Suicide Attempt and Mental Health Crisis Response

Use This Page When

A Marine in your command attempts suicide, expresses suicidal ideation directly or indirectly, is admitted to inpatient mental health or substance abuse care, or returns from inpatient treatment. The trigger is the indicator, not the diagnosis.

This page is the rapid-response application. The Mental Readiness Playbook V3 is the deep reference. Read this page first, then read the playbook in the steady-state Force Preservation topic.

The 90-Second Checklist

The Warm Hand-Off Pattern (Mental Readiness Playbook V3, Page 19)

The escort follows these six steps. They are non-negotiable.

The escort does not return until released. The escort does not become the case manager. The escort is the bridge from command to medical.

First 24 Hours

Command Notification Criteria Under DoDI 6490.08

Authority: DoDI 6490.08 "Command Notification Requirements to Dispel Stigmas in Providing Mental Health Care to Service Members," effective 6 September 2023, implementing Section 704 of Public Law 117-263 (FY2023 NDAA). The 2023 reissue superseded the 17 August 2011 version.

Default rule per Paragraph 1.2: a Service member's use of military health system mental health care, including substance misuse education, is not reported to the commander except under one of the nine exigent circumstances below.

Health care providers will notify the commander when any one of these nine exigent circumstances applies (Paragraph 3.1.b).

What the notification contains (Paragraph 3.1.c)

Providers give the minimum amount of information necessary. In general:

• The diagnosis
• A description of the treatment prescribed or planned
• Impact on duty or mission
• Recommended duty restrictions
• The prognosis
• Any applicable duty limitations
• Implications for the safety of self or others
• Ways command can support or assist the Service member's treatment

You are entitled to the notification. You are entitled to the minimum information above. You are not entitled to the clinical record.

Commander Designation (Paragraph 3.2)

Notification goes directly to the Service member's commander, OR to a person specifically designated in writing by the commander for this purpose. If you want notification routed to a deputy, the XO, the SARC, or a behavioral health officer, designate them in writing. Verbal designation is insufficient.

Routes to Care - Which Pathway Applies

Three routes exist. Pick the right one for the situation.

1. Self-referral. Marine goes to MTF behavioral health, PCM, or embedded provider on their own. Marine does not have to disclose to chain. Leadership entitled to appointment times only.
2. Brandon Act referral (MARADMIN 463/23, 18 Sep 2023). Marine requests a mental health evaluation through CO or supervisor in the grade of E-6 or above. Marine is not required to provide a reason or basis. The MARADMIN implements DTM 23-005 (effective 5 May 2023), which executes Section 704 of Public Law 117-81 (the Brandon Act). Referrals should be treated similar to referrals for other medical services. Honor the request.
3. Command-Directed Evaluation (DoDI 6490.04). You direct the evaluation. Consult with a mental health provider before initiating. Not used as retaliation. Emergent and non-emergent paths.

When in doubt, route through the Brandon Act path. Lower friction, higher engagement, no retaliation concern.

Network Referral Rule

Per MARADMIN 463/23 paragraph 6, the Brandon Act does not change network-care referral rules. Three things to know.

• Marines cannot be seen for specialty mental health care in the civilian network without a referral.
• Referrals to the network are made by the Marine's PCM or by a Mental Health Professional at the local MTF.
• For units with an embedded OSCAR Provider (Operational Stress Control and Readiness), the OSCAR provider is the primary source for mental health care.
• TRICARE patients are not authorized to be seen for behavioral health services in the civilian community without a referral from their PCM.

When a Marine wants civilian-network care, the path runs through the PCM or MTF Mental Health Professional. Brandon Act self-referral starts the chain; it does not bypass network referral rules.

7 to 30-Day Routing

1. CIRRAS profile current. Risk indication, recent events, leadership actions all reflected.
2. First FPC review of the Marine. Chair the discussion. Use the Mental Readiness Playbook V3 framework for the conversation.
3. Return-to-duty plan if applicable. Coordinate with provider on duty limitations, work schedule, supervision level.
4. Family support touchpoint. Spouse and dependents often need referrals. UPFRP and Marine and Family Programs.
5. Climate touchpoint with unit. Apply safe-messaging rules below.
6. Lethal-means follow-up. If firearm storage was the early conversation, follow up. Confirm secure storage executed.

