Category Archives: OSC

Communications Between Line Leaders and Mental Health Providers

2.10Upholding a culture that supports seeking help as a sign of strength is an all hands effort that is built upon trust, one of the five Principles of Resilience. This trust must be cultivated between Sailors and their leaders through ongoing engagement and support, which will in turn help Sailors trust in the many resources available to them should they need additional care.

As we continue to make progress in breaking down the barriers that may prevent Sailors from seeking help for psychological health concerns, commanders must ensure that they are acting in ways that support Sailor wellness while enhancing unit readiness. To that end, Navy Suicide Prevention and the Bureau of Navy Medicine and Surgery (BUMED) recommend that all commanders familiarize themselves with the policies in place to balance their need to monitor the welfare of their unit with the confidentiality protections that medical providers must adhere by in the best interest of Sailors. In order for Sailors to gain maximum benefit from mental health care services, they must feel reasonably certain that the details they share with a provider will remain private, helping to mitigate the potential decision to not to seek assistance out of fear of consequences. Line leaders and providers share in the responsibility of upholding Sailors’ rights and promoting recovery.

Department of Defense Instruction (DoDI) 6490.08 provides guidance on information flow to balance the challenges between patient-provider confidentiality and the rights of commanders, outlining the level of detail a commander can access to ensure the well-being of their unit members and maximize unit readiness. Based on this instruction, BUMED’s Psychological Health Advisory Board has developed a graphic outlining communications between the line and medical communities which is now available on the Suicide Prevention website. This graphic provides at-a-glance information on topics such as notification to commands, clarification of the minimum notification standard, best practices for sharing mental health information and additional resources. This tool is not only useful for commanders to facilitate a closer understanding of the decision making process providers must adhere to, but for key personnel (such as suicide prevention coordinators) to help dispel misperceptions among their shipmates regarding mental health treatment.

To facilitate productive dialogue—and trust—between providers and commands, line leaders should seek to develop ongoing relationships with local health providers. Proactive discussion about policies and procedures will better serve both the commander and provider when making key decisions and determining ongoing support needed for Sailors during and beyond the reintegration process. Most importantly, Sailors will feel more comfortable seeking the resources available to them knowing that their leadership has a full understanding of what can and cannot be discussed. This is yet another way we can take proactive measures to improve the lines of communication and support every Sailor, every day.

Our Chosen Family

By retired Navy Lt. j.g. Laura Root, a Navy Wounded Warrior – Safe Harbor enrollee who was diagnosed with muscular dystrophy in 2011.

Root PhotoIn May 2013, I returned to D.C. feeling elated about the gold medal in shooting I earned at the recent Warrior Games. I walked through the front door of a friend’s house and stopped short at the tell-tale expression of disaster on her face. The night before, a beloved friend, mentor and Marine died by suicide.

Despite his silent suffering from the invisible wounds of PTSD after multiple combat tours, everywhere he went people were drawn to his charisma and positive attitude. Anytime someone complained, he simply said: “That’s terrible! It’s just like the day I found out MREs (Meals Ready to Eat) weren’t organic!”

Following the loss of our friend, we were asked: “If you had a choice to receive a wonderful gift, but you knew it would only last for too short a time, would you still accept it?” We all nodded in our grief, but the feeling that we should have done more still tugs at us a year later. I can’t help but wonder if my mentor and friend would still be here if he had the opportunities that I did from adaptive sports.

Sports and interactions with the military family are incredibly powerful healing tools for wounded, ill and injured active duty and retired veterans. Focusing minute-to-minute on a shooting range, track or cycling course trains our minds to focus on what we can do, what lies ahead, and what we can still achieve. Interacting with other veterans reminds us that we are not alone. And, ultimately, we realize: shot-by-shot or step-by-step, I can put my life back together and thrive in the face of adversity.

We will never return to being the same people we were before wounds, injury or illness, but we become someone new, adapted and more resilient. Because of adaptive sports programs, there are fewer people like my dear friend – veterans who struggle in silence. To me, being a Warrior Games competitor helps you recover faster, both physically and emotionally, by connecting you to a network of support, which can be a protective factor against suicide. The athletes begin looking towards the future – together – and, with time, they triumph over obstacles that once seemed insurmountable.

