Category Archives: Suicide Prevention

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:

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

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

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 and

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.

Your Navy Chaplain: Focused on “Every Sailor, Every Day”

By: Rear Adm. Margaret Grun Kibben, Chief of Navy Chaplains

Like a family, shipmates have an obligation to look out for each other, to look out for Every Sailor, Every Day.” While September is identified as Suicide chapPrevention Month, every day, day in and day out, we must direct our efforts to prevent the deaths of our Sailors, Civilians and all our family members.

Often when people think about suicide, it’s because they feel isolated and alone, as if no one will listen to them. I ask each of you to break the silence and start the conversation if you notice someone going through a difficult time. By engaging with your shipmates with the simple question, “Are you doing ok?” you are giving that person permission to reach out and ask for help. You are helping that person realize they are not alone. By really listening to their response, you also remind them that people do care about them and will care if something happens to them.

But it isn’t just about other people. Frankly, all of us have heard that message loud and clear and most of us are on the lookout for people who seem to be at their wit’s end. I’m more concerned about those of you who aren’t letting anyone in on your feelings of despair, isolation, or crushing pain. Please hear this message: it should never be a matter of taking your life but taking control of your life. All of us, no matter where we are in our lives, will encounter stress that can feel incredibly overwhelming. I encourage each of you to consider your own self-care and to take the steps now to build your own resilience to help navigate the stress that will inevitably come your way. And that means things like staying connected to your family, your shipmates, and the resources available to you. Knowing that we are not facing life’s challenges alone can help reduce stress levels before they ever develop into a personal crisis. But when it does, it means having the courage to say something to someone – to break YOUR silence – when you’ve lost control of your life and you need help.

As chaplains, we are committed to being where it matters, when it matters, with what matters. We help people reconnect with their sources for hope. That’s really our whole reason for being. We are here to make sure you have some place safe to go where you have absolute confidentiality to share your concerns or fears when things seem out of your control. You talk, and we’ll listen. If you just want to sit and not say anything, we’ll remain by your side. Chaplains will help you tap into your spiritual foundation or whatever keeps you grounded. And when you’re ready, chaplains will help you connect with the right resources and get you the help you need. Remember, our commitment is to you.

We are a team, the Navy Team. Together, we can make a difference in someone’s life – your life.

Contact your command chaplain to learn more about your right to absolute confidentiality with a chaplain. Don’t know who your nearest chaplain is? Call 1-855-NAVY-311 to be connected with a chaplain.

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

For more information on the Navy’s ongoing efforts for suicide prevention, visit

An Intensely Personal Issue

By: Lt. Mark Peugeot, Ph.D., Clinical Psychologist, U.S. Naval Hospital Guam

September is Suicide Prevention Month, but what does that mean for us? 

SP Month CartoonWill it mean more training on suicide prevention? For some suicide prevention is a very sensitive issue. Others, who have not been impacted by suicide, please don’t roll your eyes just yet. Suicide prevention is an intensely personal issue for those who believe that barriers to care are what led to the loss of their loved one, friend, battle buddy, or member of their unit. It is entirely possible that if someone had realized the distress the person was experiencing and acted on it that death was preventable. This is where you are needed! You can help prevent death from suicide and you are the front line in the battle against suicide.

Some may not be convinced to read further, but I challenge you to continue reading and understand the importance of the problem we face as service members together. According to the Veterans Administration, in 2010 we lost 105 people each day to suicide, making suicide the third largest cause of death in the United States for persons under the age of 25. Of the suicides in the United States, roughly 1 in 5 persons who complete suicide is a veteran. This means we lose nearly 18- 22 veterans a day to suicide or as many as 8,000 of our brothers and sisters who have served this country each year. In the past, active duty military service members were significantly less likely to complete suicide and exhibited rates far below that of the general population (VA/DoD, 2013). Department of Defense data from 2012 however indicates that active duty member suicide rates have peaked significantly above the general population (DoD, 2013). If this doesn’t show that the fight against suicide is at our front door, I don’t know what will.

As a clinical psychologist, I know that psychologists, psychiatrists, and other allied health care providers can make a difference when caring for an actively suicidal person. Unfortunately, many times health care providers do not ever get the opportunity to intervene because we were not aware of the need. As a clinical psychologist, one of the greatest hurdles to preventing suicide I see is getting the person to walk through our door. The perceived stigma associated with seeking mental health care is one of the most often cited reasons by my patients when I ask why they have delayed seeking treatment. Often times, after seeking and receiving care, my patients adopt a radically different view of mental health treatment, mental health stigma, and what mental health care means to them.

Many of my patients express concern during our initial meetings regarding the long term impact of seeking mental health care. I have heard people tell me that if they go to mental health that it will be the “end of my career”, “limit my ability to pursue specific jobs/assignments”, and “will prevent me from attaining future success.” Frankly, there is always the possibility that mental illness or a specific mental condition might result in any of those outcomes. In practice, however, that is not often the case for the majority of patients. In my experience, many of the patients that are seen in mental health are able to achieve symptom resolution/management and are able to continue their careers without significant adverse impact. This includes depression, anxiety, and a wide variety of other conditions. In other cases, mental health care has prevented the premature ending of careers by providing the support and treatment needed to return service members to full duty. So, while it is true that some conditions are service disqualifying or limiting, many can be successfully treated with the final result being the return of the service member to full duty.

Accurately identifying those who are suicidal can often be more difficult than identifying persons who are experiencing psychological or emotional distress. Should you be aware of a person experiencing emotional or psychological distress, share your concern with them and encourage them to seek professional care. Ask if they are feeling suicidal or have a desire to harm themselves or others, and if they do, stay with them until you can get additional help. There are three direct warning signs that should never be ignored regarding suicide:

  1. Suicidal communications (talking, writing, etc.)
  2. Preparations (divesting of responsibility or assets)
  3. Seeking access to lethal means (firearms, medications, or dangerous/isolated areas)

If you observe any of these warning signs: Don’t think; ACT to ensure the safety of the individual.

In closing, I hope to have achieved two goals in this article. First provide information about how to identify and protect those in need of care. Second, to dispel misinformation surrounding mental health care and reduce the stigma that serves as a boundary to seeking care. Both issues are critical to preventing suicide amongst service members. Seeking help for emotional or psychological problems is important. Seeking help for suicidal thoughts, plans, intent, or behavior is critical! Simply seeking help for emotional or psychological problems will not automatically end your career. Seeking help is not a sign of weakness, but a sign of strength and resilience. Take care of yourself and the sailors around you and don’t let stigma get in the way of your health.

Together we can prevent suicide.


  1. DoD. (2013, 12 20). Department of Defense SuicideEvent Report. Retrieved August 17, 2014, from National Center for Telehealth and Technology:
  2. VA/DoD. (2013, June). Assessment andManagement of Patients at Risk for Suicide (2013). Retrieved August 17, 2014, from U.S. Department of Veterans Affairs: http://

About the Author
LT Mark Peugeot is a licensed clinical psychologist at U.S. Naval Hospital Guam. He graduated from Uniformed Services University of the Health Sciences with a Ph.D. in clinical psychology in February of 2014. LT Peugeot completed a clinical internship at Portsmouth NMC in 2012 before being assigned to U.S. Naval Hospital Guam in October 2012. Prior to being selected to attend USUHS LT Peugeot served 9 years on active duty with the United States Air Force.

Bonus: Check out the September issue of Pacific Pulse, USNH Guam’s monthly newsletter, featuring additional health promotion resources.