Task Force Recommends OSD-Level Suicide Prevention Policy Office

by U.S. Medicine

November 14, 2010


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WASHINGTON, DC—DoD should establish a suicide prevention policy office at the Office of the Secretary of Defense (OSD) level that disseminates best practices in suicide prevention to the field, a DoD task force set up to examine suicide prevention in the military found. “There is no coordinating body. There is no one looking at best practices, there is nobody keeping an eye on what works and what doesn’t, and evaluations and rolling out the best known things,” said Col Joanne McPherson, executive secretary for the DoD Task Force on the Prevention of Suicide by Members of the Armed Forces, of the task force’s recommendations.

McPherson provided an overview of the findings of the task force’s report during a webinar held in September by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. The task force was convened from August of 2009 to August of 2010 and formulated a report that included 49 findings and 76 recommendations.

The creation of a suicide policy division was one of the 13 foundational recommendations that the task force identified. The task force’s report noted that DoD has no military, civilian, or contract staff dedicated full time in the area of suicide prevention. “The absence of an adequately staffed and resourced OSD policy office on suicide prevention leads to significant challenges to the unity of effort. Service programs are not benefiting from the guidance of a department-wide strategic approach,” the report stated.

Recommendation for Suicide Policy Division

The report stated that a staffed OSD suicide prevention office is necessary to analyze and recommend best practices and to assist the services.

According to the report, DoD programs that employ a “hierarchical and collaborative structure” with the involvement of the services have helped in “establishing unity, standardization, and sharing of best practices and resources.”

One example of this type of structure cited by the report is the DoD Sexual Assault Prevention and Response Office under the deputy undersecretary of defense. The report also cited the example of VA’s Center of Excellence in Suicide Prevention, which includes a central office of suicide prevention with a full-time staff. “The VA uses this structure to quickly disseminate lessons learned throughout the country.”

The Task Force recommends that DoD’s suicide prevention office should reside within the Office of the Under Secretary of Defense for Personnel and Readiness and “be granted the coordinating authority that enables strategic suicide prevention oversight from OSD, through the services, and down to the unit level.”

Task Force Recommendations

Other task force recommendations included the need to equip and empower leaders to establish a culture that fosters prevention, as well as early recognition and intervention. McPherson also said that commanders should be held accountable for establishing a “positive command climate” where servicemembers feels comfortable seeking mental health help.

The task force also found that no DoD clinical practice guidelines exist for evidence-based assessment, management, and treatment of suicide-related behaviors. The task force recommended that clinical practice guidelines be developed. “Given that the current DoD healthcare system shows much variability in the care of suicidal servicemembers, a uniform, systematic, and scientifically informed approach is much needed. The development of clinical practice guidelines for evidence-based assessment, management, and treatment of suicide-related behaviors should address the currently observed system-wide gap.”

Other recommendations included standardizing the investigations of suicides and suicide attempts, which currently are not standardized, according to the report. “Currently, investigations are insufficient to inform suicide prevention programs. There is no policy governing the type and method of investigations of suicides or suicide attempts, and valuable information is lost that might prevent future suicides.”

RAND Study Examines DoD Suicide Prevention Programs

A study is expected to be released by RAND that examines how suicide prevention programs across DoD compare with what is considered “state-of-the-art” prevention programs. The report makes 14 recommendations about how DoD and the services’ approach can be enhanced, according to Rajeev Ramchand, PhD, who presented an overview of the RAND study in September.

RAND researchers posed three questions for the study: what are DoD and the services doing to prevent suicide; what is considered state-of-the-art for suicide prevention in the civilian sector; and do DoD and service-specific programs reflect the state-of-the-art? “We looked at the whole array of programs the services were offering, and we looked across that menu of programs for the presence of the characteristics that are considered state of the art,” said Ramchand.

Data was collected for the report in 2009. The report had not been cleared for release as of mid October.

Ramchand noted that researchers conducted interviews with those involved with the DoD and service suicide prevention programs and reviewed materials and policy on current approaches. Researchers also examined what is considered state-of-the-art for suicide prevention and identified and reviewed literature and conducted interviews with experts.

Ramchand explained that researchers then examined the whole array of prevention programs that DoD and the services offer to determine whether they contained characteristics that are considered to be state-of –the-art.

The report is divided into sections that include the analyses of the epidemiology of suicide; characteristics of state-of-the-art prevention programs; DoD suicide prevention programs and how they compare with the state-of-the-art; and a section that contains the conclusions and recommendations of the report.

Ramchand said that existing literature about the epidemiology of suicide indicates that there are similarities between those who die by suicide in DoD and civilian population, which suggests that effective civilian programs could translate well to DoD. More epidemiologic research is needed, however, to discern whether correlates/risk factors of suicide in the military are the same as in civilian population, he said.

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