Mental health awareness and the impacts of depression and suicide are critical issues facing the entire nation. The U.S. Coast Guard is not immune to this public health crisis. Studies involving Coast Guard personnel as well as Department of Defense reports show members of the service could be uniquely prone to the development of mental health issues. Many of the stressors that lead to depression and suicidal inclinations are commonplace in Coast Guard missions. In the words of Vice Commandant Admiral Charles W. Ray, many members tragically think, “no one cares if they are there.” To remedy these systemic issues the service must facilitate access to local resources, hold units accountable for supporting mental health policies, educate leaders to reduce stigma, and promote a culture that makes the emotional wellbeing of members a priority.
The many missions of the Coast Guard involve repeated exposure to occupational hazards, high stress situations, and atypical sleep patterns. Search-and-rescue missions often force members to confront the loss of human life on top of interrupted sleep and hazardous environmental conditions. Maritime law enforcement is an intrinsically dangerous evolution that carries a significant threat of injury. Even jobs in environmental response or vessel inspections that do not directly expose a member to loss of human life or violence carry physical risks and exposure to ecological disasters. Within the service, experts have correlated natural disaster events with increased rates of suicide. In all cases, the consequences of failure are extraordinarily high. By nature of the service, this workforce is also often dispersed to remote areas far from any major metropolitan area, so social support relies heavily on relationships at work. In members who have attempted suicide in the past, relationships at work were consistently stated to have influenced the individual’s decision to end their own life.
The Coast Guard does have the ability to support members before mental health injuries reach a critical point. Policy directs the headquarters office CG-112 to provide training to medical personnel on the 18 Coast Guard Medical Requirements for Managing Suicidal Behavior.Clinic staff, chaplains, and those working in health, safety and work-life (HSWL) service centers and field offices are regularly engaged with members and carry out annual mental health assessments. Emergency services are provided through Coast Guard Support and the Employee Assistance Program (EAP). Beyond providing support themselves, staff facilitate regular trainings, such as Critical Incident Stress Management (CISM) and Applied Suicide Intervention Skill Training (ASIST). Policy often requires action from commands through leadership development assessments, such as Command Suicide Incident Response Protocols and the Defense Organizational Climate Survey (DEOCS). Overall, these initiatives provide a solid framework for supporting the workforce.
Despite all existing efforts, however, suicide and depression still are persistent problems in the Coast Guard. Limited access to resources is the most apparent shortfall. A drive of 30 minutes or more substantially reduces how often service members seek out and engage with emotional health services. In the face of support resources already spread thin, billets are being cut. Recently, the EAP position at Base Detachment St. Louis was removed, leaving Base New Orleans as the closest support unit. District Eight, which encompasses both units, historically experiences the highest rate of hospitalization because of suicide attempts. Connective technology should provide increased access to resources, but a review of HSWL field office websites show inconsistencies in both accessibility and information provided. Nearly 50 percent of the 11 field office sites reviewed did not include accurate contact information for support services.Currently, there is no metric for ensuring member access to resources.
The gaps in resource distribution point to a lack of accountability for policy implementation. The responsibility falls directly on leaders at the unit level. Command Suicide Response Protocols, while required by policy, are not required to be submitted to or reviewed by HSWL offices. Assuming units actually have such a protocol, there is no way to know if they are sufficient to deal with the highly sensitive issue of suicide. An aonymous DEOCS is a great tool for assessing command climate and the emotional health of the crew. The Coast Guard’s Leadership Development Program (COMDINST 5351.1) tasks commands to pay special attention to survey answers regarding emotional wellbeing and take action to maintain a healthy working environment. Much like Command Suicide Response Protocols, an answer indicating that a member is experiencing depressive thoughts is not automatically followed up by a review from HSWL. Without a medical professional present, well-meaning commands may seek to communicate directly with members about their mental health. Even if carried out with good intentions, for many, command involvement in the treatment process reinforces a reluctance to seek help.
Awareness of mental health issues has greatly increased in the Coast Guard, lack of trust in command, fear of stigma, and a fear of losing one’s career contribute to members staying quiet about depressive thoughts or thoughts of suicide. COMDINST 5351.1 includes “looking out for others” and “health and wellbeing” as leadership competencies. Both competencies address the importance of fostering an environment that promotes physical and mental health, but provide no insight on how that is done. No specific mental health awareness training is listed under the enclosed leadership development tools. The required annual suicide prevention training is the same for all leadership levels and most often is conducted online, despite recognition that in-person instruction is significantly more effective.
There are three immediate actions that can combat the current crisis. The first is emphasizing access to local resources. A starting point would be to standardize internet resources using a well-developed format such as that provided by Base Seattle. Partnering with primary health care providers and local mental health care professionals, which is already suppored by policy, also can help reach members at remote units.
The framework for support already exists, spread over several Commandant instructions. The second step is for leaders at the highest level to hold themselves accountable and to support existing mental health wellness and awareness initiatives, including increasing staffing at HSWL offices. At the unit level, adherence to policy requirements and responses to DEOCS surveys should be reviewed by HSWL professionals. Until a true culture of understanding and responsibility is attained, institutional accountability measures are necessary. Admiral Ray recently said, “one of the most important things we are doing right now is talking from the top down.” As leaders progress in their careers it becomes more important for them to understand mental health issues, the environments that lead to depressive and suicidal thoughts, and that recovery is not only possible, but backed by research.
Mental health issues, depression, and suicide are serious problems that impact the nation and the Coast Guard. The tragic effect can be seen in the prevalence of depression and suicide. The service must take action by increasing access to local support resources, employing oversight of policy implementation at the unit level, and developing more extensive awareness training for leaders. The men and women of the Coast Guard and their families deserve the full support of the service. Until changes are made, they will continue to pay with the loss of friends, family, and their own lives.
- Lieutenant (j.g.) Luke Sanchez Shaw and Teresa Blais, “State of Coast Guard District 8 Employee Assistance Program,” (May 2020).
- . Sanchez Shaw and Blais, “State of Coast Guard District 8 Employee Assistance Program.”