How the US can address the tragedy of veteran suicide Charles P. Smith

So on May 6 of 2019,

the sun was shining, the sky was blue,

clouds were that puffy white.

It was a perfect spring day.

I was walking back to my office,

and my phone rang.

And it was one of my lieutenants.

I said, “Hey, John.

How are you?”

He said, “Sir, I’m good.

But I’ve got some bad news.”

He said our executive officer
died that weekend.

We went back and forth,

“What do you mean,
what are you talking about?”

I asked him what happened.

He said, “Sir, he killed himself.”

I walked around my office
for a couple of hours in a complete fog,

trying to understand
what had happened, why.

I had just communicated with him
a few months earlier.

And I had no idea
that this officer was in trouble.

And I fault myself as a leader
for not having known that.

I went on this process
of trying to figure out

why, what’s happening
in the veteran community,

why are these things going on.

I read reports from
the Department of Veteran Affairs,

Department of Defense,

I’ve read national studies
on mental health

and the issues associated with it.

I’m going to share with you
some of the things I found out.

Department of Veteran Affairs
has taken the lead on veteran suicide,

and it’s actually
their number one priority.

Based on the reports they have
and the numbers that I’ve calculated,

between 2001 and 2019,

during the time
of the Global War on Terror,

my approximation is
there’s 115,000 veterans

who have died by their own hands.

I also looked at the Department
of Defense report

that lists casualties.

This particular report

lists the casualties from October of 2001

specifically to November 18 of last year.

During that time frame
and the Global War on Terror,

there have been 5,440
active duty members killed in action.

So by my numbers,
115,000 approximate suicides,

5,440 killed in action.

What does that mean to me?

We have approximately 21 veterans
ending their lives by their own hand

for every one that is killed
by an enemy combatant.

It’s a staggering, staggering number.

These national studies

that deal with mental health tell us

that if you have any type of genetic
mental health issue within your family

that can be passed on,

or if something has happened to you
in your childhood that was traumatic,

your ability to deal with post-traumatic
stress disorder, or PTSD,

significantly decreases.

They also tell us

that if you want
to have a full evaluation,

determine if somebody has PTSD,

you need to have a minimum
of one hour interview

with a mental health expert

that’s trained to detect what PTSD is

to determine if you suffer from it.

Now let me talk about what happens
when you enter into the military.

When you join the armed forces,

you’re going to go through a medical exam,

you’re going to take
a physical fitness test,

you’re going to take a drug test,

you’re going to take a vocational test

so they can figure out what you’re good at

and hopefully place you
in that type of job category.

But would you believe

that with approximately 115,000 suicides
over the last 20 years,

and the data that we know
from the national studies

on how to determine if somebody
is going to be able to cope

with post-traumatic stress disorder,

we still don’t have a standardized
mental health evaluation

for our recruits
entering into the service.

That’s something I think
that needs to change.

Number two,

when you leave the service –

When I left the service in 2003,

I had to attend some mandatory classes,

about two days' worth of classes,

and then I was on my way.

Today, it’s a little different.

Today you’ll actually get a call

if you’re on what we call terminal leave

or paid time off
that you’re trying to use up

before you actually are fully discharged.

I talked to one veteran who got a call.

He was on his way home from work,

and the only thing he could think of

was, “How quick can I get off this?”

And I think the call lasted
maybe 10 or 15 minutes.

But yet the national studies tell us

it needs to be an in-person,
one-hour interview.

I think that’s something
that we can improve upon.

There’s another thing
that the Department of Veteran Affairs

talked about in the reports.

They said that our service members
that are self-medicating

tend to be at a significantly
higher risk of suicide.

So those veterans that are
self-medicating with alcohol,

or drug abuse –

and in fact, the Department
of Veteran Affairs has classified

opioid use disorder, OUD,

as one of the epidemics.

So as I talked to marines from my unit

and tried to learn more about it,

I started to find out
some really, really alarming things.

I had a marine who came back from Iraq

and he went to the hospital
for a “back pain”

and he was prescribed some opioids.

He also suffered from
post-traumatic stress disorder.

He became addicted to these painkillers,

because not only did it mask
the pain in his back,

but it helped him to cope

with some of the horrific things
that he had to see, experience and do

over in the Middle East.

And he eventually overdosed.

