Transcript

Defense Suicide Prevention Officials Brief DOD Annual Suicide Report for CY 2019

Oct. 1, 2020
Dr. Karin Orvis, Director, Defense Suicide Prevention Office; Travis Bartholomew, Deputy Director, Defense Suicide Prevention Office

MODERATOR: All right, good morning everybody -- or should I say good afternoon? Thank you all for joining us today, covering today -- we're going to have a briefing on the calendar year 2019 Annual Suicide Report. The briefing will be led by Dr. Karen Orvis, the Director of the Defense Suicide Prevention Office. 

During the -- following the -- excuse me -- following the briefing, Mr. Travis Bartholomew, the Deputy Director of the Defense Suicide Prevention Office, will be joining for the Q&A session. I ask that, again, you please wait to be called on as we get to the Q&A session.

For those of you who are on the phone lines, please keep your phones on mute until it is your time to be acknowledged and also please do not have your phone on speaker phone. If you have any questions following the briefing, please feel free to reach out directly to the -- to myself or Major Santiago following the briefing.

Without further ado, ma’am, you have the floor.

DIRECTOR KARIN ORVIS: Great, thank you. Good afternoon. Thank you all for taking the time to be with us today as we release the second Annual Suicide Report, or ASR. Suicide is a national public health issue affecting people from all walks of life. It's a growing issue that affects all ages.

Every suicide is devastating and forever changes the lives of families and communities. DoD has the responsibility of supporting and protecting those who defend our country and so it's imperative that we do everything possible to prevent suicide in our military community.

We know suicide is a complex interaction of many factors. Every individual has gone through their own unique journey. No two life experiences are identical. Although there can be many similar patterns among those who die by suicide, many times even close friends and family members are surprised by an individual's suicide.

Our data also tells us that it's often a sudden and impulsive act; yet we know that sometimes even the simplest action -- a text, a phone call or a video chat -- can make a significant impact and potentially prevent a tragedy from occurring.

We know this is a shared challenge. Nationwide, suicide rates are increasing. None of us have solved this issue. There is no quick fix, no single solution. Like you, we are very concerned about the suicide rates in our military. We in the department must do all we can to address and prevent these tragedies. With that said, our research and our data enables us to better understand and combat suicide in our military community. We will use the information from this report to inform and improve our efforts. 

Today I'll share our findings from our calendar year 2019 Annual Suicide Report and provide details about our current and future suicide prevention efforts. Before I go into the details of the report, I'd like to directly address some of the concerns and questions that are out there surrounding the COVID-19 pandemic, suicide risk within our military community, and the calendar year 2020 suicide deaths.

Quarterly suicide counts are publicly available on my office website. However, I strongly urge caution when examining changes in suicide counts. Although counts tell us the number of deaths, rates tell us the number of individuals who died by suicide per 100,000 individuals.

This is the standard used by the Centers for Disease Control and Prevention, the CDC, and other widely respected institutions. When we draw validated conclusions about changes over time -- for example, of suicides increased in calendar year 2019 or 2020 -- we use annual rates precisely because counts do not take into account changes in population size or provide enough time for essential investigations to be completed to determine cause of death.

So at this time, it's too early to determine whether suicide rates will increase for calendar year 2020. We'll need to have the full year of data and investigations completed to determine the cause of death. What may be looking like an increasing or a decreasing trend in raw counts may not be statistically meaningful once we have all of the data.

While this delay can understandably be frustrating, it is industry standard to provide enough time to allow investigations to complete and data to be gathered and rigorously analyzed. In fact, we'll not know about the calendar year 2020 civilian suicide rates from the CDC until calendar year 2022.

Because the department uses data to drive policy and program decisions, it's of the utmost importance to ensure accuracy of our data so as to make informed, deliberate decisions. We do recognize the potential impact of COVID-19 on the wellbeing of our service members and families. We're closely monitoring potential impacts and taking actions in advance.

