Suicide Prevention: DOD Should Enhance Oversight, Staffing, Guidance, and Training Affecting Certain Remote Installations

GAO-22-105108 Published: Apr 28, 2022. Publicly Released: Apr 28, 2022.
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Fast Facts

DOD recorded 384 active-duty servicemember suicides in 2020—an increase of 33.5% in the suicide rate since 2016. Some were outside the contiguous U.S., in remote locations with harsh living conditions and fewer resources.

Feelings of isolation while separated from family and friends and less access to mental health services are risk factors in these locations that may contribute to suicides.

We examined suicide data for servicemembers at remote installations, prevention efforts, and more. DOD has not fully assessed suicide risk at these installations. Our 14 recommendations address this and other issues.

A Suicide Prevention Month Display in 2021

pairs of soldiers' boots lined up in a row with a small American flag placed in each pair

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Highlights

What GAO Found

The Department of Defense (DOD) and the military services have collected statutorily required suicide data for servicemembers and dependents, including those assigned to remote installations outside the contiguous United States (OCONUS). GAO's analysis suggested that these remote installations accounted for a slightly higher proportion of reported suicide attempts, but a lower proportion of reported suicide deaths relative to the proportion of servicemembers assigned to these locations in 2016-2020 (see figure). DOD officials stated that although access to non-military firearms is limited at installations outside the U.S., remote OCONUS installations can present risk factors like less access to mental health services and increased social isolation. However, DOD has not fully assessed suicide risk at these installations. Establishing a process to do so could enhance related suicide prevention efforts.

Average Proportions of Reported Servicemember Suicide Deaths and Attempts Compared to Active-Duty Population by Geographic Category, 2016 through 2020

Average Proportions of Reported Servicemember Suicide Deaths and Attempts Compared to Active-Duty Population by Geographic Category, 2016 through 2020

Note: Due to data limitations, GAO was unable to identify a geographic category for 2.9 percent of reported suicide attempts, 1.8 percent of reported suicide deaths, and less than one percent of active duty personnel. These proportions are not adjusted for sex or age. Suicide attempts may be under- or inconsistently reported. These limitations could affect comparisons across geographic categories.

DOD and the military services have established suicide prevention policies, programs, and activities—such as counseling and efforts to encourage lethal means safety—for servicemembers and dependents, including those assigned to remote OCONUS installations. However, gaps exist in implementation. For example, the Army, the Navy, and the Marine Corps have not ensured implementation of key prevention activities, such as designating key prevention personnel. As a result, these services lack reasonable assurance that such activities are implemented across all installations, including remote OCONUS locations, and cannot ensure access to key suicide prevention resources.

DOD and the military services have established some suicide response guidance and training for key personnel, but gaps exist. For example, DOD has established guidance that fully addresses commanders' response to suicide deaths, but not suicide attempts. Further, DOD has not established statutorily required training for commanders on responding to suicide deaths and attempts. By establishing comprehensive suicide response guidance and training for commanders, DOD can better ensure that commanders are prepared to provide support to suicide attempt survivors and the bereaved.

Why GAO Did This Study

In 2020, DOD recorded 384 active component suicide deaths, representing a 33.5 percent increase in the suicide rate since 2016. Some of these servicemembers were stationed at remote OCONUS installations, defined by GAO as meeting DOD criteria involving factors such as harsh living conditions and limited resources.

In response to a provision in the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021, this report examines, among other objectives, the extent to which DOD and the military services have, in relation to remote OCONUS installations (1) collected required suicide incident data, and what is known about the incidence of suicide and related risk factors among servicemembers during 2016-2020; (2) established and ensured implementation of policies, programs, and activities that address suicide prevention; and (3) established guidance and training for key personnel for responding to suicide deaths and attempts. GAO analyzed data, policies, and guidance; reviewed installation-level documents; and interviewed officials from DOD, the military services, and four installations.

