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Ms. Beth Foster and Dr. Liz Clark Hold a Media Roundtable to Present the Calendar Year 2021 DOD Annual Suicide Report and Efforts to Address and Prevent Suicide Across the Department of Defense

STAFF: All right. Good afternoon. Good to see you all again. Welcome to the media engagement for the Department of Defense annual suicide report for calendar year 2021. This event is on the record, off camera, and the embargoes have all now lifted.

Here today is Ms. Beth Foster, the executive director for the Office of Force Resiliency, and Dr. Liz Clark, the director of the Defense Suicide Prevention Office. Ms. Foster and Dr. Clark will start with a quick overview to set the stage before we go into the question-and-answer portion.

As always, please wait to be called upon and limit yourself to one question and one follow-up. We have a hard stop of 1:00 today, so without further ado, Ms. Foster and Dr. Clark, over to you.

Great, thank you so much, Charlie.

BETH FOSTER: So I'm going to just provide a few quick comments up at the top, and then we're going to dive into the slide deck and go through all the data.

So, first, what I really want to emphasize up front is that every suicide is a tragedy, and it has an indelible impact on that family, community and unit. And I really want to be cognizant of that, while we're going to talk about a lot of numbers here today, every one of these numbers is a person and represents a family and a community that has been forever changed by this tragedy.

So Dr. Clark is going to get into more details in just a minute. But I'll provide you a quick overview of the top lines of this report. For the active component, there was over a 15 percent decrease in the rate of suicides from 2020 to 2021. Young enlisted male service members remain at greatest risk.

For the Reserve and National Guard, the rate stayed fairly static from 2020 to 2021. Our military family and dependent data lags behind one year due to access to CDC data, but the suicide rate for military families and dependents was the same from 2019 to 2020.
 
And while we are cautiously encouraged by the drop in these numbers, one year is not enough time to assess real change. The year-to-year trend provides helpful preliminary insight, but there is still a gradual increasing trend for suicide in the military over a 10-year period. And we need to see a sustained long-term reduction in suicide rates to know if we are making progress.

We know that we must continue to prioritize and invest in suicide prevention. As you all well know, taking care of our people is one of Secretary Austin's top priorities, and suicide prevention is a critical element of that commitment.

Under his leadership we've been able to advance a number of initiatives in this space, including our efforts to field a dedicated and specialized prevention workforce, improve the quality of life of our service members and families, reduce stigma and barriers to care and enhancing legal needs safety.

But we know that we have more to do. And we owe it to our people and their families and because our people are essential to our mission readiness.

So what I'll do now is just quickly walk through some of the information that -- that is on this slide that I think may be helpful as -- as you interpret the data in the report.

So, first, this year's report may look a little bit different to you than it did in previous years. That is because this year's report includes both the suicide data typically seen in the annual report, as well as the due -- DOD Suicide Event Report, or DoDSER, which includes more contextual data on how these deaths or attempts may have happened. All of this -- the reason we wanted to bring these reports together this year is that all of this is really essential data for better understanding how to tackle this problem.

And then second, before we dive into the details on the numbers, I wanted to share a bit about how we report suicide deaths and measure progress when it comes to suicide prevention. So as I mentioned in my opening, we look at suicide rates, not suicide counts. So while it's often easy to look at the numbers and say "This many people died by suicide last year, and this many more, or fewer this year," that doesn't really give us an accurate picture, and the reason for that is because the size of the military population is constantly shifting, and just looking at raw counts doesn't really tell us if we're making progress. So instead, we look at rate, which is suicides per 100,000 service members.

The other measurements of progress are we look at trends. So as -- as I mentioned, year-to-year gives us preliminary insight, which is certainly helpful. But what we need to do is look at a longer span of time, typically around 10 years, to tell -- really tell us if this problem is getting better or worse.

And finally, our other measurement is that we make comparisons to the U.S. population adjusted for age and gender. And while it's critical that we hold ourselves to a higher standard in the military, it does provide a help -- helpful benchmark because we know that our service members are not immune to societal trends.

So I'm going to turn it over to Dr. Clark now to get into the nitty-gritty on some of these numbers.

DR. LIZ CLARK: Great, thank you. Next slide, please.

So this is an overview of our service member key data. On the top left are the suicide rates per 100,000 service members for calendar year '21 for the active component, and then separately, for the Reserve and the National Guard under the Reserve component. Any Reserve or National Guard service member who were in active duty at the time of their death are still counted in the Reserve component.

