By Air Force Tech Sgt. Krista Rehmert, CADC
Jan. 29, 2021

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It's a Friday afternoon before the start of a long weekend, and you're the only mental health provider in the clinic when Sgt. Oscar walks in, accompanied by his first sergeant. You learn that Sgt. Oscar reported late for duty in a disheveled state and was visibly distraught. His behavior was reportedly out of character and prompted his supervisor to speak with him and contact the first sergeant. Sgt. Oscar was in crisis and agreed to walk in to the behavioral health clinic with his first sergeant for support. During Sgt. Oscar's triage, he disclosed that he was having thoughts of suicide. These thoughts started after his long-distance girlfriend of two years abruptly ended their relationship.

Sgt. Oscar is at an elevated risk for suicide, and a full evaluation is needed to identify the appropriate intervention that aligns with his needs. To accomplish this, you immediately reference the Department of Veterans Affairs/Department of Defense Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide. Although you're familiar with this resource, you'd like additional resources to help guide your treatment plan for Sgt. Oscar.

The Psychological Health Center of Excellence (PHCoE) has created resources that complement the behavioral health-related clinical practice guidelines (CPGs). These resources, called clinical support tools (CSTs), condense CPG material, highlight critical information, and present it in a digestible manner. CSTs are not intended to replace or supersede CPGs; rather, these tools highlight a particular aspect of a CPG (such as creating a safety plan for suicide) or help to disseminate knowledge about evidence-based treatments for patients and families. 

To support providers, patients, families, and military leaders, PHCoE currently offers 30 CSTs addressing multiple psychological health conditions. Tools for the following conditions can be accessed by visiting our website:

• Posttraumatic Stress Disorder (PTSD)
• Major Depressive Disorder
• Substance Misuse
• Suicide
• Opioid Therapy for Chronic Pain
• Insomnia
• Pregnancy

For Sgt. Oscar and his care, you end up using the Suicide Risk Pocket Guide to help evaluate and identify potential interventions. This pocket guide contains an overview of the CPG and offers evidence-based decision aids that guide an evaluation to determine level of risk. While Sgt. Oscar reported suicidal ideation, he did not report having a specific plan or intent. After following the pocket guide's algorithms, you determined that Sgt. Oscar was considered a low risk for suicide. He was willing to develop a safety plan while in your office. The Safety Plan Worksheet is a fitting tool to help identify protective factors and coping strategies. Completing this worksheet is a collaborative effort and encourages Sgt. Oscar to have an active role in the decisions that influence his care. The Safety Plan Worksheet also includes brief instructions with tips for providers to maximize patient engagement.

Sgt. Oscar's first sergeant requested advice on lethal means access and you were able to provide him with a CST on this topic (Reducing Access to Firearms: A Suicide Prevention Guide for Military Leaders). This factsheet contains information about managing a service member's suicide risk and includes best practices for reducing access to lethal means.

PHCoE's CSTs are succinct guides that help providers and patients make decisions about treatment and help engage and educate all members of a patient care team. Check them out and start using CSTs in your practice today!

Tech Sgt. Rehmert is the mental health technician subject matter expert at the Psychological Health Center of Excellence. She is an Air Force mental health technician and certified alcohol and drug abuse counselor (CADC).