During this time, we continue our efforts to educate the force, support the force, and emphasize social connectedness. The department's using a variety of communication methods, such as Military OneSource, department websites, and leader and unit social media channels to ensure our military community is aware that there are still many ways to look out for each other, build cohesion and stay connected, despite physical distancing.

The department's calendar year 2020 Suicide Prevention Awareness Month theme, which will be carried forward throughout the year, is Connect to Protect, focusing on promoting connections with others and the community as well as with resources.

We know even the smallest actions to connect with each other can make a world of difference to someone who may be at risk for suicide. Connect to Protect has taken shape across the department and is reinforced by Secretary Esper, our leaders in the Joint Chiefs of Staff and military services, and aligns with our interagency efforts on the President's executive order.

With that said, we can begin with a quick recap from last year's first ever Annual Suicide Report findings and the actions that we've taken since then. We're on slide two please. Our calendar year 2018 findings identified heightened risk among our young and enlisted service members and our National Guard members.

Based on these findings we made progress in developing and fielding programs targeting these populations of greatest concern as well as efforts to support our military families. Just as a few examples; to increase skills for young and enlisted members, we developed a video teaching how to recognize and respond to suicide warning signs on social media.

For our National Guard members, we developed a partnership with the Department of Veterans Affairs to increase behavior health access and services during drill weekends. To further support our military families and as part of a public health approach to lessen harms and prevent future risks after a death by suicide or suicide attempt, we published a post-vention toolkit.

This toolkit supports our post-vention providers such as unit commanders and chaplains in providing support to families, service members and units impacted by a suicide loss. 

I'll highlight a few other actions later in the briefing as we're building on several of these efforts this year. But I'll move to slide three to discuss this year's report findings. In calendar year 2019, there were 498 service members who died by suicide.

This slide presents the recent trends in our suicide rates examining the past two years and five years. When examining the active component, the calendar year 2019 suicide rate, which was 25.9 for 100,000 individuals, is statistically comparable to calendar year 2017 and 2018. Looking more long term, the active components suicide rates statistically increased from calendar year 2014 to 2019. 

When examining the reserve and the National Guard, the calendar year 2019 suicide rates for both the reserve and the National Guard, which are 18.2 and 20.3 per 100,000 individuals respectively.

These rates are statistically lower than for calendar year 2017. And the National Guard is also statistically lower compared to 2018. Looking more long term for both the reserve and the National Guard suicide rates, they are statistically consistent with -- from calendar year '14 to '19. Meaning there is no statistically significant increase or decrease in the suicide rate. 

While we hold ourselves to a high standard, we're often asked, “How does the military compare to the U.S. population?” In comparison to the U.S. population rates, military suicide rates for calendar year 2019 are comparable for the active component and the National Guard and are lower for the Reserve after accounting for age and sex.

Note that using CDC and industry standards we account for age and sex differences across populations when making comparisons as these are two risk categories for suicide. In other words, for our data this means that after adjusting for the age and sex differences across the military and civilian populations, with our military population being younger and comprised of more males, the military has comparable or lower rates to the U.S. population.

Collectively this data indicates strides have been made within the National Guard. Compared to last year's report, the rates are now comparable to the U.S. population and statistically down from calendar year 2017.

And likewise we see improvements for the reserve. We are cautiously optimistic but focused on long term sustained improvement for our National Guard and reserve members.

Moving to slide four, I'll provide more detail on service member demographics associated with the greatest number of suicides. Consistent with prior years, 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, Reserve, or National Guard.

This demographic – enlisted, male, under the age of 30 – made up 43 percent of the total military population and calendar year 2019, but about 61 percent of military suicide decedents for that year.

The primary method of suicide deaths continues to be by firearm, followed by hanging and asphyxiation. We also note that over 90 percent of deaths by firearm, are using personally owned firearms, as opposed to military issued firearms. 

In summary, we see continued heightened risks for our young and enlisted service members. 

Turning to slide five, this slide presents suicide rates for our military family members. This is second year the Department has reported the available data on military families and this was an important endeavor.

