Panel Discussion on Mental Health Issues Affecting Troops and Their Families

                 (These panel remarks were given at the Pentagon after viewing the HBO Documentary "WARTORN  1861-2010")

                 MR. WILSON (Assistant Secretary of Defense for Public Affairs):  All of you who are in this extraordinarily powerful documentary, thank you for presenting the reality of post-traumatic stress.

                 We now want to turn to men and women who are dealing with this daily, and I'd like to introduce our panel.

                 Next to me is Greg Goldstein, the program manager of the Marine Corps Combat and Operational Stress Control.

                 Next to him is Buddy Bucha, Army captain of 101st Airborne and recipient of the Medal of Honor for service in Vietnam.

                 Next to him, Dr. Kate Chard, director of the PTSD and Anxiety Disorders division at the Cincinnati VA medical center.

                 Next to Kate, General Pete Chiarelli, vice chief of staff of the U.S. Army.  And we're delighted that you are here and your wife Beth as well.

                 Next to General Chiarelli, Lieutenant Colonel Greg Harbin of the United States Air Force, retired. 

                 And next to Greg, my good friend and my counterpart and colleague at  Veterans Affairs, Tammy Duckworth, the assistant secretary at Veterans Affairs for Public and Intergovernmental Affairs.  And Tammy and I will be interchanging here as co-moderators.

                 But I'd like to start to ask the panel.  This documentary makes it so powerfully clear the mental-health issues that are affecting our troops and their families are not a new phenomenon.  How do you think that we are doing, both as a military and as a nation, in addressing these mental-health issues affecting our troops and their families?

                 General Chiarelli, can I start with you?

                 GEN. CHIARELLI:  Well, it's the second time I've seen this and it's the most powerful hour of TV that I've ever seen.  I can tell you that the Army and the rest of the Department of Defense is committed to finding a way -- ways to help.  As the Chief [Army Chief of Staff General George Casey, Jr.] mentioned, we're very, very proud of comprehensive soldier fitness and the fact that we had over 900,000 folks take the global assessment tool, which measures resiliency.  And we know we can teach people to be more resilient.  We're proud of the research that's being done at MRMC, the Medical Research Materiel Command, that is looking at things like biomarkers, which will be able to help us work our way through this horrible problem we have with the comorbidity, or sharing of symptoms, between post-traumatic stress and PTS [sic: TBI, traumatic brain injury] with a simple test that would allow us to know whether an individual was suffering from a concussion or mild TBI [traumatic brain injury].

                 So do we need to do more?  Yes.  But I really believe that efforts like this documentary that focus us on the necessary research that needs to be done, so we can find help for people afflicted with post-traumatic stress.

                 MR. WILSON:  Thanks.

                 Colonel Harbin, what is -- what are your views?  What did you think of the film, and what do you think in terms of how we're addressing the problem?

                 LCOL. HARBIN:  Well, this is my third time to see it, and I made the mistake of watching it at about 10 the other night, and I was up until four in the morning so -- probably a lot of you are feeling pretty upset and depressed right now.  But if you think about it, this movie has a lot of hope.  And it took me some time to get to that where, you know, here we are addressing a very difficult problem that's been around forever, and here we are taking the lead, putting resources to it.

                 I had -- not many people realize, because we're so small, but we're very specialized, put pilots on the ground.  Our job:  to call in air strikes.  I had about 24 different guys -- couple of captains, Marines, coalition, you name it -- and three of them did not come home – of the decisions I did to just let a couple of them go home early to go see their babies -- killed in IEDs.  I talk to those wives a lot.  All these stories kind of resonated.

                 And I at one time was a fighter pilot -- top one percent -- flew air shows, living the dream -- and best of the best.  Well, I'm still the best, but -- (laughter) -- you know --

                 Yeah.  But seven months ago, I had ruined every relationship I had.  I was too shy and scared to go out.  I couldn't hardly talk to anyone.  I had a TBI also so I have a brain problem, and it was embarrassing me.  I left two -- a hospital in Fallujah, and I did everything I could to run from the medical community because I wanted to go back to Afghanistan.  I was more comfortable there.  Walmart still petrifies me.  Afghanistan was comfortable.  I would go back now if they'd let me.

                 And then one day, when I thought there was just no hope, I picked up the phone and called this wounded warrior program that was on the Air Force DoD web page, and then angels descended, because I had nobody -- I was about -- I'm a single guy.  And it saved me.

                 So you people are heroes of this country, and I really feel so much better now.  This movie -- it's hard, but this is the way.  It's a start.

