Suicide And Homicide Risk Management (Page 10 of 18) in pdf

Combat and Operational Behavioral Health

EXHIBIT 26-4

STANDARD OPERATING PROCEDURES FOR BUDDY WATCH AND 24-HOUR WATCH

STANDARD OPERATING PROCEDURES

Buddy and 24-Hour Unit Watch

1. PURPOSE: To establish procedures for the use of Buddy and 24 Hour Unit Watches in the management of Sol-

diers undergoing evaluation and treatment for suicidal statements or behaviors.

2. SCOPE: All personnel assigned to or working in the Department of Behavioral Health.

3. GENERAL:

a. All patients seen in the clinic who describe a history of current or recent (i.e. within the past two weeks)

suicidal ideation, suicide attempt, or homicidal ideation must be seen by a Behavioral Health clinician prior

to release of the soldier. (Risk assessments after clinic hours will be performed by Emergency Department

staff, in consultation with the on-call Behavioral Health clinician.)

b. The evaluation of potential for harm will include a thorough psychiatric history and examination of risk

factors. The suicide risk factors assessed will include at a minimum the following: history of previous at-

tempts, frequency and duration of suicidal ideation/plan/intent, access to lethal means, presence or absence

of substance abuse, signs and symptoms of mood and anxiety disorders, current significant stresses, social

supports, reality testing, and any family history of completed suicide. The homicide risk factors assessed

will include at a minimum the following: history of previous violence, frequency and duration of homicidal

ideation/plan/intent, and determination of access to lethal means.

c. The disposition should be appropriate based on the assessment and must address the safety of all in-

volved.

d. Documentation of the assessment will be completed on the day of the evaluation.

4. PROCEDURES:

a. A Buddy Watch may be recommended to the commander if there is some risk for harm to self or others, but

the mental health officer clearly documents a risk assessment explaining that the Soldier’s risk is not high

enough to warrant hospitalization. The Buddy Watch allows for monitoring the Soldier while treatment is

initiated, and may have advantages over hospitalization. These are described in Attachment C.

b. A 24-Hour Watch may be recommended for Soldiers who require more constant supervision than provided

by a Buddy Watch and is typically implemented for Soldiers who make specific threats to harm themselves

or others in order to avoid duty or to force a discharge from service (eg, “I will kill myself if you don’t let

me out of the Army”). The risk assessment explaining the clinician’s conclusion that the Soldier’s risk is not

high enough to warrant hospitalization must be clearly documented.

c. The procedures for Buddy Watch and 24-Hour Watch are explained in detail in Attachments A and B. The

essential difference in these two procedures is that a Soldier on Buddy Watch requires observation only from

first formation until lights out, whereas a Soldier on 24 Hour Watch must be observed at all times.

When a Soldier is placed on a watch, the Behavioral Health clinician will make an attempt to contact the commander

to discuss the reasons for the watch and other pertinent concerns. The appropriate form will be forwarded to the

commander through the Soldier’s escort. If the commander requests additional information about unit watch or ex-

presses uncertainty about unit watch, the information paper titled Management of Soldiers With Suicidal or Homicidal

Ideation will be forwarded to the commander through the Soldier’s escort. A Soldier on a Buddy Watch will be seen

for a follow up appointment at least every five working days until the watch is discontinued. A Soldier on a 24-Hour

Watch will be seen for re-evaluation within 24 hours. A Behavioral Health clinician will evaluate the Soldier at each

return appointment until the watch is discontinued. The decision to recommend discontinuation of a unit watch will

be made only by a Behavioral Health clinician. A memorandum recommending discontinuation of the watch will be

signed by the Behavioral Health clinician and forwarded to the commander.

Unit watches are recommendations to commanders. Behavioral Health clinicians must discuss their recommendations

with the commander and be sensitive to specific command and unit circumstances. In all cases, the safety of the Soldier

and others that might be at risk will be the primary concern.

The Buddy Watch or 24-Hour Unit Watch will only be used for soldiers who have been assessed for their level of risk

by a clinician at this institution. Unit watches may be utilized by Emergency Department clinician if the on-call mental

health care clinician has been consulted by the Emergency Department clinician and they are in agreement regarding

the disposition.

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Suicide And Homicide Risk Management Page 10

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