- Scott, that was a really heartening story, and yet it alluded to some of the barriers and challenges that veterans face in accessing mental health resources.

Help us unpack what's going on here.

- Well, thank you, Anita.

First of all, I want to thank you for inviting me to this important discussion today.

It's one that we need to have more often, and so whenever I can be a part of this, I really am honored.

I'm also honored to be on stage today with my two esteemed colleagues.

I got a chance to meet them.

This is part of their wife's work.

They're really the experts here.

And so I'm here to listen and learn as much as anyone.

You know, when talking about the things that we just heard, especially the THRIVE Program.

Funding obviously is a major factor, but this is a multifaceted situation.

Besides funding, there's other barriers to helping people seek the care that they need.

Just a few that I can think of I'd like to point to today are stigma.

One is stigma.

When it comes to mental health, not just in the veteran community, all of us, you know, there's a block between wanting to admit that you need some help when it comes to wellbeing or mental health concerns.

If you break your arm, if you have, you know, if you have a cold, you go straight to the physician.

But when you have a concern like this, it can be something that's challenging to deal with.

It can be embarrassing.

There can be a lot of different aspects to it that we need to remove.

So that's certainly one of 'em.

You know, another one would be sort of just the transition from military to civilian life.

It's a hard one.

You think about it, you're gainfully employed.

You've got a purpose, sort of in that work community.

You've got a social network.

All of a sudden you come out of that and now you're just sort of in this void and you're not really sure who to turn to, how to connect the dots, where to go for help.

You know, where is it safe?

You know, that stigma that we talked about in that piece as well too.

You could be worried that if you bring these things to people's attention, that it might hurt your ability to stay employed or to get redeployed if you're still in the military or to reenlist, right?

That could be a concern as well too.

So people hide it.

So that transition and that stigma, and then also, even if funding is all in place, access and geography, there's people that are, we have people that are military come from all walks of life, all aspects of the country.

And are we gonna have facilities and treatment centers that are within an acceptable distance for them to be able to receive the treatment that they need?

So I would say that those are three major concerns.

We could get into just navigating the whole complex US healthcare industry, but- - Probably don't have time enough for that.

- Those are challenges as well too.

Yeah.

- I do wanna stay with the problem for a moment though.

So, Andrea, what other unique challenges are veterans facing?

There's a reason why we've got two and a half times the suicide rate in this population.

What else is going on here?

- Well, I think, you know, Scott touched on it with transitioning service members, being one of the most difficult times in a service member's life.

As he said, you're all wrapped up with everything and then all of a sudden it's all gone.

And they call the first year of a service member when they're transitioning the deadly year because of that loss of support, of losing all those close relationships that you knew exactly when to get up, when to go to bed, what to wear, and what to do every day, you know, moment by moment.

And so all of a sudden we're looking at that and with our veteran community right now, we're looking at, you know, 20 years of war as well.

So we have a lot of combat veterans that we're looking at.

We're just touching the end of our Vietnam veterans who are now, they're needing these services right now.

They didn't get the respect and love that they deserved when they came back.

So they shunned care and now we're seeing them finally, they're at the point they need it.

So finally they're coming back into the system, but by the time they come back, it's usually quite critical that we see that.

So you've got combat, you've got the loneliness aspect, losing that support system.

The military, it changes everything about you, everything about who you are.

You're not the same person when you get out as you were when you went in.

With deployments, multiple deployments for Afghanistan and Iraq, you're looking at high divorce rates, you're looking at moves, PCSing from here to there, creating no solid relationships there.

Then looking at when you're getting out, what am I gonna do?

Where am I gonna live?

You know, so there's a lot of things there that affect the whole totality, holistically of the person, not even counting on the fact that they may have disabilities.

They may have TBI, they may have PTSD and PTSD doesn't always show up in the first five days.

It may show up 10 years later.

- So thank you both Scott and Andrea for painting that picture.

Chris, talk to us about the deadly year.

What are you seeing when you are interacting with veterans who are at high risk?

- Thanks for that.

As like Scott mentioned, it's so exciting to be here on this topic with everyone here today.

And because it's important, the experiences that they both shared, we find very true with the clients we serve every day.