Another challenge we have

is that when you’re on active duty,

you are under the Department of Defense.

And so all of your doctors,
all your health care

is in that category.

When you leave the service,

you are now part of the Department
of Veteran Affairs.

So these active duty members

that seek help for their
mental health issues

and are diagnosed with PTSD
or other mental health issues,

when they leave the service,

there’s no transition to a doctor

that’s in the Department
of Veteran Affairs

or perhaps out in the civilian world

because of privacy acts.

Now there’s some good news in this.

Just recently, it was legislated

that a database will be built

that will house both Department
of Defense health records

and Department of Veteran
Affairs health records.

But I want to take
that thought a step further.

My company was 204
marines and sailors strong.

As I looked at and I talked
to my marines from my unit,

what we came up with
is we are well in excess of a dozen

of our members that committed suicide.

When I talk to senior
leadership in the battalion,

and battalion is about
six to seven hundred marines,

they estimate that we’re in the hundreds
who have committed suicide.

So let’s take this database
that we’re building,

and let’s go a little bit further with it.

What if when a veteran passes away,

whether it’s natural causes,

overdose or suicide,

we’re able to feed that
into the Veteran Affairs

who is then able to access
Department of Defense records,

identify what type of units they were in,

what contingencies and operations
did they participate in,

and let’s build the data points
to try to figure out

are there units that are more susceptible
to develop post-traumatic stress disorder

so that we can get them the mental health

prior to going on deployment,

prior to being in theater.

If they’re in theater,

get them the mental health
while they’re in theater,

and get them mental health
counseling and help

before they even come home out of theater.

(Applause)

And by the way,

if we can build those sets of data points
to be able to do that,

we don’t just apply them to the military,

we can also use that
for the general population.

If we put our minds together

and our resources together,

and we openly talk about this,

and try to find solutions

for this epidemic
that’s going on in America,

hopefully we can save a life.

Those are my thoughts, my ideas,

I hope that this talk
is not the end of this discussion

but rather the beginning of it.

And I want to thank you
for your time today.

(Applause)

所以在 2019 年 5 月 6 日

,阳光明媚,天空蔚蓝,

云朵是那么蓬松的白色。

这是一个完美的春日。

我正走回办公室

,手机响了。

那是我的一名副手。

我说:“嘿,约翰。

你好吗?”

他说:“先生,我很好。

但我有一些坏消息。”

他说我们的执行官
那个周末去世了。

我们来来回回,

“你什么意思,
你在说什么?”

我问他发生了什么事。

他说:“先生,他自杀了。”


在一片迷雾中在办公室里走了几个小时,

试图
了解发生了什么,为什么。 几个月前

我刚刚和他沟通
过。

而且我不
知道这位官员遇到了麻烦。

我责怪自己作为领导
者不知道这一点。

我继续这个过程
,试图找出

原因,
退伍军人社区正在发生什么,

为什么会发生这些事情。

我阅读
了国防部退伍军人事务

部的报告,

我阅读了
有关心理健康

及其相关问题的国家研究。

我将与您分享
一些我发现的东西。

退伍军人事务
部牵头解决退伍军人自杀问题

,这实际上是
他们的第一要务。

根据他们拥有的报告
和我计算的数字,

在 2001 年至 2019 年间,

在全球反恐战争期间,

我的估计是
有 115,000 名退伍

军人死于自己的手。

我还查看

了列出伤亡人数的国防部报告。

这份特别报告

列出了从 2001 年 10

月到去年 11 月 18 日的伤亡人数。

在这段时间
和全球反恐战争期间,

已有 5,440 名
现役军人在行动中丧生。

所以根据我的数字,
大约有 115,000 人自杀,

5,440 人在行动中丧生。

这对我意味着什么?

