Self-Referral: Seeking Help Early is a Sign of Strength

The Navy’s non-disciplinary self-referral process allows you to seek help and remain an active duty Sailor. The intent of a self-referral is to provide you with a means of intervening in the progression of alcohol abuse early enough to get help before a problem becomes more advanced and difficult to resolve without risk of disciplinary action. More information, including contact info for the Navy Alcohol Abuse Prevention, (NAAP) office, is available on the NAAP website at https://go.usa.gov/xEejq. Refer to OPNAVINST 5350.4D for details and official policies.

The following list answers some frequently asked questions about self-referral.

What exactly constitutes a self-referral? A self-referral is an event personally initiated by the member. A member may initiate the process by disclosing the nature and extent of their problem to one of the following personnel who is actively employed in their capacity as a qualified self-referral agent: Drug and Alcohol Programs Advisor (DAPA); Commanding Officer, Executive Officer, Officer- in-Charge, or Command Master Chief (CMDCM)/ Chief of the Boat (COB); Navy Drug and Alcohol Counselor (or intern); Department of Defense medical personnel, including Licensed Independent Practitioner (LIP); Chaplain; or Fleet and Family Support Center Counselor.

When should someone consider self-referring? A member should consider self-referring if they desire counseling and treatment to address potential, suspected, or actual alcohol abuse or misuse.

What could make a self-referral invalid, in which case the member would not be shielded from disciplinary action? To be valid, the self-referral must be made only to one of the qualified self-referral agents listed above; it must be made with the intent of acquiring treatment, should treatment be recommended as a result of the screening process; and there can be no credible evidence of the member’s involvement in an alcohol-related incident (ARI).

What do we mean by “non-disciplinary?” This means that a member may not be disciplined merely for self-referring and participating in the resulting process of screening and treatment, if recommended. It doesn’t mean that a member is necessarily shielded from the possible administrative consequences of treatment failure or the administrative or disciplinary consequences of refusing to participate in treatment recommended by the post-referral screening process.

Does making a self-referral count as an ARI? No.

Will other people know if I self-refer? Yes. The member’s chain of command, and others on a need-to-know basis, will be informed.

Will a self-referral mean that the Navy looks at other parts of my life/job performance? Alcohol use issues are complex, and evaluation and treatment require a holistic view. Relevant information on the member’s work and personal life may be required as part of the screening and treatment processes.

Can I re-enlist if I’ve self-referred? Yes.

What are the levels of alcohol treatment? If treatment is recommended, the command will coordinate with the appropriate SARP facility based on availability, locality, and type of treatment needed. Levels of treatment are: Level 0.5 Early Intervention/ Education Program; Level I Outpatient Treatment; Level II Intensive Outpatient/Partial Hospitalization (lOP) and Level III Inpatient Treatment.

Will I lose my security clearance for self-referring? No. Your security clearance may be jeopardized if your screening recommends treatment and you subsequently refuse that treatment.

Boost your mental performance with better nutrition

Editor’s Note: The following is a guest blog provided courtesy of the Human Performance Resource Center. Navy Suicide Prevention Branch is a proud partner of the Human Performance Resource Center. To learn more, visit https://www.hprc-online.org/.

Have you ever felt tired, sluggish, or foggy after eating a big meal? Have you seen how kids (and kids at heart) get hyper or seem like they’re not thinking straight after a candy binge? Then you probably know that what you eat affects how you feel.

In a state of optimal nutritional fitness, what you eat supports healing and your immune system, helps prevent injury, improves energy levels, and allows you to achieve optimal emotional, cognitive, and physical performance. When you eat right, you’re likely to feel more energized, less fatigued, and have better focus, judgment, accuracy, and reaction time. The opposite is true when you fuel your body improperly. Whether you’re at home or deployed, follow these tips to help you to stay alert, focused, and performing at your best.

Mental Performance Nutrition Tips

To achieve nutritional fitness, focus on a balanced diet rich in whole foods, with plenty of fruits, vegetables, whole grains, low-fat dairy, and lean meats. Read more on the recommended diet for Military Service Members.

