Joel Schofer's Career Planning Blog

Brandon Act NAVADMIN – Self-Referral for Mental Health

Posted on August 3, 2023 Updated on July 30, 2023

CLASSIFICATION: UNCLASSIFIED//

ROUTINE

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FM CNO WASHINGTON DC

TO NAVADMIN

INFO CNO WASHINGTON DC

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NAVADMIN 166/23

PASS TO OFFICE CODES:
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INFO CNO WASHINGTON DC//N1//

MSGID/GENADMIN/CNO WASHINGTON DC/N1/JUL//

SUBJ/SELF-INITIATED REFERRAL PROCESS FOR MENTAL HEALTH EVALUATIONS OF SERVICE
MEMBERS – THE BRANDON ACT//

REF/A/DOC/DOD/05MAY23//
REF/B/MSG/SECNAV WASHINGTON DC/111916ZJUL23//
REF/C/DOC/OPNAV N17/JUL23//
REF/D/MSG/SECNAV WASHINGTON DC/222101ZFEB23//
REF/E/DOC/DOD/17AUG11//
REF/F/DOC/DOD/13JUL22//
REF/G/DOC/DOD/28MAR13//

NARR/REF A IS DIRECTIVE-TYPE MEMORANDUM 23-005, SELF-INITIATED REFERRAL
PROCESS FOR MENTAL HEALTH EVALUATIONS OF SERVICE MEMBERS.
REF B IS ALNAV 054/23, IMPLEMENTATION OF BRANDON ACT.
REF C IS THE MENTAL HEALTH PLAYBOOK VERSION 1.1.
REF D IS ALNAV 015/23, INDIVIDUAL MEDICAL READINESS ELEMENTS, GOALS, AND
METRICS POLICY UPDATE.
REF E IS DEPARTMENT OF DEFENSE INSTRUCTION 6490.08, COMMAND NOTIFICATION
REQUIREMENTS TO DISPEL STIGMA IN PROVIDING MENTAL HEALTH CARE TO SERVICE
MEMBERS.
REF F IS DEPARTMENT OF DEFENSE INSTRUCTION 6490.04, MENTAL HEALTH EVALUATIONS
OF MEMBERS OF THE MILITARY SERVICES.
REF G IS DEPARTMENT OF DEFENSE INSTRUCTION 6495.02, VOLUME 1, SEXUAL ASSAULT
PREVENTION AND RESPONSE: PROGRAM PROCEDURES.//

RMKS/1. This NAVADMIN sets forth the self-initiated referral process for the
mental health evaluation of Service Members as directed in references (a) and
(b), commonly referred to as the Brandon Act. This NAVADMIN applies to
Service Members serving on Active Duty assigned to Navy commands. This
NAVADMIN ensures prompt implementation of reference (a) for Service Members
serving on Active Duty with Navy commands. For Service Members not serving
on Active Duty, command plans and arrangements for referral requests will be
established as soon as practicable.

