Transcript

Defense Department News Briefing on the Calendar Year 2018 Annual Suicide Report

Sept. 26, 2019
Dr. Elizabeth Van Winkle, director, Office of Force Resiliency; Dr. Karin Orvis, director, Defense Suicide Prevention Office

STAFF:  All right. So, ladies and gentlemen, again, thank you guys for being here, really appreciate you coming in this morning.

As you all have been informed, this is a – this is a briefing on the Calendar Year 2018 Annual Suicide Report. Dr. Elizabeth Van Winkle is the director of the Office of Force Resiliency, and she's going to be providing opening remarks.

Dr. Karin Orvis is the director of the Defense Suicide Prevention Office. She is going to be providing the content for the briefing; she's going to be talking about that.

We do have a hard stop at 1:45. Again, we're going to go with, you know, the briefing itself, going into – sorry, the remarks, the briefing, and then the Q&A session. Again, hard stop at 1:45 p.m. This is on the record, off-camera. So please, no photography, no videos. You're OK to record, again, for accuracy purposes and ensure you have the correct information, but for the most part, that's how we're going to do the (inaudible), OK?

If you have any additional follow-up questions, feel free to ask me at the end of this. If we didn't get to you, don't worry. Again, we'll work to address your question in a timely manner. Just come by my desk. I sit in the – I'm Lisa Lawrence. I sit in the desk – Pentagon – sorry, Defense Public Affairs Office. So if you guys have any questions, just drop by. All right?

I'm trying to think if there's anything else. Anybody have any questions ahead of the briefing for me? All right. Without further ado.

DR. ELIZABETH VAN WINKLE: Is this on? It is. For those of you who know me, I've been here long enough that I now need reading glasses. Tried to do this before, and it didn't work without them.

Good afternoon. Thank you all for joining us today, as we announce the publication of the Department of Defense's first-ever Annual Suicide Report. The Annual Suicide Report, or ASR, that we will discuss provides substantial information on suicide-related data. As we discuss the findings, we are ever aware that these reports represent lives lost, and the lives of loved ones forever changed and shattered.

Our research in this space is critical. It enables the department to better understand and combat this tragedy among our service members and, importantly, the family members who support them through their military service.

Although the suicide rate among most of our military populations is comparable to broader civilian rates, this is hardly comforting, and our numbers are not moving in the right direction.

In a moment, I will turn it over to Dr. Karin Orvis, who's the director of the Defense Suicide Prevention Office. But before I do, I want to share a few thoughts.

Within my portfolio, I am a strong proponent for data surveillance to understand the very issues we are trying to prevent and solve. I often say that we can't fix what we don't understand.

Since joining the department, much of my time has focused on building data surveillance systems and research efforts to better understand problematic behaviors and violence prevention. The ASR supports this goal through increased transparency of data and timely understanding to inform our policies and programs.

In addition, as some of you may know, my background is in psychology and community care. I spent 10 years providing direct service to those who struggle with the very issues I oversee in my portfolio.

For those who work in the field, many clients we care for surprise us, sharing their most vulnerable secrets and leaving us in awe of their resilience and their perseverance to move forward, oftentimes despite earth-shattering setbacks and through some of the most horrific, unimaginable and daunting crises any human being could endure. And yet somehow they find hope where there was previously only darkness.

Still, others we work with, including some of those who make the decision to end their life or attempt to do so, sometimes never share those thoughts or impulses that haunt them. Many show few warning signs, even for close friends and other loved ones.

These warning signs can be difficult to detect, they can be intimidating to respond to. And for many, if not most of those left behind after a suicide, the loss of a loved one leaves us with far more questions than answers and an empty feeling that can never be resolved.

This is the extraordinary difficulty of ending this tragedy. What I experienced working with individual clients is similar to what the suicide prevention research shows us about this deeply frustrating challenge. Suicide can often be an impulsive decision occurring only in a matter of minutes, warning signs can sometimes be few and they're hard to detect, and no two people, no two life experiences leading to suicide, are identical.

