Leaders Guide - Suicidal Behavior

Suicide is the second leading cause of death in the Marine Corps. Even one death by suicide is too many. It is a tragic and preventable loss, causing untold grief to loved ones and units, and is of highest concern to the public, legislators, the Commandant, and all Marines. In addition, suicide and suicidal behavior at all levels can take a tremendous toll on the readiness and resources of the unit involved. For all these reasons, suicide awareness, prevention, and intervention must be of highest priority to all Marines, and especially Marine leaders.

The Marine Corps sees suicide prevention as the responsibility of the entire Marine Corps community. Each of us, as fellow Marines, family members, and friends, is responsible for encouraging those who are troubled to seek help while their problems are still small, before they affect their relationships, work performance, career, mental health, or desire to live. Thus, suicide is prevented in your unit by addressing quality of life concerns and watching for “red flags” on a daily basis. Watching out for each other helps keep us ready to serve. The following information is designed to inform you of specific issues regarding suicidal behavior, what to do about it, and available resources to help your Marines be as mentally healthy and resilient as possible, decreasing the likelihood of suicidal behavior within your unit.

Suicide :: Intentionally killing oneself.
Suicide Attempt :: A potentially self-injurious act with a non-fatal outcome, for which there is at least some intent to die. A suicide attempt may or may not result in injuries.
Suicide Gesture :: A potentially self-injurious act with a non-fatal outcome for which there is no evidence of intent to die. A suicide gesture may or may not result in injuries.
Suicide Threat :: Declaration of intent or determination to kill oneself.
Suicidal Ideation :: Expressions or thoughts about killing oneself.
Medical :: The local Military Medical Treatment Facility, Company, Battalion, BAS, Mental Health Department, OSCAR Team, or whatever unit you may have, which takes care of your local Mental Health needs, specifically suicide risk evaluations and treatment.

Marines who attempt or commit suicide may face problems they feel cannot be resolved. Normally, there are alternatives to these problems. However, someone who is suicidal may not be thinking clearly and cannot see the other possible positive solutions.

Unit members who are at an increased risk for suicide present a significant challenge for leaders. Because those who are truly suicidal often keep their suicidal thoughts to themselves, effective suicide prevention requires everyone in the unit to be aware of the risk factors for suicide and know how to respond. Commanders, SNCOs, and supervisors must lead the way. Any individual who reports suicidal thoughts or behaviors must always be taken seriously.

It is also important to proactively ask about possible thoughts of suicide when unit members are dealing with significant life difficulties. Don't assume that merely because someone has not told you they are feeling suicidal, that they are safe. Be especially vigilant with individuals facing multiple stressors. Such individuals are typically at higher risk for suicide.

Marines may be reluctant to seek help because of fears that such help will negatively impact their careers. Unfortunately, this often means a Marine in distress delays seeking help until the problem becomes so big that it affects their behavior both on and off work until, ultimately, they begin to collect Page 11 counseling entries, Letters of Reprimand, and NJPs. The consequence of waiting too long to seek help is what damages their career. Getting help early does not. As leaders, you must combat the myth that seeking help early damages careers.

Another fear Marines have is that their Commander will have complete access to their mental health records. In fact, however, for most of those who self-refer to Mental Health, confidentiality is maintained. In cases where information is released, the cases either involve mandatory reporting or the unit leadership was solicited to be a resource for the member (with the Marine's consent).

Some Marines incorrectly believe mental health information is entered into their Military Record. Mental health clinical information is recorded in the outpatient medical record and the appropriate mental health file but not the Military Record unless they are found unfit or unsuitable for duty.