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Recommendations

GAO is making 14 recommendations, including that DOD establish a process to assess suicide risk at remote OCONUS installations, three services establish oversight of installations, and DOD improve guidance and training for commanders. DOD generally concurred with the recommendations and described related actions. GAO believes the recommendations are valid, as discussed in the report.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense The Secretary of Defense should ensure the Under Secretary of Defense for Personnel and Readiness, in collaboration with the Defense Suicide Prevention Office, establishes a process to assess risk factors for suicide and related challenges associated with OCONUS installations that could be considered remote and take any appropriate actions. (Recommendation 1)
Open
DOD partially concurred with this recommendation. In July 2022, DOD officials stated that the Defense Suicide Prevention Office is collaborating with the Office of Force Resiliency and the military departments to implement the recommendation by developing processes that allow the military departments to tailor appropriate actions to the unique needs of each military installation. DOD estimated these actions will be completed by December 2024. When we confirm what actions DOD has taken in response to this recommendation, we will provide updated information.
Department of the Navy The Secretary of the Navy should establish a policy that requires the designation of Directors of Psychological Health at Navy and Marine Corps installations and provides implementing guidance for these personnel, in accordance with DOD policy. (Recommendation 2)
Open
The Navy concurred with this recommendation, and in July 2022, stated that the Navy is developing a policy to implement the requirement for Directors of Psychological Health. The policy will provide implementation guidance and processes to designate installation, command, and Reserve Component Navy and Marine Corps Directors of Psychological Health. The Navy estimated these actions will be completed by January 2025. When we confirm what actions the Navy has taken in response to this recommendation, we will provide updated information.
Department of the Army The Secretary of the Army should establish oversight mechanisms, such as by updating the content of the program status report and clarifying the requirement for its submission, to ensure that installation-level suicide prevention program requirements are implemented in accordance with DOD and service policies. (Recommendation 3)
Open
The Army concurred with this recommendation, and in July 2022, stated that the Army Resilience Directorate is developing a suicide prevention policy compliance tool, intended to track fidelity of policy execution and inform program effectiveness. The Army estimated these actions will be completed by March 2024. When we confirm what actions the Army has taken in response to this recommendation, we will provide updated information.
Department of the Navy The Secretary of the Navy should establish oversight mechanisms, such as by specifying oversight requirements in policy, to ensure that command-level suicide prevention program requirements are implemented in accordance with DOD and service policies. (Recommendation 4)
Open
The Navy concurred with this recommendation, and in July 2022, stated that the Navy will update its suicide prevention program instruction to include oversight mechanisms to ensure that command-level suicide prevention program requirements are implemented in accordance with DOD and service policies. The Navy estimated these actions will be completed by December 2022. When we confirm what actions the Navy has taken in response to this recommendation, we will provide updated information.
Department of the Navy The Secretary of the Navy should ensure that the Commandant of the Marine Corps establishes oversight mechanisms, such as by specifying oversight requirements in policy, to ensure that command-level suicide prevention program requirements are implemented in accordance with DOD and service policies. (Recommendation 5)
Open
The Navy concurred with this recommendation, and in July 2022, stated that an update to the Marine Corps suicide prevention policy will include specific language to address the assurance that command-level suicide prevention program requirements are met through oversight mechanisms and communication from Headquarters Marine Corps to the command suicide prevention program officer. The Navy estimated these actions will be completed by December 2022. When we confirm what actions the Marine Corps has taken in response to this recommendation, we will provide updated information.
Department of Defense The Secretary of Defense should ensure that the Director, DHA, develops a strategy to address shortages in primary care behavioral health providers, including at OCONUS installations that could be considered remote. (Recommendation 6)
Open
DOD concurred with this recommendation, and in July 2022, DOD officials stated that the Defense Health Agency will work with military treatment facilities to identify solutions to staffing shortages in OCONUS primary care behavioral health positions. DOD officials estimated these actions will be completed by November 2022. When we confirm what actions DOD has taken in response to this recommendation, we will provide updated information.
Department of Defense The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in collaboration with DSPO, establishes guidance, such as by updating the department's suicide prevention policy, to address commanders' response to suicide attempts, including the extent of any responsibilities related to reintegration of servicemembers into the workplace following a suicide attempt. (Recommendation 7)