• Boost your intake of magnesium. Magnesium is important to regulate muscle and nerve functions, blood sugar levels, and blood pressure. It also helps make protein, bone, and DNA. Nearly half of all Americans over age one are deficient in magnesium, and the deficiency is even greater for some gender and age groups. Foods high in magnesium include legumes, nuts, seeds, whole grains, green leafy vegetables (such as spinach), fortified breakfast cereals, milk, and yogurt.
• Eat plenty of foods high in B vitamins. These nutrients support metabolism, brain development, blood and nerve cell health, DNA production, and the development of serotonin, which impacts mood, memory, and emotions. Foods high in B6 include poultry, fish, organ meats, potatoes and other starchy vegetables, and noncitrus fruits. Foods high in B12 include beef, liver, clams, fish, poultry, eggs, milk and other dairy, and fortified breakfast cereals. Foods high in folate include asparagus, brussels sprouts, spinach, oranges, nuts, beans, peas, and grains. Food is the best source of most vitamins, but supplements can help if you’re unable to eat some of these foods.

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“We don’t eat nutrients, we eat food.”

Paul Jacques and Katherine Tucker,

Tufts Human Performance Research Center on Aging

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• Fuel your body consistently. Eat meals regularly to maintain blood glucose (sugar) and muscle glycogen (stored energy) levels throughout the day. Balance meals and snacks with whole grains, lean protein, fiber, and healthy fats to help keep your blood sugar steady. Avoid skipping meals, too much sugar, and imbalanced meals that are mainly refined flours (carbohydrates). Dips and spikes in your blood sugar can make you feel tired, shaky, or less focused. If you skip meals or don’t eat enough, your blood sugar can drop, resulting in hypoglycemia (low blood sugar) and a decline in performance. Symptoms of low blood sugar include headache, dizziness, blurred vision, weakness, fatigue, sweating, confusion, and fainting. You don’t actually need to have full-blown hypoglycemia to begin feeling these effects.
• Rethink your meal choices on the night shift. At night, your body’s metabolic processes slow down. Eating at night has been shown to be bad for your health, including an increased incidence of obesity, diabetes, cancer, cardiovascular disease, and infections. But for night-shift workers, it can mean the difference between staying alert—or not—on the job. The right type and amount of foods and beverages can help keep up your blood sugar to stay alert.
• Get a caffeine boost, but not too much. Caffeine improves alertness, vigilance, attention, and reaction time when taken in small to moderate amounts. Caffeine can also help mental performance in sleep-deprived situations. But dose and timing matter;  refer to Operation Supplement Safety for more information.
• Drink enough water. Water is the most abundant component of the human body—around 50–70% of your weight—so your body needs fluids regularly to function properly. Performance can start to decline once you’ve lost as little as 2% of your body weight. Even mild to moderate dehydration can reduce alertness and cause fatigue, tension, and difficulty concentrating. Carry a water bottle with you and refill it throughout the day. Aim to drink half your body weight in water each day to stay hydrated (e.g. 100 oz if you weigh 200 lbs). And don’t rely on thirst as a good indicator of your fluid needs. By the time you feel thirsty, you’re already a little dehydrated.

Bottom Line

Mental performance is just as important as physical performance. Fortunately, proper nutrition can help with both.

Suicide Prevention and Supervisors: The Front Line When Things Get Tough

Navy leaders have great influence and impact on their shipmates’ sense of connectedness. Front-line supervisors in particular can make a difference because of their unique position—the close quarters and long hours that characterize much of Navy life mean lots of day-to-day contact and many opportunities to really get to know your teammates. Supervisors are also knowledgeable about significant events Sailors are experiencing, such as promotion, deployment or family status.

Most Sailors who die by suicide were experiencing multiple stressors before their deaths, including relationship issues, transitions, and career or personal setbacks. Annual case reviews consistently reveal missed opportunities to “connect the dots” when a Sailor is experiencing negative effects of stress. Active communication is important, especially if a Sailor is alone and away from his or her support networks. Supervisors are key to this effort.

The Supervisor’s Role in Suicide Prevention

Though Sailors may compartmentalize their personal stressors to stay focused on the mission, if those stressors aren’t being adequately addressed or continue to pile up, they’re likely to spill over into their work performance. Taking the time to get to know your people can better enable you to notice when something seems off.  For example, a Sailor who used to be engaged and happy at work is becoming more withdrawn, is unable to focus or is easily agitated. These can be signals that a Sailor is in crisis and are opportunities for supportive conversation and ACTion. Consider reaching out to one of their peers who knows them well, as well as their family members who are more likely to have a more complete picture of what may be troubling the Sailor so that you can connect the dots and offer appropriate support.

