Staff Perspective: Combatting Suicide After Suicide Prevention Awareness Month
Suicide Prevention Awareness Month may have officially ended but the efforts being taken by the DoD continue to take shape. In March of 2022, Secretary of Defense Lloyd Austin announced the establishment of the Suicide Prevention and Response Independent Review Committee (SPRIRC). The final report from the committee was released in February of this year and outlined specific recommendations on how the DoD can improve suicide prevention efforts in areas such as treatment access, training and education, public awareness campaigns, behavioral health staffing, research, and DoD policy and regulatory issues as a whole (Iwamasa et al., 2023). On September 26th, just days prior to the end of Suicide Prevention Awareness Month, Secretary Austin released a memo titled “New DoD Actions to Prevent Suicide in the Military” in which he highlighted five lines of effort the DoD has chosen to focus its efforts on the fight against suicide among military personnel.
The five lines of effort highlighted in Secretary Austin’s memo are:
- Foster a Supportive Environment
- Improve the Delivery of Mental Health Care
- Address Stigma and Other Barriers to Care
- Revise Suicide Prevention Training
- Promote a Culture of Lethal Means Safety
Out of the 111 recommendations included in the lines of effort outlined in Secretary Austin’s implementation approach, there are eight specific recommendations that target substance use/misuse, most notably the mitigation of excessive alcohol use. As stated in the SPRIRC final report, “excessive and problematic alcohol use is a national public health issue that directly impacts suicide risk” (Iwamasa et al., 2023, p. 68). It was reported by the Defense Suicide Prevention Office (DSPO) that “18% of Service members who died by suicide had an alcohol use disorder diagnosis” (Iwamasa et al., 2023, p. 68). During meetings with stakeholders, the SPRIRC committee members repeatedly heard reports from military personnel that spoke of a culture of excessive alcohol use within the U.S. Armed Forces (Iwamasa et al., 2023). Research also supports this finding and has found that one-third of active duty (AD) Service members report binge drinking in the past month and 10% report heavy drinking or binge drinking at least once per week in the past month (Meadows et al., 2021a). Among Reserve Component (RC) members the trend remains consistent with 29% reporting binge drinking in the past 30 days and 7.4% categorized as heavy drinkers (Meadows et al., 2021b).
With this increased attention on the need for enhanced services and focus on excessive alcohol use as a suicide prevention effort, many clinicians may be left to wonder- what can I do to help? In FY 2018, the Army National Guard conducted a nationwide survey of Service members who had been referred to the Army Substance Abuse Program (ASAP) although had not completed the required substance abuse assessment through a civilian behavioral health provider (White et al., 2021). In this survey, Soldiers reported access to care issues as the primary reason for being unable to complete the substance use assessment and provide required documentation to the ASAP program for further disposition. Many cited issues such as inability to pay for services, civilian providers not providing necessary documentation, and transportation issues as common barriers to care (White et al., 2021). For Service members who are already struggling with substance use, these barriers can be detrimental to their military career as well as their overall health and wellness.
While RC members have long relied on civilian providers to access care, the need among AD members has grown in recent years. In a report to Congress, the Defense Health Agency (DHA) identified the nationwide shortage of behavioral health providers has impacted DoD’s ability to provide adequate behavioral health services and has negatively impacted mission readiness. (Department of Defense, 2022). In one of the findings from the SPRIRC, it was noted that “given the DoD’s current inability to meet behavioral health care demand, leveraging community-based providers to meet the behavioral health needs of Service members is a critical strategy for addressing its current demand-supply imbalance” (Iwamasa et al., 2023, p. 86). Civilian providers are in a unique position to directly impact the behavioral health and addictions concerns for military personnel at a level we have not previously experienced.
There are key steps civilian providers can take when working with service members facing behavioral health and substance use issues to increase the likelihood of positive outcomes.
- Familiarize yourself with military culture and the potential impact of this culture on your client’s clinical presentation.
- Stay up to date on current best practices for the assessment and treatment of common behavioral health and substance use disorders experienced by military-connected clients.
- Incorporate military-specific questions into your assessment and treatment planning process.
- Consider how other cultural components may impact a military-connected client’s engagement with and preference for treatment and incorporate the tenets of intersectionality into your practice.