The main approach to suicide prevention in the Marine Corps is via each command through annual Suicide Awareness Training for all Marines (MCO P1700.29 paragraph 1005.1.a.). Commands have a variety of resources available to them, including the training kit, “Suicide Prevention: Taking Action, Saving Lives,” which is designed so that any leader can give the presentation. The kit includes an 18-minute video with real life scenarios on a wide variety of issues including a Marine Officer in distress after being passed over for promotion and another Marine whose relationship has recently ended. It also includes a suggested lecture, transparencies, and answers to frequently asked questions about suicide. The kits were originally distributed in October 2000, but can still be ordered free of charge through the Defense Visual Information Website at http://trol.redstone.army.mil/cgi-bin/davis_ditis/davis_descr.pl?recnum='999114907'&lognumber=1056325.

Suicide prevention must go beyond just training by recognizing, and responding appropriately when suicidal signs and symptoms are evident. Suicide prevention must also occur by establishing a culture in which seeking help for problems is not only acceptable but also expected to protect the readiness and effectiveness of the unit. This is done by establishment of a variety of protective factors within the individual and command, which reduce the probability that difficulties will turn into serious behavioral or physical health problems.

Every person is at a different level of risk for experiencing difficulties, based on their balance of protective and risk factors. The key to suicide prevention is to increase the protective factors and to decrease the risk factors. We are not just focusing on eliminating negative factors, but also on increasing positive factors that will improve the quality of life for Marine Corps members. As a Marine Corps leader, whether enlisted or officer, you contribute to the presence of these factors.

It is also essential that you know the agencies and resources available to help when someone comes to you with a problem. All of us, especially leaders, have a responsibility to match the needs of our members with available resources. Each installation has a branch of Marine Corps Community Services (MCCS) called the Marine and Family Services (MFS) Center, which knows and coordinates with representatives from each of the helping agencies on base. They routinely work collaboratively with other agencies to identify base-wide needs and to coordinate the delivery and referral of services to meet these needs. Services at each base vary, but typical offerings by individual agencies include:

MCCS One Source is another important resource for Marines in distress. The services of MCCS One Source supplement the existing support system for Marines and their families by providing assistance 24 hours a day, 7 days a week via toll free telephone and Internet access. In addition, MCCS One Source supports geographically dispersed Marines and their families (recruiters, Inspector and Instructor staffs, and mobilized reservists) who do not have traditional services available. Resources are available on topics to include parenting and childcare issues, education services, financial information and counseling, legal, elder care, health and wellness, crisis support and relocation.

The training kit, “Suicide Prevention: Taking Action, Saving Lives,” is designed so that any leader can give the presentation. The kit includes an 18-minute video with real life scenarios on a wide variety of issues including a Marine in distress after being passed over for promotion and another whose relationship has recently ended. It also includes a suggested lecture, transparencies, and answers to frequently asked questions about suicide. The kits were originally distributed in October 2000, but additional kits can be ordered at the Defense Visual Information Website at http://dodimagery.afis.osd.mil/ through the DAVIS/DITIS search option, using PIN #806377.

This second Navy video is now available. It can be ordered free of charge through the Defense Visual Information Website at http://dodimagery.afis.osd.mil/, through the DAVIS/DITIS search option, using PIN #806677. This video has no Marine scenarios, but is still useful.

The services of MCCS One Source supplement the existing support system for Marines and their families by providing assistance 24 hours a day, 7 days a week via toll free telephone and Internet access. In addition, MCCS One Source supports geographically dispersed Marines and their families (recruiters, Inspector and Instructor staffs, and mobilized reservists) who do not have traditional services available. Resources are available on topics to include parenting and childcare issues, education services, financial information and counseling, legal, elder care, health and wellness, crisis support and relocation.

Marines or family members seeking assistance can call 800-869-0278 in CONUS, or 800-8690-2788 OCONUS. MCCS One Source Online can be visited at www.mccsonesource.com, userid: marines, password: semperfi.

ASIST is an intensive two-day commercial workshop designed to help people feel comfortable recognizing, assisting, and referring those at high risk for immediate suicide. See your base chaplain for additional details.

Crisis hotlines provide telephone counseling for people with suicidal thoughts or feelings. Due to the anonymity involved in these services, many people are willing to contact a crisis hotline before they are willing to seek care in person. It is therefore helpful to provide hotline numbers to individuals at increased risk for suicide. Contact your local Marine and Family Services for crisis hotline numbers in your local area.

