with this.  

                Q     Studies find that it can be just as stressful returning home from combat as combat itself.  

                GEN. CHIARELLI:  For some individuals, it is.  It is.  And I know that from sitting in the SRGs, the suicide review groups, that I do, where every single suicide is briefed to me.  We know that is the fact.  

                We -- you know, one of the things we've looked at with this report is -- when soldiers used to go away from [sic] war, that family strand kind of fell off.  You know, you'd get a letter every 10 days, or whatever.  We've got soldiers in Iraq who go out in a 16-hour patrol, come back in to their CHU, or to their "hooch," get right onto their computer and get on Skype.  And they're drug back into this family strand.  And some of those soldiers, because families don't understand, become responsible for helping "Helen," because she's failing algebra; or "How are you going to work the bill that we can't pay?  What are you going to do about it?"  You know?  And that's why this composite life cycle is so critical, to understand that every soldier is not only going through the stress of being in a unit that's deployed, he's also got individual stressors that are on him.  And even when he goes to war, those family issues, looking vertically, may not be -- he may not leave those.  

                He may not just have them given to him when he comes home.  They may be part of his -- his or her complete deployment.  That's what's so essential in looking at this.  

                And we've seen some data that would show us in the more developed theaters the rate of suicide is higher than in those places where you can't necessarily get back on a computer and talk to home all the time.  And if we can help families understand the importance that, when their soldiers are deployed, of not dragging them back into life -- a life at home that they have very little ability to try to fix, that too will be a benefit of what we're trying to lay out here.  

                Q     Hasn't the war driven you to this higher-risk population? And hasn't the war made you so busy that you haven't been able to pay enough attention to this higher-risk population?  Are they more --  

                GEN. CHIARELLI:  I think it'd be -- I think it'd be fairer to say that, because of everything that we're doing, we have not paid the attention we need to on high-risk behavior.  

                Q     Yeah, but the point about whether or not it's the wars -- I mean, it does seem to be the war that is causing this, one way or the other.  The stress of combat, the recruitment demands that bring in this higher-risk population, the amount of dwell time which prevents you from doing all the normal --  

                GEN. CHIARELLI:  I will let you and Elizabeth argue that one out.  But I agree with you:  I mean, this is all connected here.    

                Okay, you know, I give this example a lot of times.  An individual that may not have been that good a soldier goes on deployment and does absolutely fantastic.  He comes back to his unit and he's back in his unit for nine months.  Goes out, gets stopped at a roadside check and he blows .09.  Okay, DWI.  Charged with DWI.    

                Comes to the brigade commander.  Brigade commander has to make a decision on what to do:  Do I go ahead and refer this soldier to ADAPC?  Well, we're -- sir, we're deploying in six weeks.  ADAPC can't see him for eight weeks.  

                We're going to have to leave him back here.  He'll be a stay-behind.  

                And then I'll really make it extreme for you.  This is a commander who's trying to get out at 90 percent, because he's got 12 percent of his soldiers that are assigned to him are nondeployable for medical reasons, all kinds of other things.  He's at 90 percent.    

                The quickest way for a brigade commander to become known to the chief of staff of the Army is have to sign a deployable exception report that says "Even though you filled me up to 102 percent, I can't get out of here at 90 percent.  So you're going to have to do special things to get me fixed once I go into theater and get me above 90 percent."    

                So it's old PFC Chiarelli.  The commander says, "Well, listen. ADAPC can't see him.  Yeah, he's screwed up.  Well, Platoon Sergeant Jones, you take care of Chiarelli.  You make sure he doesn't get in any trouble for the next two months.  We'll get him downrange where everything will be okay, okay?  He stays a deployable soldier.  And you know how good Chiarelli is when he goes downrange."  And off he goes.    

                And then the 4833 that should have been filled out isn't filled out, okay?  It comes, saying, "Hey, Chiarelli was picked up for DWI." Nobody fills (out/up ?) the action that's taken whatsoever.    

                Chiarelli goes, deploys, does a fantastic job; goes to his next unit.  This time, Chiarelli gets in an accident with a DWI, but there's no history that has been created, and we've lost track of -- this isn't the first time this great guy who won a Silver Star or a Bronze Star or whatever and has been on two deployments -- this isn't the first time he's demonstrated high-risk behavior; there was another time.  And we saw in some instances this could happen as many as three times, where you had this recidivism, okay?    

                Well, we needed to get Chiarelli the help that he needed when it showed its ugly face the first time, not wait for the second time. And that's what we're trying to do here, to reinstitute those processes we had that ensured we got him or her the help that they needed.  

                Q     But to follow up on David's point -- for example, the drawdown in Iraq:  Does the Army believe that that is going to lower the stressors on a majority of the force?  