2. Seeking Help Overview
   a. Said simply, mental health is health, and the health of our people is
   critical to being ready to fight and win. For most Sailors, mentorship,
   support, and problem-solving skills will give them what they need to stay in
   the fight. In addition, command programs such as Warrior Toughness and
   Expanded Operational Stress Control are designed to help provide additional
   skills and coping mechanisms for managing the stress that accompanies
   military service.
   b. However, there are times when our people need additional help, and
   seeking this help is a sign of strength. As a result, Navy commanders,
   leaders, supervisors, and civilian and military managers at all levels must
   continue to normalize talking about mental health issues, destigmatize
   seeking mental health care, and strongly encourage Service Members to make
   use of health and mental wellness resources throughout their careers.
   c. To make it easier for commands and Service Members to navigate the
   care options available, Navy produced the Mental Health Playbook, which has
   been updated to support this NAVADMIN.
   Reference (c) includes an abundance of helping options including, but not
   limited to, Chaplains, Military and Family Life Counseling, Military
   OneSource, embedded mental health counselors, Fleet and Family Support
   Centers, Military OneSource, and the Veterans Crisis Line. As a best
   practice, Service Members should download the Mental Health Points of Contact
   or Mental Health Resources Roadmap fillable PDFs to record local contact
   information for the relevant resources before they are needed. Files can be
   downloaded at the following website: https://www.mynavyhr.navy.mil/Support-
   Services/Culture-Resilience/Leaders-Toolkit/Mental-Health-Playbook.
   d. Service Members serving on Active Duty may directly schedule an
   appointment through the military health system for mental health care without
   a referral from their Primary Care Manager (PCM).
   This direct route is the most straightforward option and the specific steps
   will depend on the local resources available. This option is currently
   unavailable for Selected Reserves (SELRES) and Individual Ready Reserve (IRR)
   Service Members. Guidance for SELRES and IRR Service Members will be
   published in phase two in line with reference (a).
   (1) For Service Members in commands with an assigned embedded mental
   health provider (e.g., aircraft carriers, NECC, submarines), the embedded
   mental health provider is the primary source for mental health care.
   (2) For Service Members in units without an embedded mental health
   provider, Service Members may contact their local military mental health
   clinic or closest military treatment facility (MTF) to schedule an initial
   appointment with a behavioral health provider.
   Service Members may also schedule an appointment by reporting directly to a
   MTF.
   (3) Service Members experiencing suicidal ideation constitutes an
   emergency. Suicidal ideations are defined by thinking about, considering, or
   planning for suicide.
   (a) Service Members within the Continental United States
   (CONUS) experiencing suicidal ideation should call the Veterans Crisis Line
   at 988 and press 1, or go directly to the nearest emergency room.
   (b) Service Members outside the Continental United States
   (OCONUS) experiencing suicidal ideation should call Europe:
   00800 1273 8255 or DSN 118, Korea: 080-855-5118 or DSN 118,
   Philippines: Dial #MYVA or 02-8550-3888 and press 7. For all other
   locations reach out via the Veterans Crisis Line by following the country
   code dialing procedures to call the CONUS 800 number (1-800-
   273-8225 and press 1). Alternatively, Service Members can open a chat at
   https://www.veteranscrisisline.net/get-help-now/chat/ and request a phone
   call from the crisis line responder who will call them at any OCONUS location
   or follow local procedures to access emergency care.
3. The Brandon Act does not change existing referral processes for network
   care. Military Service Members cannot be seen for specialty care including
   mental health care in the civilian healthcare network without a referral.
   Referrals to the network are made by the Service Member’s PCM or Mental
   health professional (MHP) at the local MTF.
4. Self-Initiated Referral for a Mental Health Evaluation
   a. Service Members:
   (1) Service Members who prefer to have their chain of command
   involved with scheduling a mental health care appointment through the
   military health system, in line with reference (a), can receive assistance
   from the commanding officer (CO) or from a supervisor in paygrade E-6 and
   above by specifically requesting a self-initiated referral for mental health
   evaluation (MHE).
   (2) A self-initiated referral may be requested for any reason or on
   any basis including, but not limited to, personal distress, personal
   concerns, trouble performing duties, and functioning in daily activities that
   may be attributable to possible changes in mental health. Service Members
   are not required to provide a reason or basis to request and receive a
   referral. This process is considered a voluntary, self-initiated referral
   and is not the same process directed for a command-directed MHE.
   (3) Service Members serving on Active Duty may request a self-
   initiated referral at any time and in any environment including, but not