At the same time, there are reassuring stories of those that have successfully journeyed through life's most challenging times and who gives us hope, and sometimes even the smallest actions kept them from the brink and helped save their life.

As leaders and practitioners within the department, we know that suicide prevention is complex, so our strategies must be broad, not only applicable to many different people, but also effective in many different ways. Our strategies must work at the individual level and at the community level.

For these reasons, the department aligns our efforts with a comprehensive public health approach to suicide prevention. We believe each and every one of us is part of the solution and we will continue to work to ensure we all have the skills, tools and resources needed to help ourselves and to help those around us.

We recognize that our challenge is a shared challenge, nationally and globally. The most recent data from the CDC indicates that suicide rates are rising across the country. We also hold ourselves to a higher standard.

We have the command and the control necessary to set the bar for data surveillance, prevention, care and support, and we take that responsibility seriously. Dr. Orvis will go over the detailed results of this report, but at a high level here's what we found.

Across all of our populations – active component, Reserve and National Guard – the 2018 suicide rate is statistically consistent over the past two years. However, rates for the active component are statistically higher than rates from the last five years. We are not going in the right direction.

While we hold ourselves to a higher standard than civilian populations, we are often asked how we compare. This year's report indicates that suicide rates for active component and Reserve members are comparable to U.S. population rates after accounting for age and sex, but rates for National Guard are higher than the U.S. population after similar adjustments.

This report will also release data for the first time on military families. This is the first time we've released this data, so we do not have trends, but we – our military families are one of our greatest assets and our efforts need to consider the unique challenges of military life.

Dr. Orvis will talk more about the findings in a moment, as well as the efforts underway to increase support, reduce barriers to receiving care, and target our populations of greatest concern.

As Secretary Esper has stated publicly, the department is fully committed to our people and doing everything we can to build the resilience of our military members and our families to support them.

Through our words and through our actions we must make absolutely certain that our service members and families have every resource they need to be resilient and succeed, so they can thrive, not only in their jobs serving our nation, but in every aspect of their life, both in times of success and especially during those difficult times.

Supporting our military personnel is not only a critical mission for the Department of Defense, but it is the sacred obligation for all of us. They and their families have sacrificed so much for our safety and freedoms. They are the few who bravely stepped forward to protect the Constitution and our country, and as I've said in the past, our absolute dedication to their well-being must be no less than the commitment they made when they stepped forward and volunteered to serve this nation.

Our military members and the families that support them are more than a moment in time. They are part of the United States military, and in great ways and in small ways, each one of them makes up the fabric of our indelible history.

It is because of this that the findings in this report are all the more heartbreaking. We as a country need every woman and every man who bravely steps up to serve. Even one loss to suicide is devastating and reverberates through families, units and the military as a whole.

We in the department must do all we can to prevent this tragedy and we will use the information from this report to inform our efforts. I want to thank you for joining us today and I will now turn it over to Dr. Orvis to talk more about what's in the report.

DR. ORVIS: Thank you, Dr. Van Winkle. Good afternoon and thank you for taking the time to be with us today as we release the first Department of Defense Annual Suicide Report. This first ever Annual Suicide Report presents the most recent suicide data for our service members and their families, serving as the official source of data this year and in future years to come.

This year's report also provides an overview of the department's suicide prevention strategy and governance and describes current and future initiatives underway to combat suicide in our military community. Today, I'll go through key data and findings in this report and share the departmental initiatives we have underway to address these findings. Afterward, we'll open it up for questions about the report.

Before I overview the results, it's important to explain two types of data in the report – suicide counts and suicide rates. Suicide counts are the total number of suicide deaths whereas suicide rates reflect the number of suicide deaths by the size of the population.

When we're drawing conclusions about changes over time – so for example, have suicides increased over the past year in the military – we need to use annual rates, not suicide counts. The rates also factor in changes in the overall population sizes, the end strengths for the military that also may be increasing or decreasing.

Secondly, the rates represent the number of individuals who die by suicide for 100,000 individuals and this is how rates are calculated, using the Centers for Disease Control and Prevention standards and other industry standards.

