CLASSIFICATION: UNCLASSIFIED// ROUTINE R 272125Z JUL 23 MID120000330492U FM CNO WASHINGTON DC TO NAVADMIN INFO CNO WASHINGTON DC BT UNCLAS NAVADMIN 166/23 PASS TO OFFICE CODES: FM CNO WASHINGTON DC//N1// 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.// BT #0001 NNNN CLASSIFICATION: UNCLASSIFIED//