Navy Expands Suicide Intervention and Mental Health Services; Survivors Say More Must Be Done
“The reason I’m writing this is because I feel you are the only person that can make the changes necessary for others to not suffer the same fate I did,” Petty Officer 3rd Class Brandon Caserta wrote to his commanding officer. “If you can successfully take action and make the changes, you will prevent more suicides within the Navy.”
Brandon died by suicide June 25, 2018. That year, he joined a tragic roster of 68 U.S. Navy Sailors on active duty who took their own lives.
Before his death at age 21, the Peoria, Arizona, native wrote letters to his family, friends, supervisor and others that described toxic leadership and a hostile work environment. Stationed at Naval Station Norfolk while attached to Helicopter Sea Combat Squadron 28, he reported being hazed, bullied and sexually assaulted. Brandon felt the Navy had labeled him a failure. He asked for, but was denied, medical attention.
Brandon’s parents, Teri and Patrick Caserta, argue Brandon would be alive today had the military intervened to provide their son with confidential access to mental health services. Their advocacy in the aftermath of Brandon’s death led to passage of the Brandon Act, which the Department of Defense officially launched one year ago this month.
The Brandon Act requires the Navy and all military branches to make it easier for service members to ask for mental health treatment confidentially — for any reason, at any time and in any environment. Supervisors or commanders of service members who invoke the Brandon Act must quickly facilitate evaluations, assuring privacy.
“If you’re on a ship in the middle of nowhere and you need mental health care, it might take a day or two and happen by telemedicine or some other way,” Dr. Lester Martinez-Lopez, the assistant secretary of defense for health affairs, said in a Jan. 22, 2024, DoD News article on the Brandon Act. “But it doesn’t matter where you are. All you need to do is raise your hand and tell your supervisor and they will take care of that as soon as possible.”
The Brandon Act passed as part of the fiscal 2022 National Defense Authorization Act, signed into law by President Biden Dec. 27, 2021. The DoD implemented the policy May 5, 2023, giving the service branches 90 days to roll it out to all service members, starting with the active-duty components.
Along with the other services, the Navy has since reiterated that suicide prevention is a top priority and communicated about the self-referral process available under the Brandon Act. The Navy is taking other steps to reduce stigma associated with asking for mental health services and promote help-seeking behavior. Efforts include expanding virtual and in-person health, mental health and quality-of-life offerings, particularly those aimed younger enlisted service members, who data show are most at risk of death by suicide.
In 2022, the Navy began moving its Sailor Assistance & Intercept for Life (SAIL) suicide intervention program from an in-person model to a virtual model. The Navy completed the transition to fully virtual SAIL in January 2024. The virtual model is staffed with dedicated remote counselors from the Fleet and Family Support Center (FFSC). The Navy says more Sailors are now using the service, citing in the increased accessibility and privacy of virtual care and assistance. The program is operated by the Commander, Navy Installations Command (CNIC), which oversees 10 Navy regions, 70 bases and more than 43,000 employees.
By the end of 2024, the Navy plans to complete the expansion of FFSC’s virtual clinical counseling program, which will provide Sailors and their families in all 10 Navy regions with remote access to short-term assessments, treatment planning, clinical counseling, and referrals from licensed mental health professionals.
‘More Needs to be Done’
In a phone interview with Seapower magazine, Patrick and Teri Caserta commended Navy and other Pentagon leaders for their willingness to improve access to suicide interventions and other mental health services.
“The (virtual) SAIL program is a step in the right direction,” said Patrick, a 22-year retired U.S. Navy senior chief and naval counselor.
But, he added, “more needs to be done” to end military suicides, including expanding awareness of the Brandon Act and educating commanders that “if you violate the Brandon Act, you’re breaking the law.”
Among the lawmakers overseeing Brandon Act implementation and spearheading related legislation in Congress is Sen. Tim Kaine (D-Virginia), whose state is the home of Naval Station Norfolk, where Petty Officer Caserta died.
“I’ve heard heartbreaking stories from many servicemembers and their families about mental health challenges, the lack of resources, and the stigma associated with asking for help,” Kaine told Seapower in a statement.
OIG Evaluation
Kaine, a member of the Senate Armed Services Committee and chair of its Seapower subcommittee, said he’s committed to expanding service members’ access to mental health care and to preventing military suicides, including assessing the effectiveness of Navy efforts to address this issue.
Pursuant to a directive Kaine and colleagues included in the fiscal 2023 national defense bill, the DoD’s Office of Inspector General in February 2024 launched an evaluation of the Navy’s suicide prevention and response efforts.
A Feb. 27 OIG memo said subjects of the evaluation include the Department of the Navy, Office of the Under Secretary of Defense for Personnel and Readiness and the Defense Health Agency in the National Capital Region. Evaluators plan site visits to Naval Station Norfolk as well as to Naval Base San Diego in California; Naval Base Kitsap in Bremerton, Washington; and Naval Station Pearl Harbor in Hawaii. OIG said it could add other locations to evaluate.