I'd like to note upfront, all the suicide rates you see here are statistically consistent; that is, no statistical increase or decrease with the rates reported in last year's annual suicide report. The results integrate data from both DoD data sources and the most comprehensive civilian sector data set, the CDC's National Death Index.

The data is for calendar year 2018, which is the most recent suicide data available for military family members due to time lag associated with collecting U.S. population data. In calendar year 2018, there were 193 military spouses and dependents who died by suicide.

The suicide rates for our military spouses and dependents are comparable to or lower than the U.S. population rates after accounting for age and sex, with the exception of our males spouses, which is higher.

Turning to slide six, consistent with last year's family member findings, the primary method of suicide deaths for our military spouses and dependents was by firearm, followed by hanging and asphyxiation. 

For our female military spouses, this contrast similar age females in the U.S. population where suicide death by firearm was nearly as prevalent as by hanging and asphyxiation. The Department will continue to work to effectively capture military family suicide data and report on this important information each year. 

We're committed to the well being of our military families and insuring families are best equipped to support their service members and each other. Turning to slide seven, the Department focuses on fully implementing and evaluating a multifaceted public health approach to suicide prevention.

Based on the calendar year 2019 annual suicide report findings, we will continue to build on last year's efforts while also focusing on new efforts to target our military populations of greatest concern.

Our young and enlisted service members as well as continuing to support our military families. For our young and enlisted service members, we are piloting an interactive program to address service members most common health seeking concerns; such as career concerns and confidentiality concerns encourage help seeking and use of resources before challenges become overwhelming.

This training is also being developed at and piloted for military spouses as well. The department is implementing an integrated violence prevention approach in policy to address common risk and protected factors across the spectrum of violence prevention; whether suicide, sexual assault, or domestic violence.

We know that multiple readiness detracting behaviors tend to cluster together and often interact in a way that can worsen outcomes, particularly for our young service members. We're also working with stake holders to leverage the new 988 crisis line for suicide prevention, insuring our military community is supported and aware of this important change.

The federal communications commission recently approved this new crisis line number, which will go into effect by July 2022. 

In partnership with the Department of Veterans Affairs our service members, veterans and family members will still be able to access the Veterans and Military Crisis Line by pressing 1 after calling 988 in order to get support from qualified, caring Department of Veteran Affairs responders. 

We're also working with the Department of Veterans Affairs and the PREVENTS taskforce on implementing the PREVENTS roadmap which includes a national messaging campaign to help individuals cope with stress and anxiety, to seek out support and to increase awareness of resources. 

As a final example, we continue to pilot training that teaches foundational skills such as problem solving early in a service member's military career to help address life stressors. I'll now shift to discussing several initiatives that focus on supporting our military families. 

Last year we conducted a successful pilot which trained nonmedical providers, specifically military one source counselors and military family life counselors on risk factors for suicide, and counseling strategies to increase safe storage of lethal means such as firearms and medications. 

This year we are expanding this effort by training other influencers in the military community such as spouses, chaplains, and community counselors. We need to further educate the military community on the need for safe storage of lethal means to ensure family safety. 

To that end we are expanding on our work from last year and publishing multiple resources such as an educational video and a means safety guide for service members and families. We're also teaching middle and high school students in DoD schools the risk factors for suicide, and how to seek help for themselves or others. This program engages parents and school staff as partners in prevention. 

Finally we have a DoD wide program evaluation framework to track progress and holistically measure program effectiveness of our suicide prevention programs. In this year's Annual Suicide Report we share baseline metrics data on our suicide prevention efforts. 

This baseline data is a critical starting point, or point of comparison to monitor progress on outcomes over time each year. We're also continuously looking for new promising strategies to pilot, evaluate and potentially implement more broadly across DoD. 

Turning to slide eight, the next two slides highlight several misconceptions about suicide that are discussed in the Annual Suicide Report. For example, common misperception is that suicide is not impulsive. The fact is, it can be less than 10 minutes between an individual thinking about suicide to acting on it. As such, putting time and distance between a person at risk and the means for suicide is an effective way to prevent death. 