It’s also imperative to reach out to the Sailor one-on-one and mention that you’ve noticed that they haven’t seemed like themselves lately. Ask directly “are you thinking about killing yourself?” You can follow up with questions like “do you have a plan to kill yourself?” Show them that you Care by listening without judgement and paying close attention to any additional warning signs, like statements about not wanting to live, feeling like a burden, feeling hopeless or discussion of lethal means. Help them get to Treatment immediately and escort them to a medical professional or Navy chaplain for safety. You can also call the Military Crisis Line with them.

Be there throughout the process, follow up and offer continued support, regardless of the level of care needed to help the Sailor bounce back. Ensure that they have ample time to attend appointments for any services they may need and help them overcome logistical barriers. For Sailors who have experienced a suicide-related behavior (SRB), remember that your suicide prevention coordinator (SPC) will need to initiate a referral to the Sailor Assistance and Intercept for Life (SAIL) program. SAIL provides caring contacts to Sailors in the 90 days after an SRB and keeps them connected to resources. Let the Sailor know that they’ll receive a call from a Fleet and Family Support Center (FFSC) SAIL Case Manager inviting them to receive these services to support their recovery. For more information on SAIL and key messages for leaders, visit https://go.usa.gov/xEE69.

Command Directed Mental Health Evaluations and Voluntary Storage of Firearms

Sometimes Sailors may be hesitant to seek treatment, even when it could be life-saving. A commander or supervisor may direct Sailors to undergo a mental health evaluation if they reasonably believe that a Sailor’s current mental health state places them at risk of hurting themselves or others. Command directed mental health evaluations are also appropriate when a Sailor has displayed marked changes in behavior or when the leader is concerned about a Sailor’s fitness for duty. Commanding Officers may consult with the nearest available mental health provider for guidance on the referral as well as necessary precautions such as escorts and removing access to lethal means.

As an added safety precaution during times of increased stress, Commanders must ask Sailors believed to be at-risk for suicide to voluntarily allow their privately-owned firearms to be stored for temporary safekeeping by the command per NAVADMIN 263/14. Leaders must work with base security and/or other local resources to proactively determine storage and safety protocol for local implementation of this DoD-wide policy. For more information, refer to DoD Instruction 6490.04.

Be There for Every Sailor, Every Day

Fostering communication and encouraging connectedness among team members are two strategies to increase protective factors against suicide that are recommended by the International Association for Suicide Prevention. Negative attitudes about mental illness can keep people from sharing their situation and reaching out for help. Lead by example and reassure your Sailors that mental health problems can happen to anyone and are treatable. Talk about mental health openly, honestly and supportively, just as you would about physical health. Encourage use of professional resources like medical providers and Navy’s Counseling Advocacy Program, as well as confidential support from a Navy chaplain or the Military Crisis Line.

Leaders should also share resources, contact information and educational materials regularly to foster a supportive command climate. Lifelink Newsletter includes articles that can be reproduced for your command’s blog or local publication, plan of the week notes and more. There are posters and other print resources available for download as well on the Every Sailor, Every Day campaign’s “Get Involved” webpage on http://www.suicide.navy.mil. Your support helps to reshape the negative perceptions about the impacts of seeking help on one’s career, especially when it comes to treatment from leaders and peers.

An All-Hands Responsibility

All Sailors, regardless of supervisory status, have specific responsibilities for suicide prevention which are outlined in the Navy’s latest Suicide Prevention Program Instruction, OPNAVINST 1720.4B​. In addition to the mandatory general military training (GMT) required for all Navy personnel and the specialized training for SPCs and Suicide Prevention Program Managers (SPPMs), Navy Suicide Prevention Brach also provides training resources for communities who have frequent contact with at-risk Sailors. Gatekeeper Training is available for legal defense personnel, transient personnel unit (TPU) staff, ombudsmen and medical staff. This training includes a facilitator guide, can be downloaded from www.suicide.navy.mil, and meets the Suicide Prevention GMT requirements. Additionally, the new Navigating Stress for Navy Families course provides practical tools and effective techniques to help spouses and families build resilience and navigate stress.

Resources to support locally-developed training can be found on the Navy Suicide Prevention Branch website, including facts and warning signs, informational materials, videos and statistics.

