Veterans Affairs and the Defense Department come together to host a suicide prevention conference in Nashville, Tennessee, August 27, 2019, to provide continuing education and to share research findings and practical experience with other experts in the field to help prevent suicide within the military. The conference opens with an introduction ceremony featuring Karin Orvis, the director of DOD’s Defense Suicide Prevention Office.
Transcript
Good morning. I’m so happy to be here and welcome you to Nashville. To our esteemed VA colleagues, our DOD partners and conference organizers, welcome to Nashville. To our veterans and to those soon to be veterans, thank you for your service. So as I welcome you to Nashville I wanted to prepare you for your time here with us in Music City with a few friendly tips. If you don’t like country music, well that’s just un-American and you should keep it to yourself. Y’all is a proper noun and it means you. Nashville hot fried chicken was invented here. It’s hot y’all have been warned. Nashville is very, very safe, but I want you to be aware of a recent phenomena of some roaming gangs. Now I hope you didn’t already encounter this at the airport, I know I ran into two of these gangs Thursday night when I came back from DC. They call themselves bachelorette parties. (audience laughing) They’re leader can be identified usually with something white on her head. Their mode of transportation is pub taverns, which also should be avoided. So for better or worse Nashville is the number one destination for bachelorette parties, so I suggest you steer clear. And please don’t overlook all that we have to offer right here at the Gaylord. The SoundWaves upscale water experience and a lot of wonderful restaurants. But for those of you who choose to venture out, Nashville has a full-scale replica of the Greek Parthenon. Which was built for the Tennessee 1897 Centennial. It has a beautiful collection of 19th and 20th century art. We have the Frist Museum which is a classic neo-classic building with a lot of wonderful exhibits. Downtown we also have a 33-story tower that lights up the downtown skyline and looks like Batman. We don’t know why. But last as you experience the wonderful Southern hospitality and the politeness of Southerners, if they should ever say to you, “bless your heart”, that is not a compliment. While here I know that you will see and hear many of our future stars of country music on the street and in some many of our venues. You can see them practically everywhere. So please enjoy. You’ll also note the traffic, the construction, the detours. Nashville is a growing city. Estimates are that a hundred people a day move to Nashville. So you’re more than welcome to visit, but not necessarily looking for you to move here. Unless you happen to be a mental health professional looking for a job. Feel free 843-614-1346. I’m really pleased that you’re here this weekend, it shows that you share the commitment of VA Secretary Wilkie and our executive in charge Dr. Richard Stone. A commitment to preventing suicide. So I wouldn’t be a good Network Director if I didn’t brag a little bit about what our team is doing right here in Tennessee and Kentucky. You’ll hear from members of our community team in Clarksville Tennessee, which is home of the 101st Airborne Division and the 160th Special Ops Aviation for Campbell Kentucky, as they describe their participation in the mayor’s challenge. Our efforts in connecting with transitioning servicemen and women with VA Services through the Clay Hunt Initiative, as well as educating community agencies on military culture and suicide prevention. Our staff are primary trainers for the collaborative assessment and management of suicidality groups. Which makes us the only region in the nation offering this intervention at all five of our medical centers. Our Warrior to Soul Mate Retreat brings couples together to restore relationships impacted by their service to our great nation. With clinicians and high risk and at risk veterans have an innovative approach to reducing and eliminating their risk for suicide. Our Memphis Director Colonel Retired David Dunning, who many of you may know from his army career, has produced a compelling video series of eight videos which describes all of the mental health services provided at the Memphis VA Medical Center. The second video of which focusing in on preventing suicide. And you’ll also see some of our educational and outreach ads at Tennessee Titan football games. We’re so excited that you’re here in Nashville this week, and we hope this is a meaningful conference for each of you. And that you leave here having networked, shared ideas and vision, and most of all becoming more energized to carry out the mission of preventing death by suicide. Let us all be mindful, hashtag be there, in serving those that we encounter daily and their families as you explore more ways to be there, we are thrilled that you’ve chosen to be here with us in Nashville. It is now my extreme pleasure to introduce Dr. David Carroll, the Executive Director of the Office of Mental Health and Suicide Prevention at our VHA Headquarters. Dr. Carroll has held multiple clinical and supervisory positions since joining VHA in 1990 as a Staff Psychologist in Geriatrics and Extended Care at our Milwaukee VA Medical Center. During one of the most dynamic times in VHA, Dr. Carroll is responsible for the operational integrity of the VA mental health system, ensuring veterans have access to a full range of proactive suicide prevention and mental health services to ensure their health and wellness. Again welcome to Nashville, and I present Dr. Carroll. (“Witch Doctor”)
