Leaders Guide - Suicidal Behavior - Marine Has Made a Suicide Attempt, Gesture or Threat

Once a Marine has made an attempt, gesture, or threat against their own life, they have crossed the line of ambiguity and the time to take action is now. They must be taken seriously and evaluated by mental health immediately. The risk and liability are too high to wait.

What to Look For

Behavior that appears to have been a suicide attempt or gesture such as, overdose of medication or lacerations.
Suicide attempt or gesture as verified by medical authority.

What to Do

If you have not already done so, immediately call Medical for advice. Escort the Marine to Medical for treatment and evaluation of suicide risk. If the MTF is unavailable (such as after hours), escort the Marine to the closest civilian Emergency Room (ER).
If you are concerned about medical risk (excessive bleeding, delirious, etc), call for medical advice and an ambulance.
Keep them safe—DO NOT leave them alone. Take steps to remove potential means of self-harm including firearms, pills, knives, and ropes.
Involve security if agitated or combative.
If psychiatric hospitalization is required, inquire with medical staff about what assistance is needed (e.g., arranging for necessary belongings, child care, or pet care).
Generate a Personnel Casualty Report (PCR) for a suicide attempt or gesture IAW the Marine Corps Casualty Manual, sections 1001.52.d and 3102 (Table 3-2) using the SpecPat category.
Mention in the PCR any pertinent behavior that seemed suicidal (e.g. writing, verbalizations, actions, medical findings, weapons, witnesses, etc.).
Do not report incidents where there were just suicidal thoughts/ideations without an attempt or gesture – suicidal thoughts alone are not reportable (Marine Corps Casualty Manual section 3103).
Notify NCIS if the Marine had access to classified information (see Legal Quick Reference).
Determine Line of Duty/Misconduct (most cases - see Legal Quick Reference).
Coordinate with Medical on the probability of your Marine becoming fully productive again.
Determine the motivation of your Marine to continue service.
Evaluate the long-term risk versus value of retaining Marine:
- Risk of repeated attempts at self-harm and acting out.
- Cost of disruption to unit.
- Cost of administrative burden.
- Expected readiness and contribution to the unit
Decide whether to retain or administratively separate Marine
Coordinate with Medical on:

How to return your Marine to full readiness, or
How to maintain safety until administrative separation.

What to Avoid

The idea is for leaders to let their Marines know they are safe and in good hands if they ask for help. If you can communicate your genuine concern for your Marine they will tell their fellow Marines that seeing you was the right thing to do and that you had their best interests in mind. Here are some things that might destroy trust, close the lines of communication, or deter other Marines from asking for help in the future:

Minimizing the problem or not taking the problem seriously. Saying, “is that all?”
Telling them to “suck it up”, or “get over it”.
Keeping the problem a secret rather than getting appropriate chain of command involved.
Telling personnel who do not have a need to know, making the problem a source of unit gossip.
Ignoring the problem and hoping it will go away.
Delaying a necessary referral for mental health evaluation.

You may be tempted not to take action because you don't believe they are serious or that they're just trying to manipulate the system. However, the liability is too high not to take action. If it turns out that they are trying to manipulate the system, then there are administrative actions you can take later. First get them evaluated and keep them safe, and you can deal with the reasons behind their behavior later.

What to Expect after Taking Action

Usually there will be psychiatric hospitalization at least overnight for thorough evaluation and to determine ongoing suicide risk
Longer-term psychiatric hospitalization if necessary
Recommendations by medical on fitness and suitability for further military service
For entry-level Marines, namely those who have graduated from Boot Camp but have been in less than 180 days, mental health recommendations will often be for administrative separation. Although this is technically only a recommendation, and the command ultimately has the choice of whether to retain or not, the command should be aware of the liability associated with continued military service by someone has a history of suicide attempts or gestures in times of stress.
For Marines beyond their first term of service, recommendations will be made more on a case-by-case basis depending on their history and motivation for continuing service.
Ongoing collaboration with mental health personnel on the Marine's status and safety.
Ways to monitor for changes in suicide risk and what to do if risk increases.
Ways to respond to disruptive behavior in the future
Ways to increase support and decrease factors contributing to the suicidal behavior.

Troubleshooting

Marine refuses voluntary evaluation for suicide risk: If you have sufficient cause to be concerned that the Marine might be suicidal, but the Marine does not want to be evaluated, contact your local medical treatment facility for advice. In general, for risk of suicide consent is not required to transport your Marine to the medical treatment facility or local emergency room.
Marine found at some risk but not hospitalized: If your Marine is evaluated by Medical and found to have some suicide risk, but not enough to warrant hospitalization, then you will need to work with Medical on the best course of action. Upon return to the command, Medical should communicate:
- Current level of risk.
- Recommended protective measures and monitoring, if any.
- Administrative recommendations (duty status, suitability, separation/retention).
- Medical follow-up appointments.
- What to do if the Marine's risk of self-harm increases or does not improve.
Treatment is offered, but Marine refuses treatment: There may be times when a Marine will display some suicidal symptoms at the evaluation, are not imminently dangerous, are returned to full duty by Medical but, against medical advice, refuse to return to the MTF for follow-up care. These situations are challenging since a member who is not at imminent risk for self-harm cannot be mandated to receive medical or mental health treatment. It is essential that leaders and mental health providers collaborate to maximize the Marine's ongoing safety. Upon return to the command, Medical should communicate:
- Current level of risk.
- Recommended protective measures and monitoring, if any.
- Administrative recommendations (duty status, suitability, separation/retention).
- Medical follow-up appointments.
- What to do if the Marine's risk of self-harm increases or does not improve.
Marine is treated but is not getting better: If your Marine is in treatment but does not appear to be improving, you will need to work closely with Medical on the best course of action. They may:
- Have other treatment approaches available to them (different medications or therapies).
- Recommend changing the Marine to Limited Duty status to receive additional treatment.
- Recommend administrative actions or medical retirement in cases where long-term improvement is unlikely with any reasonable treatment.