The Navy issued what it is calling a technical manual for Naval leaders to address mental health, starting with laying out how commanders should lead conversations with sailors.
The Navy’s Mental Health Playbook, released a few days after the Department of Defense committee on suicide released its recommendations, gives commanders information on how to broach the topic of mental health with their sailors and how to help them find resources for help. It is meant to be read and used like sailors would a technical manual.
“It starts with the climate our leaders create and how you lead the people in your care. Navy-wide, we must become comfortable with the idea of preventative maintenance for our people,” according to the playbook released this week.
“Most of us understand preventative maintenance is necessary for our equipment and machines. Today, it is equally, if not more important to apply this term to our people.”
The playbook does not look at broader changes to the military, as the suicide committee’s recommendation did, but rather how to work within the current system.
Discussions about mental health in the military are nothing new, with leaders speaking about the need for increased attention and services over the past years. On Tuesday, Master Chief Petty Officer James Honea appeared before a House Appropriations subcommittee to discuss quality of life in the military, where he said that mental health is an ongoing priority.
What the playbook does is give a manual for leaders to engage in conversations with sailors and direct them to the services available, including professional mental health care and Navy resources.
Under the playbook, naval leaders are tasked with three roles: ensuring an environment where conversations can happen, being on the lookout for signs that sailors are at risk and helping sailors get services while allowing them to stay in the fleet.
The playbook is meant to be a response to challenges expressed by sailors, including access to services, said Rear Adm. Brett Mietus, director of the Navy Culture and Force Resilience Office, during a Monday press call.
The primary concern stressor in the Navy right now is exhaustion, Honea testified.
“We’re really working our force pretty hard, and we’re going to continue to have to do so,” Honea said. “So I need to create environments that allow for a little bit more positivity.”
Manning is also affecting mental health, Commander, Navy Installations Command Force
Master Chief Jason Dunn told reporters. Sailors worry about taking time off to get help because it will increase the workload for their teammates, he said.
“We need to reinforce the fact that it’s okay, not only for the opportunity for them to take a knee, but also during reintegration, and then put that against all the leaders and the chief’s nest to set that climate within their departments and divisions to make sure they’re welcoming folks back and it’s not with a negative connotation,” Dunn said.
For leaders, the second section of the playbook lays out how to have a conversation with their sailors. It encourages them to find a time during the day to check in with sailors, demonstrates how to use active listening during conversations and reminds them to use empathy.
“Mental health professionals, counselors, and chaplains are trained to have difficult conversations with those they serve. For the rest of us, it’s more challenging,” according to the playbook. “The person in need may not be forthcoming, and they may not want to open up no matter what you do.”
Having these conversations is necessary because given that one in five Americans will be diagnosed with a mental illness, it is likely that they will have sailors that are having mental health concerns, according to the playbook. A 2022 meta-analysis study published in leading journal Nature looked at 192 studies and found that a third of individuals in the study developed mental illness by 14. That number grew to half by 18 and then to 62.5 percent by 25.
Training is part of the next step, Mietus told reporters. It will be built into training leaders receive as part enlisted leadership development.
The guidebook also talks about how commanders can connect sailors with other services, including professional mental health services. It acknowledges the stigma held by some in the sea service that getting help can damage their career aspects.
“The stigma associated for getting help for mental health illness or disorders has unfortunately been historically rooted in our culture. As a leader, you should be explicit in letting people know it’s ok to ask for help [sic],” according to the playbook.
While it encourages commanders to address that stigma, it also reminds them that they have the ability to call a provider to give them additional information about the sailors, with a reminder to first tell the sailor that they’ll be reaching out, adding that if not, it can damage trust between leader and sailor.
“COs should know that they are under no such limitations [sic] when communicating back to medical providers,” according to the playbook. “Commands are ENCOURAGED to contact providers with contextual information that may affect the treatment team’s understanding, treatment plan, and disposition for that Sailor.[sic] Communication may include Sailor-specific factors like an uncharacteristic outburst, or ongoing disciplinary factors.”
Under DODI 6094.08, which allows for military exemptions to the HIPAA, providers are supposed to inform embedded medical providers — or a commander if there is no such provider — about a sailor if they fall under nine circumstances, including risk of self-harm, to others or to the mission.
It is important for the Navy to normalize mental health and treatment, Mietus told reporters.
Encouraging conversations and showing leaders how they can be done helps address the stigma around it, he said.
At the same time, the sea service wants to be able to connect sailors with needed services while also being able to maintain them into the fleet. That’s where the communication with providers comes in, he said. It’s meant to prevent sending a person off for help and then an awkwardness when they come. Instead, it would be more of a seamless transition.
A person might also not need medical counseling but rather skills or life management help, said Leslie Gould, director of CNIC’s Fleet and Family Readiness Programs. The Navy offers a variety of programs, and the playbook allows the leaders to have information to be able to direct their sailors to other programs in addition to counseling.
Sailors who are joining the fleet are members of Gen-Z, who are typically more open to talk about mental health than sailors from the older generations, like the baby boomers, are, Mietus said. Millennials are also more open to having those discussions.
The Navy needs to be able to adapt in order to meet the changing fleet makeup, Dunn said.
“So it’s critical that we embrace some of these evolutions and change in people’s values and needs so that we can be effective leaders and connect with our workforce,” he said.