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U.S. Suicide Rate Up 33 Percent Since 1999; Suicide A Major Problem For Military And Veterans; Preventing Suicide With The Columbia Protocol. Aired 9-10p ET

Aired June 26, 2019 - 21:00   ET


[21:00:00] ANDERSON COOPER, CNN ANCHOR, ANDERSON COOPER 360: But he finally admitted he has the best memory, so how - how to explain this discrepancy.

The President knows everyone, has heard of everyone, has made everyone until it becomes inconvenient or he becomes angry, then they're not fit to shine his golf cleats, or get his Big Macs.

And if they don't like it, tough luck, they can take it up with him or with John Miller or John Baron on The Ridiculist.

The news continues. Want to hand it over to Chris for CUOMO PRIME TIME. Chris?

CHRIS CUOMO, CNN ANCHOR, CUOMO PRIME TIME: Anderson Cooper, they tell me good things about you.

COOPER: Don't - don't believe them.

CUOMO: Thank you once again, my friend.

COOPER: OK. Thanks.

CUOMO: Good to see you. I am Chris Cuomo. Welcome to a PRIME TIME Special Report.

We're doing something different tonight. If you have some political fatigue, and you're not going to watch the debate, give me an hour of your time, please. We're going to confront something that is wildly important.

The most ignored kind of illness in our society is also the most prevalent, and it is mental illness. One in four of us have it, some sort of depression, maybe your loved one, maybe you, could be both. We all know someone. No one is immune. No kind or face or place.

Someone takes their life every 12 minutes in this country because of it. That's five lives lost in this hour. Maybe tonight, we can come together. We can give it some attention, some information, maybe there can be one less.

This problem presents the most pernicious paradox for us, because unlike other deadly diseases, we know we can treat it, and beat it. And like almost every other disease, we too often won't admit we have it or seek treatment. Only mental illness has that stigma.

The reach, the reasons, the need for the resolve to take it out of the shadows, that's the point of tonight, erase the stigma. There is hope. There is help. Let me show you the problem and the solution.

Please, come with me. Let's get after it.




CUOMO: Here is the fact. The U.S. suicide rate is up 33 percent over the last two decades. It's the highest level since World War II. On average, a 123 Americans die by suicide each day.

It's especially devastating on our most valued citizens, our veterans. 20 vets take their own lives every day.

We're so lost in this country on how to deal with the reality. Think about it. We actually criminalize the effects of this illness. Suicide is illegal. Addiction is illegal. And that seems to be the best this society can do to relate. And yet, there is no illness that touches more of us and in more ways.

Think about it. We're going to have the National Suicide Lifeline number on throughout the hour. If you need it, use it. That is strength, not weakness. If you know someone who is in trouble, reach out.

Tonight is about shining a light with the help of one of the best people I've met in this business. Chief Medical Correspondent, Dr. Sanjay Gupta.


ANGELA GLASS, MOTHER BATTLING ANXIETY: Here, let me drop these clothes (ph).

SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Angela Glass, she's a mother, a wife and a nurse from Victoria, Texas.

A. GLASS: There you go.

GUPTA: Not the type you might think would battle thoughts of suicide, but she is emblematic of a terrifying story now unfolding in the United States.

A. GLASS: I took pain medication and hydrocodone. And I took the Xanax for the anxiety.

JUSTIN GLASS, ANGELA'S HUSBAND: She'd be acting different. It got worse after we lost a child, and has just steadily gotten worse since then. A. GLASS: It's come to where I take way more than I'm supposed to. Even the other night, I was sitting there, thinking, maybe I should just take all of these and just go to sleep.

GUPTA: It's hard to see that sort of pain.

A. GLASS: I'm sorry.

GUPTA: That relentless stress with hardly any resiliency. It's also the prescription for what has become a uniquely American form of despair.


UNIDENTIFIED FEMALE: Hi, how you're doing.

A. GLASS: Good. I'm Angela Glass.

GUPTA: In the United States, suicide rates have been steadily climbing since 1999. Today, they are 33 percent higher, the highest they've been since World War II, and no one is immune, regardless of age, gender, or geography.

In 2017, more than 47,000 people died by suicide. But the other number you need to pay attention to is the number of people who wish to die. Attempted suicides that same year, 1,400,000, and that's just adults.

A. GLASS: If I knew I was going to be here right now, I wouldn't have ever started taking medication. I don't wish this on anybody.

And I don't deserve to live like this. My kids don't deserve it, my husband doesn't.