Every person at Warrior Games is one more veteran with a better quality of life, with a brighter future and a healthier outlook. It is sometimes said that our adaptive sports community is our “chosen family,” and that is a wonderful gift. It’s where we remember what our lives can become even after we face our worst-case scenarios. It’s where we always find the people we love most and our reasons to carry on.

To learn more about the adaptive sports program at Navy Wounded Warrior – Safe Harbor, visit: http://navysafeharbor.navylive.dodlive.mil.

If you or someone you know is in immediate danger, call 911. If you or someone you know is in crisis, help is just a call or click away. Call the Military Crisis Line at 1-800-273-TALK (option 1) or visit www.veteranscrisisline.net.

For more information on the Navy’s ongoing efforts to prevent suicide and support Every Sailor, Every Day, visit www.suicide.navy.mil.

Building Resilience in the Face of Injury or Illness

140928-N-OT964-While the day-to-day life in the Navy can be stressful, navigating those stressors combined with the challenges of wounds, illness or injury can make even the most resilient Sailor or family member feel overwhelmed. Adapting to a new normal takes patience and determination, and it can also be an opportunity to perhaps inspire other wounded, ill and injured shipmates to thrive in the face of adversity.

One tool to help Wounded Warriors and their families build and maintain resilience is to create a Stress Navigation Plan. This plan is intended to be private, and it outlines your personal list of positive strategies and support resources. Go to www.navynavstress.com to download a template, then once completed, keep it in a safe place so you can reference it when you are feeling down.

A second way to support your resilience is to enroll in Navy Wounded Warrior – Safe Harbor. This program provides non-medical resources and support to guide active duty and retired Sailors and their families through recovery, rehabilitation and reintegration. One such program, adaptive athletic reconditioning, trained and guided 39 wounded, ill and injured Sailors to compete in the fifth annual Warrior Games in Colorado and the inaugural Invictus Games in London.

Above all, remember that asking for help, whether for physical or emotional issues, is a sign of strength. We don’t always have control over what life throws at us, but we can learn how to identify stress reactions and take measures to deal with them. There are multiple resources supporting wounded, ill and injured service members and families, including:

A Place to Start, for you and “Every Sailor, Every Day”

By Rear Adm. Rick Snyder, director, 21st Century Sailor Office

Though September may be coming to a close, we must stay the course when it comes to taking actions to help our Sailors and families navigate stress, promote open communication, provide access to resources, and prevent suicide. Navy Suicide Prevention Month isn’t about 30 days of awareness; it’s about energizing deckplate and community efforts for the next 365 days, so that psychological health and wellness remain an ongoing priority—and an all hands effort.

Whether you joined your community to “Walk Out of the Darkness” this month, developed an inspirational Public Service Announcement, helped your shipmates and colleagues “bust work stress,” “Pledged to ACT” or offered reassuring words to others, your efforts made and will continue to make a difference in the lives of those around you—and in your own life. I encourage all to reflect on Suicide Prevention Month and use it as a place to start, for you and for Every Sailor, Every Day. To that end, I share the following blog post authored by Lt. Jay Morrison, U.S. Naval Hospital Guam, underscoring the simple, but impactful, things we can do to set a positive example for others and change our perspective during challenging times. It starts with gratitude.

For Suicide Prevention and Operational Stress Control resources throughout the year, visit www.suicide.navy.mil and www.navynavstress.com.

Expressions of Gratitude Go a Long Way
By Lt. Jay Morrison, U.S. Naval Hospital Guam

Expressions of gratitude have been linked to greater goal achievement, improved physical health, increased exercise, better sleep, and even an improved ability to overcome memories of potentially traumatic events. Here are some ideas for promoting gratitude.

Expressions of gratitude have been linked to greater goal achievement, improved physical health, increased exercise, better sleep, and even an improved ability to overcome memories of potentially traumatic events. Here are some ideas for promoting gratitude.