They're often struggling with decades of trauma that's been unresolved.

They're at a low point in their lives.

For that last year, that critical year, they just lost their entire identity.

They either served three years or 30 years, and that was their, not just their job, it was their lifestyle.

And they take that uniform off and now they have to go figure out who they are now.

And for a lot of people, that identity loss is really hard.

You lose your friends, you lose your mission.

You may have a difficult transition with employment, but if you can get past that first year, it's not all clear for you for the rest of your lives.

As Andrea mentioned, too many of the veterans who are taking their lives are actually over 55 years old.

They have chronic unresolved issues that have flagged- - And they've just deferred treatment.

- Or they've tried and they've been let down and they're tired of asking for help.

Far too often they keep knocking on doors for help, and they run into barriers.

They're not eligible, the treatment didn't work, they didn't follow through.

It makes it really hard to want to try again and trust another organization or another agency to help you when you've asked so many times for help and you keep getting let down.

- How do veterans find their way to you, to your organization?

- We acquire about 86% of our clients through digital advertisements.

While agencies like VA would say, "We're here if you need us," we spend a lot of time and effort knocking on their digital device door saying, "We're here because you need us."

- Scott, you've said repeatedly both before you got on stage and after you got on stage, "I am not the expert."

Well, let me just ask you this question.

As the expert HR professional on the stage, what do you see as key needs related to the mental and behavioral health workforce supporting the veteran population?

That is, what can employers do?

- Boy, I mean, how long do we have, right?

That's a really good topic.

It's happening in all stages of healthcare right now.

It's happening across all industries, of course.

We've heard the great resignation and the challenges with finding the best and retaining them.

You know, when you're talking about dealing with veterans and people that are coming in with things that have been traumatizing to them in many different ways, it takes a specialized skillset to be able to work with those folks to, you talked about PTSD, you talked about brain injuries and trauma and things that they've seen, distance away from their family and friends, maybe at a young age.

There's just a multitude of factors that you need to have a specialized set of skills to be able to work with that group.

So that's one thing.

Finding those people and training them up is first and foremost.

Secondly is cultural competency is incredibly important, right?

So it's not just the practitioner that's dealing with the people in that time of need.

It's everybody else associated around it as well.

When the service member, former service member comes in to be seen, do people understand things that might not seem important to all of us, but military hierarchy?

Do they understand the terminology, right?

Do they understand what a day in a life in the military looks like?

That can be important when trying to connect with these folks when you're trying to put them at ease as they're going in to seek treatment.

So those are important as well.

Peer support, absolutely important.

There's things that we do in the clinical space from a peer point of view, from an employer point of view.

Hopefully we'll touch on what we do with groups called ERGs and affinity groups to try to help develop that peer support and telehealth.

You know, we talked about things like geography and access issues.

Well, one of the things that COVID did was that it sped the whole telehealth solution, healthcare.

We really were not, I think healthcare in general, not just North Carolina, or UNC, was not at the forefront of being able to provide virtual care, and COVID sort of sped that.

And so now we're in a situation where we're able to now cast our, you know, to use the term a net further, where we can see more people than people that were geographically just tied to the area.

And then the final one I'll just, I touched on earlier, was recruitment and retention, right?

Recruiting those people here that can focus on this care, that are passionate about this care, and then retaining them.

That's like one of the hardest things to do, honestly.

For employers right now, it's not, recruitment's tough enough, but retaining them when they come in that you give them all the resources they need, you give them the attention they need, you give them the connections that they need and the support.

So they see this is a place to continue to do that work.

And so those are just some of the challenges that we're dealing with to keep that workforce in place to serve those vets.

- That's very helpful.

I'm wondering, Andrea, in your work, are you seeing other employers that are not healthcare providers trying to figure out better ways to support the mental health challenges of veterans whom they might hire?

- One thing that I'm seeing is private employers are creating these peer groups within their organizations and their companies.

They're creating specific veteran organizations and employee groups within their companies, which I feel is a great idea.

It allows them to talk to their peers, share.

They have that shared language, shared experiences.

They can support one another.

They can, you know, talk in that talk, you know, that they need to, you know, how they need to speak to one another and share that.