[21:05:00] GUPTA: Women like Angela are more likely to have suicidal thoughts.

Yet in 2017, men died by suicide nearly four times more often than women. And when we looked a little more deeply at what was happening, a larger, more frightening picture started to emerge.

Suicides along with drug overdoses and alcohol-related deaths have all shot up. They are aptly called the "deaths of despair," a term coined by Princeton Economists Anne Case and Angus Deaton.

ANNE CASE, ECONOMIST, PRINCETON UNIVERSITY: Enough people have died of deaths of despair to make it of the same order of magnitude as all the people have died of AIDS in the U.S. since beginning of the AIDS crisis. Those mortality changes were large enough to cause life expectancy to fall, first for Whites, and then for the entire population, and that's a really unusual event.

GUPTA: You heard that right. In the United States, one of the wealthiest nations in the world, a nation that spends $3.5 trillion on healthcare, life expectancy is going backwards, now three years in a row. If the disease is despair, as the Princeton Economists believe, then

what is the treatment? It's complicated and different for everyone. But, for Angela, as close as she got to ending it all, her turnaround was even more remarkable.

When you decided to go to - to rehab--

A. GLASS: Mm-hmm.

GUPTA: --how - how difficult a decision was that?

A. GLASS: It was - it was hard. I consider everything that I learned there a coping skill. They taught me to talk.

And I thought it was silly when the instructor came in, and was telling us, just sit back in your chair, just relax, take 10 deep breaths, and halfway through I was like, "Wait, this is working."

And I just felt so much better. That day was the best day that I had had in years, just knowing that I can make it through a day without that medication, it's - it's amazing.

GUPTA: I mean the - the story typically is, as you know, I mean tens of thousands of people die every year from - from these overdoses. But you came out the other side.

A. GLASS: I definitely feel like if there was a lot more people, like my husband, and my mom, how supportive they were that a lot of people would get help earlier.

GUPTA: You were so - you were so good.

A. GLASS: Thank you.

GUPTA: I'm really - I'm really happy that you're doing well.

A. GLASS: Yes, thank you.

GUPTA: I really am.


CUOMO: Wow! 80 percent who get treatment for those types of maladies, that genre of mental illness that falls into depression, or as we say, deaths of despair--


CUOMO: --they can come out of it.


CUOMO: If she's on - on any medication. Despair, my concern with the word is that it - it takes us to an emotion or a mood. Despair gives us desperate, desperation.


CUOMO: How do you keep it clear that it's an illness, not a feeling?

GUPTA: I - I think that - that it's a - it's a good point. I mean, you know, that depression is the biggest disease associated with suicide, I think, is a point that should not get lost in all this.

I think what these economists and others were, the point they were trying to really go for is, fundamentally though, if you have a country that where suicides are going up, as well as drug overdoses, as well as liver cirrhosis from alcoholism, is there a more underlying sort of issue here? What's driving that?

And, by the way, there's other countries around the world that have had similar economic challenges as the United States. They've had similar challenges politically--


GUPTA: --whatever it might be. So, why is it different than the United States? That's what they were sort of driving at.

CUOMO: And the "Who?" Once you get to us--


CUOMO: --so that it is somewhat special with us, who in this country, White people, why?

GUPTA: Primarily Whites, and primarily White working-class. And what - and what that means is if you - if you look at the three largest demographics, African-Americans, their mortality rates are actually higher than Whites, but they've been steadily going down.

Hispanics' mortality rates are actually lower than Whites, and they've been steadily going down.

But, as you say, the Whites, and primarily White working-class, they're the ones, their mortality rates have been going up so significantly that it has lowered life expectancy now for the whole country.

The why is - is - is a complicated question. I think there's two primary things that, you know, the - the economists point to.

One is this idea that we're talking about, Chris, the sons and daughters of the greatest generation, or grandsons and granddaughters, in some ways, they were supposed to inherit the earth, maybe they were supposed to inherit the United States.

And instead, they see jobs leaving, they see wages dropping, and now they see themselves dying at a faster rate than any of their similar cohorts anywhere around the world. It's almost an underlying existential sort of stress. That's - that's one of the theories put forth. And also, there's this other idea that, you know, when you live in a place of - of tremendous glaring income inequality, that's also very stressful for a society. If I can, for a second, Chris--

CUOMO: Please.

GUPTA: --let me just show you this - this experiment that we - we - we found that really illustrates this point.


[21:10:00] GUPTA: You're looking at two Capuchin monkeys. For 25 times, they've been doing a task, and they get a piece of cucumber, each time they do this. Now, you start giving the monkey on the right a piece of grape instead, a more desirable treat.