Open
DOD partially concurred with this recommendation. In July 2022, DOD stated that it will conduct a review of applicable policies and responsibilities and that the Defense Suicide Prevention Office, in collaboration with the Defense Health Agency and Office of Force Resiliency, will determine further actions based on this review. DOD officials estimated these actions will be completed by December 2024. When we confirm what actions DOD has taken in response to this recommendation, we will provide updated information.
Department of Defense The Secretary of Defense should ensure that the Under Secretary of Defense for Personnel and Readiness, in collaboration with DSPO, establishes training resources for commanders that address their response to suicide deaths and attempts. (Recommendation 8)
Open
DOD partially concurred with this recommendation. In July 2022, DOD stated it will conduct a review of applicable policies and responsibilities and will develop a plan to address any identified training needs. DOD officials estimated these actions will be completed by December 2024. When we confirm what actions DOD has taken in response to this recommendation, we will provide updated information.
Department of the Army The Secretary of the Army should develop, and ensure the availability of, training for suicide prevention program managers that covers the scope of their responsibilities, including those related to responding to suicide deaths and attempts. (Recommendation 9)
Open
The Army concurred with this recommendation, and in July 2022, stated that the Army Resilience Directorate is developing competencies based on requirements outlined in its draft suicide prevention policy. These competencies will be compared with DOD's required training for prevention personnel to determine training gaps that the Army needs to address through professional development training. The Army will then publish training guidance for suicide prevention personnel. Army officials estimated these actions will be completed by October 2022, but have not provided an update as of December 2022. When we confirm what actions the Army has taken in response to this recommendation, we will provide updated information.
Department of the Air Force The Secretary of the Air Force should develop, and ensure the availability of, training for suicide prevention program managers that covers the scope of their responsibilities, including those related to responding to suicide deaths and attempts. (Recommendation 10)
Open
The Air Force concurred with this recommendation, and in July 2022, stated that the Air Force is currently developing suicide prevention program training that suicide prevention program managers will be required to receive within 180 days of assuming that role. Air Force officials estimated these actions will be completed by December 2022. When we confirm what actions the Air Force has taken in response to this recommendation, we will provide updated information.
Department of the Army The Secretary of the Army should develop a process to ensure that installation suicide prevention program managers complete required training. (Recommendation 11)
Open
The Army concurred with this recommendation, and in July 2022, stated that the Army Resilience Directorate will establish and publish reporting requirements for training completion as part of the training guidance being developed to address recommendation 9. Army officials estimated these actions will be completed by October 2022. When we confirm what actions the Army has taken in response to this recommendation, we will provide updated information.
Department of the Navy The Secretary of the Navy should develop a process to ensure that command suicide prevention program managers complete required training. (Recommendation 12)
Open
The Navy concurred with this recommendation, and in July 2022, stated that the Navy will update its suicide prevention policy to ensure that suicide prevention program managers complete required training. Navy officials estimated these actions will be completed by December 2022. When we confirm what actions the Navy has taken in response to this recommendation, we will provide updated information.
Department of the Air Force The Secretary of the Air Force should develop a process to ensure that installation suicide prevention program managers complete required training. (Recommendation 13)
Open
The Air Force concurred with this recommendation, and in July 2022, stated that the Air Force has begun developing a plan requiring suicide prevention program managers to track completion of required training through an online database. Air Force officials estimated these actions will be completed by September 2022. When we confirm what actions the Air Force has taken in response to this recommendation, we will provide updated information.
Department of the Navy The Secretary of the Navy should ensure that the Commandant of the Marine Corps develops a process to ensure that command suicide prevention program managers complete required training. (Recommendation 14)
Open
The Navy concurred with this recommendation and, in July 2022, stated that an update to the Marine Corps suicide prevention policy will include language to ensure that suicide prevention program managers complete required training. Navy officials estimated these actions will be completed by December 2022. When we confirm what actions the Marine Corps has taken in response to this recommendation, we will provide updated information.

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