And a lot of more companies are really creating these groups.

I get calls from companies saying, "Hey, please come and tell us how to start a group."

And I'm like, "I am there, let's do it."

And it's a wonderful way to do it.

And it's not just, it encompasses the employees and it just grows throughout.

And then they start thinking, let's create the family group.

Let's have veteran family groups.

And it just keeps continuing and growing.

And that peer support, I'm all behind.

It's a great program.

- So Scott, she's singing your song.

I see you smiling.

Do you wanna add anything to this?

'Cause you really wanted to come back and talk about ERGs anyway.

- Well, I mean, listen, ERGs are incredibly important.

So we call them affinity groups.

It's a specialized group of folks that has come together around a common purpose.

There's a multitude of, we have a multitude of ERGs at UNC Health.

The military is one of the first ones that we launched because it brings all walks of life together, right?

And it doesn't just have to be people that were veterans or still in active military and reserve status or what have you.

It could be people that are just passionate about being part of that team and that organization and all the things that they do to try to help connect the dots, right?

So bringing people in is one thing.

Having them feel like they're part of something bigger is another.

Having outlets to have conversations to build new social networks, you know, to help that group help us understand how to go and find the people to recruit them.

You know, we have about 800 vets and people that are actively in the military right now that we can tell at UNC Health, remember, people self-disclose this status.

So this is what they, that's about 2.5% of our workforce.

We'd like it to be more, of course, but we've heard that there's probably only about 6% of the population in the United States is even a veteran or has served in the military at this point.

So it's, these are low numbers to begin with.

Now, North Carolina, we have a lot of opportunity.

We have a lot of military installations here.

So, and we work with USO and different groups to try to help bridge that connection to find these folks and let them understand the great opportunities that we have at UNC Health, you know, UNC Health, our hospitals are like small cities.

They have so many different jobs that people think, well, I wasn't in a, you know, I wasn't in a medical profession or MOS, but you know, we have security services, we have customer service services, we have tech services, we have HR, we have people in all walks of life.

And so A, the ERGs help us both help find those folks, bring 'em on board, and then give them social networks so they can start to build those connections and hopefully make a career out of an organization that's looking for them.

- I only have 50 million questions about how you prepare these peer groups.

Obviously there must be some training, but let me get you into this conversation, Chris.

You organization Stop Soldier Suicide has recently focused on research to better identify suicide risk among veterans.

What is your team learning?

- A lot, very quickly.

So we call it our black box project, and it's named after the flight data recorder model in aviation.

Before those existed, the only way to understand what happened with aircraft mishaps was to get investigators on the ground, collect all the pieces, go to a warehouse, and try to make guesses about that aircraft mishap.

We're taking a similar approach to understanding suicide risk by obtaining donated digital devices from families who've lost service members and veterans to suicide, and making forensic copies of those devices and putting them into a machine learning environment where we can recreate the last year of life.

- [Anita] Wow.

- I think we all agree that we don't go anywhere without these digital devices on us, and so our inner thoughts, feelings, movement, health behaviors are tracked in these devices in so many applications.

And far too often, people who are struggling hide that from their most intimate partners and friends.

But those devices don't lie.

They know the site you were on at two in the morning.

They know the text you sent, they know the chat, they know the room you are in.

They know if you're social isolating by not leaving your home four days a week.

There's so much data in these devices.

And so we've been fortunate to have almost 100 devices donated to us by families who've trusted us with their loved ones device, which you have to understand are almost a shrine to the family.

Everything that was that loved ones is a shrine.

And so to trust us with a sacred item, like a laptop, a smartphone, or a tablet, so that we can make a copy and apply it in a machine learning environment, is a sacred trust for us that these families have blessed us with.

So we've done some preliminary analysis of those device data and in some cases looking at 12 terabytes of data, 500,000 outbound text messages.

- My brain can't even get over- - Yeah, I can't either- - Any of those numbers, but.

- And thankfully I'm not a data scientist, but we have ones who can do this work with big brains to do it.

I'll give you three things that we've already seen in the initial data.

One deals with sleep pattern behaviors.

We're seeing significant changes in sleep patterns, six months and three months prior to death.