You'll also see margins of errors around the suicide rates which are per industry standards. These account for changes in the manner of death determinations that can occur. For example, when a death is first determined to be an accident and then additional evidence becomes available and the death is reclassified as a suicide by a medical examiner, or vice versa, the manner of death can be changed from a suicide to an accident.

So I'll move us into the briefing deck now. Beginning with the first slide, please? In calendar year 2018, there were 541 service members who died by suicide. This slide presents the official DOD suicide rates for calendar year 2018, as well as recent trends in suicide rates over time, examining the past two years and five years.

I'll draw your attention to the right hand side of the slide. This represents the visual depiction of the data you see to the left. Specifically, when examining the active component, the calendar year 2018's suicide rates are consistent with rates from the past two years, meaning the rates have been consistent when comparing 2018 to 2016 and 2017. But the rates have increased over the last five years, from 2013 to 2018 for the active component.

When examining the Reserve and National Guard, the calendar 2018 suicide rates are consistent with the rates from the past two years, and they are consistent over the past five years, meaning there is no statistically significant increase in the suicide rate from calendar year 2013 to 2018 for the Reserve and the National Guard.

We're often asked, how does the military compare to the U.S. population? In comparison to U.S. population rates, military suicide rates are comparable to the U.S. population rates after accounting for age and sex differences, with the exception of the National Guard.

The National Guard is statistically higher than the rate for the U.S. population after accounting for age and sex differences. Note that using CDC and industry standards, we account for age and sex differences across populations when making rate comparisons, as males and young individuals are at higher risk for suicide.

In other words, for our data, this means that after adjusting for the age and sex differences across the military and civilian population, with our military population being younger and comprised of more males, the military has comparable rates to the U.S. population, with the exception of the National Guard.

These are what are known as adjusted rates. And these adjusted rates are used for comparison purposes only. In a few moments I'll discuss some actions the department is taking to specifically support our National Guard member population, such as through our partnership with the Department of Veterans Affairs.

Turning to slide two. This slide reflects the service member demographics associated with the greater number of suicides in calendar year 2018. Service members who died by suicide were primarily enlisted, male, and less than 30 years of age, regardless of whether they were serving in the active component, the Reserve, or National Guard.

This demographic, enlisted, male, under the age of 30, made up 46 percent of the total military population in calendar 2018, but about 60 percent of our military suicide decedents for that same year. The primary method of suicide deaths for our service members continues to be by firearm.

In summary, we see continued heightened risk for our young and enlisted service members and our National Guard members. I'll discuss in a moment specific initiatives the department is undertaking to target our efforts on these populations of greatest concern.

Now turning to slide three. This report provides our first published suicide data for our military family members. This is an important first step. These results integrate data from both departmental data sets and the most comprehensive civilian sector data set, the Centers for Disease Control and Prevention's National Death Index.

Due to the time lag associated with collecting U.S. population data, the most recent data available for our military family members is for calendar year 2017. There were 186 military spouses and dependents who died by suicide in calendar year 2017. Suicide rates for our military spouses and dependents in calendar year 2017 were comparable to or lower than U.S. population rates, after accounting for age and sex.

The primary method of suicide death was by firearm for military spouses and dependents. For female military spouses, this contrasts with similar-age female U.S. populations, where suicide by firearm is as prevalent as by poisoning or drug overdose.

This is our first year of data. The department will continue to work to effectively capture military families' suicide data and report this out in a transparent and timely manner, reporting on these data each year.

We're committed to the wellbeing of our military families. And in a moment, I'll share some specific initiatives focused on supporting our military families.

Turning to slide four.

The DOD embraces a public health approach to suicide prevention that acknowledges a complex interplay of individual, relationship and community-level risk factors.

Based on the Annual Suicide Report findings, the department will focus on fully implementing and evaluating a multifaceted public health approach to suicide prevention, and will target our military populations of greatest concern: young and enlisted service members, and members of the National Guard, as well as continue to support our military families.

For our young and enlisted service members, we'll be piloting an interactive educational program to teach foundational skills early in one's military career to help address life stressors, and to enable these individuals, as they progress in their career, to teach others these skills, under their leadership.

