Mental health
Brandon Act NAVADMIN – Self-Referral for Mental Health
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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.
- 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. - 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. - 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. - 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. - 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. - Released by Vice Admiral Richard J. Cheeseman, Jr., N1.//
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CLASSIFICATION: UNCLASSIFIED//
A message from the Assistant Secretary of Defense for Health Affairs
MHS Colleagues,
Mental health care is a priority focus for the Military Health System every single day, but as May is Mental Health Awareness Month, I wanted to highlight the effort we are making to address this critical need.
Secretary Cisneros signed the implementing policy for the Brandon Act on May 5, with Teri and Patrick Caserta present. The Act, designed to help service members access timely mental health evaluations, is named for their son Brandon, a young sailor who died by suicide. We welcome this measure as part of our approach to suicide prevention and mental health and it was a privilege to meet the Casertas.
One of my personal goals is to do everything possible to eliminate the stigma that too often still inhibits our people from seeking and getting care. Mental health is health, period – and we need to embrace that fact and encourage and support people in need of this care. We are working to develop training to help educate those in leadership roles on how to support their people, to look for signs that someone is struggling and to enable them to get help. Efforts are underway to address the shortage of mental health providers in our system. We know the answers aren’t simple, but we are committed to finding them.
There is a wide range of resources available to help us all learn more about mental health, and they can be found here: Mental Health Spotlight. Please take time to learn about them, to know what is available and how to access them. Our collective success in improving mental health across the total force starts with an individual commitment by each of us, to learn as much as we can about this issue and how to put the resources we have in play, to demonstrate by our own actions and words the importance of mental health. We need to normalize seeking mental health care so it becomes as accepted as seeing a doctor for the flu or a broken bone.
As leaders of the MHS, we have a particular responsibility to help move these goals forward. I know I can count on you to keep mental health priorities in mind this month, and throughout the year.
Very Respectfully,
Lester
Lester Martinez-López, M.D., M.P.H.
Assistant Secretary of Defense for Health Affairs
Mental Health Awareness Month Message
CLASSIFICATION: UNCLASSIFIED// ROUTINE R 101606Z MAY 23 MID600053003653U FM SECNAV WASHINGTON DC TO ALNAV INFO SECNAV WASHINGTON DC CNO WASHINGTON DC CMC WASHINGTON DC BT UNCLAS ALNAV 040/23 MSGID/GENADMIN/SECNAV WASHINGTON DC/MAY/ SUBJ/MENTAL HEALTH AWARENESS MONTH// RMKS/1. May is Mental Health Awareness Month, an opportunity to help each other recognize the many ways that behavioral health conditions impact our lives, as well as our individual and team readiness. It is also an opportune time to remind ourselves to advocate for those experiencing life stressors, as well as an opportunity to highlight existing resources and services available to the Navy and Marine Corps team to ensure the delivery of the most appropriate service to meet Service Member needs. Military service can be complex, presenting stressors that are wide-reaching and have readiness impacts to our Sailors, Marines, their families, and our civilian workforce. As you stand the watch on behalf of the American people, I ask you to take time to look out for yourself and those who serve alongside you. I encourage you to reach out to others and focus on fostering social connectedness, particularly those connections that may have been weakened during the pandemic. Social connectedness is integral to our readiness as it not only improves our mental health and well-being but strengthens our immunity and can even increase our longevity. You are never alone and there is no wrong door to get help. We have a full range of mental health resources that include mental health and medical professionals, family counselors, chaplains, and other support services to help you get the right care, at the right level, when you need it. Mental health services are available across the globe at military medical treatment facilities, above, on, and below the sea, and embedded within operational units. We have non-medical mental health resources available through our Fleet and Family Support Centers, Marine Corps Community Services, Military and Family Life Counseling, Deployment Resiliency Counselors, the Psychological Help Outreach Program, Veterans Affairs Vet Centers, and Military OneSource. Our chaplains provide confidential counseling and foster spiritual readiness. Our civilian teammates can access a wide range of services through the Civilian Employee Assistance Program. Share with others when you have positive experiences seeking and receiving counseling. I especially encourage leaders to set this example. We have a duty to remove stigma, and encourage others to make time for their mental health. Your actions can encourage a shipmate to get the help they need. Check in often with your fellow Sailors and Marines. Help them feel more socially connected. Do not wait until you see them struggling. When they need additional support, help them get connected to services that can provide assistance. You can be the difference. Together, we must fight stigma, promote mental health education, and normalize taking care of our mental health. 2. Released by the Honorable Carlos Del Toro, Secretary of the Navy. BT #0001 NNNN CLASSIFICATION: UNCLASSIFIED//
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