Second is social isolation.

They're getting small, they're staying at home, they're not going to the places they used to go at the six and three month mark prior to death.

And then thirdly, anger and sentiment, the same thing in the same moments of time.

So you put those three things together and we now have a pretty clear picture that says six months prior to death, three months prior to death, they had really low points where they stayed home, they were very angry and they weren't sleeping well.

And it affirms studies that were done about seven years ago by another company using a completely different approach just looking at public social media.

And they found the almost identical patterns.

So for us, it makes us optimistic to say, how can we use those findings to improve outreach, client activation and care delivery?

- Chris, that story emphasizes the importance of connection.

If you're able to identify through this research, the indicators of disconnecting, what do you then do?

- That's a big question, isn't it?

I mean, what we believe is that by understanding the critical pathways to suicide choices and we can get left of those or in front of those, we believe we have greater opportunity to convince people that it's okay to not be stigmatized by mental health care and to raise their hand for care.

What was so encouraging about these preliminary finding is I have time.

Six months is a good amount of time for us to try to change that course.

Three months is a decent amount of time to get people to have the courage to raise their hand, to seek help.

And it gives us an opportunity.

If the signals were 20 minutes or an hour, there's nothing that can be done.

So the good news is the findings are telling us we have time.

It's gonna help us prioritize resources to focus on those who are most at risk.

Because let's be fair that this is a tragic circumstance that happens to too many families in our country every year.

But the vast majority of veterans are healthy contributors to their community.

Well employed.

They coach the little league, they serve on the PTO, they're thriving based on their military experiences that give them a launchpad.

And we want to see that for more veterans so that these numbers go down.

- That's an important message to carry.

Thank you.

Andrea, we heard in the story that the Veterans Life Center represents a safe space for veterans.

Give us some idea of what kind of impact these types of community spaces represent.

- It is a, we all know, and I think COVID definitely showed us that we need interpersonal relationships.

That isolation, as a country, we're suffering from loneliness, isolation, we need each other.

And these groups, veteran service organizations like American Legion, VFW, DAV, these local posts are providing that connection.

We have veteran coffees throughout the state.

We're trying to offer more and more opportunities for veterans to engage with one another in social environments.

A relaxed environment.

We're seeing wonderful groups pop up with horseback riding, getting out there with horses and having a good time, hiking.

There's all kinds of activities that are showing up and creating that sense of connection for all the things that we did while we were in the service.

And so they're creating that wonderful bond of camaraderie that we all need, that sense of connection that we are all talking about here.

And like Chris said, trying to get in front of it, trying to do outreach and reach veterans 'cause we don't know where the veterans are.

We bump into 'em.

And unless, you know, like Scott says, they self-identify.

So we have to be out there and let them know we are there so we can get in front and it's okay to not be okay.

It's okay to not be okay.

And I think that's a really great message.

- And it takes us back to this issue of stigma that keeps coming up over and over again.

Scott, one important milestone for many veterans in reintegrating into civilian life is finding a job.

What do you advise a non-military employer to consider when it comes to supporting veterans or the hiring of veterans?

- It comes down to that, I'll tell you.

We have a moral imperative to help our vets, I truly believe.

And it's more than, as we talked about, it's more than just finding the job, but it's, once they get there, having the right supportive environment to be able to help them and assist them as they grow in that space, you know, so there's, from our point of view, we have a lot of understanding and awareness that needs to take place with how to interact with vets.

We have supervisor training that we do in that space as well too.

Now we have flexible work environments as well.

Not just for vets, but for others.

I mean, that's something that's growing more as we transition to this remote and hybrid work space that we're in, understanding reasonable accommodations for vets that might need them.

We, again, that comes as part of the supervisory experience.

employee assistance program in EAP, having a really strong EAP is important.

It gets again, to that situation where someone has to ask for help.

But an EAP has a lot of different pathways into it.

An EAP doesn't cost the employee anything.

Or as we call them, teammates.

They'll have set number of scheduled visits that they can have that are, again, zero cost.

And then after that, our healthcare, our health insurance can kick in.

It's not just for mental or burnout situations or wellbeing situations.

It can be around finance, which we all deal with.

