By Sandy Morrison, MS, T.J. Owens, and Ashley Wierzbicki, MSW
Sept. 21, 2020

U.S. Marine Corps photo

Effective suicide prevention is made up of collaborative partnerships and coordinated preventive resources designed to provide skills to mitigate stress, identify service members in distress, provide mitigation intervention, and work together to help service members get back in the fight. Service members in distress benefit from a dedicated support network that includes family members, friends, peers, military leaders, clinicians, and other resources.

Communication and coordination across this network is critical for suicide prevention and intervention, but developing these coalitions can be challenging. There may be preconceptions and assumptions that cause allies to be perceived as adversaries. For example, clinicians may not know what information is most needed by the unit leaders; leaders may not know what information is most helpful for the clinician. Clinicians may need to know more about the service member's duties and work environment. These context gaps can lead to missed opportunities for the network to recognize and/or effectively mitigate in moments of crisis. Communication hurdles can be even more pronounced in the Marine Corps where clinicians are usually sailors and unit leaders are Marines.

Informed by the Marine Corps Death by Suicide Review Board, one of the most critical partnerships in the prevention of service member deaths by suicide is between clinicians and unit leadership. Taking the time to have cooperative discussions with unit leadership, within the boundaries of regulations, has the potential to markedly improve care and ensure that high risk service members are identified and appropriately monitored. These positive discussions also improve the relationship between the unit leadership and clinicians, both of whom are concerned about the well-being of the service member.

Leaders may not fully understand clinical practice nor what is a realistic expectation for a clinician to be able to "fix" when a service member is in crisis. Across the DOD, clinicians are often referred to as "the wizard." Although the nickname may be tongue-in-cheek for some, it conveys a potentially important divergence in understanding. Some military leaders may be under the mistaken impression that once a service member is under the care of a clinical professional, the service member can be immediately and "magically" mended. Further, this nickname may also lend to the expectation that the clinician alone is the source of improvement. Leaders may not understand or appreciate their own critical role in the service member's progress. Many leaders want to be a valuable collaborator in these scenarios, but they may not know the best thing to do or they may be concerned they are getting in the way.

Recommendations for clinicians:

• Remind unit leaders that they can provide support for service members who seek help. Help leaders understand what support looks like. Unit leaders may need suggestions on what might be most helpful in the current situation. Help them feel more certain about how and why they should stay involved in the situation even when a service member is under a clinician's care.
• Talk to leaders about the importance of access to care as soon as a concern is noted. Help them to understand the limits to confidentiality, what to look for, what types of information you need, and how quickly you might need it.
• Strategize with unit leaders about effective mitigation approaches. For example, duty restrictions, issues regarding liberty, weapons cards, and safe storage of firearms/lethal means, if personal safety is a concern. Be clear what is meant by recommendations that can be interpreted in different ways such as "keep an eye on them".
• Help a leader determine if there are any factors in the service members' environment that have become toxic and need to be changed. If appropriate, reframe service member mistakes as opportunities to learn and become stronger rather than be continually ridiculed for minor errors.
• Recognize that each unit leader is charged with a mission and has many Marines in their command. Be careful not to interpret a unit leader's limited availability as a lack of interest in the service member's well-being. Ask about others who may be able to provide additional support.
• Be the bridge. Clinicians are in a unique position to help a service member recognize mistaken expectations of their leadership during a mental health crisis. Service members may have inflated perceptions of the types of support a unit leader can and should provide or an inaccurate assumption that the leader doesn't care at all. A more realistic expectation may allow the service member to deal more directly with their challenges.

Ms. Morrison is the interim assistant branch head – integration in the Behavioral Programs Branch, Marine & Family, Headquarters Marine Corps where she has been the chairperson for the Marine Corps Death by Suicide Review Board for the past four years. Much of her graduate work was focused on the integration of suicide theories and their applicability to the military population.

Mr. Owens is the section head – suicide prevention capability in the Behavioral Programs Branch, Marine & Family, Headquarters Marine Corps where he is a member of the Department of Defense Suicide Prevention and Risk Reduction Committee. He specializes in suicide prevention within military populations. 

Ms. Wierzbicki is the program & policy specialist – suicide prevention capability in the Behavioral Programs Branch, Marine & Family, Headquarters Marine Corps. She has a master’s in social work and specializes in community health and policy development. She grew up in a Marine Corps family and understands the intricacies of military life from the perspective of a dependent.