MS. FOSTER: Well, good afternoon, everyone, and thank you all so much for joining us today.
Today, we are going to brief you on the department's next steps on suicide prevention. The secretary of defense is releasing a memo today that details the department's campaign plan to address suicide in the military. The plan is organized around five key lines of effort and will guide the department's work in this area for the next many years. The enabling task supporting this plan were adopted and modified from the Suicide Prevention and Response Independent Review Committee, or SPRIRC, as we call it.
I do want to start by thanking the members of the SPRIRC, who dedicated many long hours to developing their report. Their report and recommendations formed the foundation of the work that we're talking about today, and we're grateful for their continued leadership in this space.
The plan that will be announced by the secretary today reflects a comprehensive approach to suicide prevention that builds off the significant work Secretary Austin has led on preventing harmful behaviors. This includes the implementation of the Independent Review Commission on Sexual Assault in the Military and the secretary's "Taking Care Of People" initiatives.
Suicide is a deeply-complex problem, and there is no one single cause, risk factor or solution to these tragedies. What may lead to suicide will look different for every single person, and often, one person will experience a multitude of risk factors. You cannot solve this problem by isolating one risk factor. You have to take a holistic approach, and to be truly effective, you have to look far upstream of the point of crisis. If we are doing this right, this is as much about well-being promotion as it is about suicide prevention.
Taken together, these lines of efforts that I'll discuss today and the key initiatives and enabling tasks supporting them will allow the department to accelerate, deepen and transform the work happening in suicide prevention. As Secretary Austin said in the memo released today, change will not happen overnight, but we have no time to spare. Taking care of our people is a sacred obligation, and we owe it to our service members and families to execute and implement this work as quickly as possible.
Now, before I move through the brief, I did just want to mention very quickly that I will not be discussing the numbers or data that will be included in the calendar year 2022 Annual Suicide Report. That report will likely be released later this fall, and this conversation today, it's really focused on the secretary's suicide prevention strategy.
Now, if you turn to slide three, I wanted to start the conversation by taking a bit of a step back and looking at the work that has happened in this space over the past year and a half. As you'll recall, in March, 2022, the SECDEF launched the SPRIRC. In February, 2023, the SPRIRC delivered their report to the SECDEF and included 127 recommendations. In March, 2023, the SECDEF announced 10 immediate actions focused on behavioral healthcare that the secretary assessed could be done under the department's existing resources and authority.
The secretary also launched a Suicide Prevention Working Group to do a thorough review of the remaining recommendations. This working group included broad membership from across the department, and over the course of several months, the working group did a granular-level review of each of the 127 recommendations. They assessed feasibility, legality, cost, and in some cases, looked at where they could modify the recommendations to make them implementable for the department, but still meeting the spirit and intent of the SPRIRC.
Its work was further vetted by leadership across the department and it's culminated in the way forward announced by the SECDEF today. As I mentioned, the campaign plan includes five key lines of effort and 101 of the SPRIRC's recommendations as modified by the working group, are aligned to each of these lines of effort as key enabling tasks. This brings the total number of SPRIRC recommendation approved as modified to 111 recommendations. Sixteen of the SPRIRC's recommendations were not advised for action at this time.
You know, I'm not going to talk through each of these 111 recommendations in detail, but you will see all of them enumerated and laid out in the SECDEF memo that will be released later today. That not only lists the recommendations that we're moving forward with, but those recommendations that are not advised for action.
I'm now going to turn it over to Dr. Hoyt to talk through the initiatives that we are approving at a high level.
DEPUTY DIRECTOR TIMOTHY HOYT: So if you'll go to the next slide, you see the key lines of effort and some examples of the enabling tasks that are under each of those lines of effort. If we walk through each in that first line of effort, to foster a supportive environment, this builds on a lot of the initiatives that the secretary has already pushed forward in terms of taking care of people, and really gets at alleviating stress around improving predictability for the service member. This is all the way down to the tactical level in terms of understanding what is day-to-day life going to be in terms of predictability, as well as then, how does the training calendar look for predictability, and long term, how does career look in terms of how well they can predict and make sure that their goals are fitting with their career goals there.
It also looks at more promoting leadership focused on strengthening service member support to service members and their families, as well as improving our MWR capabilities at rural and remote locations.
The next two lines of effort deal with service provision, to include both nonmedical counseling and services as well as MTF-focused counseling.
In our first of those two that's more internally focused, we're hoping to improve the delivery of mental health care through doubling down on recruiting and retention of our existing behavioral health providers and then expanding our care provision model through a more robust mental health staffing model that includes care coordination as well as additional administrative support so that the providers we have can do more with their time, rather than getting bogged down in administrative tasks.