We struggle with finance situations or family or marital issues.

And so we have a strong EAP that provides a lot of space.

There's a new group that we're gonna be working with too, that's doing a lot of work with militaries around the world as well too, to try to help reduce the stigma.

So our EAP is trying to get at the forefront of it, not just from a reactive standpoint, but from a proactive standpoint.

And then also to your question, recruitment and retention piece that we talked about.

The retention piece is important 'cause it has to be about career, it has to be about support.

When you get there, it's everything that we promised you it would be, right.

So there's a lot of work to do in there.

But the first part of that, the hardest part is the recruitment piece.

It's really hard, as we talked about before, if you don't come from a medical MOS or your job in the military, you might not think that a healthcare opportunity is something that you could even apply to.

But like I said, I didn't, I just touched on some of the jobs, but we also have marketing and accounting, right?

We have everything under the sun.

And many of our jobs, the way we've created them, they don't require, there's all levels of jobs, of course, but depends on where you enter.

Some of them have very low requirements when it comes to past experience, right?

So what a lot of military folks don't realize is they're already qualified for a lot of our jobs and they might not even know it.

And so one of the things we have to do is have to first get that outreach to have them realize that.

And so connections with Fort Liberty and different bases and Camp Lejeune are important, right?

So people understand those pathways.

But then when they get into our, what we call our applicant tracking system, I don't wanna get too technical, our employee database is the way that they apply to jobs.

Again, you just see these titles and if you don't know what they mean, you don't know to apply to 'em.

So what we've added is, it's a military navigator, so you can put your MOS in and it automatically tells you what jobs you can apply for right away, automatically.

And so what it's trying to do is saying, listen, you don't have to go and do all that work, just put the MOS in and then we've done the work for you, and then you can just apply immediately.

So the hardest part is getting that word out and connecting those dots and then getting people to take an opportunity with us, right?

- I love that because I hear of this language mismatch between veterans and employers.

So veterans might have all the skills, but they're using different words and someone is sitting in HR, Scott going, no, no, no.

- Yes.

- I've got one more question and then I'm gonna turn to the audience.

So be thinking about your questions and let's get the mic right here in the center of the room.

In the last video, they talked about the need for systems.

We've all been talking a lot about specific strategies, but what would it take to build a system, the kind where there was no wrong door and veterans would get directed to the kinds of mental health services they need.

And I'm gonna start with you, Andrea.

- Well, we know that's gonna, that's gonna take a mind set, an attitude change, an understanding change with all of us.

I know at our department, we believe in that no wrong door, that when you come into our agency, that whoever you run into, you can ask 'em a question, whatever it's referring to, and that they will try to answer it.

And if they don't have the answer, they know who to connect you to.

And that creating that environment of warmth, of openness, letting those barriers down.

And that's really hard for people in the military.

You know, we have to be strong, especially women veterans.

We had to put on that armor, you know, to get in there and to try to allow ourselves that vulnerability that people can approach us.

And so it's gonna take a mind change, which that has to go across our whole entire culture of understanding.

You know, I believe that's gonna be a top priority for us.

- I love that you started with culture and affirmation and relationship.

Chris.

- I wholeheartedly agree.

Systems navigation is really hard when you're in a healthy place.

Imagine when you're under mental anguish.

Last thing you wanna do is go to another website, call another number, fill out another form.

So the better we can do at streamlining access to timely, relevant care and services could literally save lives.

- Yeah.

And that's what this conversation is all about.

Scott, do you wanna jump in?

- Oh, well, I mean I learned a lot just from listening to them today.

But you know, the military, the government healthcare systems can only do so much.

It's kinda like that concept that it takes a village.

We heard about these great partnership with the Butner and you know, faith-based organizations can provide a lot in that space.

Community based organizations, things like you mentioned, DAV or Tunnels for Towers and the USO are important pieces to that connection.

And then like what we talked about, the ERGs.

Again, I can't highlight enough of the ERGs.

We have about 350 people that have committed to these this military ERG.

We have a number of ERGs as I talked about.

And they do, again, things like ways to bring people together to build community, as I talked about.