Watch how the monkey on the left reacts to this. He sees the grape. He's still going to get a cucumber, looks at that cucumber, tests it out a little bit, and then actually throws it back at the examiner.


GUPTA: This is a very primal thing you're seeing here. And you watch this. This happens over and over again.

Very upset, obviously, this monkey on the left, was totally fine, 25 times in a row, getting this piece of cucumber, sees the other guy getting a grape, and now the stress levels have soared in this monkey on the left.

CUOMO: So, stress, expectation versus reality, and the idea that your thoughts become things that what starts as a feeling--


CUOMO: --can become an illness.

GUPTA: I think that's right. And - and the - and the idea ultimately that what's driving it is this idea that it's far worse to have - to have expected something and not received it, versus simply not receiving it.

Can that then spiral into manifestations of - of - of these various problems that we're talking about? I think so. That's what these economists believe can take the form of suicide, what you're talking about tonight, drug overdoses, alcoholism, in some ways, these are all self-inflicted.

CUOMO: You know, and even this wisdom sheds light on an ignorance. We're getting this information from economists because we don't study mental health the way we do physical illness.

GUPTA: You're absolutely right. This did not come from the medical--

CUOMO: Right. GUPTA: --community. And even when the economists first pointed this out to people, and they pointed it out to the medical community, at first, they were sort of ridiculed.

CUOMO: Right.

GUPTA: You - you - you can't be serious.

CUOMO: Like what do you know?


CUOMO: Right.

GUPTA: How is this possible? How is it that we are one of the wealthiest nations and we're seeing this? But - but it's true.

CUOMO: Well let's do this. When you have somebody as valuable as you, you keep them around. Stay with me--

GUPTA: All right.

CUOMO: --for the show. Help me ask the right questions in these situations. Let's try and do some good.

GUPTA: You got it. It's great to be here (ph).

CUOMO: It's great to have you, brother.

GUPTA: Yes. Appreciate it.

CUOMO: It's great to have Dr. Sanjay Gupta always.

Now, something else that will be very helpful. What do you think? Let's get a conversation going. You know how to get me on Twitter. We all know that. Go at @ChrisCuomo.

But tonight, let's keep it positive and productive, OK? And I will then, later in the show, show where people's heads are, what you accept, what you don't accept, what do you make of this theory that we just revealed to you? Do you buy it?

All right, when we come back, we have a very special guest, the widow of Linkin Park Singer, Chester Bennington. All right, what is it like to live through this to come out the other side with the pain that you hold of loss, what do you do with it, next?


CUOMO: As the Good Doctor told you, men are nearly four times more likely to die by suicide. But reality isn't as simple as a statistic. In fact, we see that women are diagnosed with depression at higher rates.

Instead, men tend to self-medicate, and we know how, right? Drugs, alcohol, men are nearly twice as likely to meet the criteria for alcohol dependence. But alcohol is a known risk factor for suicide.

So, you see one of our goals tonight is to see how these things fit together, all right? Depression, addiction, suicide, it all fits together.

The manifestation of that often looks like the life of Chester Bennington, Lead Singer of the Rock Band, Linkin Park, so talented, so special to so many, but he took his own life almost two years ago.

His wife, Talinda, has channeled her pain into purpose. Not easy, beautiful to observe, and so helpful to us tonight. Talinda, thank you for taking this opportunity.

TALINDA BENNINGTON, WIFE OF CHESTER BENNINGTON: Thank you so much for shedding light on such a necessary topic.

CUOMO: Let's start with what you want people to know because what you have lived.

BENNINGTON: Well I want people to know that you're not alone, no matter what. I'm living this in the public eye. And there are - but there are millions of people, all across the world that are living it privately, and in shame.

And you don't need to be in shame because you're not alone. Whether you're suffering from depression or you love somebody that is, you're not alone. So, that's really what I want people to understand. We're all - at the end of the day, we're all - we're all people. We're all - we're all humans.

CUOMO: And there is nothing to hide from. This is not weakness. It is illness. And you can help--


CUOMO: --by doing the simplest things of reaching out to others. Those are beautiful, but also powerful messages. Something else that you lived as a reality--


CUOMO: --the idea of how men deal with this appreciation of mental illness, what did you see in your husband?

BENNINGTON: Oh, I saw - I saw a wide range of things. It's - a lot of it is what I didn't see as well. But I did - there was alcohol, you know, alcoholism. There was drug addiction. But he wasn't off the rails like all the time, most of the time, very rarely, actually.