For the active component, the rate is 24.3, which is lower than last year, when it was 28.7. This is about a 15 percent decrease. The rates for the Reserve and Guard were roughly similar this year compared to last year. For the Reserve, the rate was 21.2 versus last year, it was 21.7. For the Guard, the rate is 26.4 compared to last year, it was 27.5.

And then looking at the comparisons, the yellow box on the top right, the suicide rates for the active component have generally increased from 2011 to 2021, although the 2021 rates were lower than 2020. The Reserve and Guard suicide rates fluctuate, but there is no increasing or decreasing trend across 2011 to 2021, and in most years, military suicide rates are similar to the U.S. population. I will provide more information on follow-on slides.

Then on the bottom left, the suicide counts. A total of 519 service members died by suicide in 2021, most of which were in the active component, as you can see here. That is compared to last year, the number was 582.

With demographics, service members who died by suicide in '21 were mostly young enlisted males, which is similar to previous years. Other demographic factors such as marital status and race were also similar to previous years, which you will see a more detailed table within the report.

And then the method on the bottom right. Firearms continue to be the most common method, followed by hanging and asphyxiation. The percentage of suicide deaths by firearm in the military has not changed over time. A large majority of firearm suicides are using personally-owned firearms. Over 90 percent of those who died by firearm were from personally-owned firearms. And then the percentage of service members who died by suicide using a firearm has historically been higher compared to the U.S. population.
 
Go to the next slide, please.

As Ms. Foster mentioned on slide one, the department assesses changes in suicide rates using three different measures annotated with the blue-numbered circles. First, we analyzed the trend between 2011 and 2021 to see if the rates are increasing, decreasing or staying the same. Then second, we look at recent year-to-year changes for preliminary insights that they're not trends. And then third, we compared to the U.S. population after adjusting for age and sex differences which are associated with higher suicide risk.

So here on the top left, we first assess if there is a trend, which is the black line, and the suicide rates for the active component have an increasing trend between 2011 and 2021. Then for that second assessment, we look at recent year-to-year changes to understand what's happening in that short term. These are not trends, but preliminary insights, and for 2021 the suicide rate for the active component service members was lower than 2020, and it was a 15 percent decrease.

We also have the same assessments for the military services within the active component, and that's on the right side. There is an increasing trend for all services between 2011 and 2021. In the short term the Army rate was similar to last year, and there was a decrease with the Navy, the Marine Corps and the Air Force. The Air Force was the only statistically-significant decrease, and although the decrease was not statistically-significant for the Navy and the Marine Corps, which means we have a low confidence that it is a true change and could be due to chance or natural variation in the data year-to-year, we did want to mention this because even though it's not statistically- significant does not mean that it's not important. The numbers are decreasing.

And then the third comparison is with the U.S. population on the bottom left. We do not have 2021 data yet from the CDC, so this is looking at 2020 rates from the CDC. After we standardize for age and sex, meaning the military and the U.S. population are more similar to each other, the suicide rates for the active component are similar to the U.S. population between 2011 and 2020, with the exception of 2012 and 2020, where they were higher.

For the next slide...

Very similar format to the previous slide, this is specifically for the Reserve and the National Guard. And for the trendline, that first assessment that we have, both the Reserve and National Guard suicide rates have no increasing or decreasing trend between 2011 and 2021, but for the short term, both the Reserve and the National Guard, the suicide rate is similar to last year in 2020.

And then for the U.S. comparison, after we standardized for age and sex, the suicide rates for the Reserve are similar to the U.S. population for all years between 2011 and 2020, although for the National Guard, the rates are similar to the U.S. population, with the exception of 2012, 2013 and 2018, where the rate was higher than the U.S. population.

Next slide?

Moving now into family member key data, so this slide focuses in on data for military family members, more specifically, dependents. As Ms. Foster had mentioned too, this data lags behind one year from the CDC, and so this suicide deaths and rates for military family members is for calendar year 2020.

So on the top left, the rates and the counts for military family members, spouses and dependents are combined, and then separately for each group, for each component. The rates represent 202 suicide deaths among military family members, 133 spouses, and 69 dependents. Last year, for 2019, there were also 202 suicide deaths.

