Suicide And Homicide Risk Management (Page 8 of 18) in pdf

Combat and Operational Behavioral Health

EXHIBIT 26-3

INFORMATION PAPER FOR COMMANDERS

MCXC-BH

INFORMATION PAPER

SUBJECT:

Management of Soldiers with Suicidal or Homicidal Ideation

1. References: FM 4-02.55 COMBAT AND OPERATIONAL STRESS CONTROL, FM 22-51 Leader’s Manual for Combat

Stress Control

2. Purpose. To provide information to commanders regarding the use of unit watches in the management of Soldiers

who express suicidal and homicidal ideation.

3. Overview:

When it is brought to the commander’s attention that a Soldier has expressed suicidal ideation, the commander

should immediately contact his supporting behavioral health activity to insure that an evaluation of risk is per-

formed. Procedures for this are not within the scope of this information paper. Once the Soldier is evaluated, the

behavioral health professional will have examined the risk factors (e.g. the psychiatric diagnosis, any history of

previous attempts, family history of attempts, the presence and lethality of a plan for suicide) and will make recom-

mendations to the commander. These recommendations will include one of the following: return to full duty with

close monitoring and support for low risk soldiers, Buddy Watch (or Basic Precautions in Operational environments)

for low to moderate risk Soldiers, 24 Hour Watch for moderate risk Soldiers, and hospitalization for soldiers at high

risk. The value to the soldier and commander of Basic Precautions, Buddy Watch, and 24 Hour Watch as opposed

to hospitalization are as follows:

The soldier is able to maintain occupational functioning at some level and maintains social connection in the unit.

This helps to prevent feelings of worthlessness and a sense of isolation that sometimes result from psychiatric

hospitalization.

The soldier avoids the stigma that is unfortunately commonly associated with psychiatric hospitalization. While

there may be some stigma associated with a unit watch, at least the soldiers in the unit see the soldier on a daily

basis and are much less likely to develop misperceptions about the Soldier’s problem, e.g. that the Soldier is “psy-

cho” and is “locked in a rubber room”. These misperceptions are prevalent in our culture and are sometimes very

damaging in the Soldier’s reintegration to the unit after a psychiatric hospitalization.

The Soldier has the opportunity to address his or her concerns with the chain of command. NCOs often provide

significant relief from depressed feelings when they listen to and support a Soldier who has expressed suicidal

ideation. In this way, the unit implements the Army’s concept of the unit as the Soldier’s “family” and provides

extra care and support to a unit member in distress.

Soldiers with “military specific” suicidal ideation (e.g. “I will kill myself if you don’t let me out of the Army”)

become aware more rapidly that the behavioral health system does not provide an escape route from their duties

and responsibilities, though it does react to help the Soldier adjust to their situation. This message is transmitted to

the entire unit and is likely to lessen the number of Soldiers who develop “military specific” suicidal ideation. This

MAY ENHANCE RETENTION AND COMBAT READINESS by reducing the number of soldiers that seek out the

mental health system as an escape route from the Army.

The unit chain of command gains significant experience in managing Soldiers who express suicidal ideation. This

experience and familiarity with unit watches MAY ENHANCE COMBAT READINESS because the unit will most

likely need to employ similar procedures in an operational environment. The proficient use of unit watches in a

combat setting may prevent an “evacuation syndrome” in which significant numbers of Soldiers who express suicidal

thoughts are evacuated from theater because units have not been trained in the management of this problem.

4. Types of Unit Watches:

a. Buddy Watch: A unit member is assigned to constantly monitor the soldier from first formation until lights out. The

soldier should not sleep in a room alone but constant monitoring is not required at night. The Soldier will follow

up with Behavioral health within 5 days (usually sooner) of the initiation of the watch so that the risk level can

(Exhibit 26-3 continues)

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Suicide And Homicide Risk Management Page 8

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