It was when he'd isolate, when he wouldn't reach out to hang out with his friends, those - that - that's when, looking back, I now know those were some of the biggest signs that were out there.

CUOMO: You know, it's interesting. Our culture has evolved in some ways and others, not enough. Your husband was one of many, not just in the entertainment world, but where they say "Yes, look, I got my ups and downs. I got some problems with substances." They're not going to say that about their mental health. It is very rare--


CUOMO: --to hear somebody say, "I think I'm in the struggle here. You know, I--


CUOMO: --I think that my chemicals are upside down. I think I'm battling with depression or some kind of ill" - they don't want to say that.

Your husband didn't say that. And the statistics reveal that we do not see men getting treated at the same rate as women, although women are diagnosed more often than men.

BENNINGTON: Right. It's - it's interesting, right? And me - that goes back to, you know, an old culture of telling our - our - our boys to kind of suck it up and deal.

With the death of Chester, I really wanted to use the platform that he spent his life creating, to let those fans, and - and the world know his death's not in vain. You're not alone. There are other people out there suffering, and let's talk about it.

You know, Chester would go to treatment sometimes. He would go to therapy. But I will be very honest. He was never open and about being OK with struggling with depression. He did speak about it. He did write songs about it. That was his outlet.

[21:20:00] But I'll tell you, at home, it - it wasn't like, "I'm having a hard day today," like "Let's talk." And that's really what I want to like do what I can to change in our - in our homes.

CUOMO: We have to make mental illness like physical illness. People aren't afraid to say--


CUOMO: --they have diabetes. They're not afraid to--


CUOMO: --say, God forbid, they even have cancer. They say it and they deal with it.


CUOMO: And we see it as strength, not weakness, as we do with mental health. Let me ask you something though about your own journey.


CUOMO: What was the hardest thing for you in all of this emotionally, and how did you deal with that?

BENNINGTON: Well telling my children, that was obviously the hardest thing for me.

But with having to tell them, our twins were only five when he passed away, so it was - it was one thing to tell - say that "Daddy's gone." But I knew that there was going to come a day where I had to explain how he died before social media did.

And that's - I just kind of dove into the mental health space, and I saw that there were so many amazing organizations, working to try to reduce the stigma, to try to help people, but it's not very streamlined.

It's - it's kind of where do you go? There is a suicide lifeline, you have - you have posted up there.

There are also different organizations all across the nation that help family members, that help friends, that even help people when you're not in that heightened state of - of emergency because it - it is health, you know. If we don't take care of our health, we will become ill. Period! So, we need to have support even when we're feeling well.

CUOMO: You are a 100 percent right. And I know now it's second nature to you. It's so commonsensical, once you've lived it and seen the reality. But so many in this society--


CUOMO: --are still blind to something that shadows every aspect of our life. Talinda, I know--


CUOMO: --that this is a conversation you wish you never had to have.


CUOMO: But having lived through it, thank you for using your experience to help others. We are privileged to give you the platform tonight.

BENNINGTON: Thank you. I'm - I'm honored. Thank you very much.

CUOMO: The honor is ours. God bless and be well.


CUOMO: And the best to the kids.

BENNINGTON: Thank you.

CUOMO: All right, so look, two decades, we have seen something that really should bother you. We all say we care about the veterans, right? And yet, there has been an unrelenting tide of suicide.

Not that all veterans are vulnerable, not that they're weak, get past that. So many veterans struggle with this. But they have twice the rate of suicide of those who don't serve. So, what is our VA doing to help our heroes? What more should be done? We have one of the experts leading the charge at the VA. Sanjay and I are going to put our minds to the matter as part of our Special Report.

Be with us, next.


CUOMO: You know, we say we support the troops all the time. But do we? The men and women who protect and defend this nation, they're taking their lives at record numbers.

321 active duty members of the Military died by suicide in the year 2018. It ties the worst year since the Armed Forces started keeping close track of this. 20 vets, every day, take their own lives. It's a number that's been pretty consistent for about a decade.

Matt Miller is with us tonight. He is the Director of the VA's Veterans and Military Crisis Line. Hey, we appreciate you being here, and thank you for the job that you do.

MATT MILLER, DIRECTOR, VETERANS CRISIS LINE: Thank you, Chris. It's a pleasure to be here with you. And thank you for giving the VA an opportunity to join in this important discussion.

CUOMO: We have our best on it. I am joined here with Dr. Sanjay Gupta, and I need him, to make sure we're asking the right questions to get as much information and perspective out from someone who knows. So, let me bring him into the conversation. What do we need to know to start of?