   limited to:
   (a) Assigned to CONUS locations.
   (b) Assigned to OCONUS locations.
   (c) In a deployed setting.
   (d) Assigned to a temporary duty station.
   (e) On leave.
   (4) Mental health issues that may affect Service Members’
   readiness to deploy, ability to perform their assigned mission, or fitness
   for retention in military service are reportable medical issues in line with
   reference (d). Service Members have a responsibility to report mental health
   issues that may impact their individual medical readiness status, such mental
   health issues must be reported to their command in line with reference (d).
   b. A supervisor is defined by reference (a) as a member of the Armed
   Forces within or out of a Service Member’s official chain of command who
   exercises supervisory authority over the Service Member and who is authorized
   in line with reference (a) to make a referral for a MHE. Referral requests
   made to civilian supervisors will be forwarded to an appropriate uniformed
   member (as determined by the civilian supervisor and consistent with
   reference (a)) who exercises supervisory authority over the requesting
   Service Member. COs or supervisors, as defined in reference (a), who are in
   the grade of E-
   6 or above must:
   (1) Ensure measures are in place so Service Members under their
   leadership understand the procedures to request a self- initiated referral
   for a MHE. Service Member requests for mental health support are
   opportunities for leaders to connect with their Service Members and further
   establish trust through use of active listening skills. See reference (c),
   section 2 “Having Effective Conversations with People in Need” for guidance
   on active listening.
   (2) Refer the Service Member to a mental health provider for a MHE as
   soon as practicable.
   (a) In making the referral, the CO or supervisor must consider
   the unique circumstances of the timing of the self- initiated referral,
   including the accessibility of MTFs, clinics, and embedded mental health
   services, as well as the availability of mental health providers. As
   applicable, COs or supervisors should use existing mental health resources
   and processes (e.g., embedded mental health) to connect Service Members with
   MHEs and care.
   (b) Supervisors may call the local mental health clinic or
   closest MTF to schedule the Service Member’s initial MHE.
   Supervisors may also accompany the Service Member to the clinic in person to
   schedule their appointment.
   (c) Supervisors will provide the Service Member with the date,
   time, and place of the scheduled MHE. Supervisors are not entitled to
   information from a mental health provider regarding the results of the MHE
   except for information that may be disclosed to command in line with
   references (c) and (e). Supervisors may call the clinic to confirm
   completion of the MHE and inquire on any duty limitations only.
   (d) For Service Members assigned to locations without a mental
   health provider, telehealth options will suffice. If no telehealth option is
   available, schedule the Service Member with an appropriately privileged
   primary care provider.
   (e) If COs have concerns about Service Member behavior,
   significant changes in performance, or fitness for duty, please see reference
   (f) for command-directed MHE procedures.
   (3) If a Service Member voluntarily shares information indicating
   that they were the victim of a sexual assault, the CO, leadership team, or
   other member of the chain of command must comply with the requirements in
   reference (g) and all other applicable policy. A Service Member’s decision
   to share or not share such information does not affect their ability to make
   a restricted report pursuant to reference (g).
   (4) Reduce stigma by treating referrals for MHEs in a manner similar
   to referrals for other medical services, to the maximum extent practicable.
   c. Mental Health Providers
   (1) Administer the mental health evaluation as soon as practicable.
   (2) Communicate with the CO or supervisor consistent with references
   (c) and (e). Follow all appropriate guidance in line with requirements for
   the confidentiality of health information pursuant to the Health Insurance
   Portability and Accountability Act of 1996, applicable privacy laws, and
   associated Department of Defense guidance. Disclosures to the command are
   limited to confirming that the MHE was provided pursuant to the referral, a
   disclosure authorized by reference (e), and any other disclosure for which
   the Service Member provided authorization.
   (3) Assess Service Member fitness for duty and document all MHEs in
   the medical record.
5. Annual Training Requirement. Upon release of developed training, COs,
   supervisors, and Service Members will receive annual training, on how to
   recognize personnel who may require a MHE, the process of how a Service
   Member may obtain a self-initiated referral for a MHE, and privacy
   protections.
6. Questions about the self-initiated referral process for MHEs of Service
   Members should be directed to Ms. Leah Fletcher, Navy Culture & Force
   Resilience Office, e-mail Leah.M.Fletcher6.civ@us.navy.mil and Captain
   Melissa Lauby, Bureau of Medicine and Surgery, e-mail
   Melissa.D.Lauby.mil@health.mil.
7. Released by Vice Admiral Richard J. Cheeseman, Jr., N1.//

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CLASSIFICATION: UNCLASSIFIED//