                 MR. WILSON:  Thank you, Colonel.  Captain Bucha, you also have had issues with post-traumatic stress, and you are a recipient of the Medal of Honor.  What are your views having seen this film?  Are we doing enough?

                 CAPT. BUCHA:  First of all, the film I saw myself in many of the incidents, but it took me almost 40 years.  I was tough and I was good, I could yell with the best, I could scream.  If you wanted to fight -- I told my wife I'd get in an elevator, look at the people and say, "I wonder who I can take down."  And I'm just going to a business meeting.  (Laughter.)

                 And it took 40 years for me to realize that that's not normal.  That's immature, and that I'm an adult.  And I got into it with a lot of work with the Vice [Army Vice Chief of Staff General Peter Chiarelli] meeting with troops and veterans.

                 And I think we are doing, for the first time, an open and solid, honest effort, but it won't change, won't be successful, until, as our Chief mentioned that we're only at 50 percent of people saying I've got a problem -- if you heard someone on a film say, "I think it's 30 percent" -- well, I can tell you it's 100 percent.  It doesn't matter if you have four stars or no stripes.  Man or woman, you have this problem.  You don't know when it's going to manifest itself, but it will.  If you see behavior that you can't explain, a four-star general or private, old man, young man, you say, what were they thinking?  That's bizarre.  They committed murder.  They weren't murderers before we got to them, but they committed murders on our watch.  How can they explain?

                 Go back and look at the record and you'll see that perhaps they've had far too much stress.  Because we know it's three to one.  That's the ratio -- not two to one, not one to one, but three to one:  One year in, three years out.  We know that, from the firemen and the police and everybody else.

                 So we know these things and we find that stress.  And now the problem is, how do we get the stigma down?  And I believe that's the biggest obstacle.  And it will start going away when all the three-stars and four-stars or CIBs [Combat Infantry Badge] and Silver Stars and their tough sergeant majors tell someone they're not available on Wednesday because they're going for psychological conditioning.  All of them. Nobody's exempt.  It's not the person with the problem.  It's us. 

                 When the Vice asked us to get the Medal of Honor recipients to do the PSAs [public service announcements], the purpose was that maybe people will see this group that by myth are tough, hard soldiers, that maybe if this group stood up and said:  Get help, it took me 40 years, it took me 20 years, it took another person 15 years. Others would say: well, what the hell, if they're going for help, why shouldn't I?

                 But the problem is if their bunkmate doesn't go or their commanding general doesn't go, there's this pressure to say:  I don't need it.  So we're doing well because we're addressing it honestly and openly. 

                 But until we take head-on the stigma by saying, when you fail to take psychological condition -- instead of saying:  You get to go home early from Iraq, no, you sit here and spend 15 more days.  You've seen the psychologist, you get to go home now, because you're doing what's right.  Until we do that and pony up to the bar and say everybody gets this conditioning -- it's the threshold issue -- we will not be succeeding; we will have the number that the Chief mentioned.  If one out of two does it, that's not good enough. 

                 MR. WILSON:  Tammy.

                 MS. DUCKWORTH:  So we've heard both Colonel Harbin and now Mr. Bucha say that it's time to go and ask for help, and that it is an honorable thing to do. 

                 I'd like to go ahead and turn it over first to Dr. Chard and then to General Chiarelli to talk about what VA and DoD are doing together and separately in order to treat individuals with post-traumatic stress.

                 MS. CHARD:  Thank you, Secretary Duckworth. 

                 It's such an honor to be here with all of my colleagues from VA, but also all of my colleagues from DoD, to talk about some of the amazing things that we've been doing together.  And I'd like to bring this more home to something that I've been involved with thanks largely to the efforts of mental health at the VA and General Chiarelli, and that's evidence-based treatment. 

                 We know that there are gold-standard therapies that work for our veterans and active-duty service members.  I personally have been part of a rollout that's trained almost 3,000 therapists in the VA alone, but also now we've trained almost 500 therapists in the Department of Defense to do these therapies so that we can have a seamless transition, so that every single service member that is suffering can start these therapies while still in active-duty service.

                 And then if they choose to, they can come back to the VA hospitals, to the vet centers, to all the facilities.  We have over 150 separate hospitals that have clinicians actively trained.  And we're prepared to help individuals regain their life and reduce the stigma and create hope that they can get better.

                 GEN. CHIARELLI:  Kate taught me a lot about this, and one of the things she taught me was that -- and Buddy, you definitely have a role in this.  If you waited 40 years -- National Institute of Mental Health would tell you that from whatever the initiating event is for PTS, the time somebody seeks help is 12 years.  That's the average in this country.  And it's not necessarily the seeking the help.  It's all the bad things that happen in between, all the bad things that happen in between.