GUPTA: Well, you - you know, it's interesting, Chris, and Matt - Matt obviously knows this.

But historically, you know, we think of veterans as having much higher suicide rates, which they do, but that historically hasn't been the case. I mean, in the past, this has actually been lower than the general population.

I think the question people always hear this number 20, 22 people dying, by their own hand every day, veterans, the big question, Matt, I mean, you know, why is that happening, why does it continue to happen over a decade now?

Do we have any insights into what's going on and how to maybe curb those numbers a bit?

MILLER: Why is the question to obviously start with. It's the question that's on all of our minds, and it's the question that comes to mind, I think, first, when we experience this.

It's the question that came to my mind first when a friend and colleague, United States Marines, died by suicide when we were stationed together back in 2004 and 2005. It's a complex answer. It's a very individually-based answer. It's a

combination of - and a complicated combination of risk factors and protective factors.

Veterans are extremely resilient, as a group, and as a population. Veterans also face unique challenges and unique risk factors within the suicide and suicide prevention fight. And--

CUOMO: Well there is also unique resistance, is there not, Matt?

I mean one of the things that we've learned is that in the community, even when it was started off with PTSD, right, we've dropped the D, because of the stigma of the word disorder.

But there are many men and women in your community where they don't want to admit this because they see it as weakness. They are warriors, and this is weakness. Now, of course, that's not true. But how do you combat that?

MILLER: I think veterans are - I - I have a little different perspective on that as a--

CUOMO: Please.

MILLER: --veteran as well, I think that there are very real questions and issues that veterans may face in terms of pursuing treatment or seeking assistance.

But I would also pose that veterans are uniquely trained and have uniquely learned when to charge, and - and go forward, and go it alone, if need be, versus when to call in for help.

[21:30:00] I think that some of the challenges that we're working hard within the VA to address are converting some of the things that you've talked about with other guests already, which is converting this awareness into increased help-seeking.

How to seek help? How to get the help? What does help look like? When do I need help, and educating veterans in that way, and that is going to be a broad community effort, including the VA, and beyond the VA.

GUPTA: Yes. I'm curious, you know. The - the resources available at the VA, I mean there's been studies shown that that veterans who interact with the VA get health services there are then less likely to die by suicide.

And yet, you also hear in the news lately, I mean, headlines last few months, that there have been veterans who have taken their own lives right outside a VA hospital right - right - right at the entrance to VA hospital, for example.

Well what's - what's going on there? Are there enough resources? Is there a concern about the mental health resources available at the VA for veterans?

MILLER: You raise several good points within that Dr. Gupta. One is the number 20. If we take a look a little more deeply at the 20 per day with veterans first, one is - is too many. Within that 20, 14 have not had care within the VA, six have.

Veteran is veteran to us, however in the VA, and we are looking to design and implement suicide prevention programs and services that reach all veterans, the 14 and the six.

Talking about the on-campus suicides, actually, on-campus rates on the VA are lower than on-campus rates at non-VA facilities. And on-campus suicides have decreased by 84 percent, the Joint Commission found from one year to the next recently, so good news overall.

Nonetheless, as I said, and coming back to the main point, one is too many. Therefore, we are working on, and have developed a national suicide prevention plan and roadmap, and are working closely with communities through the Mayoral Challenge, the Governor's Challenge to combine resources across treatment and prevention.

CUOMO: We will put the information out. We appreciate the work that you are doing. And you raise a point that whether it's veterans or non-veterans, Matt, if you get treatment, your chances of survival just skyrocket, and we have to see it as a show of strength, not weakness.


CUOMO: Thank you so much, Matt Miller. God bless and good luck with the work going forward. So--

MILLER: Thank you.

CUOMO: --here's the number that we're showing. If you need it, use it. If you know someone who you think could benefit from it, reach out, 1- 800-273-TALK or 8255, gets you to the same place.

Now, press one, if you're a veteran, when you're calling, then you'll be transferred to a VA staffer. We'll keep putting up the number. You know, it's going to be there. I'll tweet it out. It's there. If you need it, use it.

Our next guest knows how to stop this tragic loss of life. Think about that. Something so pervasive in our society and it's not like cancer, where we haven't figured out exactly what - we have something here.

She's the Lead Scientist of the Severity Rating Scale called The Columbia Protocol. This thing has dramatically helped lower suicide rates when it is implemented, even in the Military.

What are the solutions? Next.