Safe Messaging Rules (Mental Readiness Playbook V3, Pages 9 and 16)

What you say to the unit and to the Marine matters. Follow these rules.

Use these patterns

• Direct ask is encouraged. "Are you thinking about suicide?" Asking does not increase risk.
• "We are here to help you." "You are not alone in this." "We must have each other's backs."
• Open prompts. "How are you feeling?" "What support do you need?" "What can I do?"
• Lethal-means script. "I care and now is not the best time to have an unsecured firearm. How can we secure it until things get better?"

Avoid these patterns

• Minimizing language. Not "you are having a bad day." Not "get over it." Not "stop being soft."
• Judgmental tone. Do not try to have all the answers.
• The fix-it reflex. Sitting with the Marine in discomfort is the work.
• Mind reading. Do not assume why the Marine looks uncomfortable.
• Framing the firearm conversation as a rights debate. Frame as time and space.

Operational rules

• "Never leave someone alone you think may harm themselves or others."
• "Do not use your rank as power. Instead, use it for empowerment."

Non-Delegable CO Actions

• First conversation with the Marine if reachable and the situation allows.
• Warm hand-off coordination - you appoint the escort.
• Decision to initiate a Command-Directed Evaluation under DoDI 6490.04.
• FPC chair for the case review.
• Climate communication to the unit if and when made.

Return From Inpatient Treatment

The Marine comes back. Three things to coordinate.

1. Receive the discharge notification under DoDI 6490.08 criterion 5. Provider notifies you.
2. Coordinate with provider on duty assignment. Limitations, supervision, work hours.
3. Plan the return-to-duty conversation. Private, calm, focused on support and expectations. Not on the incident.

The Marine is not a case file. They are a Marine returning to the unit. Treat the conversation accordingly.

Common Failures

1. Leaving the Marine alone during a crisis. Policy violation and a known risk factor.
2. Treating notification under DoDI 6490.08 as optional reading. The notification triggers your response window.
3. Skipping the warm hand-off pattern. Drop-off at the ER without escort. Marine disappears in the system.
4. Initiating a CDE without provider consultation. DoDI 6490.04 requires it.
5. Using rank to pressure the Marine into care. Counterproductive and contrary to playbook guidance.
6. Frame the firearm conversation as confiscation. Loses the conversation immediately. Frame as time and space.
7. Skipping CIRRAS update. FPC misses the elevated risk. Warm hand-off has no record.
8. Public messaging without safe-messaging review. Unit-wide statements which sensationalize, blame, or moralize.

Individual Medical Readiness Reporting

Per MARADMIN 463/23 paragraph 7.c and ALNAV 015/23, mental health issues affecting readiness to deploy, mission performance, or fitness for retention are reportable medical issues. Marines have a duty to report these to the command. The command coordinates the IMR posture update through medical.

This does not give the command access to clinical detail. It gives the command awareness of readiness impact so the unit deployment and assignment picture stays accurate.

Documentation Set

• Warm hand-off log with escort name, time, location, medical POC
• DoDI 6490.08 notification record from provider
• CIRRAS entry with elevated risk
• FPC agenda item
• Return-to-duty plan if applicable
• IMR posture update if mental health issue affects deployability
• Lethal-means conversation memorandum for record
• Family notification record if command-coordinated

Resources for the Marine

Per MARADMIN 463/23 paragraph 7, suicidal ideation is an emergency. Use the correct line for the location.

Crisis lines by region

Standing resources

• Embedded OSCAR Provider (if assigned to unit) - primary source for mental health care per MARADMIN 463/23 paragraph 6
• Military and Family Life Counselors (MFLC)
• Chaplain
• Military OneSource
• TRICARE behavioral health (PCM referral required for civilian-network specialty care)
• Marine and Family Programs at usmc-mccs.org - "No Wrong Door" policy per MARADMIN 463/23 paragraph 8

What This Page Is Not

This page is the command response framework. It is not clinical guidance. The provider drives the clinical pathway. You drive the command response.

The Marine's care is in the provider's hands. The Marine's place in the unit is in yours.

Related Pages

• Force Preservation (forthcoming) - FPC and CIRRAS workflow detail
• Battle Rhythm (forthcoming) - monthly FPC chair pattern
• Off-Base Arrest (Incident Playbooks) - substance abuse arrests often overlap