                 Kate's teaching our medics to see the symptoms of post-traumatic stress downrange so we can begin treatment immediately.  She also taught me that most of the research that's been done on PTS has really been done with women who were sexually assaulted.  Some of the most cutting-edge treatment for women is to literally put people down in emergency rooms so that women come forward and indicate that they've been sexually assaulted.  Between 72 and 74 percent of them, at least in the studies that I've read, will have some form of PTS some time in life.  The treatment begins right then.

                 So that's where I think we need to get.  And a lot of this can be done, quite frankly, using virtual behavioral health or over the Internet or high-definition VTC.  And to me that's what we've got to be able to deliver to our soldiers.

                 MR. WILSON:  And Greg Goldstein, you deal with this for the United States Marine Corps.  What are your thoughts and comments on what's working?

                 MR. GOLDSTEIN:  One thing that we're putting a lot of effort into -- and we have a new commandant as of last week, General Amos, and we just got his planning guides, and right under "Sending Marines to Afghanistan" is "Building Resiliency."  Over the last few months, we've trained 1,400 Marines as peer mentors, doing what the corpsmen are doing or the medics are doing downrange.  So what we create is an educated Marine who is in the line, that knows the behavior of the Marines, and they're trained to intervene when they see slight changes of behavior.

                 And then we've created this comprehensive system where there's levels of support, so we teach the Marines what they can handle at their level, and then turn it up to a corpsman or a medical officer, and then up to a behavioral health team which we're embedding into our regiment level in Afghanistan.

                 So we have an evaluation going on, but we're really excited about this.  Because what we're finding is when we intervene at the earliest possible moment that we hope not to get to these tragedies that were shown on this film tonight.  We want to take a really progressive effort of not only -- you know, we're really good at creating acronyms, you know, in the Marine Corps.  We're really good at it.  We have this thing called SMITR:  strengthen, mitigate, identify, treat and reintegrate.  And that's what we're trying to teach every Marine out there, that it's natural to go and have symptoms, it's also natural to get help, and if you're a leader you need to intervene.  And so I think we're -- that's going to pay great dividends in the future as well.

                 MS. DUCKWORTH:  So let's go over there.  You know, we have our service members who are still serving, and then we have those that have been discharged and have gone home.  We often have a large number of National Guardsmen and women and Reservists, who go back and forth and do this transition from warrior back to their everyday lives.

                 And I'd like to just start with -- divide this question into two.  I'd like to ask Buddy and then Colonel Harbin what your recommendation would be, and then Dr. Chard, what your recommendation would be for this question:  How can family or friends best help those they think may have PTSD?  What would have been a way to reach out to you in those forty years, and how would we have been able to reach out to you, Colonel?  Let's start with Buddy.

                 CAPT. BUCHA:  First of all, I think the most important thing we can do for Guard and Reserve and maybe also the families itself is -- I had had the privilege of going around with our First Lady and visiting all the bases and Michelle took the time to listen.  She didn't just go for a picture, give a speech and leave.  She stayed and listened.  And when the stories brought tears, she cried, which allowed everyone in the room to relax.  There wasn't judgment.

                 So I think one of the most important things we have to do is the outreach which is shown in the film has to then be manifested by people who the audience will look to in somewhat of an awe as a leader, coming to listen and to learn.  And I think that's important, and it has to do with the troops seeing a four-star general take off his jacket and say, "How are you doing?"  It happens a lot, but it doesn't happen when they're not on point.  No one goes to the high school where they're having the Reserve meeting.  That's not where the important people go and say, "How are you doing?" and talk to people and reach out to the same families.

                 I'm worried more about the Guard and Reserve than I am about the active component because they have -- the active component has an institutional structure in which to work.  The Guard and Reserve doesn't.  They disappear.  And there isn't an active group to come -- to reach out to them, and we from the active component have to go out to them, you know, have to bring them back in and make sure that we say, as Arnold Fisher says at Fisher House the string is tied to them.

                 So I think one of the things we can do is, reach out to the families by sending our leaders there to listen and to identify, and not to judge, and then reach out to the Guard and Reserve with the exact same people, so that they aren't the second-class citizens.

                 They constitute 40 percent of the force that's going over, and after Creighton Abrams said it's a total force military that we have.  So we have to bring them in as part of the total force.

                 And their families are the ones that that tell the worst stories, the most hideous stories, the ones that are the most shocking, because they don't have anyone to tell it to. 

                 MS. DUCKWORTH:  Colonel Harbin, how would we have been able to reach out to you?  Family?  Friends?  Co-workers?  You were tricky?