CUOMO: Suicide is preventable. One of the leading ways that we can end it is through something called The Columbia Protocol. Kelly Posner Gerstenhaber, Founder and Director of The Columbia Lighthouse Project developed the protocol, joins us now. It is great to see you. We are friends. I love you, and I love this

work. I'm joined by two people I respect and admire. That is a gift. What is it? What does it do? Why does it work?

KELLY POSNER GERSTENHABER, FOUNDER & DIRECTOR, THE COLUMBIA LIGHTHOUSE PROJECT, HONORED BY DEFENSE DEPARTMENT FOR SUICIDE PREVENTION EFFORTS: Well I - I just want to step back for a second and - and start with the good news, as you're saying, that there - there is hope, there is help. Suicide is preventable. And suffering, people don't have to suffer in silence.

So, one of the things that we've known, you know, why we haven't been able to - to touch the needle very much is that 50 percent of suicides see their primary care doctor the month before they die.

We should be asking questions the way we monitor for blood pressure. We know that many adolescents, who've tried to take their own lives that show up to the emergency department, are not there for psychiatric reasons.

So, we know if we're not asking like we do vision testing or blood pressure, we won't find the people suffering in silence. But, you know, we've learned that even that's not enough.

So, the Department of Defense and the Under Secretary's Office, they had this, and the VA, had this urgent recognition, Dr. Franklin, that we must go beyond the doctor's office.

We must find people where they live, work, and thrive because many people won't have the will to come to you. So, when we start to ask everybody, put it in their hands, you know, many people won't ever get to the doctor's office, so coach, peer, spouse, janitor, even.

So, what's happened - so The Columbia Protocol is a simple set of questions that help us, for the first time, identify who's actually at risk, who to worry about, what the questions are to ask, what to do with the answers, but also breaking down those barriers of stigma that - that people want to be asked, and they need to be asked.

You know, when people, they're suffering, they actually want help. And there's this myth that if you ask somebody, it's going to cause them to be suicidal, when it's actually the opposite. They feel - they feel relief, and they feel grateful, when you ask, and - and it - and it's quite an empowering feeling.

And the other thing is forget about that it's the right questions. When you're asking, and when we have a language, it builds connectedness. You know, the CDC has told us that feelings of isolation and loneliness are one of our greatest risk factors.

[21:40:00] Do you know that loneliness is equal to having 15 cigarettes a day? It can be more lethal than--

GUPTA: It's so toxic.

GERSTENHABER: --smoking and hypertension. I mean, it's amazing. And when you actually connect, that caring, and that asking can be - can be medicine.

GUPTA: I - I think that's such an important point. And anybody, as you're saying, it's not just the doctors, but anybody can potentially have a role here.

Is this - is this a screening test, in your mind, or I mean, or have I already identified something in somebody, and now I'm concerned? I mean, because the - the issue is that lot of people may not have symptoms, right?

GERSTENHABER: Exactly. Exactly. So, we must ask, like blood pressure, we must ask everywhere. And when you're at the doctor's office, it's not who are you worrying about. You're asking everybody.

But the - the parent and everybody else, they'll just have a tool, or the guy that works at the gun counter, because that guy who goes up to the gun counter to buy that gun to kill himself does not want to die, and does not know there's help.

So, something as simple as having a public health approach, and finding people, you know, we've - we've seen dramatically how well that works, you know.

CUOMO: How so?

GERSTENHABER: So, the Air Force, for example, they were the first ones, every airman, every spouse, dentist, they were the only service this year to reduce suicide. The Marines were the first ones to test that. Every legal assistant, clergy, they've reduced suicide 22 percent that year. So, we're rolling this out.

You know, we talked - we talked about people taking their own lives in the - in the parking lots of VAs. So, we're going to give it to the parking lot attendants, hopefully. I just did a training with--


GERSTENHABER: --all the lawyers and the community workers.

CUOMO: It works well enough that the recognition from the government that you got for the work was the highest.

I can't - you are the only person I've ever had who hides the Highest Civilian Honor that they can get behind your hair. Will you show them the award? And what did it mean to you to get to it about the promise of the Protocol?

GERSTENHABER: You know, I - I - I was awarded the Secretary of Defense Medal for Exceptional Public Service because the work with the Military, you know, really showing, it - it was so empowering to - to show that we can, we can combat this, you know, shared humanitarian crisis that we have in suicides, so, and they were the first ones to really--

GUPTA: That's great. GERSTENHABER: --show and partner that we must put it in everybody's hands and, you know, by breaking down these barriers of not identifying the people who suffer.