MCO 1510.89B Individual Training Standards (ITS) System for Marine Corps Common Skills (Vol 1)

Administrative Actions:

Any alcohol related misconduct or unsatisfactory performance will be subject to prompt and appropriate administrative action. Charges of intoxicated driving in violation of local legal blood alcohol content (BAC) will be treated as an alcohol related incident.

Career Consequences:

Many Marines worry that seeking help will make them appear "weak" or "defective" to their peers or leaders. In the past there has probably been some basis for this worry, and the stigma associated with seeking help may still be a problem in some units. Current Marine Corps policy is for commands to create a climate where seeking help is encouraged to promote maximum personal and unit readiness. If a Marine were drowning, they would not hesitate to ask for help, and peers and leadership would do everything in their power to help, regardless of the reason for the distress. It needs to be the same way for Marines "drowning" in personal problems or distress. Our readiness and their lives may depend on it. It is important for Marines to be confident they can ask for help without prejudice to their careers. It is especially important for them to understand that what is more likely to affect their careers is not seeking help, and waiting until problems affect their job performance or mental health. But at any point, seeking help should be welcomed and encouraged as the right and courageous thing to do, for the benefit of not only the Marine involved, but also team-mates who depend on him/her to be there when needed.

Command Directed Evaluation (CDE):

When a Marine will not go for a Mental Health Evaluation for suicide risk, and there is good cause to suspect the Marine is at risk, the unit commander will have to initiate a Command-Directed Mental Health Evaluation and order the Marine to submit for evaluation. This requires specific sequence of actions due to the legal issues involved.

Helping Agencies:

The following agencies offer the services listed.

Marine and Family Services – Personal counseling, stress management, family/relationship counseling
Chaplains – Spiritual guidance, personal counseling, life issues counseling
Military OneSource – Anonymous personal, financial, and other advice, brief face-to-face counseling
Navy/Marine Corps Relief Society – Financial counseling and monetary assistance
Legal Services – Legal assistance and advice
Medical – Mental Health evaluation and treatment, health promotion strategies

Hospitalization:

Psychiatric hospitalization (also known as inpatient treatment) is necessary when a Marine is evaluated for suicide risk and found to be at high enough risk for self-harm that it would be unsafe to treat them as an outpatient. Inpatient treatment is usually done in a locked ward, where the patient can be contained for their own safety, and monitored 24/7 by specially-trained staff an appropriate level (one-on-one, line of sight, or safety checks at prescribed intervals) depending on the level of risk determined by their mental health provider. Further, their behavior can be assessed in more detail and in a more continuous and controlled manner to see if they are truly depressed, mentally ill, suicidal, or manipulative. More intensive, daily therapy is also available in the inpatient environment than in outpatient services. However, such services are also exceptionally expensive, and so are generally reserved for c ases where outpatient services are unlikely to be enough to keep them from harming themselves, or in cases where a suicide attempt or gesture has just occurred and further evaluation, treatment, and monitoring are advised, at least overnight, to ensure their ability to be treated safely on an outpatient basis.

Just In Time Counseling:

For those times of heightened stress, the command is able to request Stress Management support from the local Marine and Family Services (MFS) counseling staff. They may also be able to tailor briefs relative to the needs of the unit and families who, for example, may require help coping with a suicide in the unit or a training accident. MFS also provides classes on a variety of other topics such as parenting, new parent support and couples counseling. Contact your local MFS office to coordinate.

Limited Duty:

Limited Duty status allows a Marine to remain on active duty when they are not currently fit for full duty, but there is high likelihood that, with appropriate treatment, they can be restored to ongoing full and productive duty in a reasonable amount of time (defined as 6-14 months). This status will usually prevent them from being deployable and has some other administrative ramifications

Malingering:

Deliberately faking symptoms of a disorder, including suicidal thoughts, personality disorder, etc, for secondary gain, such as getting out of military service obligations.