The comparison in the yellow box on the top right -- the number of suicide deaths in corresponding suicide rates for 2020 are similar to last year and the year prior. The same is true when we examine spouses and dependents separately. As you can imagine, those demographics are very different from each other, so we do have those comparisons. And then the suicide rates for spouses and dependents were similar to the U.S. population when accounting for age and sex differences, with the exception of male spouses, who had a higher rate.

The bottom left demographics and the report, you will see more detailed information but I'm providing a high level summary here. For spouses, military spouses that died by suicide in 2020 were almost equally male and female. However, the important context here is that male spouses make up about 13 percent of military spouses. But additionally, please keep in mind that males are more likely to die by suicide in the
U.S. population overall.

About 79 percent were under the age of 40, which is similar to the overall military spouse population. About 47 percent did have service history -- that includes current service at 19 percent and then former service at 28 percent. And about 75 percent of male spouses that died by suicide did have a service history, compared to 25 percent of female spouses. While this data is not shown here, I'm providing context just for more information.

For dependents, male dependents accounted for about 73 percent of suicide deaths. About 62 percent of dependent children were under the age of 18 and less than five percent had service history. And then the method on the bottom right -- as in previous years, firearms continue to be the most common method of suicide death. About 60 percent of spouse suicide deaths and 55 percent of dependent suicide deaths were by firearm. Hanging is the next leading method, ranging from 21 percent to 38 percent between the two.
 
And then when comparing to the U.S. population, what stands out is a higher proportion of female spouses that used firearms as a means for suicide compared to adult women within the U.S. population. This really underscores the relevance of lethal means safety initiatives for our military families.

So what is all of this telling us? We have four years worth of data and we're now seeing consistency between those years in demographics and rates, and we're using this information to better inform our key partnerships that support military family members internally, within military community and family policy, as well as external agencies, such as the VA, HHS, SAMSA, and then non-governmental organizations throughout the nation that are providing the community-based services to support our military families.

We're also continuing to expand programs such as REACH, which is Resources Exist, Asking Can Help, and are looking for options to expand CALM, Counseling on Access to Lethal Means, more broadly so our military families can continue to benefit, where we're seeing promising efforts on how to safely store lethal means and have conversations about lethal means safe storage.

MS. FOSTER: Great. You can go to the next slide please. So at -- as I mentioned at the top of this briefing, while we're cautiously encouraged by these numbers, we know that we have more work to do to get after this problem.

I think as we've spoken about before with you all, the department takes a public health approach to suicide prevention. We know there are many different factors that contribute to suicide -- behavioral, psychological, environmental, among others. And so our efforts at prevention have to reflect these multitude of factors, and to be successful, we have to be comprehensive and integrated in our approach and we have to be data- driven and follow the latest science and research in this space.

So one of the tools that has allowed us to be better integrated across the department is the Deputy's Workforce Council. I think you all have heard me talk about this before. This is a forum co-chaired by the Deputy Secretary of Defense and the Vice Chairman of the Joint Chiefs of Staff and brings together senior leaders from across the department, the services, OSD because many suicide prevention issues extend well beyond the -- the human people space, right? And so this forum allows us to break down some of those structural barriers that have impeded progress in the past.

So to that end, we wanted to highlight a few of our suicide prevention efforts where we've been particularly focused in 2021 and in recent months, and I do just want to emphasize that the data you're looking at today is 2021 data, although we're going to speak about some efforts that have been ongoing into 2022.

This list is not exhaustive of all of the work happening in the suicide prevention space but hits on some key thing -- themes that we want to emphasize. So first, I'll focus on that yellow block there -- fostering a supportive environment for service members and families. And what I want to emphasize first is the work that the department has done to field a dedicated and specialized prevention workforce.

So I know you typically hear me talk about the prevention workforce in a sexual assault context. This was a major recommendation of the Independent Review Commission on Sexual Assault in the Military. But a critical element of our integrated prevention strategy is the prevention workforce is also focused on suicide prevention.

That's because we know that we need to focus on common risk factors and building up common protective factors that lead to a range of harmful behaviors, and that includes suicide, sexual assault, harassment, domestic violence, and child abuse.

Historically, we've really taken a one-to-one approach to suicide prevention. So we focus on an individual's particular risk factors and reducing those factors, and that's still a critical part of suicide prevention, to be clear, but what we're also focused on and what we're moving towards in this space is focusing on common community risks and protective factors. And our prevention workforce is designed to focus on building healthy climates that lead to a reduction in these behaviors.

