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Office of Public and Intergovernmental Affairs

Remarks by Secretary Eric K. Shinseki

Mental Health Summit - Opening Remarks
Washington, DC
October 26, 2009

Good afternoon, ladies and gentlemen. 

Secretary Gates, Members of Congress, distinguished guests, ladies and gentlemen.  I am honored to be here and excited about the potential for this summit to help us address some of our most pressing and vexing mental health issues.

 

For 38 years, I was privileged to serve with the men and women who were entrusted with the security of our Nation.  The spirit of our service is captured in the lines of the Soldier’s Creed.  No matter the uniform, no matter the nation, most everyone I’ve met who has read the four seminal lines of the Creed, agree that they define what service to nation is all about:

 

            I will always place the mission first;

            I will never accept defeat;

            I will never quit;

            I will never leave a fallen comrade.

 

Four simple, declaratory statements—promises, really—that form the basis for trust within military formations.

 

In time of war, heavy sacrifice is borne by those who wear our Nation’s uniforms—and their families.  A new generation is engaged in the close fight, and the demands for courage, strength, dedication, and stamina are as daunting today as ever.  Failure is never an option, and they have never failed the Nation, the mission, or their comrades.  The toll for this kind of loyalty and commitment is high in terms of human capital.  This summit is for them—our promise that we shall not fail them.

 

We convene to marshal our talent, our knowledge, our energy, and our resources to redouble our efforts on behalf of service members and Veterans who are dealing with the effects of combat.  Troops today are returning from Iraq and Afghanistan with invisible wounds as debilitating as the physical trauma sustained on those battlefields. 

 

Who’s vulnerable?  Everyone.  Warriors suffer emotional injuries just as they do physical ones.  The residual effects of combat manifested themselves in my life.  You have to be strong to prevail.  You must be loved, respected, and supported to weather the worst of the storms.  You must grow, even as you are growing up.  You must be patient, and it helps to be lucky.

 

There is urgency in addressing the mental baggage of war that either leads to, or is compounded by, severe personal isolation; dysfunctional behaviors; losses of identity, confidence, and personal direction; shattered relationships; failed marriages; depression; substance abuse; and often enough, tragedies like homelessness or suicide.  Next week, the Department of Veterans Affairs will be hosting a summit on our plan to end homelessness among Veterans.  But for this summit, dealing with the mental baggage of war requires ready access to high-quality mental health services.

More Veterans have committed suicide since 2001 than we have lost on the battlefields of Iraq and Afghanistan—each one a tragedy.

 

In Profiles in Courage, President John F. Kennedy, himself a combat Veteran, noted, ‘Without belittling the courage with which men have died, we should not forget the courage with which men live.  The courage of life is no less a mixture of triumph and tragedy.’

 

He describes the courage our troops and Veterans show every day as they deal with their mental health issues.  Our newest generation of Veterans, returning from the ongoing conflicts, are experiencing increased rates of alcohol and drug abuse, and domestic violence as they undergo reintegration at home.  While OEF/OIF Veterans comprise no more than 10% of all Veterans being seen for mental health care, they could be in treatment for a very long time if early intervention, diagnosis, and treatment are not priorities.

 

As a provider of mental health services, VA is challenging all of our assumptions about mental health care.  We are undergoing a fundamental and comprehensive review of our programs to see that our approaches are Veteran-centric, uniform, and accessible.  This summit figures prominently in that review.

 

VA does not operate in a vacuum.  Our collaboration with DoD is mission-critical because we share the same clients—the same population—at different stages in their lives.  There can be no ‘seamless transition’ or ‘continuum of care’ without serious and high-quality collaboration between both departments.

 

VA welcomes input from all quarters—from Veterans and their families; from other federal agencies; from advocacy and service organizations, national mental health experts, local community groups, and representatives of service members.  We seek good ideas, initiatives, and forward-leaning strategies that would expedite an individual’s return to managing day-to-day living successfully and, ultimately, discarding the mental baggage of war.

 

We hope this summit enables us to measurably enhance, strengthen, and expand and better coordinate the operating relationships between DoD’s and VA’s mental health activities.  Additionally, we want to ensure a fail-safe network of support for service members and Veterans that reaches out beyond the confines of either department.