                 LCOL. HARBIN:  Yeah, a lot, a lot.  So I didn't -- I wanted to be on the battlefield.  So after I got hurt in Fallujah and the corpsmen patched me up, I left the hospital and went back to the fight.  And that was really the start. 

                 The person that I did not want to hurt at all -- because she always thought of me as a guy, outgoing, laughing, and everybody saw me rescuing cats -- was my mother.  So I hid it.  The people that cared about me, I did not let them know what was starting to bother me on the inside, and that was the first Marine casualty I saw.  That sent guilt through me, but I hid it by sense of humor and by running from it, what I was doing was, I was really -- the military part was successful, and I was failing in life. 

                 What happened -- and it wasn't -- some did reach out to me, because I was still not telling my mother the truth, until -- it was not too long ago, but the Air Force, who raised me since I was 17 -- I owe this country more than it owes me -- so they assigned a person to me who came to my house and said:  Man, you're not eating right.  You're not sleeping.

                 He came to my house and said:  We can do better than this.

                 And from then on, a recovery care coordinator -- a special program, again, that we have out there, but you have to reach out to it.  And for the -- and for the wounded themselves, it is a two-way street.  You have to pursue happiness.  You may not get it, but it's what this country guarantees you.  I'm fighting with it too.  But this movie has got me very excited.  It was -- it is hard, no doubt.  So.

                 MS. DUCKWORTH:  Dr. Chard, can you talk a little bit about what help is there not just for the service members but for the families, and especially for those -- some of the programs that you're working on with Guard and Reserve units in terms of getting help out?

                 MS. CHARD:  Definitely.  I think it's important that family members begin getting help before the individual even deploys.  Going to family readiness meetings, finding out what the deployment's going to be like for the service member, staying in touch with other family members while the service member is gone, and remembering that the VA and the vet centers are there for you even before the individual comes back.  We can begin seeing someone at a vet center -- and these are veterans, even, often, at these vet centers -- that can talk to the family members and talk with them about what they're going through and what they need. 

                 And then once the service member comes back, we can offer family counseling in the VA system.  We can reach out to our service members who are still on active duty that perhaps live closer to a VA hospital than they do to an active-duty station.  And we can begin care there.

                 And I do want to stress the point that we do have a hotline that is open to active-duty, Reserve, Guard, veterans, family members.  That's 1-800-273-TALK [8255].  And that's not just for someone who's suicidal.  That's for someone who's having problems with a family crisis, someone who's going through a difficult time at work.  We want to be there for family members and our service members and our veterans at any time when they're stressed.

                 And so I want to second everything I was hearing, of look for the symptoms, get involved, and tell the person you think they need help when you see anything that looks strange. 

                 And if you say, "Well, how do I know what the symptoms are," go to the Web.  Everyone seems to have a computer nowadays.  And go to a -- you know, a website, www.NCPTSD.VA.gov.  It's a great resource for family members and for veterans and service members to be educated about what PTSD looks like, and what you can do.

                 LCOL. HARBIN:  My abnormal behavior was in fact I kept volunteering to go back at every opportunity.  That was my abnormal behavior.  And it's going to come back.  It can be that simple.  My team leader who was a Spartan warrior; 6'5"; Special Forces guy; "yes, sir," "no, sir;" hit the wall.  And then one day while we sitting in Afghanistan, he became a laughing, jovial -- telling jokes, all this weird stuff.  We're like, "You're not that kind of guy."  And, yeah, within three weeks, he said, I need to go talk to somebody.  So it can a very -- changes in the behavior.  And it's not always, you know, something that you would expect, or something you'd see.

                 MR. WILSON:  As we bring this discussion to a close, I want to end by asking each of you -- and we will end with Tammy, who has the penultimate word here -- from tonight's film and the discussion that we have and the folks who will be watching both the film and this panel, what do you think is the key message that you would like people to take away from the film and discussion we've had tonight?  Greg?

                 MR. GOLDSTEIN:  I can pretty much sum it up in one word, education.  I mean, knowing helps defeat the stigma, and it creates an understanding.  It's -- taking this from where it was -- what you saw from the Civil War to World War I, World War II -- to where it is today, is really, really fascinating how far we've come.  But we have a long way to go as well.  So learning about this will ultimately create an awareness that will -- people will understand that something's happening to them before it turns into -- hopefully before it turns into a diagnosis.

                 MR. WILSON:  Captain.

                 CAPT. BUCHA:  Well, first, I was a captain.  I'm not a captain now.  I think, first of all, there's no silver bullet.  This isn't a switch you flip on.  It takes tremendous work.  Psychological conditioning and physical conditioning ought to be a requirement on both sides.  You fire the person who won't go on the five-mile run, you fire the person who doesn't go to the three-hour counseling. We don't want either one. We want to be physically strong and psychologically strong.