As we move through suicide prevention month, we’re reminded of the important warning signs to watch for in our shipmates, and to spot signs of trouble: increased substance use, withdrawal, recklessness, changes in mood or personality, and especially expressions of hopelessness or wishes to die.

We all face adversity and can help each other to be ready for the day that adversity rears its head. Cultivating gratitude is a great place to start.

We’ve heightened our sensitivity to shipmates who feel alienated, think they don’t belong, or have a sense they are a burden to others. We’ve pledged ourselves wholeheartedly to reach out to those in distress, or those who have had setbacks in their lives. We’ve pledged to ACT (Ask, Care, Treat). We’ve re-qualified with our weapons to fight suicide: our connections to our chaplains, mental health providers, Fleet and Family Support Centers, Navy suicide awareness resources and suicide prevention hotlines.

Our defenses are ready – our early detection tools for trouble are calibrated and our vehicles for rapid intervention well-maintained. As we move forward, we must commit as a team to building our offense – positively building health, happiness, and resilience in ourselves and those around us. We all face adversity and can help each other to be ready for the day that adversity rears its head. Cultivating gratitude is a great place to start.

Build Gratitude
Expressions of gratitude have been linked to greater goal achievement, improved physical health, increased exercise, better sleep, and even an improved ability to overcome memories of potentially traumatic events. Here are some ideas for promoting gratitude.

  • Before going to bed, list five things that happened in the last 24 hours for which you’re genuinely grateful. Think big (I’m grateful for seeing a good friend) and small (my favorite galley meal today – love that meatloaf!). It can be done mentally, or you can write it down.
  • For a limited time, give up something you take for granted. Even if underway or forward deployed, there’s at least a small luxury you enjoy every day. Let it go for a week and notice what happens. Do you appreciate it even more? Do you feel stronger for having gone without it at will?
  • Express gratitude to others often. Give three sincere compliments a day. We feel at our best when we help others to do the same. Express your appreciation for the actions of others. Be clear and specific. After a week, see what happens – are you more focused on people’s positive qualities? Do those around you seem more motivated? Are you more enthused?
  • Think flexibly about adversity. Bring a challenging experience from your past to mind, or a challenge you’re experiencing now, and write a list of the ways in which this thought-provoking experience has helped you to grow. This is not the same as simply “looking on the bright side” or denying that a bad event was, in fact, bad. It is about looking at stimulating experiences in their totality, flexibly from all sides, and focusing energy on the lessons learned, and the muscles strengthened.

Remaining mentally tough, resilient and ready takes effort, the same way we need three healthy meals a day, and a commitment to regular exercise, psychological strength takes continuous action and reinforcement. These activities are a place to start, for you and Every Sailor, Every Day.

For more ideas, see The Complete Guide to Resilience by Glenn R. Schiraldi, Ph.D.

Enhancing Resilience and Recovery of Reservists

By Paul A. Finch, LCSW, Program Manager, Reserve Psychological Health Program and Director, Psychological Health for Navy and Marine Forces Reserves, and Dr. Mark Long, Health Promotion and Wellness Department, NMCPHC

CHARLOTTE, N.C. (Sept. 18, 2010) El-Brenda Wiley, a psychological health outreach program counselor(left), advises Ensign Chris Love, a member of the reserve component assigned to Cargo Handling Battalion (CHB) 4, and his wife during a pre-deployment family readiness conference. The Psychological Health Outreach Program is geared toward providing mental health care to service members who have served in support of Operation Iraqi Freedom and Operation Enduring Freedom. (U.S. Navy photo by Mass Communication Specialist 2nd Class Maddelin Angebrand/Released) http://www.navy.mil/view_image.asp?id=91996

CHARLOTTE, N.C. (Sept. 18, 2010) El-Brenda Wiley, a psychological health outreach program counselor(left), advises Ensign Chris Love, a member of the reserve component assigned to Cargo Handling Battalion (CHB) 4, and his wife during a pre-deployment family readiness conference. The Psychological Health Outreach Program is geared toward providing mental health care to service members who have served in support of Operation Iraqi Freedom and Operation Enduring Freedom. (U.S. Navy photo by Mass Communication Specialist 2nd Class Maddelin Angebrand/Released) http://www.navy.mil/view_image.asp?id=91996

