the sun was shining, the sky was blue,

在 2019 年的 5 月 6 日，

clouds were that puffy white.

陽光普照，天空蔚藍，

It was a perfect spring day.

雲朵雪白蓬鬆。

I was walking back to my office,

是個完美的春日。

and my phone rang.

我正在走回辦公室，

And it was one of my lieutenants.

此時手機響了。

I said, "Hey, John.

是我一個中尉打來的。

How are you?"

我說：「嘿，約翰。

He said, "Sir, I'm good.

你最近還好嗎？」

But I've got some bad news."

他說：「長官，我很好。

He said our executive officer died that weekend.

但是我有一些壞消息。」

We went back and forth,

他說我們的執行官週末去世了。

"What do you mean, what are you talking about?"

我們來回對話，

I asked him what happened.

「這是什麼意思，你在說什麼？」

He said, "Sir, he killed himself."

我問他發生了什麼。

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

他說：「長官，他自殺了。」

trying to understand what had happened, why.

我迷茫地在辦公室 來回踱步了幾個小時，

I had just communicated with him a few months earlier.

嘗試理解發生了什麼，和為什麼。

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

幾個月前我剛和他交流過。

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

我完全沒想到 當時這位軍官正深陷麻煩。

I went on this process of trying to figure out

作為長官，不知道那件事是我的過失。

why, what's happening in the veteran community,

我踏上了這個歷程，

why are these things going on.

嘗試找出退伍軍人團體怎麼了，

I read reports from the Department of Veteran Affairs,

為什麼會發生這些事情。

Department of Defense,

我閱讀了來自退伍軍人事務部 和國防部的報告，

I've read national studies on mental health

我閱讀了心理健康 和相關問題的國家研究。

and the issues associated with it.

我會和你們分享一些我發現的事情。

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

退伍軍人事務部帶頭調查 退伍軍人自殺事件，

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

並且是首要事務。

and it's actually their number one priority.

根據他們的報告和我的計算結果，

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

在 2001 和 2019 之間，

between 2001 and 2019,

在全球反恐戰爭期間，

during the time of the Global War on Terror,

我的估計是大約有 115,000 名退伍軍人

my approximation is there's 115,000 veterans

自殺了。

who have died by their own hands.

我也看過國防部的傷亡報告，

I also looked at the Department of Defense report

這份報告列出了從 2001 年 10 月

that lists casualties.

到去年 11 月 18 日的傷亡人數。

This particular report

在那段時間和全球反恐戰爭期間，

lists the casualties from October of 2001

有 5,440 名現役軍人 在戰鬥中陣亡。

specifically to November 18 of last year.

所以，根據我的數字， 大約有 115,000 人死於自殺，

During that time frame and the Global War on Terror,

5,440 人戰鬥中陣亡。

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

那代表著什麼呢？

So by my numbers, 115,000 approximate suicides,

每當一位軍人死於敵軍手中，

5,440 killed in action.

就有 21 位退伍軍人 結束自己的生命。

What does that mean to me?

這是怵目驚心的數字。

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

這些關於心理健康的國家研究

for every one that is killed by an enemy combatant.

告訴我們，

It's a staggering, staggering number.

如果你家中有可被基因遺傳的

These national studies

心理健康問題，

that deal with mental health tell us

或者你童年時發生過創傷性事件，

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

你處理創傷後遺症 或稱 PTSD 的能力

that can be passed on,

明顯下降。

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

它同時告訴我們，

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

如果你想要全面評估

significantly decreases.

某人是否患有 PTSD 的話，

They also tell us

需要和心理健康專家 進行至少一個小時的面談，

that if you want to have a full evaluation,

他們受過檢測 PTSD 的訓練，

determine if somebody has PTSD,

可以判斷你是否患有 PTSD。

you need to have a minimum of one hour interview

現在讓我講述 進入軍隊後接下來會怎樣。

with a mental health expert

在你加入武裝部隊之後，

that's trained to detect what PTSD is

需要通過健康測試，

to determine if you suffer from it.

需要通過體能測試，

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

需要通過藥物測試，

When you join the armed forces,

還需要通過性向測驗，

you're going to go through a medical exam,

讓他們知道你的特長，

you're going to take a physical fitness test,

派你去合適的工作崗位。

you're going to take a drug test,

但你是否相信

you're going to take a vocational test

過去二十年大約 115,000 宗自殺，

so they can figure out what you're good at

加上國家研究的數據，

and hopefully place you in that type of job category.

關於如何判斷人們 是否有應付創傷後遺症的能力，

But would you believe

我們依然沒有標準的心理健康測試

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

給予進入軍隊的新兵。

and the data that we know from the national studies

這是我覺得需要改變的事情。

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

第二，

with post-traumatic stress disorder,

當你退役的時候——

we still don't have a standardized mental health evaluation

我在 2003 年退役，

for our recruits entering into the service.

需要參加一些強制性的課程，

That's something I think that needs to change.

那是大概兩天的課程，

Number two,

然後上路。

when you leave the service --

現在有點不一樣。

When I left the service in 2003,

你會接到一個電話，

I had to attend some mandatory classes,

那是如果你在完全退伍之前 使用末次假期或者帶薪休假的話。

about two days' worth of classes,

我跟一名接到電話的退伍軍人談過。

and then I was on my way.

當時他正在下班回家的路上，

Today, it's a little different.

