The Defense Health Agency’s Psychological Health Center of Excellence and the Defense Suicide Prevention Office have partnered to enhance and expand a public health awareness campaign in efforts to continue reducing stigma associated with seeking care for mental health.

Soon, the award-winning Real Warriors Campaign, which originally rolled out in 2009, will include additional emphasis on suicide prevention in line with Secretary of Defense Lloyd J. Austin III’s goal to eliminate suicide in the military.

“PHCoE and DSPO are developing a new five-year strategic plan for the Real Warriors Campaign. The plan will be based on current research, have an evaluation plan in place that is monitored frequently, and work actively to link to other federal agencies with similar goals,” said Kate McGraw, PHCoE branch chief, and a doctor of clinical psychology.

PHCoE is developing a joint strategy with DPSO to ensure it identifies and optimizes every available means to publicize campaign messages, McGraw said.

PHCoE’s Multilayered Outreach

Established in 2017 as a DHA center of excellence but originally dating to 1995, PHCoE has led DOD’s use of evidence to inform mental health efforts across the services. Its new partnership with DSPO is poised to enhance the campaign to further awareness of getting help for mental health and suicide prevention.

“We serve as senior experts on task forces and work groups across the federal government, with international military mental health leaders and scientists, and with the White House to help shape policy and practice of mental health care research, services, and programs for our service members and their families, not only within the DOD, but also within civilian communities where our military families live,” McGraw explained.

“PHCoE conducts a portfolio of health systems and services’ research, provides surveillance and epidemiological expertise, and is responsible for the Department of Defense Suicide Event Report, which allows DOD to better understand the factors associated with suicide attempts and deaths, and to inform leadership at all levels to help develop evidence-based plans to reduce suicide in the DOD,” she added.

The center also oversees the joint DOD/Department of Veterans Affairs Practice-Based Implementation Network, established in 2012, to more effectively bridge the gap between psychological health research and clinical practice. It allows DOD to more rapidly translate mental health research findings into clinical practice across the enterprise, McGraw said. On Feb. 7, 2023, The White House Report on Mental Health Research Priorities named the network as a best practice.

DSPO’s Roles

“From the beginning, policy, oversight, and data have been foundational to DSPO. As DSPO looks to the future, our vision is to be a hub of hope,” said DSPO Director Liz Clark.

“DSPO is expanding its focus to create comprehensive prevention, response, and postvention training resources, to lead surveillance and data analysis efforts, to translate research into practice, to promote partnerships, and to effectively communicate that life is worth living,” Clark said.

The joint efforts of PHCoE and DSPO to reduce suicide come at a time when deaths by suicide in the military were down in 2021 but have still been trending upward over the last three decades.

DSPO reported that 523 soldiers, sailors, airmen, and Marines died by suicide in 2021, down from 581 in 2020.

On Feb 24, 2023, the Suicide Prevention and Response Independent Review Committee released a report with recommendations to the DOD on reducing suicide in the military. The four main areas of focus are:

• Restructuring suicide prevention training
• Providing additional resources to help service members access existing support services
• Promoting lethal means safety
• Emphasizing leader stewardship in addressing service member needs

“Once approved, DSPO will play a key role in implementing the recommendations to include oversight of the integrated primary prevention workforce,” Clark explained.

In addition to the Real Warriors campaign, DSPO and PHCoE are “collectively working on developing ideas for a robust practice-based implementation pilot focused on integrating suicide prevention and response into community care settings,” she said. “Within the last year, DSPO has collaborated with the unique skills and talents of the research experts at PHCoE on several research synthesis efforts aimed at helping DOD leaders to understand issues related to suicide prevention and response.”

Clark recognized that stigma can be a barrier to seeking help, adding: “Even when resources exist, fear can and does prevent people from reaching out. Normalizing getting help is key.”

Ultimately, the campaign aims to raise awareness of mental health and suicide prevention by putting the service member, family member, and veteran first.

“Death by suicide is complicated. There is not easy answer to this tragedy. By taking a comprehensive and collaborative approach, DSPO ensures that all service members and their families know they matter,” Clark said.

Resources

Critical areas of public outreach are available across the services, including:

• Educating and training programs such as the U.S. Air Force and Space Force’s “Ask, Care, Escort” program, the U.S. Army’s SP2 suicide prevention efforts, and the U.S. Navy’s “Ask, Care, Treat” training that give service members the skills to link someone thinking about suicide to support
• Increasing service members’ knowledge of, and comfort in, reaching out to helping resources via DSPO’s Resources Exist Asking Can Help program, or REACH
• Encouraging supportive language through DSPO’s informational resource based on the Your Words Matter national campaign, which calls for the end of stigmatizing or negative language when addressing mental health
• Sharing resources to support service members and their families in nurturing, growing, and maintaining healthy relationships through the Healthy Relationships program, a free, educational consultation designed to strengthen relationships through a series of personalized coaching sessions tailored to help set goals and strengthen communication skills
• Collaborating with the DOD Educational Agency to support school-age children in talking about their feelings via the Acknowledge, Care, Tell program
• Contacting the Military Crisis Line and Veterans Crisis Line, which are free, confidential resources for all service members, including members of the National Guard and Reserve, and veterans. Call, chat, or text with a qualified responder, who will listen and can connect you with the resources you need. There's no charge and you decide how much information to share. The resource is accessible 24 hours a day. For the crisis lines, dial 988, then press 1.