Good morning everyone. Good morning, there we go alright. (audience cheering) It’s so wonderful to be here, and thanks Ms. Breyfogle for welcoming us to Nashville and for your introduction. Thanks to Wendy and the teams from VA and DOD who put together this conference for us this week. And thanks to all of you for not only being here, but for the work that you do every day. And it was remarkable this morning to just spend a few minutes and maybe talk to ten people before we got started, that represented different places in the world, different places in the spectrum. I talked to VA colleagues, I talked to DOD colleagues, I talked to family members, I talked to representatives from our congressional offices and partners, talked to our partners. We’re all here together and that’s wonderful, and that’s so exciting. And the energy that I feel, and hopefully all of you feel, is tremendous in this room. And thanks for what you do every day, and thanks for coming here because this is a pivot point for all of us. We’re here for one reason, death by suicide is a public health crisis in America and it disproportionately affects service members and veterans. And we have one mission, that’s to prevent suicide. But when we look at our data we know that we have a lot more to do. This is a journey it’s not a destination and we’re here to take a moment on our journey to pause and to look at what we can do better, what we need to learn. The point here is not to work harder, longer, stronger. We’ve all done that. The point here is to work differently, to not do what we’ve always done before but to learn new things, to learn new approaches, new best practices. And we’ve already done that. We’ve done that with our partnership experience, we’ve done that with our inner agency work, we’ve done that through the support of our congressional oversight committees, the support of the White House, our important public private partners as we work together. But and we also know one of the things that we’re doing in this mission at this time is to get out behind the walls of our buildings, to get out behind the walls of our bases. To get out behind our desks and to get into our communities where service members and veterans and their families live, and to hashtag be there for them. We’ve had tremendous opportunities recently, if you think of what’s happened over the last couple of years starting with the executive order that the President signed in January of last year looking at how we can improve our services to service members as they make that transition out of active duty into civilian life. I had the experience two weeks ago to talk to the Secretary of the Navy’s Retiree Council and it was a remarkable morning that I got to spend with them and to hear about their interest in serving their fellow service members in retirement and looking at what we can do in VA to further support that effort. So we’re in this together, it’s not something that any one of us do alone. We have the recent executive order that establishes the Prevents Task Force, and we’re going to hear some more about that I think on Thursday morning on our program. A Dr. Barbara Va Delan, the Executive Director of that program will be here. Over the last couple of years in VA in particular we’ve worked with our SAMHSA colleagues on mayor’s and governor’s challenge work. Our partnership space has increased tremendously over the last couple of years. We’re really doing things differently but there’s more to do. One of the things again that we’re going to talk about in the conference this week is the concept of a public health approach to suicide prevention. And we have some national experts here at this conference that are going to talk to us about that. You know that’s important because we know that of those who die by suicide at least 50% have never had a mental health diagnosis or been in mental health treatment. We also know in VA that at least 50$ of the veterans who die by suicide have no connection to VA. So we need to get into the communities. We need the communities, it’s not just us, but we need our communities to rally around those women and men and their families who are there who have given their lives and service for our country. And we need to be there as a grateful nation to support them. On the other hand we can’t back away from what we’re doing in mental health. My title or the office that I lead is the office of Mental Health and Suicide Prevention. It’s both and we have important treatment resources and, just a disclaimer, I get to talk about the office but we have incredible people in our office in the mental health space in the suicide space who hopefully you all know, who do the work. These are the smart people in our office, I get to make sure they have what they need to get the work done, but thanks to all of your on our team. But it’s mental health and suicide prevention. In VA currently at this point in time, we see roughly 500’000 veterans in our mental health clinics every month, and another 70’000 veterans in our integrated primary care mental health clinics. The veteran and military crisis line is answering 2000 calls a day on average, and making almost 100 emergency dispatches for immediate care as well as somewhere in the