 

Your work this week holds a profound potential for good—for service members and Veterans, and for the families who care for and support them.  Our goal is threefold:  1) to build on and enhance the existing level of mental health excellence that is the hallmark of our clinical programs and services; 2) to set and maintain the cutting edge of advances in mental health care by strengthening DoD-VA services that promote psychological health, enhance resilience, and prevent mental illness; and, 3) to establish a coordinated mental health model that leverages the resources of American society-at-large.  Beyond families, we must look to workplaces, educational institutions, houses of worship, and community-based health and other organizations.

At every juncture of care, we must ask ourselves pivotally:  What else can be done?  How can we improve our treatment protocols?  Have we met the full spectrum of patient and family needs?  Have we taken advantage of all non-government organizational resources at our disposal?  Have we overlooked any opportunity to better support our patients and their families as they cope with the challenge of mental illness?

 

Your charter is to think broadly and boldly to envision a future with a unified ‘public health’ approach to mental health.  Where mental illness is better prevented, demystified, accepted, and more effectively treated.  Where new and emerging technologies advance the quality of care and the success of patient outcomes.  Where Veterans and active duty personnel don’t feel stigmatized or threatened by the idea of seeking help for mental or emotional problems.  And where research encompasses complementary and alterative medical treatments so that we may determine which are the safest and most effective in relieving suffering and restoring health.

 

My message here is that we are open to innovation.  We must translate the most promising ideas and strategies into research, policy, and practice.  And we must produce outcomes that enhance the well-being of all service members and Veterans, as rapidly as possible.  While longitudinal studies and research will always be important, it is not our only, nor our primary interest at this point.

 

Not long ago, VA’s Dr. Janet Kemp had the foresight to anticipate the emotional toll that might result from prolonged exposure to high-risk, hyper-stress environments like combat.  She developed VA’s life-affirming Suicide Prevention Hotline, and potentially thousands of lives have been saved as a result of real time intervention.

 

VA recently elevated Dr. Kemp’s vision to the next level by launching an internet-based, suicide prevention ‘Chat Line.’  Appealing to today’s web-savvy Veterans, this initiative has also intervened with several Veterans in the midst of crisis.  Dr. Kemp’s seminal idea represents the kind of forward-thinking initiative that is the mandate of this summit.

 

Your deliberations this week will provide an overarching framework for strengthening existing programs, developing new strategies and evidence-based approaches, and garnering broader societal involvement in mental health care.  There is only one goal—to ensure that returning service members and Veterans have available to them the best possible care for PTSD, TBI, and other mental health problems.

 

We cannot fully address these problems without looking deeply at their root causes.  Accordingly, research is a priority.  We must ask the right questions to enhance our overall approach to mental health programming.  What research should we pursue?  Where are the gaps in our current research program?  How doe we go about avoiding expensive duplication with DoD and others in the private sector? 

Most importantly, how do we facilitate the translation of research findings into practice and policy?  By aligning our roles as a sponsor of research and a provider of health care, VA has had some recent successes.  A few years ago, a VA cooperative study demonstrated that prolonged exposure therapy was effective for the treatment of PTSD.  Even before the results of this study were published, VA funded and began to implement a large-scale training program to teach providers how to deliver this and related exposure-based psychotherapies.  Now, we are on the way to delivering these treatments—that’s forward-leaning.

 

Technology is the handmaiden to medicine.  We must leverage information technology, and other technologies, to expand the capabilities of our finite fiscal and human resources, and treat patients effectively.  We must look toward creating proven preventive measures that stymie the development of acute and chronic mental conditions.  We need to target early intervention strategies that can break the progression of mental health problems, especially the predictors and co-existing factors that could inform those strategies.  And we must explore all options available to enhance wellness, psychological health, and resilience in the remarkable men and women who live by the Creed.

 

I am honored to join Secretary Gates in launching this summit today.  You have an important and ambitious agenda before you.  Thank you for participating and for what you do daily on behalf of our men and women in uniform and our Veterans.  I look forward to this week’s outcomes.

 

Thank you.