Under Navy policy, commanders must submit a SAIL referral after a Sailor experiences suicide ideation or attempts suicide and is evaluated by a medical treatment facility or emergency department, Cornealius L. Stamps, the SAIL clinical counseling program analyst, said in an email interview with Seapower.
A SAIL case manager must contact the referred Sailor within one day to offer assistance and care services. Sailors who accept services can receive virtual counseling from a remote SAIL or clinical counselor or see an FFSC clinical counselor in person.
SAIL’s move to a virtual model with dedicated case managers has coincided with an increase in Sailors accepting services, Navy-provided data shows. The percentage of Sailors referred to SAIL who accepted services rose from 46.5% in 2020 to 62.67% in 2023. To meet the demand for services, SAIL’s staff of case managers rose 42%, Stamps said.
It’s too early to say if these and other programs are reducing the number of miliary suicides. In all of calendar year 2022, 492 active-duty, National Guard and reserve service members died by suicide, according to the DoD. This was fewer than the 524 service members who died this way in 2021. Most military deaths by suicide occur among enlisted men under age 30.
More recent quarterly data showed no increase or decrease in Navy active-duty service member deaths by suicide, even as these deaths increased in the active Army, Marine Corps and Air Force. Those three services combined saw 19 more active-duty service member deaths by suicide in the first quarter of calendar year 2023, compared to the first quarter of calendar year 2022.
Stamps said the response to virtual SAIL so far is encouraging.
“Sailors have shared positive feedback about SAIL’s virtual services through the program’s anonymous surveys, during conversations with their case managers,” she said, noting, “we’ve also heard similar sentiments echoed by referring leaders.”
Sailors can also request SAIL services by contacting their local FFSC, a chaplain or another available mental health program. And although CNIC doesn’t oversee ship operations, Sailors aboard a ship without counseling services can ask their command to arrange SAIL services by phone.
“It’s well-known that military service is challenging and comes with unique stressors that those in the general public will never face,” Stamps said. “Recognizing that you need help and asking for it is a sign of strength.”
Greater Awareness
In addition to offering virtual SAIL and more remote counseling options, the Navy in July 2023 issued Brandon Act-related guidance and resources in a directive-type memo and fact sheet. The service issued a revised Navy Mental Health Playbook addressing mental health within commands and plans to update and send out additional marketing materials throughout the year. In January 2024, the Navy distributed to all commands the Suicide Related Behavior Response and Postvention Guide, streamlining suicide crisis response guidance and providing step-by-step instructions on the SAIL referral procedures.
Despite these efforts, Patrick and Teri Caserta said too many service members and military families still don’t know about the Brandon Act or how to access mental health services.
They’re working for change through the Brandon Caserta Foundation, making sure all service members and veterans get the help they need, without retaliation. They want new military recruits educated about the Brandon Act before service even begins. They want Brandon’s image on military posters with the message that it’s OK for Sailors and service members to seek care, for any reason. They want mental health counselors embedded at the unit level and for the military to establish a uniform response to this crisis.
Ultimately, they want to continue to share what Brandon’s experienced — to raise awareness about military suicide, empower service members and families and enact policy changes that will end military and veteran deaths by suicide.
“We know that Brandon’s story saves lives,” Teri Caserta said.
Sidebar: Navy Goes Virtual to Boost Sailors’ Access to Quality-of-Life Programming
To boost the quality of life and health of today’s Sailors, the Navy in late January launched a new Virtual Single Sailor Program (VSSP), a platform offering service members and their families worldwide remote access to electronic sports contests, fitness programs and other entertainment and wellness resources.
“Obviously, the modern-day Sailor has changed in the way that they interact with information and each other,” said Lisa Sexauer, who is director of Fleet Readiness for Navy Installations and oversees the Navy’s Morale, Welfare and Recreation programs. “And so being able to reach them with useful information and also virtual dynamic programming — wherever the Navy operates and wherever their mission allows them to access that information — is kind of the brainchild behind it.”
Sailors can log onto the platform to virtually participate in esports, locate community-based recreational events, access workout builders and find vacation discounts and other resources.
“The real effort here is to create some connectedness and for people to build communities of support (and) friendships,” Sexauer told Seapower.
VSSP emerged from an ongoing effort to pilot- and focus-test quality-of life-programs that better meet the “desires and needs” of Sailors, she said, particularly those in the E-1 to E-6 enlisted paygrades.
Along these lines, the Navy said earlier this year it is considering offering free highspeed Wi-Fi to all Sailors. This is pending the results of a February-September pilot test of the service at 12 permanent party unaccompanied housing locations at Naval Station Norfolk, NAVMEDCEN Portsmouth and Norfolk Naval Shipyard.
In early March, installation commanders also got the go ahead to implement 24/7 entry to staffed or unstaffed fitness facilities.
“If we require our Sailors to be physically fit and healthy so they can fulfill the Navy mission and deploy at a moment’s notice, then we must provide the facilities and resources for them to do so,” Vice Admiral Scott Gray, commander of Navy Installations Command, announced March 8. “Not only does this make sense, it is the right thing to do for the quality of life of our Sailors and other service members.”