It is well known that extended and repeat deployments can impact the readiness and psychological health of Sailors and Marines who put on their uniform every day in defense of freedom, but what about the Sailors and Marines who temporarily set aside civilian and family responsibilities and lace up their boots in support of the same cause? They receive the same pre-deployment training and experience the same potentially traumatic events, such as injury and loss, during deployment. Yet, studies indicate that Reserve and National Guard members may be at greater risk for developing psychological health conditions than their active duty counterparts. How can we bridge the gap?

Know the Facts

About 40 percent of Reserve and National Guard members returning from deployment report experiencing psychological health conditions (Hoge, Auchterlonie, & Milliken, 2006; Seal, Metzler, Gima, Bertenthal, Maguen, & Marmar, 2009). In addition, rates of post-traumatic stress disorder (PTSD) and depression actually increase in these service members during the period following a return from deployment, with some reports more than doubling in the first six months post-deployment (Milliken et al., 2007). This is substantially greater than that observed in active duty service members with similar combat experiences and suggests that post-deployment reintegration issues may pose a significant obstacle for Reserve and National Guard members (Milliken et al., 2007; Thomas, Wilk, Riviere, McGurk, Castro, & Hoge, 2010).

Identify the Challenges

Significant differences in occupations and social and military support structures likely contribute to the additional stress experienced by Reserve service members following their demobilization. Reservists are rarely employed in the military full time and frequently hold jobs in the civilian sector that may be disrupted by prolonged absences during deployments. When they return home, some Reservists may be out of uniform and back at their civilian jobs within weeks or even days, which can isolate them from the military community and its support systems. Many Reservists live and work in rural locations away from military bases, which can impede access to Medical Treatment Facilities (MTFs). This geographical limitation can delay treatment and further isolate a service member in need. In addition, families of Reservists may be less accustomed to the frequent and extended absences of their service member and are less likely to be integrated into a military community and culture that can offer support before, during, and after deployments (Erbes, Kaler, Schult, Polusny, & Arbisi, 2011).

Overcome the Barriers

Although Reservists face unique challenges when it comes to serving in the military and living in the civilian population, they may share the same negative perception of seeking support for a psychological condition as their active duty counterparts. Research suggests that only 23 to 40 percent of service members who were thought to have a moderate or severe psychological health condition following a recent deployment received professional assistance. Service members cite a variety of perceived barriers to psychological health services, including lack of trust toward professionals, the expense of seeking treatment, and the negative attitudes toward receiving psychological health support (Hoge et al., 2004; House Armed Services Committee 111-491, Report to Congress on Barriers to Seeking Treatment, 2012).

Bridge the Gap

The U.S. Bureau of Medicine and Surgery (BUMED) created the Psychological Health Outreach Program (PHOP) to serve as a psychological “safety net” for Reservists and their families who are in need of support services. Licensed mental health clinicians work to address and overcome the unique challenges that Reservists face and reduce barriers to seeking help. They provide assistance with issues related to PTSD, Traumatic Brain Injury (TBI), depression, substance abuse, and relationship issues. Services are available at six Navy and six Marine regional offices, which offer behavioral health care screenings, referrals, and 24/7 phone and email support. The PHOP staff also provides command support in the form of briefings and consultations. If you or someone you know is a Reservist in need of support reintegrating or transitioning back to civilian life, don’t hesitate to reach out for help.

If you or someone you know is contemplating suicide, seek immediate assistance. Do not leave the person alone. Call 911, seek help from a healthcare professional and/or call the Military Crisis Line. Chaplains, corpsmen, health care professionals at your MTF or branch clinic, and your local Fleet and Family Support Center can also provide assistance.

Available Resources

Psychological Health Outreach Program (PHOP)
Military OneSource
Military Crisis Line
Marine DSTRESS Line
Vets4Warriors
Moving Forward