- Assess, treat, and refer military-connected clients to treatment for co-occurring disorders, such as sleep issues, to support sobriety and/or harm reduction efforts.
- Seek out information on current standards of documentation needed by military behavioral health staff to ensure accurate and timely dispositions can be achieved.
- Connect with military behavioral health staff in your local community and establish positive working relationships to assist with consultation and continuity of care.
- Review your professional ethics code and consider seeking additional education on unique ethical challenges you may face when working with military-connected clients.
- Integrate lethal means safety counseling into your intervention process with every client.
- Encourage military-connected clients to engage in pro-social military activities and peer-support communities.
Visit the below resources and training opportunities to establish and further develop these skills for working with service members, veterans, and their families.
- Military cultural competency and evidence-based practices: Star Behavioral Health Providers; Center for Deployment Psychology, Psychological Health Center of Excellence Clinical Support Tools
- Clinical Practice Guidelines for the assessment and treatment of military-connected clients: VA/DoD Clinical Practice Guidelines
- Best practices for treating substance use issues: American Society of Addiction Medicine, Substance Abuse and Mental Health Services Administration
- Inclusive language and health equity: Inclusive Language Guide | OHSU, Diversity, Equity, and Inclusion Collection | MedEdPORTAL
- Documentation standards for military behavioral health staff: DoD Instruction 6490.08, "Command Notification Requirements to Dispel Stigmas in Providing Mental Health Care to Service Members", DoDI 6490.04, "Mental Health Evaluations of Members of the Military Services"
- Resources and communities for military personnel: Center for Minority Veterans, Modern Military Association of America – The voice of the LGBTQ+ military and veteran community, Team Red, White & Blue, Military OneSource
- Lethal Means Safety Counseling Training: Lethal Means Counseling: Recommendations for Providers, Counseling on Access to Lethal Means
- Enroll as a provider with organizations that support Service members: Give an Hour, Military OneSource, Become a TRICARE Provider
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jennifer Nevers, LCSW, is a Military Behavioral Health Social Worker for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. She assists in the implementation and expansion of the Star Behavioral Health Providers Program (SBHP).
Suicide Prevention Awareness Month may have officially ended but the efforts being taken by the DoD continue to take shape. In March of 2022, Secretary of Defense Lloyd Austin announced the establishment of the Suicide Prevention and Response Independent Review Committee (SPRIRC). The final report from the committee was released in February of this year and outlined specific recommendations on how the DoD can improve suicide prevention efforts in areas such as treatment access, training and education, public awareness campaigns, behavioral health staffing, research, and DoD policy and regulatory issues as a whole (Iwamasa et al., 2023). On September 26th, just days prior to the end of Suicide Prevention Awareness Month, Secretary Austin released a memo titled “New DoD Actions to Prevent Suicide in the Military” in which he highlighted five lines of effort the DoD has chosen to focus its efforts on the fight against suicide among military personnel.
The five lines of effort highlighted in Secretary Austin’s memo are:
- Foster a Supportive Environment
- Improve the Delivery of Mental Health Care
- Address Stigma and Other Barriers to Care
- Revise Suicide Prevention Training
- Promote a Culture of Lethal Means Safety
Out of the 111 recommendations included in the lines of effort outlined in Secretary Austin’s implementation approach, there are eight specific recommendations that target substance use/misuse, most notably the mitigation of excessive alcohol use. As stated in the SPRIRC final report, “excessive and problematic alcohol use is a national public health issue that directly impacts suicide risk” (Iwamasa et al., 2023, p. 68). It was reported by the Defense Suicide Prevention Office (DSPO) that “18% of Service members who died by suicide had an alcohol use disorder diagnosis” (Iwamasa et al., 2023, p. 68). During meetings with stakeholders, the SPRIRC committee members repeatedly heard reports from military personnel that spoke of a culture of excessive alcohol use within the U.S. Armed Forces (Iwamasa et al., 2023). Research also supports this finding and has found that one-third of active duty (AD) Service members report binge drinking in the past month and 10% report heavy drinking or binge drinking at least once per week in the past month (Meadows et al., 2021a). Among Reserve Component (RC) members the trend remains consistent with 29% reporting binge drinking in the past 30 days and 7.4% categorized as heavy drinkers (Meadows et al., 2021b).
