Remarks by the First Lady at a Joining Forces Medical College Event at Virginia Commonwealth University in Richmond, Virginia

MRS. OBAMA: Thank you. (Applause.) Thank you all so much. Thank you so much. You all, please be seated. Good afternoon. And again, thank you. I want to thank John for that very kind introduction.

And a very special thanks to Specialist Cedric Holland. That was I know a very difficult thing to share, but that's what this is all about. And we thank Specialist Holland for your service to this nation and for showing strength by standing up today and sharing that story. It is truly admirable.

I'd also like to thank Virginia's First Lady, Maureen McDonnell, who is here with her daughter Rachel. Thank you for being here. (Applause.) There they are. And I want to thank you for your work, your efforts; you've been doing it on the ground for years. And I'm grateful for your support. I'd also like to recognize Congressman Scott, who is here, as well as -- Congressman. (Applause.) As well as Richmond Mayor Dwight Jones, who is here today. (Applause.) Thank you all for joining us.

I also want to thank Jerry Strauss and everyone here at VCU not only for hosting us today, but for all that you do every day to advance our understanding of the signature injuries of our 9/11 generation of troops -– post-traumatic stress and traumatic brain injuries.

And finally, I want to thank everyone here -- our active duty troops, our veterans, the deans and administrators from medical schools across the country, and of course the VCU medical students. Thank you all for coming together to support the health and welfare of our veterans and their families.

Now, as many of you know, I have devoted much of my time as First Lady to military family issues, because quite frankly, these families truly inspire me. It's as simple as that.

I have traveled to bases all across the country. We have held barbeques. We visited hospitals. I've sat with our courageous wounded warriors, spoken with the survivors of our fallen. I have been especially moved by the strength of our military spouses and our military children.

I am awed by the sacrifices they make -- enduring long deployments; uprooting their lives; moving from base to base, year after year; running households and raising kids all alone while a loved one is overseas.

I'm amazed by the young people who manage to stay so strong while adjusting to new schools every few years; children who pick up extra chores around the house, take on new responsibilities, all while shouldering the emotions of a parent's deployment.

These are the men, women and children who inspired me and Jill Biden to start our Joining Forces initiative. We wanted to honor, to recognize, and to support these magnificent military families.

And the idea is very simple: In a time of war, when our troops and their families are sacrificing so much, we all should be doing everything we can to serve them as well as they're serving this country.

And it's an obligation that extends to every single American. And it's an obligation that does not end when wars draw to a close and troops return home. In many ways, that's when the real work begins.

And that was never more clear to me than last month, when I joined my husband to welcome home some of our troops from Iraq. We were in Fort Bragg, in a huge hangar packed full of soldiers. And it was a proud, historic day; an extraordinary achievement nearly nine years in the making.

Every single soldier there had done their duty and they had done it well. And as the President said, their service now belonged to the ages. But I couldn't shake the feeling that even though we were marking the end of a war, even though so many of our troops were coming home, this was not an ending for them.

See, we all must remember in this country that, for our troops, the end of war marks the beginning of a very long period of transition. For some, it means a transition from combat to duty in a base, or perhaps even a future deployment.

For those whose military service is over, those who will enter our newest generation of veterans, it means a transition home -- a transition to our cities and our towns to our classrooms and offices, to finally just being Dad or Mom, a husband, wife, neighbor or friend once again.

And the truth is, those transitions are not always easy. In some cases, they bring with them the hardest moments our troops and their families will ever face. For some of our men and women, coping with the realities of war long after they've faded is the most difficult struggle they will face yet.

And that's what we're here to address today -- the mental health challenges that so many of our troops face once they return home.

Now, first, it's important to emphasize that the majority of our troops return home with few or no mental health issues at all. And they are continuing to give back. They are continuing to do so much for this country, even when they're out of uniform.

They're in our communities leading our businesses and jumpstarting new careers. They're volunteering everywhere, serving on school boards, getting active in our faith communities. And they do it all with such grace that most of the time, the rest of us don't even notice the enormous transitions they've gone through.

The military has a number of programs to help troops decompress and make these transitions, but the fact remains that they make these sharp physical and emotional shifts in unimaginably short periods of time. I mean, just think about it -- when they're deployed, they have a clear, urgent, and all-consuming mission. They're surrounded by colleagues and friends who completely understand exactly what they're going through. But when these young men and women get back to their home communities, so much of that vanishes.