This is also the case with our on-site installation evaluation effort, which is a biennial effort designed and -- and started last year by Secretary Austin to provide early detection of risk factors at a really granular level, so down to the unit level, so leaders can take corrective action and the department can determine if additional resources are needed down at that really local level.

Finally, the last thing I want to highlight is -- is this last yellow bullet -- actions in response to economic challenges due to COVID-19. And I think you may be surprised to see us talk about this in a suicide prevention context but what we really want to emphasize is that quality of life is a critical part of suicide prevention and it's really important that we consider this in our approach.

As you all well know, in 2021, Secretary Austin took a number of steps to strengthen economic security throughout the force, and then of course, just a few weeks ago, Secretary Austin made a number of announcements related to enhancing the financial stability of our service members and families.

So these are really critical elements to building an environment where service members and families can thrive.

Dr. Clark?

DR. CLARK: Thank you. And so the next section, the addressing stigma as a barrier to help seeking, the DWC, or the Deputy's Workforce Council, and -- has been really imperative for us to have a collaboration of partnerships outside of P&R.
 
So we're really working with USD(I&S) but specifically the security manners -- managers and law enforcement and getting outside of just suicide prevention and -- and the prevention realm.

And this includes focusing on high party workforce issues, including mental health, suicide and we've developed a work group to specifically address stigma towards help seeking by addressing the misperceptions and misconceptions on how help seeking might impact security clearances and prospects for career advancement to include assignments, deployments and promotions.

And we've included as part of connect to protect support is within reach communications campaign, a plan on developing messaging to actually talk about those misconceptions and the facts. The deputy has also directed us to review stigmatizing language within DOD policy, procedures, and regulations to insure that DOD policy is not also a barrier in removing stigmatizing language.

Then lastly we're continuing to our efforts to educate on the availability and benefits to support resources such as the Reach resources exist, asking can help, as well as Military OneSource non medical counseling such as the military life counselors and then service specific resources.

And then the last area that promoting lethal means safety. Many of these efforts are aligned with the White House's strategy to reduce veteran and military suicide, in particularly working with the VA and Department of homeland security on developing a lethal mean safety campaign in tools and messaging to implement priority one of the White House strategy.

But specifically within the Department of Defense we are engaging with researchers and subject matter experts in academia on best practices and novel approaches and are holding quarterly meetings to allow for awareness and discussion on best practices of lethal means safety throughout the nation.

There are also efforts across the department on focusing on messages that enhance this culture of safety. Our service members are trained in a variety of ways to safely engage with our firearms and the professional rolls. And so our hope is that our methods of communication and education really reinforce these same practices with personally owned fire arms.

This past year we also updated the joint travel regulation to allow service members to ship empty gun safes, not to exceed 500 pounds in addition to their household good weight allowance in their next permanent duty assignment, which includes the home of record, home of selection upon leaving the service, which is really an example of PCS weight limits as an example of the policy encouraging that safe storage of lethal means.
 
Then lastly we published lethal means safety suite of tools for our service members, which promote key messaging and providing education to service members, their families and community partners about lethal means safety.

MS. FOSTER: Great. OK, last slide, I promise. I appreciate you guys bearing with us. Next slide please. So we just wanted to highlight a couple of upcoming efforts in this space and in particular wanted to highlight the Suicide Prevention and Response Independent Review Committee, which as you all know was chartered by Sec. Def. in March 2022 and is an independent committee that is designed to do -- to provide an outside look at what's working well in our suicide prevention efforts and what do we need to change.

And it includes 10 experts from across the leading areas of suicide prevention. And what the SPRIRC, we call it the SPRIRC, we love an acronym; has been doing is taking a number of different briefings both inside and outside the building. And then this summer they embarked on a nine installation visit tour to see what's happening on the ground, engage with our service members.

And we expect that report will become public in February 2023 and it's really going to drive a lot of action in this space moving forward. The second thing I just quickly wanted to highlight is our continued investment in the prevention workforce.

As I mentioned that's been a major effort standing up that workforce but we are hiring over 2000 prevention personnel that will be stationed around the world. And so that's a major investment. It's going to be a continued effort moving forward. So with that, thank you.

STAFF: All right, we'll start off with Lita.