But I - I just want to say, so we know we need to identify and find people who need help. But the other thing is the biggest cause of suicide is this treatable medical illness called depression. But we don't think of depression like we think of cancer.

GUPTA: Right.

GERSTENHABER: You would never hear the word "Choice" when it comes to cancer. So that means that because of that stigma and misunderstanding, 50 percent to 75 percent of people who need treatment don't get it.

And let me just say how many people are touched, you know. It's the number one cause of global disability, number one, cost humanity more than anything, but incredibly treatable, once we break down that barrier.

GUPTA: Is there enough resources available though, because we talk about the fact like if I identify somebody, and now I say, "Well I want to get them into a hospital or get them care," because of the stigma, in part at an institutional level, there may not be enough doctors, enough beds, enough resources overall.

GERSTENHABER: Yes. Well I - I think that's one of the benefits of having the right questions to identify who's at risk. So, only 1 percent of people on The Columbia actually need a next step.

GUPTA: Oh, that's OK.

GERSTENHABER: So, you're able to maximize, you know, and optimize your resources in very powerful ways. And when we think about the simplicity of some treatments, antidepressants that anybody can prescribe--


GERSTENHABER: --right? So, we of course have to address the--

CUOMO: And what we'll do is, in social media tonight, we're going to put out how people can go to the site, see what it is, understand how if they're a manager, they're responsible for anything, they can bring this in, bring this information and - and spread the awareness.

My friend, thank you for the work that you're doing.

GERSTENHABER: Thank you, Chris.

CUOMO: Deserve the award.

GERSTENHABER: Grateful to be here.

CUOMO: All right-- GUPTA: Thank you.

CUOMO: --we asked you, "What do you think? Let's talk. What do you buy? What do you not buy? What are you worried about? What do you want to know?"

We'll go through some of the biggest, most popular comments, next. Well--


CUOMO: Hey good news, even with the debate going on right now, the reaction to this special edition of PRIME TIME about mental illness has been overwhelming, so many of you reached out on social media to join the conversation. So, let's give you a few baskets, few buckets of comments, all right?

Here's one about people who are confused by what they saw in their own lives. "My 23 year old son died by suicide. One day he was laughing, living life. And the next, he was gone. I don't understand how someone who just loved life would just leave."

First of all, we are sorry for your loss, Jacqueline, and thank you for sharing it with us, so we can spread some understanding.

That's a constant - common confusion. But they were happy. How were they depressed?

GUPTA: Talinda's, you know, that's what she had originally talked about with - with her husband as well, you know, she was so surprised. He seemed happy, everything was going great.

You know, 54 percent, you know the statistic, 54 percent of people who die by suicide had no diagnosed mental illness. Now, what does that mean? Did they not have depression? Probably not.

That - that - that's not what it means. It means that they had not been diagnosed, as of yet. This was the first time they outwardly displayed something that people took notice of. There were probably warning signs earlier, but sometimes they're hard to find.

CUOMO: May have been masking.

GUPTA: May have been masking.

CUOMO: Maybe even trying to cope.

All right, next one, "Many studies have shown the impact of social media contributing to rates of depression/anxiety. We now live in a world where some feel inadequate compared to others' perceived or actual successes."

And I would add, Hollagirl, thank you for that. And also, this is one of the most toxic places in the world, this Twitter, where people are preying on weakness. GUPTA: You see it, you know, because you're - you're in - in the public eye. You know, it's I have three preteen girls at home, and the social media part of it, I - I got to tell you, Chris, is probably my - my biggest concern.

I feel like they're physically safer than they used to be because they don't go out as much, they don't do those sorts of things, but they're - they're on the devices, they're on social media, and I worry about the mental health toll this is going to take.

I mean I think we should all worry about it. We are seeing something we've never seen before. I read this thing the other day that said this - with the smartphone and social media, we've seen the single biggest behavioral shift ever recorded in human history, because of this device, and because of the way that we're now utilizing it.

[21:50:00] CUOMO: Last one, "So often I hide my thoughts and feelings due to the stigma of mental illness, even though I know it's more self-inflicted than anything else."

Thank you to all who reached out and shared. But listen to this. It's not self-inflicted, all right?

We're going to have perspective on what is happening to us as opposed to what we are doing to ourselves. That's why we want to get this out. You didn't make yourself sick with mental illness anything - more than you did with cancer. What happens to your body is not what you necessarily control.

I have a closing that is about what I learned in my own life, and what we all need to be more aware of, next.