But they also do things on the front end, on the onboarding piece that when we bring, when someone identifies as military and we bring them in, we celebrate them in orientation and then we offer to a, they don't have to, but we offer to attach 'em to a peer, to an ambassador sort of, buddy, if you will.

And then that builds connection for them instantly.

You know, we always say it's not just veterans, but people that start in organizations.

It's not hard to leave a place that you never felt connected to in the first place.

So the minute that you can start to get that friend or that acquaintance or somebody that you feel like you can ask a question, not necessarily in your department, your supervisor, a safe sort of space orientation is that safe space.

That's what we're trying to do.

And again, that's kind of that community that we're talking about, but our ERGs do a, I just can't highlight enough on the great work that they're doing.

It's totally voluntary and these are just people that stood up and wanted to be part of it, so.

- Love it.

All three of you have said you start small and then you rely on the contagion effect to build the system.

And that's given me reason to smile.

Questions from the audience.

[Scott chuckles] - Hi, I know that you emphasized, talked a lot about peer support.

How are you providing training for your employees to get peer support certified so that they can support the veterans and the employees who are coming in that need the peer support?

- Yeah, that's a great question.

And we can certainly be more purposeful and do more in that space.

Again, I keep talking like a broken record, but the ERGs are doing a lot of that work right now.

They're organizing conversations around the complexities of being a veteran in today's healthcare space specifically.

They're the ones that are special or are focusing on the supervisor training and things of that nature.

One of the things that we're looking at, not to get too far in front of it, is building a leadership curriculum that has a number of different pieces into it that's required sort of on that pathway of leadership that helps support the teammates at the end of the day.

And one of those things will be a big focus on what you just talked about, how to be a great peer.

And again, I have, we're talking about veterans today and it's incredibly important.

We know there was a lot of challenges that have happened in healthcare space too with healthcare practitioners.

So I don't wanna quad those two, but could you imagine if you're a healthcare practitioner and a veteran, I mean, even more complicated.

So we're heavily focused in wellbeing and wellness.

We have great resources.

Also Taking Care of Our Own is one of the resources that we have internally.

Again, not just focused on veterans, but they are certainly one of the populations that we focus on in that space.

And we have fantastic psychological services groups that help sort of train all of us as well.

So we could do more in that space, trust me, and we will, but it has to be focused to make an impact to your point.

- That's a great question.

Other questions?

- How you doing?

Question probably for you, I know the DoD spends a lot of money on mental health awareness, some suicide prevention.

We talk about stigma, but, you know, when the service member's in, there's a stigma of like, I'm not gonna ask for help.

If I ask for help, I can't advance, I can't deploy, I can't promote.

And so what when people transition, we talk about getting a job, you know, your resources for this, but we don't spend enough time talking to, educating them about who you need to talk to when you're alone and isolated.

Have you heard from your organization is the DoD trying to invest in educating the person on the way out?

Like, connecting with them right away and counseling them, not just one day, like, hey, this is your resource, we're checking the box out the door, but truly educating the person on the way out.

Like, hey, you know these organizations are available, you know, these resources are there.

'Cause right now we're playing catch up trying to find them.

But if we can get ahead of it and it's gonna start in the DoD with bringing that education to the service members.

So I just don't know if you've heard of that happening or if there's talks of that.

- It's a great point.

I mean the DoD has a tremendous opportunity to improve the transition outcomes for veterans.

They're the sole provider of veterans in America except for the Coast Guard.

So they have a monopoly on what happens when they leave the door.

I know the DoD, I was, I worked in the Pentagon for two different tours and I was part of a couple offices that were focused specifically on trying to improve the transition experience and enhance those programs.

I think they've made significant progress to improve the availability of those services.

I think there's a long way to go, but I also recognize that the DoD's job is not to make civilians, but to fight and win our nation's wars.

And that's always gonna take priority.

So it's a tough balance to maintain.

Don't get me wrong, I think we as a nation have an obligation to do much better with how veterans are treated and supported when they've raised their hand.

I have a member on my team who deployed 17 times.

It makes me angry every time I say that.

How do you send a human to combat 17 times and think that's okay?

It's the sacrifice that he and many others made for our nation.

So yes, the DoD can do better.

