Alan Berman, PhD, ABPP David Jobes, PhD, ABPP Colonel John Bradley, MD, MC Janet Kemp, RN, PhD USA Bonnie Carroll David Litts, OD Major, USAFR, Retired Colonel, USAF, Retired Robert Glenn Certain, DMin Richard McKeon, PhD, MPH Colonel, USAFR, Retired Chief Master Sergeant Jeffory C. Gabrelcik Master Gunnery Sergeant Peter Proietto USAF USMC Sergeant Major Ronald Green Major General Philip Volpe, DO, MC USA USMC Marjan Ghahramounlou Holloway, PhD Commander Aaron Werbel, PhD USN Table of Contents TABLE OF CONTENTS EXECUTIVE ABSTRACT ............................................................................................................ v EXECUTIVE SUMMARY ........................................................................................................... 1 DEDICATION .......................................................................................................................... 1 1. BACKGROUND, ORGANIZATION, AND ACTIVITIES OF THE TASK FORCE ............................. 1 1.1 Congressional Charter and Task Force Membership ......................................................... 1 1.2 Methodology ..................................................................................................................... 3 1.3 Task Force Meetings .......................................................................................................... 3 1.4 Sites Visited ........................................................................................................................ 4 1.5 Writing Groups .................................................................................................................. 4 1.6 Guiding Principles .............................................................................................................. 4 2. INTRODUCTION ............................................................................................................... 7 2.1 Overview ............................................................................................................................ 7 2.2 Nature of the Challenge of Preventing Suicide .................................................................. 7 2.3 International Perspective on Suicide and Suicide Prevention............................................ 9 2.4 National Perspective on Suicide and Suicide Prevention ................................................. 10 2.5 Military Perspective on Suicide and Suicide Prevention .................................................. 11 3. EVOLUTION OF SERVICE SUICIDE PREVENTION PROGRAMS ............................................ 13 3.1 Department of Defense ................................................................................................... 13 3.2 United States Army .......................................................................................................... 15 3.3 United States Navy .......................................................................................................... 19 3.4 United States Air Force .................................................................................................... 22 3.5 United States Marine Corps ............................................................................................. 26 3.6 United States Coast Guard .............................................................................................. 30 4. VISION ........................................................................................................................... 35 5. STRATEGY ...................................................................................................................... 35 6. ASSESSMENT ................................................................................................................. 41 6.1 Service Suicide Data and Statistics .................................................................................. 41 6.2 An Assessment of Service Suicide Prevention Programs ................................................. 42 6.3 Occupational Risk and Military Suicides .......................................................................... 43 7. FINDINGS AND RECOMMENDATIONS ............................................................................. 45 7.1 Organization and Leadership .......................................................................................... 49 7.1.1 Create, restructure and resource suicide prevention offices at OSD, the Services, installations, and unit level to achieve unity of effort .............................................. 49 7.1.2 Equip and empower leaders (provide them tools) to establish a culture that fosters prevention as well as early recognition and intervention. ....................................... 56 7.1.3 Develop strategic communications that promote life, normalize “help-seeking behaviors,” and support DoD suicide prevention strategies. ................................... 59 i DoD Task Force on the Prevention of Suicide by Members of the Armed Forces 7.1.4 Reduce stigma and overcome military cultural and leadership barriers to seeking help ............................................................................................................................ 62 7.1.5 Standardize Suicide Prevention Policies and Procedures ......................................... 67 7.2 Wellness Enhancement and Training .............................................................................. 70 7.2.1 Enhance well-being, mental fitness, life skills, and resiliency ................................... 70 7.2.2 Reduce Stress on the Force and on Military Families ............................................... 73 7.2.3 Transform suicide prevention training of Service Members, leaders, and families to enhance skills............................................................................................................. 75 7.3 Access to, and Delivery of, Quality Care .......................................................................... 78 7.3.1 Ensure available and reliable access to high-quality behavioral healthcare. ........... 78 7.3.2 Leverage and coordinate military community-based services, as well as local civilian community services (especially with respect to the Reserve Component) .............. 81 7.3.3 Ensure continuity of behavioral healthcare, especially during times of transition, to ensure seamlessness of healthcare and care management. .................................... 84 7.3.4 Standardize effective crisis intervention services and hotlines ................................ 90 7.3.5 Ensure all “helping professionals” are trained in the competencies to deliver evidence-based care for the assessment, management, and treatment of suicide- related behaviors....................................................................................................... 92 7.3.6 Develop effective postvention programs to support families, Service Members, and unit leaders after a suicide. ....................................................................................... 94 7.4 Surveillance, Investigations, and Research ..................................................................... 99 7.4.1 Conduct comprehensive surveillance aimed at identifying individuals at-risk and informing prevention efforts. .................................................................................... 99 7.4.2 Standardize investigations of suicides and suicide attempts to identify target areas for prevention policies, procedures, and programs. ............................................... 101 7.4.3 Ensure that all initiatives and programs have a program evaluation component . 105 7.4.4 Support and incorporate ongoing research to inform evidence-based suicide prevention practices. ............................................................................................... 105 8. CONCLUSION ............................................................................................................... 107 Appendix A. Section 733 of the National Defense Authorization Act of FY 2009 ................... A-1 Appendix B. Summarized Responses to NDAA 09 Requirements ......................................... B-1 Appendix C. Task Force Member Biographies ...................................................................... C-1 Appendix D. Task Force Meetings October 2009–July 2010 ................................................. D-1 Appendix E. Briefings Received at Task Force Meetings ....................................................... E-1 Appendix F. Sites Visited by Task Force Delegations ............................................................ F-1 Appendix G. Service Suicide Data by Career Field ................................................................ G-1 Appendix H. International Perspective on Suicide in Military Populations ........................... H-1 Appendix I. Listing of DoD Suicide Prevention Research ....................................................... I-1 ii Table of Contents Appendix J. Recommended Level of Responsibility to Implement Task Force Recommendations ......................................................................................................... J-1 Appendix K. Glossary .......................................................................................................... K-1 Appendix L. Acronyms ........................................................................................................ L-1 Appendix M. References ...................................................................................................