Connectedness: Relationships Strengthen Resilience

How connected are you? Many people value their self-reliance – the ability to solve and manage problems on their own. While self-reliance and grit are important qualities, relationships are one of the key principles of resilience.

What is Connectedness?

In its Suicide Prevention Strategic Direction published in 2011, the Center for Disease Control (CDC) defines connectedness as “the degree to which a person or group is socially close, interrelated, or shares resources with other persons or groups.” Connectedness can include relationships with friends, a spouse or other family members, as well as professional relationships and community ties. No matter what type of relationship is involved, the connection created can have significant positive effects on a person’s well-being. According to the Suicide Prevention Resource Network (2019), “positive and supportive social relationships and community connections can help buffer the effects of risk factors in people’s lives.”

Is There a Connectedness Crisis?

In today’s world, it appears like we are more connected than ever – at least with technology. Social media and mobile communication seem to make it easier to stay close to others. However, a 2018  survey by global health company Cigna of more than 20,000 U.S. adults showed increasing levels of loneliness despite the ability to stay in touch. Some of the key takeaways from the survey were:

• Nearly half of Americans report sometimes or always feeling alone or left out.
• Two in five Americans sometimes or always feel that their relationships are not meaningful and that they are isolated from others.
• One in five people report they rarely or never feel close to people or feel like there are people they can talk to.
• Only around half of Americans have meaningful in-person social interactions on a daily basis, such as having an extended conversation with a friend or spending quality time with family.
• Generation Z is the loneliest generation and claims to be in worse health than older generations.

It’s important to find a balance between healthy use of social media, maintenance of in-person social connection and opportunities to create new relationships. Check out this article from the NavyNavStress blog for tips to help you reset your relationship with social media and your relationship with yourself.

Building Community Connectedness

In addition to unit cohesion and finding meaning in the mission, belonging to a social group can increase a person’s sense of personal value and feelings of connectedness with others. It also gives people access to a larger source of support. According to the CDC (2011), these effects indicate that people who belong to social groups may be more capable of healthy coping in stressful situations. Additionally, group members can notice when someone is struggling with a problem and offer support to that individual. Stronger ties to community organizations may also benefit people by providing better access to formal helping resources outside of the group itself.

A social group may be a formal organization, like a faith-based study group or a petty officer association. They can also be informal, like coworkers who grab lunch together or gym buddies who work out together a few times a week. What’s most important is that the social group is positive and supportive for its members.

For Sailors and their families, two resources to find opportunities for social connection are the Fleet and Family Support Program (FFSP) and the Navy Morale, Welfare and Recreation (MWR) program.  FFSPs support individual and family readiness through a full array of programs and resources which help Navy families to be resilient, well-informed and adaptable to the Navy environment. MWR offers diverse programs with something to interest almost everyone, and the offerings are great opportunities to meet others who share similar interests.

Connecting with a Spouse or Significant Other

A romantic relationship is the closest form of social connectedness for many people. Conversely, the loss of a romantic partner can cause significant loneliness and stress. Navy life can be tough on romantic relationships. Unpredictable schedules, time apart and other factors can make it difficult to sustain and grow romantic partnerships. There are many resources to help, though. One of the most productive options to consider is to attend some form of counseling, and the Navy has several options for Sailors and their loved ones to reclaim their connection. Those resources include non-medical counseling through Military and Family Life Counseling, Navy Counseling, Advocacy and Prevention services  at Fleet and Family Support Centers (FFSCs); Navy chaplains and medical counseling available through a Military Treatment Facility.

Building Connection 1 Small ACT at a Time

Caring is at the heart of connectedness. When interacting with others, remember that 1 Small ACT can make a difference. Like U.S. Navy Operational Stress Control on Facebook or follow @NavStress on Twitter for information from the Every Sailor, Every Day campaign. For additional resources, messages and materials, download the FY-19 1 Small ACT Toolkit.

Is it SAD or the Winter Blues?

If you find yourself feeling down during the coldest months of the year, you’re not alone. Whether on a ship or working shore duty, it can be challenging for Sailors to get outside and reap the benefits of natural sunlight, especially in winter.

Many people face the “winter blues” – a generally mild sadness that’s usually linked to something specific, like stressful holidays or reminders of absent friends or loved ones. The winter blues are unpleasant but usually short-term in duration. More severe sadness that sticks around longer may indicate that you are experiencing Seasonal Affective Disorder (SAD), and not just the winter blues.