We'll also be teaching young service members how to recognize and how to respond to suicide red flags on social media, to help service members recognize how they can reach out to help others who might show warning signs.

For our National Guard members, we're partnering with the Department of Veterans Affairs to increase National Guard members' accessibility to mental health care through the V.A. Mobile Vet Centers during drill weekends.

We will also implement the new Suicide Prevention and Readiness for the National Guard initiative, also known as the SPRING Initiative, which will examine protective factors, risks and promising practices related to suicide and readiness in the National Guard.

The department's committed to the wellbeing of our military families, and ensuring families are best equipped to support their service members and each other. We will continue to pilot and implement initiatives focused on increasing family members' awareness of risk factors for suicide, to help our military community recognize when they are at risk so they seek help.

We're also developing initiatives on safe storage of lethal means. That is, safely storing medications and firearms to ensure family safety, as well as how to intervene in a crisis to help others who might show warning signs.

The department has also developed the joint program evaluation framework, to better measure effectiveness of our suicide prevention efforts. We also look for new promising practices from the civilian sector, in which to pilot and potentially implement more broadly across the DOD.

In summary, the department is committed to preventing suicide within our military community. Today, we release our first ever DOD Annual Suicide Report. This report helps us understand the complexity of suicide, where there is no one fix. Our efforts must address the many aspects of life that impact suicide, and we are committed to addressing suicide comprehensively through a public health approach to suicide prevention.

I am disheartened that the trends in the military, as in the civilian sector, are not going in the desired direction. Calendar year 2018 suicide rates are consistent with rates from the past two years across the military for the active component, Reserves and National Guard.

Our suicide rates are steady over the past five years for the Reserves and National Guard. However, we've seen a statistically significant increase in the active component over the past five years since 2013. Our populations of greatest concern continue to be our young and enlisted service members and our National Guard members.

This report also publishes suicide data for our military family members for the first time, with these suicide rates being comparable to or lower than the U.S. population rates after accounting for age and sex.

I fully recognize that we have more work to do and much more progress to make to prevent this devastating loss of life. We will do more to target our initiatives to our service member populations of greatest concern, while continuing to support our military families.

We must all partner together to prevent these tragedies. A public health approach looks at promoting health and prolonging life through the strength of a connected and educated community. It's not limited to just health professionals. We all have a role to play in preventing suicide for both our military community and the nation as a whole.

And, with that in mind, before we move into Q&A, I want to spend a few minutes sharing some key information on safe reporting on the topic of suicide. You, as the media, you can help us prevent suicide. DOD is committed to being transparent and sharing our findings and initiatives with you, so you can help us in sharing information with the public.

It's important that everyone has the tools to safely report on the topic of suicide. Careful coverage of suicide, even if only brief, has the potential to change misconceptions and correct misunderstandings. By following best practices in media coverage, vulnerable or at-risk individuals may be encouraged to seek help.

On the other hand, media coverage can also negatively influence behavior by contributing to suicide contagion. Suicide contagion occurs when one or more suicides are reported in a manner that contributes to another suicide. The speed at which reports, photos, videos and stories can go viral makes it critical that coverage of suicide follows safe reporting best practices.

The risk of additional suicides or contagion increases when media stories provide explicit and graphic descriptions of the method of suicide, if the stories include graphic or dramatic headlines or graphic images, and if there is repeated or excessive coverage that sensationalizes or glamorizes the death.

The media can support suicide prevention efforts by advocating and implementing safe reporting guidelines. These are simple but effective strategies for covering suicide. We're providing you with a fact sheet on safe reporting recommendations, but I'd like to highlight a few of these for you now.

When reporting on suicide, be sure to avoid misinformation and to offer hope. Suicide is complex, and it results from a combination of factors, not just a single cause. Avoid stating that a single event caused the suicide. This can lead to misunderstandings about suicide, as suicide is a result of a combination of many factors.

