Mental Health Problems

Overview | What to Look For | What to Do | What to Avoid
What to Expect | Troubleshooting

Overview

A Marine whose behavior appears irrational or completely out of touch with reality may be seriously mentally ill. The care required is beyond the scope and capabilities of leadership or non-medical agencies to help with the problem. In such cases the Marine should be escorted to a mental health evaluation immediately.

What to Look For

• Irrational, out-of-control behavior.
• Behavior that is dangerous to self or others.
• Not sleeping for several days.
• Hearing voices that are not there.
• Seeing things that are not there.
• Delusions (firmly believing things that seem irrational to anyone else).
• Paranoia (e.g., exaggerated fears of being watched or attacked).
• Markedly deteriorating hygiene.
• Talking to self.
• Speech or other communication that does not make sense.
• Extreme changes in behavior.

What to Do

• If the safety of the Marine or others is at risk, call security.
• Try to keep the Marine calm and remove any distractions in the room.
• When it is safe to do so, observe and try to recognize what you think the problem may be.
• Privately ask others what they feel the problem may be.
• With others present for safety, but in an otherwise private manner, ask the Marine how he is doing.
• Use active listening skills so that the Marine may open up to you.
• If the Marine is reluctant to talk, help him understand that you are concerned that he seems to be having a hard time and you want to help him get back on track before it affects his career.
• Listen closely for what the underlying problems may be.
• Suggest some possibilities (sounds like you are having problems with …)
• If you think the Marine might be suicidal, take appropriate action.
• If the Marine endorses a problem, ask if they would like some help with it.
• If upon observation it does not seem like the problem is a severe mental health problem, see the suggestions for what to do when a Marine is disruptive in the unit.
• If the problem does seem like a serious mental disorder, ask if the Marine is willing to go voluntarily for mental health evaluation.
• If so, call ahead to mental health to let them know you need an urgent evaluation and ask how they suggest for you to escort the Marine over there safely.
• If not, call mental health and initiate a Command Directed Evaluation.

What to Avoid

Marines who are mentally ill can be dangerous. There are certain things that are just not safe to do, such as:

• Interviewing the Marine alone - have someone else there just in case the Marine turns on you suddenly.
• Yelling at or acting aggressively toward the Marine.
• Taunting the Marine.
• Trying to contain the Marine if they try to leave – Call Security
• Ordering the Marine to go to a mental health evaluation in voluntarily without due process (see Command Directed Evaluation)
• Telling others who don't need to know.
• Gossiping about the Marine.
• Making an example out of the Marine.

What to Expect after Taking Action

Assessment of serious mental illness is best accomplished as a voluntary collaborative effort between the Marine, a qualified mental health professional and others who know the Marine and have observed their daily activities. Here is how the process should go:

• Most Marines will consent voluntarily to evaluation and treatment.
• If found seriously mentally ill, the Marine may be hospitalized for further evaluation and treatment.
• If the Marine is not hospitalized, appropriate outpatient treatment will be recommended and the Marine will be returned to the command.
• Upon return to the command, Medical should communicate the following to the command:
  • Current level of risk.
  • Recommended protective measures and monitoring, if any.
  • Administrative recommendations (fitness for duty, suitability for continued service, recommendations for separation/retention).
  • Medical follow-up appointments.
  • What to do if the Marine's condition worsens or does not improve.
• In most cases, serious mental illnesses (schizophrenia, bipolar disorder, other psychotic illnesses) are not compatible with continued service in the Marine Corps. If the disorder is less serious, such as with some cases of moderate depression or anxiety, the condition may be treatable to the extent that active duty may be continued on a limited duty or even full duty basis.
• Commanders, SNCOs, and supervisors may be asked by the mental health provider to provide information that might otherwise be unavailable. Leaders are encouraged to contribute to the evaluation by sharing observations related to the member's functioning in the unit. This is important, because the Marine may minimize problems during the evaluation, leading to inadequate diagnosis of the problem, especially if it is subtle.
• Sometimes Marines with serious mental illness will have thoughts of suicide but will not meet criteria for admission to a hospital. In this situation, outpatient treatment is offered to address the suicidal thoughts and behavior, in addition to the other mental illness. Often, outpatient treatment is preferable to hospitalization when risk of self-harm is not imminent. Commanders will be notified of any increase in dangerousness or changes in recommendations regarding duty status.
• If hospitalized at a civilian facility, prompt re-evaluation at the Medical Treatment Facility following discharge is essential, because civilian providers may not understand the special risks of the military environment or fitness-for-duty issues. Leaders will be notified as to the time of this appointment. Leaders can help ensure that the Marine attends the post-discharge appointment.
• The unit, as well as the mental health provider, should monitor Marines who have recently been evaluated or discharged from a psychiatric hospital to ensure safety is maintained and any relapse is recognized early. Unit leaders should consider the following to ensure appropriate monitoring and support:
  • The Mental Health provider responsible for the Marine's care will share information about the member's status that is important for leaders to know.
  • The mental health provider should see the Marine regularly in follow-up. Additional visits with a Chaplain, Substance Abuse Counseling Officer (SACO), or Family Advocacy Program (FAP) staff do not substitute for face-to face contact with a mental health provider.
  • Someone in the unit should check in with the Marine daily to monitor their condition, provide support, and ensure their needs are being met.
  • Leaders should share changes in the Marine's status at work with the mental health provider (e.g., deterioration in performance, recent disciplinary action, etc.).