Q: Basically on the last point you made, when you talk to people at bases around the country the biggest complaint you hear is lack of professionals, lack of counselors, lack of access. Counselors will tell you how frustrated they are that when someone calls they have to say I can see you in three weeks.

Give -- can you give us the amount of money the Department spent last year on such mental health providers et cetera, what it's going to spend this year, fiscal year, however you can break it out? And then where are you exactly in this 2000 -- the hiring, what can -- what is that -- you know how many to how many?

MS. FOSTER: Yes, absolutely. So Lita, I will be honest. We're from the Defense Suicide Prevention Office and so I don't have those numbers. Those are our health affairs colleagues and we'll be sure to get you that, you know, shortly after this briefing because we know that's -- that's a critical area of need and we know that that's something that our suicide prevention and response independent review committee is looking at very closely.
 
What I'll say and with our prevention workforce, what we're really focused on is getting to the left of this. So how do we reach those service members before they get to that point of crisis? And -- and with our prevention workforce in FY '22 and leading into FY '23 we're focused on hiring the initial 400 person cohort. That hiring is happening within the services and they can speak to it in more detail but -- but there's a lot of hiring efforts underway.

And we anticipate it is going to take a few years for us to hire that -- that full 2,000 folks that will staff that workforce.

Q: Just a quick follow-up. The 400, is that for the 2023 fiscal year, the 400 by when, what's -- what was that, I guess, goal?

MS. FOSTER: Yes, absolutely. So we're focused on hiring those folks within the next few months.

Q: So by the end of this year?

MS. FOSTER: I -- it -- we have some limitations because we are under a CR right now, as you know, and that does limit some of our actions that we can take in this space. But -- but yes, we would like to have our initial cohort on very soon.

Q: So that goal -- the goal would be in the next several months.

MS. FOSTER: Yes.

STAFF: All right, Matt, from ABC.

Q: Thank you. Thank you both. I think one thing that gets confused a lot in reporting when comparing military and veteran populations to the broader U.S. population is that it's not really comparing apples to apples in terms of demographics. So I wonder if you can elaborate a little bit more on standardization of data, why that's important and why did you choose specifically sex and age, are those just the top correlates with suicide and are there any other factors you considered accounting for as well?

MS. FOSTER: Yes, absolutely. So I'm going to turn over to Dr. Clark to speak in more detail.

DR. CLARK: Sure. So we know when we look at the age and sex differences we look at ages 17 to 59, which is just more what our military population is established. And those are just the two factors that are -- that we have at our data available that we're able to do with the amount of numbers and the statistical power to be able to look at the rates. If not then the numbers are just too small.
 
Q: As a follow-up, I wondered if when you're comparing say active duty military to the U.S. population and it tracks pretty closely, if you look at just, say, the female service members to the general population -- is -- is there any kind of positive correlation with women serving and the -- are they more likely to take their own life than women in the general population?

MS. FOSTER: So they -- we're -- we -- we -- we do look at that and it is -- statistically, the trend is comparable.

Q: Thank you.

STAFF: Meghann?

Q: I have another comparison to the general population question. You've mentioned -- and you've kind of touched on it a little bit -- but the big chasm, right, is that the general U.S. population doesn't have a chain of command that is invested in their wellbeing and they don't have free access to behavioral healthcare. Is there any way to get closer at the comparison? Because this is a comparison that you make and is sometimes held up as, like, "we're doing an OK job cause we're not any worse off than the general population." And is there any population you could compare the military to where they do have that behavioral healthcare access and what their outcomes are like? Because you would assume that the military would have -- have a better time with it at least because if they're in crisis, they always have somewhere to go, and if they -- there's access to a therapist and you're trying to do a better job of, you know, make -- of getting those appointments.

MS. FOSTER: Yeah, absolutely. I think -- I think that's a really key point because there are inherent protective factors to serving in the military and there are some additional stressors, as well, but we need to acknowledge those protective factors.

Do you want to speak to any comparisons we may have done with other groups?

DR. CLARK: Sure. I mean, we -- well, the one that's closest to what it's like to be a military service member is -- is really that law enforcement. And so we are working, you know, tirelessly with the law enforcement community to understand their protective factors, risk factors, as well as resources, and in taking some of those lessons learned back to us as well as sharing some of our successes that we've also had to the law enforcement community.