Their combat buddies gone, spread out all over the country. And while they cherish the love and support of those closest to them -- spouses, children, parents, siblings -- often their loved ones can't begin to fathom what they've been through.

And for so many of our returning troops and veterans, that's when the memories, the images, the emotional wounds that they learned to cope with overseas come flooding back. It might be the aching loss over a fallen friend. It might be the memories of shock from an explosion that rocked their vehicle, or a flashback to the chaos of a firefight.

For some, it could be anything that triggers a traumatic episode: an engine backfiring, a passing ambulance, a rock hitting the windshield.

And some can't sleep at night. Others suffer nightmares that keep coming back, or they're overwhelmed by deep despair that just won't go away, or fits of rage that seem to come from nowhere.

Now, the rest of us can try, on an intellectual level, to understand PTSD or TBI, or post-combat depression. We can learn terms, and we can certainly listen compassionately to stories. But mere words and anecdotes don't do any of this justice. Just doesn't.

Those of us who have never experienced war will never be able to fully understand the true emotional costs. And as a result, many of us often misinterpret what our troops and vets and military families go through.

Even today, as we continue to educate the public and learn more and more, there is a certain stigma that still remains. So I want to be very clear today. These mental health challenges are not a sign of weakness. They are not a sign of weakness. PTSD, TBI, depression, and any other combat-related mental health issue should never again be a source of shame. Never.

These emotional waves, these traumatic incidents are natural, human responses to the brutality of war. And it's been that way throughout the ages -- and today's wars are no different.

Fortunately, we are developing a better understanding of these issues. Studies show that as many as one in six veterans of Iraq and Afghanistan have reported symptoms of PTSD. Similar numbers have reported signs of post-deployment depression. Our National Guardsmen and Army Reservists are affected by higher rates of both. And since the year 2000, more than 44,000 of our service members have suffered at least a moderate-grade traumatic brain injury.

And those are the invisible wounds of war.

To cope, some turn to substances. Some contemplate suicide. And many of our troops just don't ask for help because, as one of our troops said, and this is a quote, "You don't want people to think you're weird, so you bury it." You bury it. But at home, you can't always bury it. It affects the whole family. Kids notice that Dad or Mom is acting differently. Spouses, parents, friends notice that something's changed. And sometimes, the effects can't be ignored.

Gina Hill, a military wife from Kansas, wrote me a letter about how her PTSD-stricken husband would lapse into full combat mode right in their own home. And she wrote -- and this is what she said -- she said, "We are struggling here. It shouldn't be this hard. We shouldn't have to fight the war once our spouses come home. But the reality is, we do."

Now, this is a feeling that's shared by military families all across this country. Our heroic military spouses, for all of their strength, you could see how they might begin to feel a sense of personal isolation, or perhaps a strain in their marriage, or that they lack the knowledge or the skills to properly care and help the ones they love.

Those incredible, resilient military kids and teenagers can sometimes end up shutting down, maybe acting out in school, or maybe they become distant, even scared of a parent suffering from PTSD or TBI. And many of these veterans and families, they don't live in military communities. If they seek help, they rely on family doctors, local clinics, or public or private hospitals throughout the country.

And we've seen from prior wars that as many as 60 percent of veterans with PTSD sought help outside of the VA system. And of our Iraq and Afghanistan veterans who have returned home, only about half have sought any type of care through the VA system at all.

So what this tells us is that we have to meet our veterans and military families where they live. We have to engage all of this country's doctors, nurses, health care providers on the variety of health issues these families face, especially on issues of mental health.

And that's why I am so proud to be with all of you today, because we are taking a big step forward to achieving that goal -- now and for years to come.

Today, the nation's medical colleges are committing to create a new generation of doctors, medical schools, and research facilities that will make sure that our heroes receive care that is worthy of their service.

It is an effort that's led by the Association of American Medical Colleges, or the AAMC, and 105 of its member institutions. It also includes the American Association of Colleges of Osteopathic Medicine and 25 of its schools.

Together, these organizations are committing to train their medical students, as well as their current physicians, faculty, and staff to better diagnose and treat our veterans and military families. They're going to develop new research and clinical trials on PTSD and TBI so that we can better understand and treat those conditions.

They're going to share their information and best practices with one another through a collaborative web forum created by the AAMC. And they will continue to work with the VA and the Department of Defense to make sure that everyone in this country is providing the best care available. So that's their pledge.

And I want to emphasize that these commitments are coming from schools all across the country: Harvard, Stanford, Wake Forest, UCLA, Michigan, and so many more. Everyone is stepping up. And we've seen that so many of these institutions are already making strides on these issues.