Always include information about available resources and treatment options, and promote the use of crisis and other supportive resources that encourage help-seeking, such as the Veterans and Military Crisis Line and Military OneSource.

Emphasize that suicidal thoughts and behaviors can be reduced through support and treatment, and that these are not signs of weaknesses or flaws.

Seeking support is a sign of strength. It can be powerful and inspiring to share stories of those who have overcome a suicidal crisis, and also including warning signs and what to do to help in your article is beneficial.

Certain phrasing can contribute to suicide contagions. Terms to avoid – avoid saying a person committed suicide or characterizing attempts at successful or unsuccessful. Instead, report that someone died by suicide.

Avoid using sensationalizing words referring to suicide, such as skyrocketing or as a growing problem. Instead, use non-sensationalizing words like rise or higher when referring to increases in suicide rates.

As I explained earlier, when reporting on trends or changes over time, use the official suicide rates, not counts. We need to use those annual rates, not the counts, as the rates factor in the changes in the overall population sizes that may also be increasing or decreasing.

For military rates, use the rates in our most recent Annual Suicide Report. And for U.S. population rates, we recommend using the most recent CDC data. Consider sharing stories of hope and recovery and information on how to overcome suicidal thinking. It can increase coping skills and increase help seeking.

Finally, there are several misconceptions in the general public about suicide and about military suicide, in particular, and effective reporting on suicide can help dispel those misconceptions. I'd like to highlight several misconceptions that are discussed in the Annual Suicide Report.

First, a common misperception is that deployment increases suicide risk. Several studies have shown that being deployed, including combat experience, length of deployment and number of deployments, is not associated with suicide risk amongst service members.

A second common misconception is that the majority of service members who die by suicide have a mental illness. This is not true in our military or civilian populations. More broadly, we know that when access to one lethal means is removed, someone at risk is unlikely to substitute another means.

As I also explained earlier in the brief, we are often asked how do we compare to the U.S. general population? And there is a common misconception that the military suicide rates are higher than the U.S. general population. This is not true for our active component or the Reserve after controlling for age and sex differences.

However, as we have discussed, we hold ourselves to a higher standard. A final and critical misconception is that talking about suicide with someone may lead to suicide. This is not true. The fact is talking about suicides provides other – the other person an opportunity to express thoughts and feelings about something they may be keeping secret and to be able to obtain help and support.

To close, we all play an important role in suicide prevention. We certainly recognize the critical role the media plays in sharing information about our public health prevention efforts, and we encourage your support in helping to prevent suicide by using safe reporting practices.

We urge you to use the fact sheet we provide today as a resource for future media stories that address suicide, and this information is also available online at reportingonsuicide.org. Please share this important information and resource with your colleagues.

And with that, we will open it up to question and answers on the Annual Suicide Report. Thank you.

QUESTION: Hi, Lolita Baldor with the Associated Press. A couple of quick questions. Just – number one, is there any cost associated with either the broader – either new or increased programs to help suicide – prevent suicides? Is there, and that’s for the military population, as well as any new efforts for the families? Is there any costs associated with that?

And then, are there any current regulations across the military on gun storage or how military members are supposed to secure their weapons? Does that not exist already? Is that something that you could – would do on a department-wide basis? Is that a service question? How – how do you deal with that?

DR. VAN WINKLE: In terms of your first question, you said the costs associated with ...

QUESTION: Budget.

DR. VAN WINKLE: Oh, for the budget. Well there are a number of initiatives and there's – and certainly – Dr. Orvis can talk about those initiatives that we do, and we also partner with the civilian sector in terms of a – a budget list. I would have to get that for you.

But the initiatives that we do are often informed by our partnerships with – in the civilian sector, and again Dr. Orvis can talk about some of those partnerships. In terms of firearms, I think this is an important part of the report.

The firearms – in this conversation, because they are the most lethal means by which to attempt suicide, and our installations and installation commanders have a number of tools to ensure that individuals are safe if they are experiencing distress, or if they are showing signs that they may not be safe, in – including removing the firearm.

So some of this is installation – installation-specific but there are certainly regulations in place.