According to the American Psychiatric Association, about five percent of Americans suffer from SAD, a form of depression that can last 40 percent of the year and is usually most severe in January and February in the U.S. SAD is a clinical disorder that must be diagnosed by a professional.

SAD, like other forms of depression, can be debilitating, with symptoms that may affect every aspect of daily life. Some common symptoms include fatigue, mood swings and changes in appetite. The effects of SAD are typically seen in the winter months when there is less sunlight (though this may vary with geographic location) and symptoms usually improve with the arrival of spring. Whether it’s SAD or the more-common winter blues, there are steps you can take to help yourself and your shipmates.

Why Winter?

We all have an internal biological or circadian clock. This 24-hour “master clock” uses cues in your surroundings to help keep you awake and to help you sleep. Our circadian clocks are highly sensitive to changes in light and dark. When days are shorter and nights are longer, the body’s internal rhythm can be altered, and lead to changes in two specific chemicals, melatonin and serotonin.

At night, a gland in the brain produces and releases melatonin, a chemical that helps you sleep. Changes in season and sunlight can disrupt the normal levels of melatonin, contributing to disrupted sleep patterns and mood changes. Serotonin is a brain chemical affecting mood, and reduced sunlight can cause serotonin levels to plummet.

Lack of direct exposure to sunlight can also lead to deficiencies in Vitamin D. Strong associations have been found between vitamin D deficiency and depression, according to the Mayo Clinic. “Many who are Vitamin D deficient don’t know it,” said CAPT Tara Smith, Ph.D., clinical psychologist assigned to OPNAV N171. “it’s very hard to get outside the skin of the ship and feel the sun on your face underway, and even in Iraq you’re completely covered. Although it’s a sunny 135 degrees, you’re not getting any sun on your skin.” Being Vitamin D deficient can contribute to sadness, especially in winter.

Beating the Blues

There are several treatments used to help those suffering from seasonal mood changes. For SAD, these can include talk therapy, light treatments, vitamin regimens or medications. Although symptoms of the winter blues usually improve with the change of season there are a few ways you can help your body adjust:

• Optimize your sleep. Fatigue can affect mood, performance, memory and judgement. Aim for seven to eight hours of uninterrupted sleep per night, preferably at the same time each day. If you can’t get that amount of uninterrupted sleep, compensating with a nap has proven benefits. Crew Endurance, developed by Naval Postgraduate School with collaboration from Navy’s Operational Stress Control Program, offers practical tips, research and operational tools for promoting adequate rest.
• Choose foods that help to balance your mood. Studies indicate people who suffer from SAD may have lower levels of serotonin in the winter months. A balanced diet that is high in fruits, vegetables, whole grains and lean protein can provide a natural source of serotonin. Try a breakfast of steel cut oatmeal, bananas and eggs for a mood-balancing boost. Check out this post for additional tips.
• Go for a workout outdoors. It may be chilly, but exercising outdoors when possible during daytime hours can help you soak up some Vitamin D even when it’s not particularly sunny. Plus, physical activity improves your mood, helps you sleep, increases endurance and helps you navigate stress. Round up a few shipmates and go for a run around the flight-deck, try a group fitness class on your installation, sweat it out on the yoga mat or get fit with interval training.

When to Seek Help

It’s important to recognize that SAD is a serious condition and is characterized by the same symptoms as other forms of depression. Signs may include a sustained feeling of depression that occurs most days and most of every day, loss of interest in activities that were once enjoyed, low energy and feelings of sluggishness, hopelessness or agitation. Sometimes, symptoms may start off mild and progress in severity over time. Symptoms of a Vitamin D deficiency can mimic SAD, but also include issues like joint pain. If you suspect a Vitamin D deficiency, a simple visit to your Primary Care Manager (PCM) for a blood test can determine your levels, Smith said.

No one has to try and navigate seasonal depression or SAD alone. Reach out to a mental health provider at your command, installation or nearest military treatment facility, or seek confidential non-medical counseling from Military OneSource. If you feel hopeless or are thinking of suicide, get immediate help through the Military Crisis Line at 1-800-273-8255, press 1.

For more information on psychological health and navigating stress, like U.S. Navy Operational Stress Control on Facebook or follow @NavStress on Twitter. For additional resources, messages and materials, download the Every Sailor, Every Day campaign’s FY-19 1 Small ACT Toolkit.