For example, researchers at the University of Pittsburgh are developing a new imaging tool that allows us to see the wiring of the brain in vivid high definition, which could lead to some wonderful new breakthroughs in the diagnosis of TBI.

At the University of South Florida, they're working with the Department of Defense and the VA to create a first-of-its-kind Center for Veterans Reintegration, which will mean a single, cohesive, research, treatment and education facility for veterans and families.

And right here at VCU, they're leading a groundbreaking project to provide resources and training to health care providers, to volunteers, to community members throughout the state of Virginia who can help ease the transition home for veterans with TBI and PTSD.

So there is already a lot of wonderful work going on, so just imagine how much more will be achieved when 130 of some of the best schools in the country are better connected with one another, when they're sharing their best practices, when they're communicating more quickly and more effectively. So this is a big deal.

From what I understand, you guys don't collaborate a lot on stuff, right? (Laughter.) And it comes on top of the unprecedented steps that this administration has taken on behalf of our veterans and their families.

By husband is strengthening the VA and its ability to treat PTSD and TBI. And he's hiring and training more mental health counselors. He's improving suicide prevention. And he signed legislation that allows caregivers to receive the skills and stipends they need to care for their loved ones.

And just yesterday at the White House, we hosted representatives from many of the nation's largest health care organizations for our Joining Forces roundtable discussion with America's medical associations. And in the coming weeks, we're going to be announcing commitments from these groups that we hope will begin to take effect immediately.

So we are making some magnificent progress here. And I know that if we continue to engage government, military, and the entire health community, we will continue to make progress. But it will mean real work. It will mean every single one of us doing our part.

And with that in mind, I just want to take a moment to speak directly to the medical students who are here today.

To all of you young people, I just want to emphasize the power in your chosen profession. And I couldn't do it. That's why I went to law school. (Laughter.) It's too hard. And I know you hear this a lot from your professors and alumni, but you will be there for some of your patients' most powerful life moments.

It is the essence of true service. And when that patient is one of our veterans or one of their family members, you will a have a unique opportunity and responsibility to make an impact on their lives. You will single-handedly be able to show these heroes that this country is there for them, no matter what they're going through.

So this country is counting on you -- no pressure --counting on all of you to do exactly that for our veterans and military families. We're counting on you to be medical professionals who understand their unique challenges; professionals who make these heroes feel comfortable, who will give them a level of care that honors their service and sacrifice. And again, those are big responsibilities, but I know you can do it.

I know how much talent, commitment and discipline that it takes to succeed in medical school. And I know that when you direct all of your skills and passions toward helping our veterans and military families, you will make a world of difference on these issues. You will change these heroes' lives for the better forever. You'll uphold our nation's sacred trust with our veterans and their families.

And to all of the troops and veterans we have here, I want you to know one thing: that no matter where you are, no matter what you're going through, please know that America will be there for you and your families. So if you are struggling, please don't be afraid to speak up. If you know someone else who is struggling, encourage them to seek help. Don't bury it.

Asking for support is a sign of strength. We're already proud of you. It can also set an example for those who have served alongside you. It can help fight the stigma that surrounds PTSD, depression, and other mental health issues, and not just in the military, but for Americans of all kinds who struggle with these issues. Because if others see that the strongest, most courageous among us are sure enough to step up and speak out, then maybe, just maybe they might be more likely to find the strength within themselves to do the same thing.

And once you do reach out, I am confident that you will feel America's unmatched capacity for compassion. You will find doctors and people throughout the health care system who understand these issues and can give you the care you need. You will see how much goodwill there is out there for you and your families. And that's what I see every day through Joining Forces. That is the beauty of this initiative and my role in it.

We are seeing America step up on issues of all kinds -- when asked. It's happening all across the country, and it's going to keep happening. There is no shortage of people who want to help because America is here for the long haul -- not just today when the lights are bright and the cameras are on. Not just at a rally at Fort Bragg. Not just on Veterans Day or September 11th, but every day.

And I'm not going to stop. The President is not going to stop, and all the people here are not going to stop until you feel the full force of this country's love and admiration. That should be our pledge to you.

So I want to thank you for your unparalleled service and incredible sacrifice. I want to thank the medical school students. I want to thank the deans, the administrators for helping us fulfill this country's commitment to our troops, veterans, and military families.

And I truly look forward to working with all of you in the months and years ahead.

God bless you all, and may God bless the United States of America. Thank you so much. (Applause.)