QUESTION: Well, just so I’m clear – is there no, you know, service or DOD rules that say they have to keep their weapons locked at home or they have – does that or does that not exist? I'm not really clear.

DR. VAN WINKLE: Some of it depends on the installation and the jurisdiction. There's a lot of – there are legal implications to that, but across the DOD, if a commander is concerned about the safety of a service member, they all have the ability and – and they all have the responsibility to remove weapons from – and – and keep that service member safe.

QUESTION: But broadly, so there is no broad DOD military rule? And I'm sorry, but you were going to – (inaudible) civilian partnerships?

DR. ORVIS: Oh, sure, I can share about the civilian partnerships. As I shared earlier, we all play a role in terms of suicide prevention. So the department has many partnerships, not only with other federal agencies but also non-profits and the private sector to address military suicides as well as suicides more broadly.

And just as – one example I will share is we're part of the National Action Alliance for Suicide Prevention, which is a public and private partnership targeting nationally how to reduce our rates for suicide.

QUESTION: Hi, Jennifer-Leigh Oprihory with Air Force Magazine. I have two questions. Well, the first is, what was the motivation behind the decision to release mismatching calendar years data for the military family members versus the service members?

And the second question is, has there been any discussion on the strategy side about potentially increasing the empowerment of chaplains across the services to take a more active role, especially with respect to (inaudible) distribution as was suggested at a recent DPH training for (inaudible)?

(CROSSTALK)

DR. ORVIS: Absolutely. In terms of the timing – I appreciate that question – we want to provide the most timely and current data that we have available. For our service members, that's calendar year 2018. For our family members, that is calendar year 2017 because our civilian data follows the CDC's same timeframe in terms of releasing data and their most recent data is available as calendar year 2017.

So the effort is to provide the most current data, even if the years are not comparable.

Q: And just to interject on that, can you – for those who might not have been tracking this issue previously, can you comment as to how the military family members for '17 compare to the calendar year '17 suicide findings before the ASR's rollout?

DR. ORVIS: Comparing to the (inaudible) service member 2017 findings?

Q: Yeah, pretty much.

DR. ORVIS: We would – I would not want to compare between two different populations. Our family members are distinct populations with their own unique risk and protective factors from our service members.

DR. VAN WINKLE: Do you mean within family members to family members, is that what you mean?

Q: No. I'm just – I'm very curious, as to whether there's a correlation between the number of suicides in a given year of service members and with their relatives. Because just in the way that you talked about the idea of negative reporting on suicides being – having the potential to make it contagious, we've also seen PTSD be reported as being somewhat contagious, proverbially speaking, so I was wondering if there was any way to track whether a domino effect occurred.

DR. VAN WINKLE: So I think we'll be able to do that in future years. And the reason is, we – this is the first time we have these rates for our military families, so we can't trend over time to see if they kind of mirror each other. So we'll be able to provide more information as we continue to report these out.

And then your second question was about chaplains, is that correct?

Q: Mm-hmm. To empower them more with respect to distribution of gun locks or otherwise.

DR. VAN WINKLE: Well, certainly, the chaplain is a critical partner in terms of suicide prevention. So we have many programs in place that involve chaplains, and we have new initiatives under way as well. One of the future initiatives that we are working toward is chaplains providing counseling access to lethal means training, in addition to other gatekeepers.

Q: Thank you.

Q: Thank you for your time today. I wanted to address the idea of sort of the contagion with suicide clusters sometimes, you hear about. And it seems like they come up anecdotally. There was another couple reports this week about a specific Navy ship dealing with one.

Do you see any trend lines there, that are especially concerning or troubling, as compared to the civilian population? And is there any, I guess, message for commanders in terms of how they work with their people when it comes to that kind of thing?

DR. ORVIS: Certainly, we are concerned. And suicide contagion is a real phenomenon, both in the military community and nationally. We are – commanders are trained how to handle (inaudible) within their unit. And in fact, we have – we'll be releasing a new post-vention toolkit to help units, help commanders, help families deal with that intense loss.