Another critical misconception that's highlighted on slide nine is that talking about suicide with someone may lead to suicide, this is not true. The fact is, talking about suicide in a supportive way provides the other person an opportunity to express thoughts and feelings about something that they might be keeping secret, and to be able to attain help and support. 

Such misconceptions can hinder our suicide prevention efforts in our military community and across the nation. Knowing the facts may allow us to take lifesaving steps to help our loved ones. I would like to ask for your help in dispelling misconceptions and educating on the facts. Our collective efforts can help reduce the risk of additional suicides. 

Finally, the way we communicate about suicide influences perceptions, attitudes and behaviors such as how people view, or make decisions to seek help. 

We encourage using resources located at [www.ReportingonSuicide.org] when communicating with reports findings, or other suicide related communications. 

In summary, and to recap, our findings show that the calendar year '19 National Guard and Reserve suicide rates are statistically lower than 2017, and the active component rate is statistically comparable to 2017. We have a statistically significant increase in the active component from 2014 to 2019. 

Our findings also show our service member and family member suicide rates are comparable to or lower than the U.S. population rates after accounting for age and sex with the exception of our male spouses. 

I am very concerned with the trends in the military, as well as in the civilian sector. This is a shared challenge. We cannot prevent suicide alone, we must continue to collaborate on research, data sharing, outreach, and other key efforts with other federal agencies, nonprofits, and academia. 

Our efforts must address the many aspects of life that impact suicide. We're committed to addressing suicide comprehensively through a public health approach to suicide prevention. Suicide is preventable. We continue to do more, including targeting our initiatives to our young enlisted members while continuing to support our military families. We will not relent in our efforts, we owe this to our service members and families defending our nation. 

I want to thank you again for taking the time to be here with us today, and with that, I'll ask Ms. Lisa Lawrence to help us open up for questions on the calendar year '19 Annual Suicide Report. 

MODERATOR: Thank you, Dr. Orvis. At this time, we will go to the line with Luis Martinez with ABC. Luis Martinez, are you there on the line? 

Q: Hey, Lisa -- sorry, didn't hear you. Thank you, doctor, for doing this presentation. Just two points, please. You lead up by talking -- referring us to the quarterly report. 

Unfortunately the only quarterly report that's been posted for this year is quarter one, and we're already six months beyond that timeframe. So I'm just wondering when we're going to be seeing that data come out so that we can see the counts that you're referring to, or that have been reported in the press? 

Secondly, when Army officials are already on the record talking about what they see as higher numbers year-to-year comparisons, and they're making a direct correlation between what they see as an increase in suicide count numbers vis-a-vis the timeframe for the COVID, can you address that? And do you think that that is an oversimplification of what you're seeing? And is it also possible that this is just an anomaly? 

DR. ORVIS: Thank you, I appreciate that question. It is accurate that currently the most current quarterly suicide report is for quarter one. Quarter two is expected to come out this month and will be posted on the DSPO website. 

In terms of the numbers, as I shared before, we really cannot use suicide counts in order to make determinations of are we seeing an increasing or a decreasing trend over time. We need to have that full, annual rate to be able to do so. We need to have time to have the investigations complete. We have seen in the past that at times where it looked like if we were just looking at counts there may have been an increase. But once we have the full years of data it was not statistically significant. 

MODERATOR: Alright. In the room, Meghann Myers with Military Times. 

Q: So we know that the biggest barrier to getting help is not really the availability of resources but it’s the wherewithal to take advantage of them. Earlier this week the head of Army training and doctor in command threw out that he doesn't see a problem with every soldier having a mandatory behavioral health meeting, appointment, every year just to check in. Is that something you guys might consider recommending at least for the services, if not putting into policies?

DR. ORVIS: Thank you for that question. Certainly our barriers to care and stigma for seeking help is real and so we're looking for many ways in which we can encourage folks to seek help and to seek help early before the challenges become overwhelming and we do have a number of initiatives in place right now to -- to do so and there are different ways in which individuals can also seek help. 