他腦中只想 「我能多快掛斷電話？」

Today you'll actually get a call

我想那通電話持續了 10 到 15 分鐘。

if you're on what we call terminal leave

但是，國家研究告訴我們，

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

必須是一小時的面談。

before you actually are fully discharged.

我想這是我們可以改進的地方。

I talked to one veteran who got a call.

退伍軍人事務部 在報告裡提到另一件事。

He was on his way home from work,

它說選擇自我治療的軍人

and the only thing he could think of

有明顯更高的自殺風險。

was, "How quick can I get off this?"

也就是那些使用酒精或濫用藥物 來進行自我治療的退伍軍人——

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

事實上，退伍軍人事務部 把鴉片類使用障礙（OUD）

But yet the national studies tell us

定義為一種氾濫疾病。

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

當我和部隊中的海軍談話，

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

並嘗試了解更多的時候，

There's another thing that the Department of Veteran Affairs

我發現了一些令人震驚的事情。

talked about in the reports.

有個從伊拉克回來的海軍陸戰隊員

They said that our service members that are self-medicating

因為背痛去醫院治療，

tend to be at a significantly higher risk of suicide.

被開了些鴉片類藥物的處方。

So those veterans that are self-medicating with alcohol,

他同時患有創傷性後遺症。

or drug abuse --

後來他對這些止痛藥上癮，

and in fact, the Department of Veteran Affairs has classified

因為它們不止掩蓋了背部的疼痛，

opioid use disorder, OUD,

同時也幫他應付

as one of the epidemics.

他在中東地區看到、體驗到 和做過的非常糟糕的事情。

So as I talked to marines from my unit

最終他用藥過量了。

and tried to learn more about it,

我們另一個挑戰是，

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

現役軍人

I had a marine who came back from Iraq

隸屬於國防部。

and he went to the hospital for a "back pain"

所以，你全部的醫生和醫療設施 都屬於那個部門。

and he was prescribed some opioids.

當你離開軍隊之後，

He also suffered from post-traumatic stress disorder.

你屬於退伍軍人事務部。

He became addicted to these painkillers,

因此，一些現役軍人 為心理健康問題尋找幫助，

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

被診斷患有 PTSD 或其他心理健康疾病；

but it helped him to cope

一旦他們離開軍隊，

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

沒有辦法轉移給另一位醫生，

over in the Middle East.

無論是退伍軍人事務部

And he eventually overdosed.

還是民間的醫生，

Another challenge we have

這是因為保護隱私法令。

is that when you're on active duty,

現在有一些好消息。

you are under the Department of Defense.

最近制定了一條法例，

And so all of your doctors, all your health care

將會新建一個數據庫，

is in that category.

以同時保存國防部的健康記錄

When you leave the service,

和退伍軍人事務部的健康記錄。

you are now part of the Department of Veteran Affairs.

但是我想再更進一步。

So these active duty members

當時我帶領多達 204 名海軍陸戰隊和水手。

that seek help for their mental health issues

在和我單位的海軍陸戰隊 進行了解和交流之後，

and are diagnosed with PTSD or other mental health issues,

發現當中超過 12 個成員死於自殺。

when they leave the service,

當我跟軍營中的高級領導談話後，

there's no transition to a doctor

軍營裡有六七百名海軍，

that's in the Department of Veteran Affairs

他們估計數百名海軍死於自殺。

or perhaps out in the civilian world

所以，使用我們建立的數據庫，

because of privacy acts.

我們可以再更進一步。

Now there's some good news in this.

如果一名退伍軍人去世，

Just recently, it was legislated

無論是因為自然原因，

that a database will be built

用藥過量還是自殺，

that will house both Department of Defense health records

我們能把資料傳給退伍軍人事務部，

and Department of Veteran Affairs health records.

然後他們可以存取國防部記錄，

But I want to take that thought a step further.

識別一下他屬於哪一個部隊，

My company was 204 marines and sailors strong.

參與了哪些偶發事件和軍事行動，

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

然後我們可以根據這些資料，

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

判斷是否某些部隊 更容易患上創傷性後遺症，

of our members that committed suicide.

這樣的話我們可以 預先治理他們的心理健康，

When I talk to senior leadership in the battalion,

在部署之前，

and battalion is about six to seven hundred marines,

在進入戰區之前。

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

如果他們正在戰區，

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

趁他們在戰區時治理他們的心理健康，

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

在他們離開戰區回家之前，

What if when a veteran passes away,

給他們心理健康輔導和幫助。

whether it's natural causes,

（掌聲）

overdose or suicide,

順帶一提，

we're able to feed that into the Veteran Affairs

如果我們能成功建立 這些數據點的話，

who is then able to access Department of Defense records,

不單適用於軍隊，

identify what type of units they were in,

還可以用於普羅大眾。

what contingencies and operations did they participate in,

如果我們同心協力，

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

共用資源，

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

開放地討論，

so that we can get them the mental health

尋找辦法，

prior to going on deployment,

解決這場美國的流行疾病，

prior to being in theater.

希望我們可以拯救生命。

If they're in theater,

這些是我的想法、主意。

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

我希望這場演講不是最後的討論，

and get them mental health counseling and help

而是討論的開始。

before they even come home out of theater.

最後，謝謝你們聆聽。

(Applause)

（掌聲）

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)