Yes, agencies can do better.

I think we all have a role to play to make that better.

1% of our nation serves, 100% of our nation can help on this problem.

- I would like to jump in on that as well.

DoD's program is the Transition Assistance Program, which is what you're talking about.

And it is for transitioning service members and they can start transitioning up to two years before they get out.

And the thing we need to remember is that the TAP Program depends on the unit commander.

So if the unit commander on mission has people being deployed, then those members don't get to go to TAP.

So that certainly is something that is being looked at.

The VA is trying to step in that space, the US Department of Veteran Affairs.

They only get one day at TAP to try to give you all that information about their programs.

And so the state's, the state offices of Veteran Affairs are petitioning and asking to step into that space as well to provide local community resources.

We're the experts.

We're there on the grounds in the states.

We know who needs, what the resources are in Winston-Salem, what they are out in Buncombe County, what they need out at the coast.

We know those resources.

The state veteran offices have those resources.

So we are engaging with the VA and they're allowing us in a few states and soon they're gonna be spreading it to even more where the states get to come in and say, "Hey, here we are.

We wanna be that connector piece.

We wanna be your local contact and connect you to anything and everything, employment, education, housing, disability compensation claims, pension, caregiver resources.

We wanna be there to help you at the state level."

- Thank you.

Additional questions?

Yes, please.

- You guys repeatedly talk about resources and making resources available.

You get in a big community like Mecklenburg County or Wake County, you know, resources are available.

What are the plans to push those resources out to like the Ashe County, Allegheny County, you know, the Macon counties, you know, the further outreach in the corners there that seem to be forgotten a lot of times.

- In the state, our department, the North Carolina Department of Military and Veteran Affairs, we only have 13 offices spread across the states.

So that means every one of our offices has about 20 some counties under it that we try to take care of.

It is really then down to our county veteran service officers that are out there on the ground.

They're wonderful.

They're our partners, we cannot do without it.

When you look at a community in North Carolina of over 100,000 active duty, then you're looking at over that with our reserves, National Guard.

Then we also are looking at over 700,000 veterans.

That's a lot of people to tap into, to talk to.

It takes all of us, states, counties, they're out there.

The counties know who's their resources out there.

They know their housing partners, they knew the food banks, they know the shelters, they know the transitional homes for women and children.

We heavily rely on our county veteran service officers and the programs that they're connected to with their local posts for American Legion.

Like I said, DAV, there are a few wonderful women only veteran organizations in the state.

So we have to rely on our partners to reach that expanse, to get those further out communities on the edges.

And some of our wonderful partners like Veteran Bridge Home, Veteran Services of the Carolinas that can provide numerous resources.

- I wonder if I might just follow up on that question and any one of you can try to answer what may well be an unanswerable question.

Clearly we understand that stressors, whether it's housing, childcare, food, whatever it may be, only exacerbates mental health challenges.

So it's important to have those resources.

It's also important to have mental health providers.

And we know in North Carolina there are many places that are just deserts.

What are the opportunities there?

- I guess I'll go into that one.

We provide suicide specific therapies nationwide via telemedicine for that exact reason.

We are not relying on a fixed facility model.

Our licensed clinicians can work with any veteran in any state they're licensed to provide that care.

And we're literally doing it from homes to homes.

And I think what my team does every day is a model that many others should start to embrace if they haven't already.

A lot of our clinicians on our team came from hospital settings and their answer was always bed space, inpatient, maybe delayed outpatient.

They were shocked at the acuity of risk that we're able to manage through these modalities to keep people alive and healthy and safe without having to hire more behavioral health professionals into rural areas to create more bed space.

And I think if COVID did one thing good for us, is it's shown that 76% of adults are now open to telemental Health.

So I think the opportunity is right, that people are more interested in getting behavioral health via telemedicine.

And sadly, I think we're only experiencing the tip of the results of COVID and the need for those services.

So I would encourage anybody that's in the behavioral health space to ramp up their abilities to serve more people where they're at and don't make them try to come to you.

- Thanks for that, Chris.

And I'm glad you had a chance to share the scope of the work that you're doing.

Other questions?

Come on up.

Did I see a hand over here?