So they could seek help through a behavioral health provider, as you were mentioning. They could also seek help through a chaplain, through the veterans and military crisis line, Military OneSource. There are a variety of options.

So certainly we are always looking on what can we do to reduce that stigma and increase that access to care.

Q: But something like a mandatory yearly appointment, where does that fall on your recommendations?

DR. ORVIS: We're certainly looking into all possibilities.

MODERATOR: All right, back to the line. We're going to start with Jennifer-Leigh Oprihory, Air Force Magazine.

Q: Thank you so much for taking the time today. My question is because last year's report included breakdowns for race, I was just wondering if you could comment, since it wasn't included in the presentation slides, whether there were any racial trends observed, especially what -- with DOD's increased focus on diversity and inclusion initiatives, we were just wondering how suicide trends for calendar year '19 tracked along those lines, whether there were any trends that might be concerning to you all? Thank you.

DR. ORVIS: Thank you for the question. Yes, so within the Annual Suicide Report, which is now published on the DSPO website, it does still include race. So you'll still be able to look at all of those demographics similar to last year and our trends are consistent with last year in terms of race. Our individuals that primarily die by suicide are Caucasians. That is also true this year.

MODERATOR: All right, back to the line. Caitlin Kenney, Stars and Stripes.

Q: Hi, yes, my question is for the military spouse and family programs, are these focused on addressing some of the, you know, loneliness or isolation, some of the career challenges or financial concerns that can cause stress to -- to family members?

DR. ORVIS: Yes, thank you for that question. We -- the new pilot that I mentioned, the interactive program REACH -- it's called REACH for short – but it's in time -- intended to help those perceived barriers of seeking help and some of those are -- we're still working that out in terms of identifying what are the most common concerns for our spouses, so we are tailing that -- tailoring that program specifically for our spouses but we also see that our military community is not aware of all of the resources or may not be, for instance, through Military OneSource and financial counseling and relationship counseling that is all free and available for our service members and family members.

So that -- yes, that will be in -- included and addressed, that that is a primary concern for our military spouses.

MODERATOR: All right, in the room here. Jeff Schogol with Task & Purpose.

Q: Thank you. Officials have confirmed that for 2020 the suicide deaths in the active Army are up 30 percent as of August 31st and in the Army Reserve, up 40 percent. Would you describe that as a statistically important increase -- or statistically significant increase? Excuse me.

DR. ORVIS: What I would say is we really can't look at the counts in terms of understanding the trends that are happening for 2020. I know that's incredibly frustrating, it's frustrating for us too. We want to be able to know what's going on.

I can't validate those numbers for you. They are continuously changing week by week. 

Q: Well if I could follow up, counts -- colloquially known as deaths – are up a lot and I'm asking why it's too early to reach a conclusion for this year? That data seems to have already indicated that deaths are up and it coincides with COVID.

DR. ORVIS: What I would share is -- and this is a part of understanding the phenomena of suicide and -- and the processes that we have to make sure our data's accurate, is that investigations do take time to complete and in fact investigations can change over time. 

So initially, a death may be determined to be an accident and then later on there becomes additional evidence and the official manner of death becomes a suicide or vice versa. And so there is quite a bit of shifting that's happening and there's additional data coming in that -- to make a conclusion at this point in time would be premature and we really need to make sure our data is accurate because we use our data to drive our policy and program decisions.

MODERATOR: All right, back to the line. Abraham Mahshie, Washington Examiner.

Q: Yes, I'd like to follow up on my colleague's question about increased numbers this year during the peak COVID time. I understand that you don't want to draw a correlation but -- and there's a bit of confusion about what you mean by "data." If someone died by suicide, how does that number change? 

Can you address why it is – It appears as though you're dodging this question. And can you talk about, like, what factors COVID has added to the service members lifestyles, the pressures? Maybe you could address those two points for us. Thank you.

DR. ORVIS: Sure, thank you. You know, I -- first, what I would like to -- I'll go to the data in a minute to -- to explain that but I -- I would like to say that, you know, we are equally concerned about this, as -- as everyone is.