In the third line of effort, we're specifically addressing more stigma and other barriers to care and going about this through expanding our non-medical counseling to include things done through programs like military family life counseling, as well as things like chaplain-focused programs.
We're also working to meet service members where they are, including expanding mental health services in primary care, as well as expanding telehealth services for mental health.
Overall, across these models, we're also working to then implement an episodes of care model in which the service members can have some predictability over when and how they're going to be seen so that they can know, and have less impact on their training schedule.
In our fourth line of effort, we're going to revise suicide prevention training. I don't think there's any argument from the department side that suicide prevention training thus far, delivered to large auditoriums and death by PowerPoint has been ineffective.
In revising these suicide prevention training models, we're going to modernize the content and delivery so that, in the course of a service member's entire career, they're getting training that is tailored to their role and that is evidence-based.
We're also then working on models to better integrate leaders into that training so that they're equipped to have these difficult conversations about risk factors with individual service members.
The fifth line of effort focuses on promoting a culture of lethal means safety. This begins with ensuring that we've got secure firearm storage options for our service members, first through incentivizing secure firearm storage device purchase at our exchanges.
That would allow service members to have the locking devices that make the most sense to them, rather than solely distributing locking devices as a department, giving them the opportunity to purchase things like hard shell cases and other storage options that best meet their needs.
Similar to efforts that have already been undertaken by the V.A., we're also going to work on a public education campaign for secure storage, to make sure that we're really inculcating a culture of treating firearms with respect.
Finally, there are several other initiatives under this line of effort that are going to enhance the safety of barracks and dormitories, to provide alternate storage locations for firearms, as well as reducing ligature or hanging points in our barracks and dormitory rooms.
What's not on here then is a detail of our 16 recommendations that were not approved. Those, kind of, break out in several different categories, primarily things that are either happening in other places right now throughout the department or were just not feasible based on our current assessment.
Some of those relate to some of the information technology recommendations, as well as some of the housing recommendations, such as furnishing barracks with light-blocking window coverings, or ensuring that air conditioning was installed in every single barracks room.
On the lethal means safety avenue, there were a few recommendations that were not advised for action at this time, that included the seven-day waiting period for firearms purchased on DOD property name, the similar waiting period for ammunitions, or raising the minimum age for firearm purchases. None of these are being pursued at this time, although the department remains open to assessing how we might be able to do these in the future.
And if we go to the next slide, this provides just an overall assessment of impact. And, really, I think the overall focus of all of these is a focus on wellness of the service member, rather than saying that suicide prevention is solely the purview of mental health services, really getting outside that and looking at outcomes throughout these recommendations and what things can we affect as we work towards changing suicide rates over the long term.
With that, I'll turn it back to Ms. Foster to talk about the next steps.
MS. FOSTER: Great. So as we think about next steps, I imagine that one of the first questions that you all will have for me is how much is this all going to cost?
And, as you know, the department is currently undergoing our program and budget review process. And this issue is being very closely examined throughout that process. But because of where we are in the cycle, I can't give you a number. I can't release that publicly at this time.
But what I can tell you is that the SECDEF wanted to make this announcement now because he wants implementation to begin immediately. We do anticipate that some key investments will be necessary in F.Y. '24. But we have assessed that much of the work over the next year is going to focus on building the infrastructure necessary to implement these transformational actions.
You know, a lot of what we're talking about here is quite significant. And we can't just, sort of, flip a light switch and make all of this happen. So that is what this, sort of, building this infrastructure is going to look like. And then we anticipate most of the cost will come later in the process, in F.Y. '25 and beyond.
Certainly, once we're able to, and once the president's budget for '25 has been released, we would be happy to brief you on more specifics when it comes to funding.
Now, in terms of building that implementation infrastructure, there are a few key things happening in that space. The first is that the SECDEF has directed that all department stakeholders develop detailed implementation plans for each recommendation. This will ensure that the department can move forward quickly, cohesively and methodically in pursuing implementation. The secretary has also directed that all recommendations will need to reach their full operating capability by 2030.
In addition to building this implementation infrastructure, a lot of what we're going to be looking at in this process is ensuring that we are able to evaluate and track our progress in this space. We know that it may take some time before we see the overall trend in suicide deaths shift, but we need to put in place some near-term metrics so that we can assess whether or not the recommendations that we're putting in place now are having an impact on this problem.
And if they're not, we need to course-correct and make sure that we are effectively targeting this and really addressing suicide prevention in the military.
