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Paula Clayton, M.D.

Paula Clayton, M.D., American Foundation for Suicide Prevention, Medical Director

Chairman Mitchell, and Ranking Member Stearns, and members of the Committee. Thank you for inviting the American Foundation for Suicide Prevention (AFSP) to provide a written statement on the issue of suicide and suicide prevention among our nations veterans.  My name is Paula Clayton. I am a physician.  I currently serve as AFSP’s medical director.  My responsibilities include overseeing and working closely with the AFSP’s scientific council to develop and implement directions, policies and programs in suicide prevention, education and research.  I also supervise staff assigned to the research and education departments within AFSP.

Prior to joining AFSP, I served as professor of psychiatry at the University of New Mexico School of Medicine in Albuquerque.  I also currently serve as professor of psychiatry, Emeritus, for the University of Minnesota, where I was a professor and head of the psychiatry department for nearly twenty years. My research on bipolar disorder, major depression and bereavement allow me to understand some of the antecedents of suicide and to appreciate medical research and public/professional education programs aimed at preventing it.

AFSP is the leading national not-for-profit organization exclusively dedicated to understanding and preventing suicide through research, education and advocacy, and to reaching out to people with mental disorders and those impacted by suicide.  You can see us at

To fully achieve our mission, AFSP engages in the following Five Core Strategies, (1)Funds scientific research, (2) Offers educational programs for professionals, (3) Educates the public about mood disorders and suicide prevention, (4) Promotes policies and legislation that impact suicide and prevention, (5) Provides programs and resources for survivors of suicide loss and people at risk, and involves them in the work of the Foundation.

I have provided the committee staff with a Power Point presentation I delivered here in Washington, DC on March 8, 2010, entitled, “Suicide Prevention – Saving Lives One Community at a Time.”  I also included a copy of AFSP’s 2010 Facts and Figures on Suicide.  Both documents will provide Committee members and their staff an overview on  the issues associated with suicide in America today, along with some examples of programs and services to prevent this major public health problem.

Chairman Mitchell, Ranking Member Stearns, suicide in America today is a public health crisis.  Consider the facts:

  • More than 34,500 people die by suicide each year in the United States. Approximately 20 percent of those individuals – or one in five – are veterans.
  • Suicide is the 4th leading cause of death in the United States for adults 18 - 65 years old and the third leading cause of death in teens and young adults from ages 15 - 24.  Currently 67 percent of all Marines are between the ages of 17 and 25.
  • Male veterans are twice as likely to die by suicide as male non-veterans. On average 18 veterans commit suicide each day.
  • Men account for 80 percent of all completed suicides in America.
  • A suicide occurs approximately every 15 minutes, totaling over 90 suicides a day.
  • Suicide in the military is not just a mental health problem; it is a public health problem.  The number of suicide attempts by Army personnel has increased six-fold since the wars in Afghanistan and Iraq began.
  • Depression, Post Traumatic Stress Disorder and traumatic brain injury are real medical conditions.

We need to let our veterans know that seeking help for mental health and substance abuse problems is a sign of strength. The keys to improving these statistics are reducing the stigma associated with mental illness, encouraging help-seeking behavior, and being aware of warning signs and treatment options.

Suicide is the result of unrecognized and untreated mental disorders.  In more than 120 studies of a series of completed suicides, at least 90% of the individuals involved were suffering from a mental illness at the time of their deaths. The most common is major depression, followed by alcohol abuse and drug abuse, but almost all of the psychiatric disorders have high suicide rates.

So the major risk factors for suicide are the presence of an untreated psychiatric disorder (depression, bipolar disorder, generalized anxiety and substance and alcohol abuse), the history of a past suicide attempt and a family history of suicide or suicide attempts. The most important interventions are recognizing and treating these disorders.  Veterans have strong biases against doing that.  These must be identified and overcome.

Whether a civilian or a veteran, there are signs that healthcare professionals look for, what we call risk factors.  In addition to those above, they include:

  • Difficulties in a personal relationship;
  • A history of physical, sexual or emotional abuse as a child;
  • Family discord; 
  • Recent loss of a loved one;
  • A recent arrest;
  • Sexual identity issues;
  • Availability of firearms.

Protective factors or interventions that work, again in the general population and for veterans include:

  • Regular consultation with a primary care physician;
  • Effective clinical care for mental and physical health, substance abuse;
  • Strong connections to family and community support;
  • Restricted access to guns and other lethal means of suicide.

It is vitally important that we communicate effectively with our veterans that consulting a healthcare professional does not in and of itself preclude an individual from obtaining a security clearance.  On May 7, 2010, Admiral Mike Mullen, stated concerning behavioral health issues, “If you feel as though you or a close family member needs help, please don’t wait.  Tell someone.  Asking for help may well be the bravest thing you can do.”   Mr. Chairman, and members of the Committee, we must make sure that Admiral Mullen continues to be heard loud and clear inside and outside the military and veteran community.

AFSP is pleased to report that help is available. The Department of Veterans Affairs (VA), Veterans Health Administration (VHA) founded a national suicide prevention hotline to ensure veterans in emotional crisis have free, 24/7 access to trained counselors.  To operate the Veterans Hotline, the VA partnered with the Substance Abuse and Mental Health Services Administration (SAMSHA) and the National Suicide Prevention Lifeline. Veterans can call the Lifeline number, 1-800-273-TALK (8255), and be routed to the Veterans Suicide Prevention Hotline. This Hotline is available 24-hours a day, 7 days a week. It is important to note that friends and family members of veterans in crisis are welcome to call the Veterans Hotline.

The VA has expanded an advertising campaign that debuted in Washington DC, and is now active in 124 cities with advertisements on local buses.  The ads are designed to make veterans and their family members aware of the VA Suicide Prevention Lifeline. The VA has also been distributing brochures, wallet cards, bumper magnets and other educational items to veterans, their families and VA employees to promote awareness of the Lifeline number. These items serve to educate the public, veterans and family members about suicide risk factors and how to get help for those veterans that need it.  They are all important building blocks in our efforts, both public and private, to get the word out regarding the services and programs available.

Another valuable service that veterans, their family members, and even friends can access, is a program called Veterans Chat through the National Suicide Prevention Lifeline website.  Veterans Chat enables veterans, their families and friends to go online where they can anonymously chat with a trained VA counselor.  If the chats are determined to be a crisis, the counselor can take immediate steps to transfer the individual to the VA Suicide Prevention Hotline, where further counseling and referral services are provided and crisis intervention steps can be taken.

Additionally, AFSP supports President Obama and the new VA policies that will make it easier for war zone veterans with PTSD to receive disability benefits by stripping the requirement to produce evidence that a specific incident triggered their stress disorder.  This policy has kept those who served in non-combat roles in war zones from getting the care they need and the new policy changes will expand access to care for those veterans. 

AFSP would like to commend the US Department of Veteran Affairs, Dr. Antonette Zeiss and Dr. Jan Kemp for their leadership and vision in constructing and implementing this program designed to help our veterans contemplating suicide. We urge this subcommittee, the full committee and the entire Congress to fully support Dr. Zeiss and Dr. Kemp in their important efforts.

Chairman Mitchell, Ranking member Stearns, suicide in Veterans is an absolute crisis.  Depression can be fatal.  Excessive drinking or drug use can be fatal.  The fatality is mainly by suicide.  Culturally sensitive but sustained efforts with multiple approaches offer our best hope to get veterans into treatments.  We must reduce this fatal outcome.  The American Foundation for Suicide Prevention is ready and willing to offer our expertise and advice to this Committee and to all Members of Congress as you make the important decisions on how to reduce suicide among our veterans.