Certainly COVID pandemic is -- many of us are experiencing some level of stressors, anxiety, disconnectedness. To your question of what might be happening, we know with physical distancing across our nation, folks may be experiencing disconnectedness or not feeling that they can have the social interactions they are regularly having.

We are taking actions in the department to stay ahead of this, as I mentioned in the -- the earlier statement, so I won't repeat myself there, but this is something that we have urgency to -- to be looking after the wellbeing of our service members and our family members.

I -- I'll also add to your question on the data, within our report, our deaths by suicide include both pending and confirmed, and that's because we want to be as inclusive as we can, but those pendings sometimes do change to not be a suicide after all, for instance. So those do change over time.

MODERATOR: All right. We're going to go to Jeremy Redmon with Atlantic Journal [Constitution]. Jeremy, are you on the line? OK, we're going to go to Tara Copp with McClatchy News.

Q: Thanks for doing this. As you look closely at the suicide data for 2020 and in recognition of the impact COVID has had, is your program considering making any changes to, as this pandemic is expected to continue on through 2021, where vaccines won't be regularly available and this -- you know, this longer term isolations could possibly exacerbate suicide rates next year too? Thank you.

DR. ORVIS: Thank you. Certainly as a department, we have already made changes, similar to other organizations and agencies, we've changed the way we get people into care. We have increased telehealth as well as increased our peer support services. 

We're continuing to increase our resources and our information to our services members and our family members, so they are aware of the various supports that are available to them. Financial challenges or relationship stressors can be addressed by helping each other and looking out for each other, but also though our structured resources and support like Military OneSource within the department. 

Another thing that we're doing is -- and this is illustrated in our calendar year 2020 suicide prevention month’s theme, Connect to Protect, but it's emphasizing that connectedness. And while that is particularly important right now in light of the COVID pandemic, that has always been a key piece of an effective public health approach strategy for suicide prevention. So we are encouraging our service members and our family members to look out for each other, look out for themselves, your own self care is just as important as your care of folks that you love. 

And we also have senior leaders within our department as just exemplars, for instance, Secretary Esper, also Vice Chairman Hyten, as an example, sharing not only what recesses are available, but sharing – Vice Chairman Hyten shared experiences in his past where he was having some life challenges and where he sought help. 

And those kind of stories and that candid sharing of seeking help is incredibly important, that helps us encourage folks, that we're all going to face these kind of challenges and it's a sign of strength for you to reach out and seek out support. 

MODERATOR: All right, here in the room, Barbara Starr with CNN.

Q: Hi, ma’am. I'm going to come back to what so many of my colleagues have come back to; no personal, professional disrespect, but we all sitting in this room know that the second quarter numbers for 2020 are within days of being published. We know that -- we know that you've been told not to talk about them. But if there is concern that COVID isolation is a contributing factor and everybody knows that the actual numbers are up, setting aside statistical trend analysis, the actual cases, the Army's statistics show 35 soldiers died by suicide in July alone. 

Isn't it important in real time to talk about this 2020 increase? Again, apologies, rather than stand on statistical analysis, which in everything, can ebb and flow and change? We all understand that. But if COVID is a concern, isn’t it time to talk about it and the increase that you're seeing that every senior military leader worries right now, may be tied to COVID being a contributing factor?

DR. ORVIS: I would go back to, we are -- we are concerned. We are concerned like everyone across our nation, of the impacts that this is having on our community and also what's happening across our nation, frankly. And so we are putting actions in place now, we're not waiting for the data to say, how can we better support our military family members and service members? We're doing that now. 

I understand. I understand the need and the desire to be able to say this is an increase or this is not an increase. Unfortunately, we are not there to be able to say that. The numbers are continuing to change. 

Q: But I don't understand that. It is an increase. We know that the numbers are more than they were. That's an increase.