Troubleshooting

• Marine refuses voluntary evaluation: If you have sufficient cause to be concerned that the Marine might be mentally ill, but the Marine does not want to be evaluated, the Commanding Officer will need to initiate a Command Directed Mental Health Evaluation. In cases where the Marine is at risk for harm to self or others, an emergency evaluation is appropriate and the process of a Command Directed Evaluation is not necessary. If you have concerns, call medical immediately to discuss your options.
• Marine found to have mental disorder but is not hospitalized: If your Marine is evaluated by Medical and found to have a mental disorder, but does not warrant hospitalization, then you will need to work with Medical on the best course of action. Upon return to the command, Medical should communicate:
  • Current level of risk.
  • Recommended protective measures and monitoring, if any.
  • Administrative recommendations (fitness for duty, suitability for continued service, recommendations for separation/retention).
  • Medical follow-up appointments.
  • What to do if the Marine's condition worsens or does not improve.
• Treatment is offered, but Marine refuses treatment: There may be times when a Marine will be found to have a mental disorder but not imminently dangerous, and so is not hospitalized but is returned to full duty. Sometimes the Marine may refuse to return to mental health for follow-up care. These situations are challenging since a member who is not at imminent risk for self-harm cannot be mandated to receive medical or mental health treatment. It is essential that leaders and mental health providers communicate and collaborate to maximize the Marine's ongoing safety. Discussion topics should include:
  • Current level of risk.
  • Recommended protective measures and monitoring, if any.
  • Administrative recommendations (fitness for duty, suitability for continued service, recommendations for separation/retention).
  • Recommended Medical follow-up appointments.
  • What to do if the Marine's condition worsens or does not improve.
• Marine wishes to leave the hospital against medical advice (AMA): After a Marine has been hospitalized against their will for a certain maximum amount of time, they cannot legally he held any longer without appropriate due process. Usually they will stay when they see that they are receiving the treatment they need, but sometimes they will not. A court order is usually required in such cases. Medical usually takes care of this, if the Marine is at high risk. However, in rare cases you may know something medical does not know and will need to assist them. In some cases they may still be at more risk than you feel comfortable handling back at the unit, but the Marine just does not meet the legal hurdles for further hospitalization. In that case you will need work closely with Medical on the best course of action. Upon return to the command, Medical should communicate:
  • Current level of risk.
  • Recommended protective measures and monitoring, if any.
  • Administrative recommendations (fitness for duty, suitability for continued service, recommendations for separation/retention).
  • Medical follow-up appointments.
  • What to do if the Marine's condition worsens or does not improve.
• Marine is treated but is not getting better: If your Marine is in treatment but does not appear to be improving, you will need to work closely with Medical on the best course of action. They may:
  • Have other treatment approaches available to them (different medications or therapies).
  • Recommend changing the Marine to limited duty status so they are not deployable.
  • Recommend administrative actions or medical retirement in cases where long-term improvement is unlikely with any reasonable treatment.