                 And then I think the most important word that men in particular and the women now serving in our military run away from, but it's a word that I heard first from another man getting off the plane at Travis Air Force Base from Vietnam, when a young Spec-5 turned around to me, having not been welcomed to America, and said, "Welcome home, sir.  I love you."  And we have to understand that that's the feeling from which the outreach has to be -- a leader loves the men and women in his or her command.  They are your family for life, if you lead them into combat.

                 And that compassion, that love is what's got to drive us to outreach, and to make sure things get done the right way.  Not by the regulation, but by your brain and your heart.

                 MS. CHARD:  I want to follow up.  I think you said that so beautifully.  And I think the piece that we also need to be aware of is that within the stigma is the idea that it's only the weak that develop PTS.

                 But there's also stigma against our combat veterans that PTS is something that only happens to people in the military.  And I think the thing we can educate society about is that PTS is something that affects people from natural disasters, from interpersonal traumas, from horrific car accidents.  And if we can reach people and help them understand that, then perhaps they can have more empathy and sympathy for what our combat troops are going through.

                 Make it more personal for them, because we have to get across this idea that PTS is treatable, and it's treatable quickly, if we can only instill hope, and get rid of stigma at the same time.  And that's where I think we need to focus our efforts.

                 MR. WILSON:  Thanks, Dr. Chard.  And in the five minutes that we have left, General Chiarelli and Colonel Harbin, your takeaway.

                 GEN. CHIARELLI:  As well as reducing the stigma, I hope it forces us all to focus the research efforts on working the cures.  You know, it's unfair to talk almost -- it's almost unfair to talk about PTS without talking about TBI, because they share so many of the same symptoms.

                 And that's really what's baffling our doctors today.  Just because someone's been through an explosion, there's a natural tendency to believe they have traumatic brain injury.  That's not necessarily the case.  Many times, it can be post-traumatic stress.  And when you look at how you treat each of them just from a pharmaceutical standpoint, I will tell you -- doctors tell me that -- totally different set of medicines for one than the other.

                 So if we can really get to a point where we could untie this Gordian knot so that we could better diagnose PTS from TBI and other behavioral health issues -- and if this film, this documentary helps us do that, it will make a huge contribution to our service members and the nation as a whole.

                 MR. WILSON:  Colonel.

                 LCOL. HARBIN:  Yeah, sir, I don't know what to say now.

                 An art gallery owner, 28 years old -- I let him watch the film, just no military background whatsoever.  And his solution was, well, stop going to war.

                 Well, that's not reality.  The reality is that we may not have a choice, but there are people who rescue cats and have a sense of humor that are just as strong and tough as any terrorist in this world.  And they will hunt you down.

                 But if we get a hold of this PTSD and factor it in, it will make our country better.  You know, we'll know what we're dealing with -- our soldiers will be stronger and a more confident nation.  We're better than them.

                 MR. WILSON:  Tammy, my friend, you get the penultimate word.

                 MS. DUCKWORTH:  Very generous of you, Doug.  (Laughter.)  I have to buy him dinner later.

                 You know, I think everyone in this room has had a very deeply personal reaction to this documentary.  And I have to say that the segment that touched me personally the most was, Mr. Cambin, your drawings of those troops with dismembered bodies on the battlefield that you saw.

                 And it really touched me because I am one of those troops with the blown-off body parts.  And I saw hope, because, you see, I survived.  I saw hope in your pictures.  And I survived because the amazing men of my National Guard unit saved me, because Walter Reed saved me, because my peers -- my Vietnam veteran peer visitors saved me.  And I've been given everything that I needed to survive, but also to thrive, to have the amazing job that I do.

                 And I can tell you that all of us at both DoD and VA want that.  Not just me, all of us want nothing more than that for all of our troops.  And that's what today is about.  It's about every veteran having the kind of support that he or she needs in order to survive and be successful.  And I want you to walk out of this room today with hope, because we know that we can treat PTS.  We know that together we can do better by each and every one of our warriors.  Thank you.

                 MR. WILSON:  Ladies and gentlemen, a final thanks to Colonel Marcella Adams and to Marianne Oliva and to the inimitable Carl Woog and to the Community Relations Department of the Department of Defense, who have done a superb job in your mission of bringing these kinds of issues to the attention of America, and reconnecting America to its military.

                 Thank you, General Casey, for saying yes.  Thank you, Richard and your team.  And now on behalf of HBO, we'd like to invite you for refreshment outside.