Suicide And Homicide Risk Management (Page 12 of 18) in pdf

Combat and Operational Behavioral Health

Deployed Settings

The second reason is that, depending on the unit,

the clinician may have ready access to a “patient hold”

The garrison system for unit watch must be modi-

area such as that operated by the medical company

fied to function in a deployed setting for two reasons.

in a brigade support battalion. Although traditional

The first is a recognition that access to lethal weapons is

combat stress control doctrine has emphasized sepa-

heightened immeasurably in a deployed setting; thus,

ration of soldiers presenting with psychiatric issues

the buddy watch must be removed from the range of

from those presenting with medical and surgical

options. The 24-hour watch is used instead for soldiers

illness, utilization of the patient hold area for brief

at heightened risk who do not require hospitalization.

management of suicide risk has been effective in

Another option for lower risk soldiers used during the

deployed settings. Based on these two modifications,

deployment has been dubbed “basic precautions.” The

a model for conceptualizing the role of unit watches

essential elements of the basic precautions profile are

in a deployed setting is presented in Table 26-2. This

removal of the firing pin (or bolt) from the soldier’s

model was used by one author (SP) to train primary

weapon and suspending combat duties until further

care clinicians and mental health professionals in the

notice. Exhibit 26-6 shows the basic precautions memo-

management of suicide and homicide risk during the

randum that was used to successfully communicate to

2006–2007 deployment. The following is an example

the commander the necessary precautions by one of

of a unit watch used in a deployed setting.

the authors (SP) during a 2006–2007 deployment. Dur-

ing this deployment, basic precautions were applied

Case Study 26-1: A 31-year-old married African-Amer-

extensively in a variety of situations, including those

ican man deployed to a combat zone came to the mental

involving vague suicidal or homicidal thoughts but

health clinic after learning that his wife planned to leave

few other risk factors in soldiers requiring a period of

him. He stated that if only he was given the chance to go

treatment before return to full duty.

home, he could save his marriage. He reported that he was

EXHIBIT 26-6

BASIC PRECAUTIONS

________ TMC

FOB ____, Iraq

Date _________________

MEMORANDUM FOR Commander,

SUBJECT:

Basic Precaution for _____________________________ SSN:________________________

This service member was evaluated at the FOB ______ TMC. Based on this evaluation of the service member’s recent

behaviors and current mental status, the following precautions are recommended to the commander for the service

member’s support and safety. The evaluation did not indicate a high enough risk of dangerousness to warrant hospi-

talization or a unit watch at this time.

2. Precautions:

a. Remove the firing pin (or bolt) from this service member’s weapon.

b . No combat or “Off-FOB” duties until further notice.

c. Service member should perform duties not involving combat operations and should participate in PT. PT may

help improve the service member’s behavioral health symptoms.

3. If this service member’s condition worsens, the service member’s supervisor should call FOB ________ TMC Be-

havioral Health at xxx-xxxx or escort the service member to the TMC for evaluation.

This service member’s next appointment at FOB _______ TMC is on_______________________

at __________________________ with ___________________________________________.

________________________________

______________________________

Representative from Command

Clinician

FOB: forward operating base; PT: physcial therapy; SSN: social security number; TMC: troop medical clinic

434

Suicide And Homicide Risk Management Page 12

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