This has been another tough year for the Navy, with far too many sailors lost to suicide. The Centers for Disease Control and Prevention (CDC) research notes that at any given time, one in 20 of individuals will think of suicide, and one in 100 has a plan. On an aircraft carrier, that could be 150 sailors experiencing suicidal thoughts, and 30 with a plan to act on those thoughts at any given time. In my case, my only real suicidal thoughts came in the summer of 1987. I had been standing port and starboard duty in the shipyards, the 7:00 pm to 7:00 am “mid” shift, for several months. I had just arrived home around 9:00 am and hit the rack, knowing I had to get up in just a few hours to go back to the ship. The phone rang about 10:30, and I was informed that I had failed to sign out of the logbook and was required to drive back in. I drove across the Bay Bridge with one thought on my mind: “I can’t take this anymore. If I drive into a piling on this bridge, that’ll teach them a lesson.” I was angry, and the thought passed, but it was so stark—what I have since learned is a “passive suicidal ideation”—that I remember it today.
Thoughts of suicide are part of life, and no one is immune. While there have been several investigations and reports in recent months, and many excellent recommendations to address the root causes, many of these fixes—such as addressing shipyard living conditions, manning, operating tempo, extended deployments and maintenance periods, and leadership failures—will take years and significant funding to fully implement. In the meantime, the Navy must double down on proven programs to support suicide prevention—and could do so for relatively low cost.
A Plethora of Programs
The Navy already has a wide range of mental health and suicide prevention programs in place. Unfortunately, these programs are often in competition with each other, fighting for the same promotions and funding. This need not be the case. The following programs are already in place across the fleet but could be more impactful if properly applied and resourced. Some examples:
SafeTALK and ASIST
These evidence-based suicide prevention training programs are already funded and in place with more than 1,000 certified trainers across the Navy. Suicide Alertness for Everyone (SafeTALK) teaches participants to recognize and engage people who might be having thoughts of suicide and to connect them with community resource officers trained in suicide intervention and longer-term care. The program is designed to help participants realize the effect of false societal beliefs that can cause people to miss, dismiss, or avoid signs that those around them may be considering suicide, and to practice steps to move past these barriers. SafeTALK is an ideal course for both new and seasoned personnel and could be implemented today at training commands across the Navy for little cost. It has a proven track record if the population has a high percentage of graduates. By adding it to the curriculum at boot camp, A and C schools, the Naval Leadership and Ethics Center, and officer pipelines, the number of trained individuals could rise significantly in a very short time.
The Applied Suicide Intervention Skills Training (ASIST) is a two-day suicide intervention skills training program. Participants learn how to help someone thinking about suicide develop a personalized SafePlan to keep safe for now and connect with further help. Participants learn to apply a safety framework to guide the development of a SafePlan through a collaborative, helping relationship. Participants also consider how personal and community attitudes about suicide can affect an individual’s willingness to seek help and their ability to provide it.
These programs currently are managed by Commander, Naval Installations Command Navy Chaplains Religious Enrichment Development Operation, which does an exceptional job with limited resources, but expanding them out into the operational fleet would accelerate the implementation of a broader program.
Chaplains on All Ships
This relatively new initiative has proven effective, and feedback on the current policy is positive, but it is strained to meet the demand signal. Consideration should be given to ideas such as the direct accession of experienced chaplains at a higher rank and leveraging the Navy Reserves to get to 100-percent coverage sooner.
Behavioral Health Technicians
Behavioral health technicians (BHTs) have been well-received on ships, performing assessments, crisis triage and management, co-facilitation of therapy groups, short-term counseling, training and education classes, and psychological testing. However, the medical community has resisted more widely employing BHTs on small ships because of their need for supervision by a psychologist. By applying technology and innovation, this supervision could be achieved through reach-back to a Medical Officer on the CVN or ashore, as allowed by the governing instruction. A 2019 RAND study provided some excellent recommendations to strengthen this program, specifically citing the idea of deploying them on escort ships with a reach back capability to the CVN or large deck amphibious ship. As a DDG and CG Commanding Officer, I would have welcomed this peer resource and I hope the Navy will expand the program to support the smaller ships by exploiting all options for BHT support.
Deployment Resiliency Counselors
Deployment resiliency counselors (DRCs) receive excellent marks from the ships that have them, but they suffer from poor retention and challenges in recruiting, due to the high demand for mental health providers. The Navy’s deployed resiliency counselor program evolves, 10 years in (yahoo.com). An overhaul to include better pay, recruiting, and perhaps a change of ownership to an operational command such as U.S. Fleet Forces could invigorate this program. Placing two DRC at each fleet concentration area (perhaps under the destroyer squadrons in Mayport, Rota, Bahrain, Sasebo, etc.) to support the smaller ships could be a force multiplier.
Therapy Dogs on Ships
The USS Gerald R. Ford (CVN-78) has deployed with a dog on board to great reviews. This program could be expanded quickly to include at least all CVN and big-deck amphibious ships. Truth in advertising, I had a dog on my 2002 Operation Iraqi Freedom deployment (Oscar P. Dog). My leaders were not pleased, but that was then. There is science that shows the positive impact of canine companions and even on their ability to detect stress. It can and should be expanded to any ship that desires a canine crew member.