DR. VAN WINKLE: One of the things I'll add, that just having been in this space for about 10 years for the DOD, is the number of conversations that leaders are having around suicide is really beneficial to try to reduce that stigma around it.

And – at all levels, the conversations that folks are having around this issue and what people can do, and seeing getting help as a strength and not a weakness. I've certainly seen an amazing amount of support from leadership on that.

Q: Meghann Myers, Military Times. You guys have this good list of ways to talk about suicide, to report about suicide. Are you pushing anything down similar to commands and to leaders? And I ask that specifically because the Secretary of Defense, a couple times over the past couple of days, has referred to suicide as a national epidemic, which seems counter to the messaging that you guys are trying to put out.

And I also wanted to ask about the messaging you're giving to service members about what's going to happen to them if they report, because one of the biggest barriers to them reporting is thinking they're going to be flagged, they're not going to get promoted, they're going to lose their security clearance, and that can cause, you know, issues, to get kicked down until it's too late.

DR. VAN WINKLE: To address both of those, absolutely. People have a fear about talking about this. And talking about one of the misconceptions we reviewed, that there is a fear that if they talk about it, they may give somebody the idea. There's also the fear of, "If I talk about it, what happens if they say yes? What do I do?" That's on us, to make sure that everyone at all levels, all the way down in the ranks, know what to do and know what to say.

So absolutely, that safe messaging is something we promulgate out so people know how to talk about this if they see somebody that may be showing signs of distress, or may have a stressor in their life that they know will increase their risk, how do they start having that conversation. The stigma is something that we absolutely struggle with.

And one thing to remember is, that as an institution and as a country, we expect a lot of our military members. But we also understand that they're human beings. And as human beings, we all share the chance that we could experience an earth-shattering, catastrophic event that we are neither prepared for, nor can we anticipate. We are all – we all have that common, unique challenge.

And we are also an all-volunteer force, which means that every single service member is critical to our mission, to ensure we have a ready and lethal force. Our goal is not to pretend that people aren't going to face crises, or to discharge them if they're going through difficulty.

Our goal is to care for them and to reach out to them, and to get them the help that they need and the care that they need, so we can get them back into the field, back on the line. That's how we win missions, that's how we stay strong.

It's our responsibility to make sure people understand that, that that's our goal. It does not help us if we just discharge them. We need them, but we need them to be more strong and more resilient, and none of us are immune to these crises that can come up.

Q: Hi. Lauren Meier with The Washington Times. Thank you both for doing this. Is there any particular explanation that you guys found, as to why the National Guard rates were particularly higher than across the rest of the force?

DR. VAN WINKLE: That's something that we're exploring with the National Guard. Initial look at the data, we find more similarities between the National Guard and the Reservists than dissimilarities. We have a couple thoughts on what might be happening, but we need to do a little bit more analysis, a little bit more work with the National Guard. They're very focused on this.

And what I would tell you – and for those of you who know me, as we will be back out, sharing what we find out from that.

DR. ORVIS: And that new initiative, that SPRING initiative, is focused on that, understanding those unique risk factors and protective factors for the National Guard.

Q: Thank you. Caitlin Kenney with Stars and Stripes. You talked about how, for the active component, that you found that the rate was statistically an increase. Can you, like, quantify what that – what the significant increase means? Like, by what percent over the five years?

DR. ORVIS: Sure. And I want to refer to this so I can – we are seeing about – on an average annual increase, about a 6 percent for our active component.

Q: OK. So 6 percent every year?

DR. ORVIS: On average, across that time period.

Q: OK. Thank you.

Q: Thanks for doing this. I have two questions. One, on your chart about method of suicide death, the dependents you have age 12 to 23. Is that just the way you measure? Or were there no suicides under the age of 12?

DR. ORVIS: Thank you. For this particular calendar year, yes. It was the suicides that were present in that calendar year, was age 12 to 23, and that's for the – the 23 is for Title 10 dependent ...

QUESTION: But 12 was the lowest?

DR. ORVIS: Correct.

QUESTION: OK. My second question similar to that is, you've mentioned a couple of times about how firearms are the largest method for suicides. Do you have a breakdown between firearms that are personally owned as opposed to the military issue?

