1. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Department of Defense Office of Inspector General Changes to the Guidance for Command Directed Mental Health Evaluations Rich Leatherman Outreach Specialist, Whistleblower Reprisal Investigations 703-604-9564 richard.leatherman@dodig.mil

2. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Purpose Brief members of WRI on the changes made to DoDD 6490.1 and DoDI 6490.4 and their effect upon WRI.

3. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Laws and Regulations Public Law 102-484, Section 546 “National Defense Authorization Act for FY 93”  Prohibits referring Service members for MHEs in reprisal for making protected communications  Required DoD implementing regulations to establish procedures for referring Service members for MHEs Public Law 112-81, Section 711(b) “National Defense Authorization Act for FY 12”  Wholesale changes to PL 102-484.

4. “One Professional Team” Accountability - Integrity - Efficiency - Excellence References WAS  DoD Directive 6490.1(October 1, 1997) “Mental Health Evaluations of Members of the Armed Forces”  DoD Instruction 6490.4(August 28, 1997) “Requirements for Mental Health Evaluations of Members of the Armed Forces” NOW  DoD Instruction 6490.4 (March 4, 2013) “Mental Health Evaluations of Members of the Military Services”

5. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Applicability of DoDI 6490.04 Applies to:  OSD  The Military Departments (to include the Coast Guard)  The Office of the CJCS  The Joint Staff  The Combatant Commands  The DoD IG  The Defense Agencies  The DoD Field Activities  All other organizational entities within DoD

6. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Applicability of DoDI 6490.04 Does not apply to:  Voluntary self-referrals  Required pre and post deployment mental health assessments in connection with contingency operations  Responsibility and competency inquiries for courts martials  Family advocacy program interviews  Drug and alcohol abuse rehab interviews  Clinical referrals by healthcare providers (when member concurs)  Evaluations under law enforcement or corrections system procedures  Evaluations for special duties or occupations

7. “One Professional Team” Accountability - Integrity - Efficiency - Excellence What is an MHE? DoDI 6490.04 defines MHE as: A psychiatric examination or evaluation, a psychological examination or evaluation, an examination for psychiatric or psychological fitness for duty, or any other means of assessing the mental health of a Service member.

8. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Policy of DoD  Destigmatize mental health referrals  Use of mental health referrals should be comparable to use of other medical and health services  Extends to fitness for duty, returning members to duty after injury, and managing conditions that may endanger the member, others, or mission accomplishment

9. “One Professional Team” Accountability - Integrity - Efficiency - Excellence MHE Referral Authority Who has the authority to involuntarily refer a service member for an MHE under the new Instruction? COMMANDERS AND SUPERVISORS

10. “One Professional Team” Accountability - Integrity - Efficiency - Excellence MHE Referral Authority A Supervisor is: “A commissioned officer within or out of a Service member’s official chain of command, or a civilian employee in a grade comparable to a commissioned officer, who:  Exercises supervisory authority over the member; and  Is authorized due to the impracticality of involving the commanding officer

11. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Non-emergency Referrals

12. “One Professional Team” Accountability - Integrity - Efficiency - Excellence  Commanders and supervisors who in good faith believe a subordinate Service member may require a mental health evaluation are authorized to direct an evaluation  A command directed mental health evaluation has the same status as any other military order  A command directed mental health evaluation can only be initiated by the commander or supervisor  Evaluations may be for fitness for duty, occupational requirements, safety issues, significant changes in performance, or behavior changes that may be attributable to possible mental status changes Policy for Non-emergency Referrals

13. “One Professional Team” Accountability - Integrity - Efficiency - Excellence  When directing an MHE, the Commander/Supervisor will:  Advise the member there is no stigma associated with obtaining mental health services  Provide to the member the name and contact info for the mental health provider when referring them for a mental health evaluation  Tell member the date, time, and place of the MHE  What isn’t required anymore?  Does not require above info to be placed into a memo  Does not require outlining rights to contact IG and/or attorney  Does not require providing 2 business days between notice and evaluation Procedures for Non-emergency Referrals

14. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Emergency Referrals

15. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Emergency Referral as Defined by DoDI 6490.4 “A situation in which a Service member is threatening imminently, by words or actions, to harm himself, herself, or others, or to destroy property under circumstances likely to lead to serious personal injury or death, and to delay a mental health evaluation to complete administrative requirements… could further endanger the Service member’s life or well-being, or the well-being of potential victims.” WAS NOW “Any situation in which a Service member is found or determined to be a risk for harm to self or others.”