neighborhood of 400 referrals into care. You know this is important mental health and crisis intervention work. We can’t stop that. But obviously the data tell us that we need to do more. We know that there is no single cause or simple solution to suicide prevention, if there was we wouldn’t be here for this conference. But we know one of the things, that it’s multifactorial, and I’m going to pick on one thing for just a moment. And that’s the fact that we know that a lack of a sense of belonging, a lack of sense of connection, is one of those higher order factors that several individual risk factors may pass through and connect with. We have an incredible problem with people being isolated in our country today. Former service members, current service members, veterans, individuals in our communities, families, that feel a tremendous burden of isolation. Maybe it’s because of some condition, or maybe it’s because of homelessness, or maybe it’s because of some economic factor, it can be for any number of reasons. But we are not well connected, and if we can come out of this conference with anything it’s a strategy to help each other make sure that we are connecting and make it a low threshold experience for people to reach out and to ask for help. And so we’re looking for new practices and best practices, and it’s not just about preventing death. Of course that’s what we want to do, but the way to do that is to engage veterans and military service members in lifelong health, wellbeing and resilience. So it’s to give that message of hope to help them learn skills, to help them manage risk factors and protective factors in their lives. We’re going to talk some more about this at this conference, but I just want you to think for a moment about the risk and protective factors in your life. We all have them. All of us have them. What we need to do as people who are committed to this mission of suicide prevention is to help people accept that fact. To see that and to help them tip that balance favorably in their own lives. And it’s not just about knowledge. It’s not just about having good practices. But it goes to that point of engagement. We can have all of the skills, we can have all of the best practices, we can have all the knowledge in the world but if we’re not helping people get engaged in care or get engaged in services or get engaged in their communities than we’re not doing our job frankly. We have to help people get engaged. We have to help people, perhaps starting with us frankly, accept the fact that we all have vulnerabilities. We all have vulnerabilities. We need to encourage people, we need to enable people to talk about vulnerability in their life. We need to encourage each other to raise our hand and say I need some help with this. Whether it’s a family problem, a legal problem, a mental health problem, whatever it is, and to make sure that it’s okay. So in, wrapping up I guess I would leave you with a couple of questions. One is how can we make sure that it’s easy for people to engage and to ask for help? And I’m not just talking about mental health treatment, of course we want it to be easy for people to get mental health treatment. But how can we make it easy easier for people to ask for help whatever it is that we all need help with in our lives. How can we do that? And secondly how do we respond when people do that? And I’ve had the opportunity to think about this quite a bit within our VA mental health care system. How do we respond when people ask for help? Or how do we respond when someone is learning a new skill? And I was thinking about my own experience in parenting, in when you have a child who is learning to walk or we had a child who had a journey in learning to speak, and now you know he speaks all the time. But it was a journey to get him to that point. Or someone learning to ride a bicycle or whatever it is learning the new skill. As a parent you’re proud and you’re supportive, we need to have that same attitude when people come to us for help. And maybe it’s asking us for help over a cup of coffee, maybe it’s talking over the fence in the backyard. Maybe it’s coming in to our clinics and saying I’d like to see somebody but I don’t know who. You know we need to approach those moments with the same enthusiasm that we would a child learning to ride a bike or learning to walk. That’s just an incredible moment of someone coming forward. It takes so much courage at those moments. And we need to make sure that all of us and the people who work around us embrace those moments, celebrate those, that’s not just I’ll see if I can work you into my schedule sort of thing. It’s like okay we’re here for you, how can we help you, let me get you connected. We need to make sure that we welcome people who are asking for help. Whether it’s a big ask or a small ask. And finally, we’re not alone look around you. There is tremendous energy in this room, I feel energized and I don’t know, maybe a year or two younger already this morning, for being in this room with you. That’s wishful thinking but we’re not alone. We’re not alone in this. We need to support each other. We need to make sure that this is a pivot point for all of us on our journey, to be the people who are going to carry forward this critically important work of preventing suicide. And so thank you for being here, thank you for what you do every day, thank you for this commitment to work together. And I hope everyone has a great conference.