我们有大约 21 名退伍军人

为每一个
被敌方战斗人员杀死的人而自杀。

这是一个惊人的,惊人的数字。

这些

与心理健康有关的全国性研究告诉我们

,如果您的家庭中有任何类型的遗传性
心理健康问题

可以遗传,

或者如果
您在童年时期发生过创伤性事件,那么

您应对后遗症的能力 - 创伤性
应激障碍或 PTSD

显着降低。

他们还告诉我们

,如果您
想进行全面评估,

确定某人是否患有创伤后应激障碍,

您需要与受过训练的心理健康专家进行
至少一小时的面谈

,该专家

经过培训可以检测出创伤后应激障碍是什么,

以确定您是否患有创伤后应激障碍。

现在让我谈谈
当你进入军队时会发生什么。

当你加入军队时,

你要通过体检,

你要
参加体能测试,

你要参加药物测试,

你要参加职业测试,

所以他们 可以弄清楚您擅长什么,

并希望将您
置于该类型的工作类别中。

但是你

相信在过去的 20 年中大约有 115,000 起自杀事件

以及我们
从国家研究中知道的

关于如何确定某人
是否能够

应对创伤后应激障碍的数据,

我们仍然不相信 对我们进入服务的新兵进行标准化的
心理健康评估

这是我
认为需要改变的地方。

第二,

当你离开服务时——

当我在 2003 年离开服务时,

我不得不参加一些强制性的课程,

大约两天的课程,

然后我就上路了。

今天,情况有些不同。

今天,

如果您正在休我们所说的临终假

或带薪休假
,而您在

真正完全出院之前试图用完这些假,那么您实际上会接到电话。

我与一位接到电话的老兵交谈。

他正在下班回家的路上

,他唯一能想到的

就是,“我能多快下班?”

我认为通话可能持续了
10 或 15 分钟。

但是,国家研究告诉我们,

这需要进行面对面的
一小时采访。

我认为这
是我们可以改进的地方。

退伍军人事务部

在报告中谈到了另一件事。

他们说
,我们自我治疗的

军人
自杀的风险要高得多。

因此,那些
用酒精或药物滥用自我治疗的退伍军人

——事实上,
退伍军人事务部已将

阿片类药物使用障碍(OUD)

归类为流行病之一。

因此,当我与我单位的海军陆战队员交谈

并试图了解更多信息时,

我开始发现
一些非常非常令人担忧的事情。

我有一个从伊拉克回来的海军陆战队员

,他
因为“背痛”去了医院,给

他开了一些阿片类药物。

他还患有
创伤后应激障碍。

他对这些止痛药上瘾了,

因为它不仅掩盖
了他背部的疼痛,

而且还帮助他应对

了一些
他不得不在中东看到、经历和经历的可怕事情

他最终过量服用。

我们面临的另一个挑战

是,当你现役时,

你就隶属于国防部。

所以你所有的医生,
你所有的医疗保健

都属于这一类。

当您离开服务时,

您现在
是退伍军人事务部的一员。

因此,这些


心理健康问题寻求帮助

并被诊断出患有创伤后应激障碍
或其他心理健康问题的现役成员,

当他们离开服务时,

没有过渡到

退伍军人事务部

或平民世界的医生

因为隐私行为。

现在有一些好消息。

就在最近,立法

将建立一个数据库

,其中
包含国防部的健康记录

和退伍军人
事务部的健康记录。

但我想把
这个想法更进一步。

我的公司有 204
名海军陆战队员和水手。

当我看着
我的部队并与我的海军陆战队员交谈时,

我们得出的结论
是,我们的自杀人数远远超过了十几个

当我与
该营的高级领导交谈时,该

营大约有
六到七百名海军陆战队员,

他们估计我们有数百
人自杀。

因此,让我们以
我们正在构建的这个数据库为例

,让我们更进一步。

如果退伍军人去世时,

无论是自然原因、

服药过量还是自杀,

我们都能够将其
输入退伍军人事务部

,然后他们能够访问
国防部的记录,

确定他们所在的单位类型

、突发事件
他们是否参与了行动

,让我们建立数据点
,试图找出

是否有更
容易患上创伤后应激障碍的单位,

以便我们可以在部署之前让他们获得心理健康

在剧院。

如果他们在剧院,请

在他们在剧院

时让他们获得心理健康,

在他们从剧院回家之前获得心理健康咨询和帮助。

(掌声

)顺便说一句,

如果我们能够建立这些数据点集
来做到这一点,

我们不仅可以将它们应用于军队,

还可以将其
用于普通人群。

如果我们把我们的思想

和资源放在一起

,我们公开谈论这个问题,

并尝试为

美国正在发生的这种流行病找到解决方案,

希望我们能挽救一个生命。

这些是我的想法,我的想法,

我希望这次谈话
不是这次讨论的结束,

而是它的开始。

我要
感谢您今天的宝贵时间。

(掌声)