DR. ORVIS: Perhaps I can give you an example from the past -- and this was not even that long ago, this was calendar year '18. If we were just looking at -- through the first two quarters’ worth of data and if we were to calculate a percentage increase based on counts, which I strongly urge not to do because it doesn't take into account those population changes, our end strengths are also going up and down each year, we saw -- if I -- if I calculated it, we saw a 20 percent increase through Q2. And at the end of the calendar year for 2018, when we had -- were able to calculate the rates and account for our population changes and we were able to allow investigations to complete and have the full year's worth of data, calendar year 2018 -- and this was for our active component, apologies for not saying that up front -- was not statistically higher compared to 2017.

Q: I'm asking you not to address statistical analysis, though I understand the validity of it in your profession. What I -- I think what we are all asking you -- and I won't, you know -- I won't go on too much further -- but it's just the -- the human numbers, there are more people dying -- military personnel dying by suicide. 

Let's just talk about the Army in -- in the month of July, than there were each month previously, just the human cases, not the statistical analysis, and I'm wondering what you can offer us in terms of trying to understand that increase in human cases and what it means.

DR. ORVIS: I don't think I'm going to be able to provide you with an answer that's satisfying because we do not have data that is -- it's going to change tomorrow, it's going to change the next day. These cases are -- are live and in fact when you look at our suicide rates over time and our counts over time, they continue to change.

We'll have manner of death determinations that change years later and we can -- we are updating those counts. And this is so hard because every death by suicide is such a tragedy and so, you know, I can't under-emphasize how concerned we are too and that we are taking forward actions.

MODERATOR: OK, we’re going to go on to the next question. Lucas Tomlinson with Fox News.

Q: You say you want to know what's going on but clearly somebody knows what's going on. These Army officials who spoke to the Associated Press were saying they're seeing a massive spike in suicides and they blame the lockdowns in part for this spike.

Is the Associated Press not accurate? Are these officials not telling the truth?

DR. ORVIS: I'll defer to the Army in terms of their own comments.

Q: But -- OK, let's try this again. What are the bigger threat right now to the U.S. military, is it the coronavirus or suicides?

DR. ORVIS: I don't think I could answer that question, to be fair. I -- I think that's not a fair comparison.

MODERATOR: All right, we have time for -- we have time for one more question. We're going to go to Patricia Kime, Military.com, on the line.

Q: Yes, can you tell me whether there is, like, manual (sic) suicide prevention training for NCOs and -- and how is the word getting down to the people who are dealing with the young enlisted service members at every level?

I've spoken to a couple of people who just say it's completely lacking and there's lacking of empathy down at the -- the middle leadership level and I'm wondering what exactly is the -- are the rules in terms of trying to educate NCOs on how to deal with this issue?

DR. ORVIS: And just for clarifying, I don't think I heard your -- your first word. Did you say "manual suicide" -- I -- apologies, I just want to make sure I understand the question.

Q: Annual. I'm wondering if there is annual suicide prevention training mandated across DOD.

DR. ORVIS: OK, thank you for that. Suicide prevention is a regular occurrence across DOD and it happens in a variety of ways. That public health approach to suicide prevention -- you know, I highlighted a few of those initiatives earlier on, but it's more -- there is -- I think what folks commonly think about, which is do we understand the risk factors of suicide, do we understand what to do if we might be at risk or -- or someone we know might be at risk and how to either get ourselves or someone else to -- to support and care, but it's really much bigger than that.

It's also providing and -- and -- providing education on improving coping and problem solving skills, it's about that connectedness that we talked about and having -- with your fellow service members and -- and certainly very important for our NCOs and commanders to have that.

To your question, I think probably the -- the broader question too, is we do hold leaders accountable in terms of having a positive climate and taking these kind of issues seriously. I mentioned the integrated violence prevention approach that the department is undertaking, specifically focused on our young and enlisted service members, and we do have a new policy that was just recently released that is looking at those intersections.

And with -- we've taken into account, as well, our -- our -- our commanders and the responsibilities that our NCOs, for instance, would have.

MODERATOR: All right. With that, we're going to go ahead and -- this is going to conclude the briefing today. For any follow up questions, please reach out to me directly. Dr. Orvis and Mr. Bartholomew, thank you for your time today and thank you all for being here. Thank you.