With this increased attention on the need for enhanced services and focus on excessive alcohol use as a suicide prevention effort, many clinicians may be left to wonder- what can I do to help? In FY 2018, the Army National Guard conducted a nationwide survey of Service members who had been referred to the Army Substance Abuse Program (ASAP) although had not completed the required substance abuse assessment through a civilian behavioral health provider (White et al., 2021). In this survey, Soldiers reported access to care issues as the primary reason for being unable to complete the substance use assessment and provide required documentation to the ASAP program for further disposition. Many cited issues such as inability to pay for services, civilian providers not providing necessary documentation, and transportation issues as common barriers to care (White et al., 2021). For Service members who are already struggling with substance use, these barriers can be detrimental to their military career as well as their overall health and wellness.
While RC members have long relied on civilian providers to access care, the need among AD members has grown in recent years. In a report to Congress, the Defense Health Agency (DHA) identified the nationwide shortage of behavioral health providers has impacted DoD’s ability to provide adequate behavioral health services and has negatively impacted mission readiness. (Department of Defense, 2022). In one of the findings from the SPRIRC, it was noted that “given the DoD’s current inability to meet behavioral health care demand, leveraging community-based providers to meet the behavioral health needs of Service members is a critical strategy for addressing its current demand-supply imbalance” (Iwamasa et al., 2023, p. 86). Civilian providers are in a unique position to directly impact the behavioral health and addictions concerns for military personnel at a level we have not previously experienced.
There are key steps civilian providers can take when working with service members facing behavioral health and substance use issues to increase the likelihood of positive outcomes.
- Familiarize yourself with military culture and the potential impact of this culture on your client’s clinical presentation.
- Stay up to date on current best practices for the assessment and treatment of common behavioral health and substance use disorders experienced by military-connected clients.
- Incorporate military-specific questions into your assessment and treatment planning process.
- Consider how other cultural components may impact a military-connected client’s engagement with and preference for treatment and incorporate the tenets of intersectionality into your practice.
- Assess, treat, and refer military-connected clients to treatment for co-occurring disorders, such as sleep issues, to support sobriety and/or harm reduction efforts.
- Seek out information on current standards of documentation needed by military behavioral health staff to ensure accurate and timely dispositions can be achieved.
- Connect with military behavioral health staff in your local community and establish positive working relationships to assist with consultation and continuity of care.
- Review your professional ethics code and consider seeking additional education on unique ethical challenges you may face when working with military-connected clients.
- Integrate lethal means safety counseling into your intervention process with every client.
- Encourage military-connected clients to engage in pro-social military activities and peer-support communities.
Visit the below resources and training opportunities to establish and further develop these skills for working with service members, veterans, and their families.
- Military cultural competency and evidence-based practices: Star Behavioral Health Providers; Center for Deployment Psychology, Psychological Health Center of Excellence Clinical Support Tools
- Clinical Practice Guidelines for the assessment and treatment of military-connected clients: VA/DoD Clinical Practice Guidelines
- Best practices for treating substance use issues: American Society of Addiction Medicine, Substance Abuse and Mental Health Services Administration
- Inclusive language and health equity: Inclusive Language Guide | OHSU, Diversity, Equity, and Inclusion Collection | MedEdPORTAL
- Documentation standards for military behavioral health staff: DoD Instruction 6490.08, "Command Notification Requirements to Dispel Stigmas in Providing Mental Health Care to Service Members", DoDI 6490.04, "Mental Health Evaluations of Members of the Military Services"
- Resources and communities for military personnel: Center for Minority Veterans, Modern Military Association of America – The voice of the LGBTQ+ military and veteran community, Team Red, White & Blue, Military OneSource
- Lethal Means Safety Counseling Training: Lethal Means Counseling: Recommendations for Providers, Counseling on Access to Lethal Means
- Enroll as a provider with organizations that support Service members: Give an Hour, Military OneSource, Become a TRICARE Provider
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jennifer Nevers, LCSW, is a Military Behavioral Health Social Worker for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. She assists in the implementation and expansion of the Star Behavioral Health Providers Program (SBHP).