Norfolk-based Navy installations reported seven sailors died by suicide last year, renewing concern about the progress of efforts to improve mental health services and suicide intervention within the military.
Lawmakers are now prioritizing implementation of one key piece of legislation, which was signed into law by President Joe Biden in 2021 but has yet to take effect. The Brandon Act would allow service members to confidentially seek mental health care.
The deaths also have spurred interest in a review of how to address the unique mental health needs of service members, particularly those who may be placed on limited duty status.
The Norfolk deaths include three sailors linked to the USS George Washington, who died by suicide within a week in April while the carrier was undergoing an overhaul at Newport News Shipbuilding. A Navy report issued in December concluded that the deaths were not connected. Less than eight months later, between Oct. 30 and Nov. 26, four sailors assigned to Norfolk’s Mid-Atlantic Regional Maintenance Center died by apparent suicide.
The Brandon Act
Biden signed the Brandon Act into law as part of the 2022 National Defense Authorization Act. Under the law, service members would no longer be required to inform superiors about seeking mental health care, nor would they have to seek treatment from military medical providers. The act also would provide a confidential channel for service members to self-report mental health struggles.
But enforcement and implementation requirements were not included in the language of the bill, leaving it up to the Department of Defense to work the legislation into its policies at its leisure.
While the 2023 National Defense Authorization Act, signed by the president this week, does not include amendments to the Brandon Act, it will require the Secretary of Defense to provide an assessment of how suicide prevention reforms will be implemented across the armed forces.
The report, due March 1, will require the Department of Defense to detail how it will mandate comprehensive and in-person annual mental health assessments of all military members and training of leaders at all levels in suicide warning signs and suicide-specific interventions.
Sen. Tim Kaine, who serves on the Armed Services Committee, said in mid-December he would prioritize the implementation of the Brandon Act in 2023.
“That is going to be my most urgent priority going into writing next year’s defense bill, is really understanding with the Navy and the entire military, what is the status of the Brandon Act. It could be different from service to service, what can I do to put pressure on them to implement faster?” Kaine said.
The DOD did not respond to questions about how it is working to implement the legislation across the armed forces by this article’s deadline.
But Patrick and Teri Caserta, who championed the Brandon Act after son Brandon Caserta died by suicide in 2018, said they feel the military is “dragging their feet.” The Petty Officer 3rd Class was a naval squadron flight electrician serving a helicopter sea combat unit when he died in June 2018 at Naval Station Norfolk.
“It took us two years to get it passed because they fought it behind the scenes. And now, a year later, it is still not implemented. The military did not come up with (the Brandon Act), so they don’t want it. But this change wouldn’t hurt the military — it would save lives,” Patrick Caserta told The Virginian-Pilot.
In recent weeks, the Casertas have met with lawmakers across the country, as well as the Assistant Secretary of the Navy, Robert Hogue, to press the DOD to implement the act.
“Needless to say, I am very disappointed that it has not been implemented yet,” said Teri Caserta, Brandon’s mother. “Every time I get word of a suicide in the US Armed Forces, my heart shatters. It shatters for the one we lose — it shatters for their families and their friends.”
Other avenues for improvement
The Brandon Act may not be a “one size fits all” solution.
Following the suicides linked to the maintenance center, Sen. Mark Warner suggested taking a closer look at the mental health needs of service members on a case-by-case basis. The four recent deaths were identified as Kody Decker, Deonte Antwoine Autry, Janelle Holder, and Seaman Cameron Elan Armstrong. While the Navy has not confirmed if all four sailors were on limited duty, Warner said “hundreds and hundreds” of individuals are assigned to the command because the duties they can perform are restricted for medical or mental health reasons.
“We’re going to let the Navy finish the investigations, but it does raise a bigger question about how these sailors, in limited duty status, how we take care of their unique needs,” Warner said.
Sailors may be assigned limited duty for wide-ranging physical, mental or circumstantial conditions, including pregnancy, nearing retirement, recovering from surgery, or even diagnosis with a terminal illness.
Being placed on limited duty status is generally sign of “a major change to their regular life,” said Kayla Arestivo, a mental health professional called in by the Navy to conduct a mandatory seminar following the second suicide linked to the maintenance center.
Arestivo said while the military’s protocols and procedures on how care is handled need to be “revamped,” the additional privacy that would come with the Brandon Act may not be a good solution for service members on limited duty. If sailors withhold information from superiors about their mental health and well being, it can put leadership at a disadvantage, she said.
But Arestivo does think allowing service members to seek care outside of military physicians, as the Brandon Act specifies, will improve access to quality care.
“It’s not the Navy’s job to fix everybody’s mental health. That’s not the purpose of the Navy. You join the Navy to defend America — that’s the point. However, there is a civilian standard of care that is not being transmitted into the Navy. So, sailors are not getting the necessary investment and the attention from internal mental and health care professionals,” Arestivo said.
Since the suicides reported out of the USS George Washington and the Mid-Atlantic Regional Maintenance Center, the Navy has worked to improve quality of life at the installations by installing cell repeaters and wireless internet and stepping up morale and welfare programs. The Navy also provides sailors with immediate access when calling the Hampton Roads appointment line and is working to expedite appointments for mental health referrals. Sailors are encouraged to seek help from the Navy’s chaplains, psychologists, counselors, and leaders.
Arestivo also suggested requiring limited duty service members to attend counseling once a week and urged the DOD to start bringing in civilian physicians at a competitive pay rate to bring the military standard of care up to par with the civilian standard of care.
Would that fix everything? Arestivo says, “no.”
“We could do better,” Arestivo said. “Everybody (in the military) is trying to make sure they show what they did in response (to the suicides), but I don’t think anybody (in the military) is doing anything to implement a lasting change.”
Resources for service members and veterans struggling with mental health, including 24-hour crisis hotlines:
The Military Crisis Line: call 1-800-273-8255, ext. 1; or text “273Talk” to 839863
Military OneSource: 1-800-342-9647
National Suicide Prevention Lifeline: 988 — call or text
Caitlyn Burchett, firstname.lastname@example.org