So with that, I will pause, and really looking forward to your questions.
STAFF: Okay, everyone. Like I said, thanks again for joining us. So I'm going to go ahead and get started with asking questions. And first up is Heather Mongilio from USNI. Just a reminder, you get a question and then you have a follow-up, and we'll go from there.
So go ahead, Heather.
Q: Thank you so much. I was wondering if you can talk a little bit about this timeline. So these recommendations are ones coming from the recommendations that came out in February. It's now September. And you're talking about a plan that's going through 2030. Can you talk about concerns about timeliness here and whether or not this is going to be fast enough to prevent members of the military from killing themselves in the years that you're still making these changes?
MS. FOSTER: Yeah, thanks so much for the question, Heather. And I do want to be clear that while we're saying that 2030 is the final time for all 101 recommendations to be fully complete, we are going to focus on implementing some of these recommendations much sooner. And, you know, in an ideal world, we would have all of them implemented before that final date.
But what I also want to emphasize is that we need to urgently get after this problem but we also need to be very careful and methodical in our work, because nothing will, you know, sort of break faith with our service members in this space more than if we rush out this new initiative and we don't get it right. We want to make sure that we're getting this right from the outset.
We've learned a lot of lessons from our other kind of transformational work that we've been undergoing at the department in the past two and a half years, and what we really say is we need to -- you know, we need to be very careful and deliberate in that implementation process.
STAFF: -- do you have a follow-up?
Q: I do, yes. So looking at specifically the fact that you're looking to retain and hire more mental health professionals, there is a shortage that just -- it happens with mental health professionals. So how are you working within this timeline to make sure that there are enough mental health professionals within the services to be able to make sure people can be seen in a timely manner?
MS. FOSTER: Yeah, that's such a great question, Heather. And what I'll say -- and I'll turn it over to Dr. Hoyt in just a minute to speak in more detail on this -- but I think what was so creative about the approach that this -- this work took to this is that yes, we do need to recruit and retain more mental health professionals, but we do recognize that there is a nationwide shortage of those professionals.
And so a lot of what our work is focused on is increasing the availability of our existing providers, and we do that through adjustments to some of our staffing models, by bringing in this new case management workforce so that they just have more time to see more patients.
But Dr. Hoyt, do you want to chime in there?
DR. HOYT: I think this creative model really gets at leveraging anyone that we can that can work under supervision, that can do case management, and can accomplish the overall goal without every single person needing to say "see a psychiatrist," and that includes fully leveraging our behavioral health technicians, fully leveraging case management, getting the right number of administrative personnel into the clinics to alleviate those burdens on the providers, as well as several initiatives recommended by the SPRIRC to enhance our training pathway to be bringing in and growing more of the behavioral health providers that we need so that we're not just, say, wrestling with our interagency partners over who gets the most number of psychologists. Over.
STAFF: Great. Thank you. Dan from PBS? Dan, are you there? Okay, we'll move on to Ellen from Synopsis.
Q: Hi, thank you all so much for doing this. You might have already answered this question but the SPRIRC addressed more than just the lethal means safety and mental health aspects leading to suicide, things such as promotions and financial literacy and assistance.
I don't see particularly the financial literacy stuff mentioned here. Does that fall under the 16 recommendations not acted upon?
MS. FOSTER: No, those fall under the line of effort "foster a supportive environment." And absolutely, we do recognize that and the SPRIRC was quite clear that financial challenges can be a key risk factor for suicide.
We know that ensuring that our service members get paid on time and making sure that our pay systems are adequately supporting them is a key part of this as well. And so you will see those recommendations reflected in line of effort one in the SECDEF’s memo.
Tim, is there anything you want to add there?
DR. HOYT: No, just that those are some of the key initiatives -- no, they weren't reflected directly on the slide, just because we couldn't fit the 111 recommendations onto one slide, but yes, those are a key part of taking care of people initiatives and that the emphasis on service member wellness overall.
Q: And a follow-up real fast -- SPRIRC recommended y'all updating your IT processes for managing personnel. Does that fall under the ones that are just not feasible?
MS. FOSTER: Dr. Hoyt, I'll kick it over to you for that question.
DR. HOYT: So there were some SPRIRC recommendations that sort of generally indicated that we should improve the usability and reliability of information technology systems or ensure that military installations and units are properly resourced with computers.
Those are listed in the memo as recommendations not approved at this time but, you know, that doesn't mean that we're not working on those through other efforts throughout the department. I think it was just a little bit of a stretch to be able to say that those specifically were tied in the way they were worded to suicide prevention.