16. “One Professional Team” Accountability - Integrity - Efficiency - Excellence  Commanders and supervisors will refer a Service member for an emergency MHE as soon as is practicable whenever:  A member, by actions or words, such as actual, attempted, or threatened violence, intends or is likely to cause serious injury to him or herself or others  When the facts and circumstances indicated the member’s intent to cause such injury is likely  When the commanding officer believes the member may be suffering from a severe mental disorder NOTE: Previous version required all three elements to be present; it is unclear from the language whether this is still true  The commander may designate a senior enlisted member to order emergency MHEs for enlisted members Policy for Emergency Referrals

17. “One Professional Team” Accountability - Integrity - Efficiency - Excellence  When directing an MHE, the Commander/Supervisor will:  Protect the safety of the member and others  Communicate to the mental health provider circumstances and observations that led to the referral prior to or during transport  What isn’t required anymore?  Does not require a memo outlining the member’s rights and reasons for the referral  Does not require a memo by given to the mental health provider as soon as practicable; oral communications suffice Procedures for Emergency Referrals

18. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Mental Health Care Providers

19. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Mental Health Care Provider Responsibilities  Only a psychiatrist or, when a psychiatrist is unavailable, a doctor with admitting privileges may admit a member for an inpatient MHE  Evaluation conducted in most appropriate setting IAW least restrictive alternative principle  Involuntary admission can only happen when member has, or likely has, severe mental disorder or poses imminent or potential danger to self or others

20. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Mental Health Care Provider Duty to Protect Others from Harm  When a member communicates an explicit threat to kill or seriously injure or destroy property likely to cause injury or death and the member has an apparent intent and ability to act, the mental health provider will notify:  Member’s commander or supervisor that the member may be dangerous  Law enforcement (military or civilian) where threatened injury may occur  Law enforcement of specifically named or potential victim(s)  Member’s commander or supervisor and any individuals threatened or harmed by the member about member’s pending discharge from inpatient status Recommend, when appropriate:  Appropriate precautions to member’s commander or supervisor  Referral of member’s case to the Service’s physical evaluation board  Admission of member to inpatient psychiatric or medical unit  Administrative separation of member to the commander or supervisor

21. “One Professional Team” Accountability - Integrity - Efficiency - Excellence MHCP Findings and Recommendations  Mental Health Providers advise member’s commander or supervisor on:  Information and recommendations to understand member’s condition so they can make reasoned decisions about safety, duties, and medical care requirements  How commander/supervisor can assist member’s treatment  Member’s fitness and suitability for continued service  Whether separation from Service is recommended

22. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Member Rights

23. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Rights of the Member  The member has the right, as soon as the member’s condition permits, after admission to the hospital, to contact:  A relative  A friend  A chaplain  An attorney  An IG  Anyone else the member chooses

24. “One Professional Team” Accountability - Integrity - Efficiency - Excellence IG Responsibilities

25. “One Professional Team” Accountability - Integrity - Efficiency - Excellence IG Responsibilities  Receive and analyze complaints from Service members that allege a command-directed mental health evaluation was conducted in reprisal for a protected communication. (see paragraph 8 of Enclosure 3)  That’s it, honest.  Ok, DoD Hotline and the Service IGs may still receive complaints about procedural errors but those can be referred to command and do not require IG involvement

26. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Implementation  The implementation date is 4 Mar 13  The new rules only apply to alleged violations occurring on or after 4 Mar 13  Reprisal allegations fall under the rules in 10 USC 1034 and 7050.06

27. “One Professional Team” Accountability - Integrity - Efficiency - Excellence Department of Defense Office of Inspector General Questions? Richard Leatherman Outreach Specialist 703.604.9564 richard.leatherman@dodig.mil