But also, I -- I think looking at how do we really enhance the support system to build up those protective factors and reduce the risk factors. And many of the -- you know, the prevention workforce that Ms. Foster has talked about is aiming to get more left, more upstream prior to it becoming a crisis. So instead of focusing in right on those crisis services, how do we make life worth living for the service members?
 
Q: Thank you.

STAFF: Jim?

Q: Thanks for doing this. You know, at -- for -- it seems like forever, you know, you guys and the previous team have always talked about -- about changing the culture. And Secretary Austin, in one of his first talks about -- about changes talked about mental health is health, period. Are you actually seeing this sort of change in the culture? Is this -- is this actually making a difference now?

MS. FOSTER: Well, I think it's difficult to isolate -- when it comes to suicide prevention, it's difficult to isolate it to one particular factor, but we are seeing the rates decrease this year. And I think part of what -- you -- you -- you know -- and again, we don't want to get too far ahead because we -- we need to see a trend to know if we're truly making progress -- but I think it is incredibly powerful that our most senior leaders of the department, even in the midst of everything else that is happening in the world, have made this a priority and are speaking about it just in the way that you characterized, right?

So just when -- when we focus on physical health, you know, if -- if -- if there is -- if you have -- is -- you know, it's some -- it's some physical issue -- you -- you broke your leg, you broke your arm, you're -- you're going to go get that addressed. We know that that's an impact on readiness.

What is so powerful about what Secretary Austin has said is we need to treat mental health the same way. We know that that has an impact on readiness, and so you need to go get that addressed. And I think what -- what that has done is it's empowered some of our leaders up and down the chain to say "even in the midst of -- of everything that I've got to do, we need to be encouraging our service members to seek that help."

Q: ... just ask a further question and -- I guess it was -- I forgot on -- what it was --  we were going with -- the Secretary was going to the Indo-Pacific, and I guess there was a spade of suicides in Alaska and he stopped in there. Just the other things -- but to also find out -- find out what was going on in Alaska that -- that was causing all these -- all these suicides over -- over the standard suicides. What -- did you ever figure out what was going on with that? And do you have, like, SWAT teams that go out to places that seem to be having a -- a significant problem?

MS. FOSTER: Yeah, so I'll -- I'll answer that question in a -- a couple ways. So --  so absolutely, I -- I think the -- the department's leadership was very concerned about what we were seeing with the suicide numbers in Alaska and the Army sent a team out there to determine what exactly is going on.

And it's difficult to isolate it to one factor but what we do know is that life in Alaska can be challenging for some of our service members. It's a geographically isolated place, it's cold, it's -- you know, there -- there are hardships at -- to -- to that life. There are also great opportunities for some service members, right? Some folks love the adventure and -- and everything that comes with that environment.

And so the Army has taken a number of steps to address some of those quality of life issues to get after that -- we also -- and has surged a -- a number of support elements to Alaska to help with that as well.

What I'll say to your question of the SWAT team, that's exactly what our on-site installation evaluation effort is, is, using data at a very granular level, we can see where are we seeing, you know, risk jump. And we -- and we send that team there to look at what's happening and -- and determine do they need additional resources, do they need additional tools to get after the problem that we're seeing?

Q: Thanks.

MS. FOSTER: Yeah, thank you.

STAFF: All right, we'll – Kasim?

Q: Yeah, the -- in the slides, I didn't see -- do you have any numbers for the U.S. service members who committed suicide overseas, like in other installations out of the United States? Is there information like this, data like this?

MS. FOSTER: This data is inclusive of installations abroad, OCONUS and CONUS.

Q: But is there -- is there a breakdown, like how many of them ...

MS. FOSTER: Oh.

Q: ... from the outside of the country?

DR. CLARK: So the -- the information is included in the report and the DODSER does break it down in more granularity.

STAFF: All right, we'll go to the phones. Heather from USNI?

Q: Thank you so much. I was wondering if you could talk a little bit more about the Navy numbers because we saw a spat of suicides with the George Washington. So do you have any data looking at where these suicides are happening, whether they were -- you know, as part -- on the installations, while people are serving on ships, while they're in barges waiting for their ships to be finished with work?

MS. FOSTER: Do you want to speak to that, Dr. Clark?
 
DR. CLARK: Sure. We are looking at systematic issues, community needs, quality of life, specifically with each of the services and installations as well. One of that is -- is Alaska, that was already talked about, as well as the USS George Washington, where we've had team members from the Navy, to find out what is happening. And then Ms. Foster, I think if you want to talk a little about -- about the OCs?