And so, you know, yes, there are other efforts going on, you know, in terms of access to information technology, leveraging technology to better address the concerns that we've got in our service members. Just those specific ones were among those 16 not approved for action at this time. Over.
Q: Thank you so much.
MS. FOSTER: I think at the one thing I'll add to that as well is I think one of the things that the SPRIRC really emphasized and that I think you'll see come through in these approved recommendations is that we need to ensure that our leaders are better engaged with their people in understanding what problems they're experiencing, whether that is a financial challenge, whether that is an IT challenge, whether that's a housing challenge, all of these things.
You know, certainly we understand that there can be a culture of -- you know, I'm going to sort of bear down and not complain, but what we need to ensure is that our leaders have the requisite skills that are necessary to have some of those hard conversations with their service members so that they're getting them the resources that they need, and I think you'll see that come through in a lot of these recommendations.
Q: Thank you. So I wanted to circle back to a few of the things you mentioned that you guys are not going to be tackling. You know, two things that jumped out at me specifically were not tackling ensuring that barracks rooms all have air conditioning and not tackling increasing the age at which service members can purchase firearms. Can you offer any more details as to why either of those two recommendations are not being tackled? And then I have a follow-up.
MS. FOSTER: Yeah, absolutely. So I think a couple things on that. First, when it comes to some of the housing recommendations like the air conditioning recommendation that you mentioned, the SPRIRC really made some very tactical-level recommendations that are focused on some, you know, specific observations from installations that they visited. What is currently happening in the department is our partners in A&S are looking very closely at challenges in our housing writ large. And so we wanted to ensure that that effort is able to continue, and that they're looking at programs that will be helpful to helping our service members kind of at scale. We do not want to get out ahead of that effort from the suicide prevention lane, but we do think it's absolutely critical and important, and we are going to continue to support our colleagues in that work.
When it comes to lethal means safety recommendations, specifically the recommendation that would not allow service members under the age of 25 to purchase firearms on DOD installations, that's something that we worked really closely and did a very thorough review of that recommendation across the military departments with our partner in intel and security, and then of course, with our General Counsel. And ultimately, we determined that there are some significant legal barriers to implementing that recommendation at this time.
Q: Got you. Okay, I thank you for offering some more clarity there.
I think, you know, stepping back a little bit more broadly, you know, as somebody that frequently engages with service members, you know, the E1 to E4 folks, you know, I often struggle to take these very high-level OSD policy announcements and translate it down to the service member level, you know, because I think ultimately for them, the question is, okay, this all sounds great. You know, it sounds like this'll be great for somebody who's serving in 2030, but not so much great for me right now. I mean, you know, can you sort of speak to that a little bit? Like, if there's an E4 service member that's struggling on this call right now, like, what should they be taking away from this announcement today?
MS. FOSTER: Yeah, absolutely, and I think that's a great question, and I do hope that, you know, there are a number of services that are already available to our service members that are experiencing a suicidal crisis, and I want to make sure that we're pushing that information out as much as possible.
But in terms of this announcement, while some of the more transformational actions are going to take some time, we are going to see some changes start to happen right away. So some of these recommendations that are focused on kind of schedule predictability or after-hours communication, you know, a lot of that is just kind of pushing that information out to leaders and making sure that they are making that a priority. So we could start to see some of that shift in -- in our service members' daily life, you know, quite soon.
I think what I'd also offer is that a lot of our recommendations, as I mentioned earlier, focus on leadership engagement and making sure that our leaders understand how to have these conversations with our service members, that understand the value of seeking help when you are experiencing challenges, and that they're pushing that information down and throughout the force.
So Dr. Hoyt, I'll turn it over to you to add there.
DR. HOYT: Well, I enjoy that question because so much of it gets to, what is the culture change? And how does the culture change really permeate all of the way down to the lowest buck private, who is just trying to get through a training day out at the far-flung installation? And I think the overall secretary's campaign plan here really does focus our efforts so that we know, these are the main lines through which we can reach all the way from the strategic level all the way down to the tactical level and influence the daily life of that service member.
You know, if we get more then into the weeds on that, you know, we hope to be able to see in the near term that the experience of training and their experience of interacting with their leaders is going to change, or even their experience of calling the behavioral health clinic and trying to get an appointment, that is going to change in the short term as we enact some of these closer targets, rather than some of the longer-term things that will require, you know, additional investments before we can bring them to fruition. Over.
Q: Got it. Thank you both.
STAFF: Okay, well, that concludes today's call. Thanks so much again for joining us. Shortly, I'll send you a press release and the memo. You're free to publish after this call, and we appreciate your time. Thank you so much.