Yeah.

- So I served both as an active duty Marine and as a military spouse.

And what I can tell you from my personal experience is that it was much easier to be the active duty Marine than it was to be the military spouse.

And working with active duty spouses of Marines in Eastern North Carolina, one of the things I realized is when we're talking about the mental health and I know y'all already know this, is the impact that it has on the family.

So my question for you is, with the organizations that you work with and the work that you do, what kind of services are provided and available to military spouses?

And then what are the ways that we can make sure that our military spouses have that information?

Thank you.

- Such a great question.

Who wants to go first?

- Ladies first?

[Andrea chuckles] - Well, I was a military spouse and a veteran and now I'm a caregiver.

So I do understand that whole process, what you're talking about.

And of course we're also think about the impact of military spouses having over 20% unemployment rate.

So we're actively working on that as well at the state level, trying to find that portability.

But we always encourage our active duty spouses to look at their local resources on base.

You know, look at Military OneSource, fantastic connection, lots of resources at Military OneSource on there, as well as out in their local communities.

Veteran service officers aren't just for veterans, All veteran service officers in our state are actively and open and willing to help anyone that touches the military community.

The whole life cycle of someone that's in the military.

From the day they raise their hand, they're there willing to help you with anything.

Our job at the state and county level is to be that resource for all those touch points that you have to help you with employment, social enrichment, connect you with your community and faith-based organizations.

That's what we wanna do.

We are there 100% to support the military family, the whole culture around there.

We wanna be there.

We actively work at the state level trying to work on childcare and employment because all these issues that we're talking about are suicide prevention.

Everything we're talking about, employment, education, all of them are part of suicide prevention.

- Another great question that allowed us to get clear about the scale, the scope of the work.

Thank you.

We've got another question.

- I think that we would be remiss if we didn't have a conversation about firearms.

Over 70% of veterans that do die by suicide use a firearm.

What sorts of conversations are you guys having about lethal means safety, creating time and space during those moments of crisis?

- I'm so glad you brought this up.

This is really, to your point, a very, very important conversation.

We spend a lot of time in our research and the community and as a whole is focused on why do people die by suicide?

And as we talked about prior to the show, there's no one pathway to death.

It's so complex.

We should also, if not more so be focusing on how people die by suicide.

The lethality of firearms is very powerful.

About 95% of people who attempt suicide by a firearm die, that means about 1,500 people a year in the US adult population live.

It's a very small number.

I think, you know, I'll just tell you about our clinical practice.

We immediately look at firearms ownership as a precondition that puts you at greater risk.

And we talk very candidly with our clients about safe storage, strategic storage, locks, sensors, giving access to your firearm to someone else if that's more appropriate.

And we focus on a graduated scale based on their lethal means, choice of means, all of those things to ensure that we're providing as much time and space, as you said, between an impulsive decision about a potentially short-term problem that has a permanent solution.

So we take it very seriously with our clients.

I'm encouraged that our clients are very open to the conversation.

This is not about their lawful right to own firearms.

It's just asking, is this the right time for you to have access to those?

I'm an avid gun owner, I hunt, I like to shoot.

But if I'm not okay, that's not the time for me to have access to those.

And I think the more we can have safe conversations like that with friends we trust and know, I think it's gonna make a big difference and put more time and space so that people have time to make a more rational decision about what's right in front of them and the pain they might be experiencing.

So we take it very seriously.

We work closely with doctors at Harvard that lead the Means Matter initiative on this very issue.

They're finding conversations on this issue with gun owners, shop owners, firearms instructors, range owners.

They're very receptive to having these conversations with their gun enthusiasts.

And we're actually a recipient of a DHHS grant in the state of North Carolina to activate more firearms safety teams in the veteran community across the state to have these conversations.

- I'm struck by how often in this conversation we've talked about the need to talk, to be connected, to be able to say out loud and hear back from others.

Scott, Andrea, Chris, I cannot thank you enough for spending time to share your insights with this wonderful audience.

And of course, we don't ever close an ncIMPACT show without thanking those experts who showed up in those videos who are willing to let us tell their stories.

Thank you all so very much for being with us this evening.

Thank you.

[audience applauding]