[Announcer] Dr. Karen Orivis, Defense Suicide Prevention Officer.
Good morning how are we all doing? Talk about the energy indeed, I feel it as well. Yeah I’m really struck by the number of people, as I look around, that are dedicated to the wellbeing of our service members, veterans and our families. I want to thank you for what you’re doing day in and day out for our community and also for participating in our conference today. I’m really excited about the opportunities that we have to collaborate and cross-share our promising practices, our policy initiatives, as well as the latest research. This is our way that we can advance suicide prevention in both our military and our veteran communities. As Dr. Carroll said we know that suicide is complex. It’s an interaction of a variety of factors. From environmental to biological. To social to psychological. And there is no one fix. We have to have our efforts address those many aspects of life that contribute to suicide. In the DOD we have a number of ways in which we are tackling those different ways. And we’re striving to implement a public health approach to suicide prevention. Today I want to highlight three areas in particular. Our data surveillance and reporting, our program evaluation, and our public and private collaboration. So first talking about our data surveillance and reporting. Transparency is of the upmost importance to us. And over the past few years we’ve ensured reliability and standardization of our data for all of our service members that die by suicide across the military services including the reserve component. We’ve also made important strides in terms of data collection and reporting of suicide deaths among our military family members. But I stand here today disheartened that the trends are not going in the right direction for our military community. We must do better. We have much more progress to make. We must do all that we can to prevent this tragic loss of life. And events like today are important. They bring us together so that we can share that important information. I also believe strongly that it’s important that we have transparency in terms of what is going on in our military community and in our veteran community. And I recognize the need that we need to provide more transparent and timely data. So beginning this year the DOD, with my office in the lead, will be publishing the first ever Annual Suicide Report. And that report will release the calendar year 18 annual suicide counts and rates for our service members. As well as this will be the first time that we publish suicide statistics on our military family members. This is an important step forward. The ASR is also going to report trends over time in terms of suicide with our service members. And we’ll also be discussing some of our current and future initiatives that the department is undertaking to combat suicide. Our second area that I’d like to highlight. Program evaluation. We continue to implement and evaluate our policies and our multifaceted strategies, that embody that public health approach to suicide prevention. We’ve developed a robust program evaluation framework. It maps to our defense strategy for suicide prevention, and it includes outcomes, not only in terms of suicide deaths and attempts, which are critical for us to be tracking, but it’s also looking at unit cohesion, help seeking behaviors reducing barriers to care. We’re conducting program evaluation efforts through our enterprise-wide executive level governance body. And what we’re also doing is we’re continuously looking for those promising practices that exist in the civilian sector. And looking to pilot those and see how we might be able to implement those more broadly across the DOD. And that’s part of why this conference is so important to really understand those best practices that may be out there. For example we’re currently conducting several pilots right now. They’re focusing on problem solving and emotion regulation skills for our young service members. Help seeking also means safety as a few examples. Last thing I want to highlight this morning is the importance of collaboration. We can’t act alone to prevent suicide, and in fact this year’s conference theme really emphasizes that. One mission many roles. In the DOD we are strongly committed and believe that we need to partner with everyone, public and private sector, to be able to achieve what we’re all striving for. We have various partnerships from federal agencies to non-profits, to academia, to the community, all looking to see how can we best support our services members, veterans and their families. We’re also looking to foster a climate that reduces stigma and increases help seeking. Just a few examples. The department’s part of a national public-private partnership known as the National Action Alliance for Suicide