DR. ORVIS: Yes, we do have that breakdown.

QUESTION: Would you share that?

DR. ORVIS: Absolutely, yes. So referring to the most recent DOD suicide prevent report, which is our complimentary report within the Department of Defense, that's calendar year 2017 that just came out recently, and that data shows that approximately 90 percent of our active duty suicides that were by firearms, were through personally owned firearms, about 90 percent.

QUESTION: So that was – that was – to go back to what Dr. Van Winkle was saying before, where it would be a base-by-base type of decision, on how they can – following up on Lolita's question about how they can control access if they're concerned?

DR. ORVIS: I ...

QUESTION: ... what you said, that ...

DR. ORVIS: I will add there's common policies and procedures in place in terms of commander’s authority. So they have – they have policies and procedures in place in terms of if they are concerned that someone is at risk, they may ask to store the individual's firearm during that time of risk. They may direct a behavioral health evaluation, but they may also order an individual into the barracks if they're concerned for their safety.

QUESTION: I'm sorry, I – I know – but just to ...

STAFF: ... have very much ...

QUESTION: ... I know, I just – I have to clarify this. You said state laws and local laws apply.

DR. VAN WINKLE: For some – for some installations. There are also specific policies and regulations for those who live on base versus those who live off base. So I think what I'm saying is, it's a bit nuanced and so I can't give a blanket statement of a policy, to Lolita's point, but what we can do is to get you more information of what those look like.

QUESTION: OK, I just wanted to be clear. I heard ...

(CROSSTALK)

STAFF: ... one more question?

QUESTION: Patricia Kime with Military.com. In 2012, the rate was 22.7 for active duty personnel per 100,000 and we met – that was the highest rate at the time and there was a big push by the Pentagon to bring those rates down and the next year it was 18.7.

Have you all done, like, a post-mortem to go back and see what was successful then, and are there things, lessons learned that you're going to be implementing now that perhaps had fallen from the wayside from those – that year?

DR. VAN WINKLE: Absolutely, and I'll speak to this because it's actually – it's similar across my portfolios, whether – whether we're talking about sexual assault initiatives or suicide initiatives. Often when we first start in this – in this space, the first thing we want to do is to ensure there is an infrastructure there to support and care for our folks.

This includes making sure that there is care available, that there are resources available. As we build in that infrastructure, we start to build up on our strategies. And within the 2012 timeframe, we obviously had a number of strategies that we pushed out as well as building that infrastructure for care and support.

One of the things we need to improve on, and to your point, is making sure we understand how the initiatives that we put out, how effective are they? And that's something we're taking on. Dr. Orvis mentioned the joint program evaluation framework.

Part of that is starting to understand what initiatives are working, by piloting them on certain installations, understanding what's working in the civilian sector, and bringing it into the military as a promising practice and to measure the effectiveness.

That's something we need to improve on, and that's something that we're doing moving forward so we can better understand what works and what doesn't work.

(CROSSTALK)

STAFF: We have to cut the briefing.

QUESTION: Right, but the (inaudible) military and I just wanted to get more of an understanding on how you can say that? ‘Cause I know that when it comes to suicide there are key factors ranging from deaths of a family member, divorce, financial issues, and these can pile up and happen years over time.

So I just want a clarification on why you can say that deployment is not associated with ...

DR. VAN WINKLE: Sure. In terms of those misconceptions, we are trying to help clarify ones that are most common out there in the public sector. And so we do have a bulk of data that indicates that deployments does not increase your risk.

What we see from the DOD suicide event report – as an example, the 2017 report – is that of individuals that died by suicide that year in the active duty, 40 percent had never been deployed before. So it's not a single – as you say, it is not a single factor for anyone.

It's very complex, the complex interaction of a variety of factors. So we do need to take into account what's happening for each individual and what might be their circumstances.

STAFF: Right. Thank you all for your time, really appreciate it. If you have any follow up questions, please feel free to stop by or just send me an email and I'll get back with you. Thank you.