MS. FOSTER: Yeah, absolutely, but I -- I do want to acknowledge -- I -- the -- the information about where these suicides are occurring is included in the report -- we'd --    if I'm correct. So we don't have those numbers right at our fingertips, but we'd be happy to get you more information on that.

MS. FOSTER: Yes, absolutely. And that's something that our -- our on-site installation evaluation teams are looking at as well, is, you know, is this -- is this happening off base? Is it happening on base? Is -- is -- are there specific populations affected? So...

Q: Great, and then if I can just follow up...

STAFF: Sorry. Jeff from Task & Purpose, and then we'll go to Moshe.

Q: And I think Heather has a follow-up.

Q: Oh, yeah, sorry. I just want to ask for some clarification of -- about what you said about the Navy numbers, Marine numbers. You said that they dropped, but that they were not statistically-significant. So can you expand on more about what we can take away from that?

MS. FOSTER: Sure. So looking at statistical significance, that really means that we are confident that it wasn't to chance or to volatility within the data. And so when just looking at that year-to-year comparison, the Navy and the Marine Corps was lower. It's just not statistically-significant, so we don't have that confidence that it is a true statistical decrease, but it is trending in the right direction.

STAFF: Jeff?

Q: Thank you. I just -- when Ms. Foster mentioned that the department is working to destigmatize certain language to encourage service members to seek help, can you give a couple of examples of what types of language have been changed in order to reduce the stigma of -- of seeking mental health?

MS. FOSTER: Sure, and we are in the process of reviewing all DOD policies, regulations and procedures, but language that would be stigmatized and would be -- such as "commit suicide" would be one, "mental retardation" and taking some stigmatizing language out of the policy and really being able to look at, if you were to have a mental health appointment, if you were to have suicide ideation or suicide-related behavior, what is then that limitation of any type of waiver or a denial of a position or assignment, and having a -- an opportunity to examine each one of those.

Q: Are the statistics broken down by race?

MS. FOSTER: We do.

Q: Is that something you could share?

MS. FOSTER: It is included within the report.

STAFF: All right, Caitlin from New York Post?

Q: Hey, there. I remember last year there was some talk about -- that the 2020 increase was not -- there was no -- nothing to lead us to believe that the coronavirus had anything to do with that. I wonder if that still stands the case, now that we're seeing a reduction from 2020 to 2021, if there's any, you know, any insight into why the suicides are happening?

And just to follow up with Jeff's question, I think he asked something about -- I'm sorry, Jeff. I just forgot your question. Oh, if you could talk about why and committing suicide is a -- a negative stereotype, that -- that term. Thank you.

DR. CLARK: Yeah, so on -- in terms of the impact of COVID, it -- it's -- it's difficult for us to say definitely this is what caused the decrease in suicide rates this year. What we can say is -- is that we know that -- that COVID -- there were less COVID restrictions for our service members than some of the general population may have experienced. But also, we know that the period of COVID was very stressful for the country. I mean, I think it was stressful for everyone. You know, there's a lot of uncertainty. There's a lot of impacts while even -- while some of our service members may have been serving in person, their childcare may have been restricted, or their spouse may have been experiencing difficulties. And so we can't discount that, but we can't say definitively that that's why we're seeing the decrease.

MS. FOSTER: And then to the point of the language "commits suicide", we're really looking at, you know, we're -- today, we're talking 519 people that died by suicide, calendar year '21, and every single one of those was tragic. Families, communities, units were affected by them. But we also know that there are many people that have suicide ideation. And so when we're talking about suicide and suicide-related type of behaviors and we use words like "commit", we use that typically when we talk about crimes, of committing the crime, committing violent behaviors. And so to reduce some of that stigma, we use things such as "died by suicide" or "have had thoughts of suicide", versus "committed suicide" -- very similar to not -- not having words such as "a successful suicide". No suicide is successful, right? That's not -- those are not terms that we want to use.

So we really want to switch that language so it isn't as judgmental and is, in particular of those family members, service members and those that might have had thoughts of suicide aren't feeling as judged, and they do feel more willing to go seek help. Yeah.

STAFF: All right, I think we got to everyone, so thank you for attending. Thank you, Ms. Foster and Dr. Clark. For any additional questions, feel free to reach out to our press operations team. We'll get back to you as soon as possible, and have a wonderful day.