Marine Corps Community Services (MCCS):

Enhances unit and family readiness by delivering programs such as Marine Corps Family Team Building (MCFTB), Military One Source Information and Referral Service, Counseling Services and New Parent Support. The programs are designed specifically for Marines and families to increase their awareness of relevant readiness issues, while offering creative ideas to build a healthy family. Through proactive education, training, coordination of support services, materials and tools, MCCS promotes personal and family readiness that can be applied in everyday situations. Military One Source is also able to coordinate counseling services for Marines and families in need of counseling support to help cope with deployment related issues, reunion concerns, parenting, childcare and other everyday issues. Marines and family members are allowed six face-to-face counseling sessions per incident with a civilian mental health practitioner for free. A Marine or family member will call a One Source consultant who will determine if there are on base resources readily available to assist the caller. If on base resources are not available, the One Source consultant will provide the caller an immediate referral to counseling assistance, and using their nationwide network of providers, will find a licensed mental health practitioner near the caller. Utilizing Military One Source is ideal for Marines and Marine Reservists (and families) needing counseling services but who are not located near an installation. Marine and Family Services (MFS) counseling is available to those units and families in need of counseling support in the areas of combat stress, stress reduction, anger management, new parent support, and couples counseling.

Marine and Family Services (MFS) Center:

The EFMP Coordinators are located at the MFSCs. MFSCs also offers a wide variety of counseling services for families who may need some help in coping with the emotional side or caring for a family member with special needs. The MFSCs also have financial counselors who can assist families who need help achieving their financial goals or when they need guidance when problems arise. Click here for more details.

Medical Retirement:

Medical Retirement is an option for Marines who are not in Entry Level status (>180 days active duty), are suffering from a problem that did not exist prior to enlistment, and are not suffering from a problem that requires administrative separation instead.

Military OneSource:

The services of Military OneSource supplement the existing support system for Marines and their families by providing assistance 24 hours a day, 7 days a week via toll free telephone and Internet access. In addition, Military OneSource supports geographically dispersed Marines and their families (recruiters, Inspector and Instructor staffs, and mobilized reservists) who do not have traditional services available. Resources are available on topics to include parenting and childcare issues, education services, financial information and counseling, legal, elder care, health and wellness, crisis support and relocation. Marines or family members seeking assistance can call 800-342-9647. Military OneSource Online can be visited at www.militaryonesource.com.

Personnel Casualty Report (PCR):

An electronic message containing casualty information for the purpose of reporting as well as the primary source of information used to inform the next of kin of a casualty's status.

Protective Measures:

Commanders can expect to be informed promptly when dangerousness issues arise in the course of a mental health evaluation or treatment. If the Marine was referred for a formal Command-Directed Evaluation, both oral and written feedback will be given to the commander addressing the specific issues raised by the commander. The provider may recommend duty restrictions such as removal from weapon-bearing duties or temporary change in flying status. Commanders can also help ensure the individuals duties do not involve significant time alone which there would be opportunity for dwelling on problems and potentially attempting suicide. Commanders may also be directly advised to take steps to reduce access to weapons at the individuals home. While it is impossible to limit a persons access to all potential suicidal means, it is important to take reasonable steps to ensure safety when possible. Firearms pose the greatest risk as a readily available means of self-harm and should always be removed from a suicidal individuals home when legally possible. When this is not possible, counseling the Marine, family, or friends, about the dangers of keeping a firearm available to the suicidal Marine so that it is voluntarily removed, should accomplish weapons removal. Security Forces will generally secure personal firearms in the armory.

Trying to Manipulate:

Occasionally a Marine may feign suicidal thoughts or behavior for secondary gain, such as to get out of the Marine Corps. Even if you think this is the case, the liability is too high not to take appropriate action, so you must get the Marine evaluated by Medical for suicide risk whether you think they are faking or not. Medical is qualified and licensed to determination the level of suicide risk and will let you know what to do with the Marine, including possible administrative actions to hold a manipulative Marine accountable, if appropriate.