Prevention. Focused on hope, help seeking, and education of what support, resources and services are available for those in need. As another example we’re also partnering with the Tragedy Assistance Program for Survivors TAPS, to ensure we have postvention support services for our suicide loss survivors. And finally we partner with a variety of federal agencies. And in particular we have a lot of collaboration with the Department of Veterans Affairs. We’re deeply committed to that ongoing work that we’re doing with the VA as well as the Department of Homeland Security. And in particular right now we’re focused on that high risk population of transitioning service members and recent veterans. Dr. Carroll mentioned the first EO that work is currently ongoing for, Executive Order 13822. And in fact we’ll talk more about that I think on Wednesday’s session highlighting what’s the progress so far in terms of executing that Executive Order, and making sure that we have provided seamless access to mental health care resources and suicide prevention resources for our transitioning service members. For me I was the former Director of the Transition to Veterans Program Office in the Department of Defense. So I am keenly aware of how critical that transition period is for preventing suicide. And then lastly I’ll give the example of this biennial conference that we hold. This is another example of the important partnership between DOD and VA. And this demonstrates our commitment to making sure that the leaders that are here today, service members, veterans, behavioral health experts, community providers, that we can all get together and share our expertise and cross-share in terms of what is the greatest research that’s out there and promising practices. I’m really looking forward to getting to interact with as many of you as possible over the next couple days. And cross-sharing that critical information. And I’ll end with saying again the theme of the conference. One mission many roles. We have to partner together to prevent these tragedies. We each have a role to play. So as we move into the conference, think about your role. Think about how you can advance what you’re doing. Coming together as this collective, this powerful passionate collective, we can make the difference. So I thank you for being here today, and I thank you for all that you do.
[Announcer] Ladies and gentlemen, Dr. Matt Miller VA Suicide Prevention Program. (“Hang On Sloopy”)
Good morning. I am born and raised in Dayton, Ohio and the interesting thing about “Hang On Sloopy” someone must have known what they’re doing here, because that’s an Ohio garage band right? So what better introduction than that. I get to follow a fellow Michigan State graduate as well. Yes my parents are still working through that whole issue. I am honored and humbled to stand here this morning before you and represent the Suicide Prevention Team for the VA that works so hard on a daily basis. They dedicate their heart, mind, soul, and strength to the mission. And I have grown in my respect tremendously watching them passionately engage the work that they do on a daily basis. Which includes the weekends. I’m also proud to represent the Veterans Crisis Line. As Dr. Carroll mentioned, right now as we speak up to 2’000 phone calls are coming in, that doesn’t include 200 chat messages, 300 text messages or in reverse that our team is answering in eight seconds or less 99.96% of the time. And that is happening right now. (audience clapping) In Topeka, Kansas, Atlanta, Georgie, and Canandaigua, New York. I’m also proud and humbled to represent the suicide prevention coordinators, mental health clinicians, VA clinicians and staff, who are equally dedicated to this mission and only a small portion are represented here today while the rest are back hard at work front lines within the mission. I was raised professionally I’ll say as a United States Air Force clinical psychologist. (audience cheering) I think in the Air Force we say, we say “hooah” but I think we ripped it off from the army I’m not sure. (audience laughing) (audience member calling out) I never understood that I kind of just said “hooah” went with it and tried not to stand out too much. But what a, incredible experience it was serving within the Air Force within that role endearing OEF/OIF and it’s great to be with you all in the DOD here as part of that. So I travel somewhat frequently, and my weekend a lot of times is a chance to catch up with my girls. I have twins. I always say I have two twins but that’s redundant, I have twins Eve and Ella. And they are reluctantly entering the eighth grade here this week and for us to spend time together and kind of get away from the phones and the internet I take them in the car with me every weekend, we do our errands runs. And those two can talk. They just they as soon as the car