Improved Training for Shipboard Suicide Prevention Coordinators
Shipboard suicide prevention coordinators are the first line of defense on ships. They are often very junior, receive very little training (a two-hour webinar is offered on the MyNavyHR website) for such an important position, and have no real shore infrastructure to support them in their jobs. They could be sent to the SafeTalk and ASIST classes in the near term and have a more robust training program built over time.
Operational Stress Control and Warrior Toughness
The Expanded Operational Stress Control (E-OSC) program has been hit or miss on ships and commands based on the individuals who become trainers and the amount of attention given to the program by the individual ship. The former OSC program provided training by professionals in these areas and was much more effective. A version of that—a small OSC team to provide support and training to the EOSC reps on ships, perhaps one team in each homeport—to support the ship’s EOSC programs could be beneficial and likely is feasible under the current contract. Plans are in place to combine this program with Warrior Toughness, a positive step to streamline and simplify these important resources.
Sponsor Program for Limited Duty Personnel
Many commands receive large populations of limited duty personnel and are not well equipped to lead and manage them. This population is at high risk because of a loss of belongingness/connectedness and their ability to contribute. A formal sponsor program could provide mentors to act as individual guides and listening ears. They could help limited duty personnel navigate the system and mitigate many of the hurdles faced by sailors who are already experiencing challenges and stressors during their transition. Combined with attendance at SafeTalk, and assignment of a dedicated suicide prevention counselor to this group would be good steps toward dealing with their special circumstances.
Crew Endurance Policy
The DoD’s 2022 Report on Suicide had a critical recommendation to “provide a stable watch schedule and eight hours for sleep.” There is currently no overarching Navy Crew Endurance Policy above the type-commander level. The Chief of Naval Operations or Commander, U.S. Fleet Forces could issue a requirements document for each subordinate echelon to create a policy that includes use of circadian watch rotations, ashore and afloat, and supporting schedules, using basic guidelines that can be tailored at each type-commander or fleet staff.
Coalition of Sailors Against Destructive Decisions
The Coalition of Sailors Against Destructive Decisions (CSAAD) is already in place but lacks centralized support and guidance. A centralize hub for sharing good ideas and best practices, and assisting commands in standing up CSADD would better serve this program.
Additional Ideas
Cognitive Behavior Therapy
Cognitive Behavior Therapy (CBT) has produced good results in other populations and could be implemented in the fleet using known providers in the commercial sector. CBT empowers individuals to challenge negative thought patterns and develop healthier coping mechanisms, offering hope and resilience in the face of adversity. These concepts could be combined with Warrior Toughness and E-OSC to create a true Mind-Body-Spirit program. A Marine Corps Pilot might show promise in this area.
Focus on Belonging, Connection, Contribution, and Leadership
Most literature about suicide describes the lack of these common factors among those that attempt it.1 They experience feelings of worthlessness, loneliness, loss or lack of belonging, an inability to contribute effectively, and have access to means, such as a gun. Positive, intrusive leadership can help recognize those at risk and take action to help them find purpose, support, and even something as simple is a gun lock. Strengthening processes such as the Command Resilience Team and Human Factors Council can go a long way toward making a difference when it counts. But at the end of the day, it comes down to creating a positive and psychologically safe work environment and being alert to the signs of trouble at work and at home.
Professional Resiliency Coordinators at Navy staffs
The Navy should provide funding for one general schedule billet at each large Navy staff to facilitate implementation of the above programs. Most are currently managed by active-duty personnel as a collateral duty and are marginally effective. A focused manager would provide continuity, oversight, and a direct conduit to Fleet and Family Support and to OpNav N17. If left to the individual type commander, these billets would never be funded nor centrally managed. The 12 human factors billets created after the Navy’s 2017 Comprehensive Review of Surface Fleet Incidents could be used as a model.
The Time is Now
Many of these programs are seen as an either-or proposition. It need not be so. Refocusing OpNav N17 on Culture and Force Resilience is a great first step; their newly published Mental Health Playbook (and the entire website) is an excellent resource. However, the reality is that different sailors respond to different processes, and what works well for one person could be less effective for another. The purpose of this article is not to cast aspersions, but to highlight processes already in place that are perhaps under resourced, underutilized, or otherwise limited by funding, policy, or a lack of visibility.
I will offer one final example. My next encounter with suicide came in 2010, when I shared my weekly cup of coffee with a friend on the waterfront. He was a geographic bachelor, living in the bachelor officer’s quarters in Norfolk, Virginia, while his family stayed in Washington, D.C. He shared that he was having a rough patch in command of a destroyer squadron, expressing doubts about his heretofore bright future. I recall telling my wife that “something was off” with my friend, but I either missed or avoided the tough conversation. The next night he was gone. I never forgot that conversation and how it might have ended differently if someone, possibly me, had picked up on the signs, and known what to do next.
When was in command, I was oblivious to many of these programs. If had it to do over, I would be much more proactive in several areas: adding SafeTALK to Command Indoctrination, pushing for a BHT and DRC, holding monthly Human Factors Councils, and ensuring that every crew member had 988 programmed into their phones. I would buy gun locks for every crew member (a $10 investment per Sailor seems worth it!). I would pay for the printing of Mental Health Playbooks for all Khaki. Most of all, I would listen, and make sure my leaders do too!
In the end, there is no one answer to prevent suicide. But now is not the time to make lists—it is time act.
1. Thomas Joiner, Why People Die by Suicide (Boston, MA: Harvard University Press, 2009).