                GEN. CHIARELLI:  Well, I know for a fact, I know for a fact, right, looking at units -- for reasons that I won't explain here -- that have had dwell time back in the states of 2-1/2 years, I see nondeployable rates running at 4 percent, as opposed to a unit that's getting ready to go downrange that has a nondeployable rate of 14 percent.  I mean, just the opportunity for somebody to come back and take care of the need that -- went out on the first deployment but they didn't have time to get it fixed because they wanted to go back with their unit in the second deployment, now they get it fixed, they have the time to get it fixed, they have the time to do it right, they have the time to rehabilitate the right way, I mean all those things happen when you have more dwell back at home.  

                And if you go to the composite life cycle model you've seen right up there, you start eliminating stressors.  You start eliminating those little dots down there in those stressor windows.  And we know if we can do that at the same time we're doing programs like comprehensive soldier fitness to build up resiliency so the stressors that are left, that individual can handle better, my gosh, that's where we want to be.  

                Q     What's your message, though, to the commander who is dealing with PFC Chiarelli, who just found out that maybe there's a second DUI somewhere?  How do you make that matter to him?  How do you make him understand the long-term implications of having someone who is compromised  in a mental-health kind of way?  

                GEN. CHIARELLI:  I think our commanders are understanding that now.  As we get deeper and deeper into this and as we start talking more and more about this, and as we get together, our commanders -- the realization has come.  

                I think it was The Washington Post or somebody -- I don't mean to point at different papers -- did this article the other day about this commander at Fort Bliss who's done all these novel things based on his second time coming back home.  If you compare the things that he's doing to the recommendations we have in the report, they're almost the same thing.  It's almost like he's reinvented the wheel and gone back to pick up some of the policies that we had before.  

                Q     So everybody understands this is a priority now.  

                GEN. CHIARELLI:  That's exactly right.  

                Q     General, I think your explanation on the sort of sum of the stresses has been very good.   

                But would you say of this 20 percent which are the sort of multiple deployments, if we didn't have the multiple deployments, would the -- would the suicide rate per 100,000 in the Army be lower than the population in general?    

                GEN. CHIARELLI:  I have always felt the increase that we've seen, in suicides, has been that 21 percent.  I have nothing -- I have nothing that I can lay that on.  That has just always been -- my concern is that that may be it, that may be the reason.  But I don't have any data that I can tie that to.    

                I just have to believe that any of those stressor dots that we can take away, at the same time we build resiliency, is going to help the health of the force.  It's going to help the health of our families, okay, because these stressors are shared by everyone.    

                When you have a no-pay-due as a soldier, guess who else has a no- pay-due, particularly if your spouse can't find a job at the new post, camp or station that you've moved to?  

                You know, when you give birth to a child and your spouse is located 8,000 miles away, okay, and Mom can't come and help, that's a stressor that not only the spouse feels back home but the soldier feels.    

                I mean, these are the things that we know are always going to be a part of life.  But what we have to do is try to give soldiers the tools that they need, to handle those stressors.  At the same time, for those who can't and demonstrate high-risk behavior, we've got the programs in place to help them.    

                One more question.    

                Q     Did you find a connection between doctors or other mental- health-care providers who might have made a recommendation, about how a soldier should be treated -- commanders overruling them and ignoring them?    

                So for example, a doctor or a mental-health-care provider would recommend a soldier be returned from the battlefield to the United States or not be deployed, for PTS reasons, but the commander says, no, I want them, they're coming?    

                GEN. CHIARELLI:  I did not find any of that.  I did not find any of that, and that's not anything that I tried to look at at this report.  What I tried to do -- what we tried to do -- what the report team tried to do was to look at what we saw when we went out and what we were hearing as we dug into suicides and high-risk behavior and policies to try to wrap it together.  

                One of the things I just have to talk about here that is so critical, every time I get a chance, is, you know, this co-morbidity thing is huge, okay?  And I know there's a tendency to take a look at behavioral health issues and think that they're just like mechanical injuries of war.  I get shot in the shoulder, I get shot in the shoulder, and you could probably give a diagnosis:  "Chiarelli's been shot in the shoulder."  But when you, you know, are working behavioral health issues used for TBI, those drugs aren't going to help somebody with PTS. 

                One of the things we hoped to do and one of the chapters I'm happiest about is chapter 10, that talks about research.  I want to get us some of this research.  I want to make it as easy for our doctors to be able to determine -- make -- get -- push brain science further so that we can get a proper diagnosis the first time and not have to, in many instances, get it wrong the first time only to have to go back and try to get it right the second or third time.  

                This is a huge issue, and that's what makes many of these problems so very, very, very, very difficult.  

                Q     Thank you.  

                GEN. CHIARELLI:  Thank you. 

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