door closes they start firing away questions. It’s just question after question after question. If Eve relents Ella picks it up, if Ella takes a breath Eve picks it up. So a lot of times they’ll ask me, where are you going in the next week, what are you doing and why are you doing it? And then they’ll give me a little bit of a rating or feedback on my answer. So this Saturday we were driving around and they said, “Where are you going?” I said Nashville. They said, “Oh that’s new I haven’t heard that before”. “What are you doing there?” And I started to explain it and basically their question was just why are you going and who’s going to be there? So let me tell you what I told them real quickly and you can rate it along with them, but I will tell you they rated it highly if I can skew it in that direction. So who’s going to be there? Trying to think of how to describe this group and paint this image for them. I said who is going to be there is a group of people who are passionate about saving lives and fighting suicide. From whatever angle, whatever history, whatever experience they come from, they are passionate about it. It’s more than a job. It’s a mission. Second they have probably been impacted in some way by suicide. And as such that fuels in many ways their passion for the mission. Eve said, “Daddy are you going to share your story?” I said maybe a little at points, but I was directly impacted by the suicide of a colleague and a friend while we were stationed at a joint services undergraduate pilot training base. And I went through a process of I’m the base psychologist what did I do wrong? How did I miss this? So at that Eve and Ella said, “That sounds like a good trip daddy”. I think that’s worth it. And I know you all are taking time away from loved ones, family, mission, directly front lines to come here and you’re making sacrifices to do that. And what we’re going to do here is at least three things. First what we hope to do is we hope to stimulate your thoughts, your creativity and reignite that for you. You know that when you’re on the front lines and you’re in the daily it’s hard to step back sometimes and think programmatically, systematically and creatively. We want this to be a rich opportunity for you to think broadly and creatively by collecting this group of subject matter experts sharing ideas. Second we want it to be a time where you share ideas, where you share thoughts, where you share considerations. And then third we want it to be a time where, and Dr. Carroll mentioned this, we want it to be a time where you partner. Because we know that for us to make the progress we’re passionate about we have to work together. It’s like strands, if you have one strand here one strand here they’re not connected they’re not as strong. It’s connecting the strands together. Think of the power across 2’000 people here that we can engage connecting the strands together. So with that I don’t have any talking points up there because the Comms. group is saying he completely riffed that on his own we have no idea what he’s doing. So I know that and the teams knows that’s how I work, they’re they already know that. But I want to transition now as we think about this conference and we think about what we’re going to do and I want to introduce someone really special to you for the final part of this introduction. Now I live in Michigan most of the time, or some of the time, and we have the Great Lakes Cemetery there. Beautiful place. Every Memorial Day the girls and I go there and we place flowers and pay our respects. I want to introduce someone to you who has done something incredibly laudable and it’s just such a privilege to have him here with us. Check out this story. On Veteran’s Day 2015, Preston Sharp visited the grave of his grandfather in a Redding cemetery to place a flag and some flowers. He was ten at the time. Ten year old Preston noticed the lack of flags or flowers on the graves to honor local Veterans. In response he’s organized now the placement of more than 220’000 flags and red carnations on veteran’s headstones all over the United States. I was asking him about his trips and travels and he said thirty states so far. Just absolutely incredible. And this I think mirrors what we’re going for here as well. Which is awareness moving to engagement. And the level of awareness and engagement that this demonstrates is just so inspiring and so notable. His efforts to honor veterans were recently recognized by President Donald Trump. He was invited as a guest at the President’s State of the Union speech. He was also awarded the first ever Legacy Keeper Award from the VA. Now he’s dedicated himself to preventing veteran and service member suicide as well as honoring veterans with flags and flowers. With that as a background let’s get on to the good stuff here and please help me welcome Preston.