[21:55:00] CUOMO: So, think about this. When a virus spreads, it becomes a pandemic. The tragedy is compounded by our inability to do more, right? That's the most frustrating part about mental illness. It's hurting us more than any virus, and there's so much more we can do to alleviate, treat, even cure.

The illness is real. It's the stigma and the attendant shame that are manufactured. Suicide kills more people than car accidents every year, kills more firefighters than fire, kills more police officers than criminals.

All of us have heard or lived a tragedy. We can do so much better. The key, break the stigma, access to care, ask the right questions, let the right information get out, like the fact that with something like depression, up to 90 percent of those who do seek treatment get better, and being honest.

OK, when I told people we were doing this special, they were like "Great!" And when I said, "And I'm going to talk about me, there were concerns." Well look, I get it, and I love the people around me.

But my concern was being at my best for my family and friends, not some faceless haters or ignorant people. So, know this.

I came home many years ago from one tragedy too many. I had weeks of bad dreams and days with flashbacks and emotional confusion. I realized over time with people telling me around me that it was affecting me, and my relationships, in ways I thought "It would pass. I'd get used to it. It was a phase. I'm just a jerk," and some of that is true.

But, finally, someone told me, "If you had a click in your knee, you'd go to see someone, right?" True. So, I went to see someone. They prescribed medicine and that I had to talk through this. I had to go through a therapy process, and understand why I wasn't processing things that were haunting me.

It helped a lot, maybe more than any other treatment I've ever had on my body. I made therapy part of my routine, to this day, and it helps, to this day. It is better than the gym, OK?

I wish I went more often. In fact, I should. In fact, maybe I don't go more often, yes, it's expensive, but also, because there's part of me that doesn't want to say "I rely on it."

Everybody say that they go to the gym five days a week. You say you go to therapy, "Oh," right? No. Like what? It betrays a weakness in me, like I care what you think, or I care about how I take care of myself, and those around me?

Too many of us do what I did and worse. Many don't even consider it illness, like cancer or diabetes or heart disease, yet none is as daunting as mental illness in terms of what it robs us of us - in this society, kills too many, debilitates many more.

Depression is not a mood. It is a malady, a medical, treatable illness. And yet, we hide from it despite it shadow-casting over everything and everyone.

The number one cause of global disability, it costs humanity more than anything in terms of productivity, $23 billion, the cost in terms of work productivity lost in the U.S. alone, forget about the families and the friends.

Think about it. Only half of all Americans experiencing an episode of major depression get treatment, but if you get it, it works. That's that 90 percent number. Think about if we had that in one of these other major illnesses.

The dark inverse, same idea, men account for 79 percent of deaths by suicide. Only 11 percent of them are found to have antidepressants in their system. They don't get treatment.

Mental illness includes addiction, very often. The reach is worse than the stat. There's one suicide for every 25 attempts. So, there's a multiplier effect of negative impact. 47,000 Americans died of opioid overdoses in 2017. Two decades ago, the number was 8,000.

Am I overwhelming you with statistics and suggestions of how big a problem mental illness is, and how the shame is in our hiding from a reality we can actually improve? Good. Then this hour was worth it.

Thank you to my good friend and Dr. Sanjay Gupta, and all of you for watching. I hope it made a difference. I know you always do.

GUPTA: Thanks for sharing that, Chris.

CUOMO: Absolutely.

GUPTA: That's going to make a difference.

CUOMO: Absolutely. If we get the information out, if we take away that it is your weakness that it is an illness, it's got to put us in the better place.

GUPTA: Yes. And I think we could all reach out, reach out to each other. You see something, you know, you see a physical malady, you reach out, mental, we often turn away. We need to change that.

CUOMO: It's the stigma.

GUPTA: That's the stigma.

CUOMO: It's the shame. I'm telling you, you know, people can say what they want. I'm huge into self-improvement. I've always believed it. Sanjay and I have been friends for a long time. I've never had anything help me in my life other than my kids, and my wife, my family, as therapy.

GUPTA: Well I think you sharing that, just like you did, and I'm just hearing this for the first time, you're my friend, I hadn't heard all that, I - I think that's - that makes a difference.

People, it helps erase that stigma. You're of strong body, you're of strong mind, Chris, so I mean I think it's - I think it's great you shared that.

CUOMO: Listen, anything I can do to help--


CUOMO: --starting with myself. Good Doctor, always a pleasure. Thank you for watching. CNN TONIGHT with D. Lemon starts right now.


CUOMO: Uh-oh, golf clap from D. Lemon.