Q: How do I know if an individual is serious about harming themselves and not just trying to get out of their obligation to the AF?

A: Predicting who will kill themselves is difficult. Anyone expressing a desire to die requires assistance and should be referred to the installation mental health professionals.

Q: Is a Commander Directed Mental Health Evaluation (CDE) mandatory after a Non-Fatal Self Injurious Event (NFSE)?

A: There is nothing in the AFI that mandates pursuit of a CDE following a NFSE, though it would be highly advisable. Requesting a CDE does not mean the member will be automatically recommended for separation. Instead, a CDE is the formal, legal means for you to get feedback about a suspected emotional condition or distressing situation. It protects you and the member.

Q: If a person admits feelings suicidal, can I order them to go to the Life Skills Support Center (LSSC)?

A: Yes. Ordinarily when a person is referred for a CDE, they have 48 hours to consult the Area Defense Counsel first. But in an emergency where it is suspected they might be a danger to themselves or others you can immediately refer them for an emergency CDE. Experience reveals the vast majority of people will willingly go the LSSC when their commander, First Shirt, or supervisor expresses concern for their well-being.

Q: What happens when an airman who is assessed as suicidal refuses to go to the hospital? What is my role as the commander regarding hospitalization?

A: Your role as the commander is to ensure the proper referral is made to the mental health provider. If the medical provider believes, after adequate assessment, that the active duty member is in need of hospitalization, and the member is unwilling to be hospitalized, an involuntary hospitalization will occur.

Q: I visit with many Service members who are going through difficult emotional times, some of which are quite severe. At what point do I refer them for an emergency CDE?

A: Call and consult with a professional first at the base legal office and at the LSSC. DoDD 6490.1 is clear however; “The commanding officer shall refer a Service member for an emergency mental health evaluation as soon as is practicable whenever a Service member, by actions or words, such as actual, attempted or threatened violence, intends, or is likely to cause serious injury to himself, herself, or others and when the facts and circumstances indicate that the service member’s intent to cause such injury is likely...” Short of this, highly encourage the member to self refer.

Q: What kind of information will I receive back from the mental health professional when someone is referred for voicing suicidal thoughts?

A: You can expect the mental health professional to provide you with enough information to make decisions as the commanding officer while at the same time protecting the privacy of the member.

Q: There seems to be some confusion in terms between a suicide “attempt” and a “gesture.” What is the difference between the two?

A: Behaviors that result in a non-completed suicide are referred to as Non-Fatal Self Injurious Events (NFSE). This eliminates having to discriminate between a gesture, attempt etc. All NFSE should be taken seriously and the proper referral made, regardless of how non-lethal the method or injury may seem. Anyone who voices a desire to kill him or herself or has taken action to kill themselves no matter how mild it may appear to you, is in need of assistance.

Q: What actions should be taken following a NFSE in the case when emergency personnel have already responded and the Service member is in the hospital?

A: When first hospitalized, the member needs to be medically cleared/stabilized. Once this has occurred, the person will need to be assessed by a professional for continued suicidal thoughts/plans. This will likely come through the Life Skills Support Center, or medical center professionals. If the Service member continues to be suicidal, hospitalization may be necessary in a traditional psychiatric environment. If not, a safety plan is established with buddy care and follow-up with a provider as necessary. It is wise to have any means of self-harm removed out of the home such as firearms or medications as necessary. As stated previously, a CDE is recommended so that any ongoing mental health difficulties can be ruled out.

Q: What options do I have for helping those people trying to cope following a suicide, especially when there are larger numbers of people involved? They all don’t need to see a professional.

A: There should be a Critical Incident Stress Team on the installation, most often at LSSC, that is responsible for the management of the emotional demands of larger groups of people. Contact LSCC directly or contact your base Integrated Delivery System (IDS).

Q: I’ve got a huge number of active duty members, including civilians in my squadron. What is the best way of getting them all trained on suicide awareness education?

A: You can contact the installation’s IDS and let them know your specific requirements (i.e. number to be briefed, shift work considerations, and forum in which the education will take place). A trained educator will then provide the briefing. Each squadron’s Unit-Training Manager (UTM) should ensure that everyone in the squadron is accounted for and report these numbers quarterly to the IDS chairperson or their appointee.

Q: Time at commander’s call is a scarce commodity. How much time should be allowed to cover suicide awareness education?

A: At least 30 minutes. We know that all the indicators of increased vulnerability of suicide cannot be rushed through. It does not do any good if the information is approached as “just another briefing.” Emphasize the briefing is about more than suicide, it’s about how we as a community take care of each other. General Foglesong sent out a 15 Jul 02 memo where he requests squadrons ensure 30 minutes is devoted to the briefing.

Q: Can the suicide material be presented on a videotape or Power Point presentation? It would be much easier because I have several shifts that need to be covered.

A: Per AFI 44-154, a live person presentation is mandatory. We know that learning in this manner is best because it fosters interaction and personalizes the material. The only exception to this would be for Air Force members and civilian employees who are assigned to units that are geographically separate from the installation IDS.

Q: I’ve got a member that is having thoughts of suicide, but they are in a special duty status. How will referring them affect this?

A: It depends on the severity of the problem and what special duty status they have. Most individuals (90+%) who self-refer will not have their career negatively affected. If necessary, the special duty status can be placed on hold while the problem is sorted out. Consult with your professionals but when in doubt, refer. A temporary hold, or in a worse case scenario, permanent loss of the member’s special duty status, is far less severe than the potential loss of life. Early intervention is paramount.

Q: There is a variety of demographic information out there on who represents the greatest risk for suicide. Who is at greatest risk in the AF?

A: White males, aged 25-34. Multiple indicators of vulnerability include being no longer married, relationship problems, alcohol abuse, financial problems, criminal acts/under investigation and legal problems. Behavioral indicators include depressed mood manifested by the following: a feeling of no solution, hopelessness/helplessness, agitation/anger, being anxious, withdrawal from others, poor sleeping/eating, talk of death, and loss of interest in work and pleasurable activities.

Q: What do I do if I refer someone to LSSC but they are not found to be suicidal and refuse to return to LSSC for additional assistance?

A: In Jan 03 an Air Force Guide for Managing Suicidal Behavior is being released to mental health clinicians. A portion of the guide instructs clinicians on additional non-treatment ways they can assist commanders, such as: collaboration on developing a means for monitoring ongoing risk in the workplace, possible leadership responses to disruptive behaviors, collaboration to increase support and decrease negative factors, etc. In addition, in Mar 03 a similar guide will be released for commanders and community gatekeepers.