Command Directed Evaluations

General Considerations

While various life circumstances can produce added stress for the Sailor aside from demands of his/her rate and work duties, it is recommended that Navy leaders encourage Sailors to voluntarily seek assistance when signs of distress appear. Resources such as Military OneSource, Fleet and Family Support Centers (FFSC), and the MTF Mental Health are available for providing an evaluation and offering appropriate counseling services. With some exceptions, information provided by a service member during an evaluation is kept confidential. These exceptions include:

Command Evaluations
  • If there is a need to be removed from weapon-bearing duties or if access to classified information is not recommended.
  • There is a significant risk of danger to self or others.
  • The service member represents a significant security risk.
  • Hospitalization is required.
  • Domestic violence, child abuse or neglect, physical abuse of elders or dependent adults is suspected or reported.
  • A diagnosis of substance abuse or dependence is made.
  • The Sailor is involved with the Personnel Reliability Program.
  • The Sailor's mental health has deteriorated to the point that it may significantly affect work or family functioning.

If an exception does exist regarding the confidentiality of the service member's evaluation, then feedback of the evaluation can only be provided to the service member's Commanding Officer. It cannot be given to anyone else unless this person is designated in writing by the Commanding Officer to receive this information.

Is a Command Directed Evaluation (CDE) Appropriate?

In accordance with SECNAVINST 6320.24a, DoD Directive 6490.1, and DoD Instruction 6490.4, the Commanding Officer (CO) may direct the Sailor to undergo a mental health evaluation. A Command Directed Evaluation (CDE) is appropriate whenever the CO believes that the Sailor's mental state renders them a risk to themselves or others, or may be affecting the Sailor's ability to carry out the mission. A CDE can provide the CO with information needed to make an appropriate administrative action. Examples of questions commands may ask include:

  • Does the Sailor have a mental health condition that is contributing to current difficulty?
  • What is the potential for the Sailor to resume full duty given successful treatment?
  • Is the Sailor suitable for carrying a weapon at the current time?
  • Is it appropriate for the Sailor to have access to classified information?
  • Is the Sailor world-wide qualified for deployment?

* A Command Directed Evaluation can be accomplished on a routine (non-emergency) or an emergent basis.

Routine CDE

Once a decision has been made to request a routine non-emergency CDE, the CO is required to:

1. Consult with a privileged mental health provider to determine whether a CDE is appropriate. The CO is responsible for communicating the actions and behaviors of the service member that is believed to warrant an evaluation; this responsibility cannot be delegated. The mental health provider shall provide advice and recommendations about whether a CDE is appropriate and whether it warrants an emergency CDE. The mental health provider will also discuss other options that may be appropriate. If a routine CDE is recommended, the CO should forward to the mental health provider a letter formally requesting a CDE. (see enclosure (2) in SECNAVINST 6320.24a)

2. Provide a written letter to the Sailor at least two business days prior to the evaluation (see enclosure (3) in SECNAVINST 6320.24a). The letter must include:

  • The date, time, and location of the evaluation.
  • The name and grade or rank of the mental health professional who will be conducting the evaluation.
  • The name and grade or rank of the mental health professional with whom the command has consulted.
  • A brief factual description of the behavior(s) that gave rise to the need for a referral.
  • A listing of the Sailor's rights per PL 102-484, section 546, "National Defense Authorization Act for Fiscal Year 1993" of Oct 1992 and SECNAVINST 6320.24a.
  • The names and telephone numbers of the resources on-base that can assist Sailor (e.g., Area Defense Counsel, chaplain, Inspector General).
  • The name and signature of the Commanding Officer.
  • Sailor's acknowledgement of receipt of letter or command's annotation of Sailor's refusals.

3. Forward the request for a CDE to the mental health provider. It is vital for the Sailor's command to provide all available documentation concerning the Sailor's problem behaviors. This may include as available, Article 15's, Letters of Reprimand, Letters of Counseling, and Enlisted Performance Reports/Officer Performance Reports. The documentation is necessary for a comprehensive evaluation.

4. If the provider believes that the evaluation has been requested improperly, he/she will contact the command to clarify issues about the process or procedures used. If, after such discussion, the provider believes the referral may have been conducted improperly per DoDD 6490.1 or DoDD 7050.6, (reference(c)), he or she is required to report related evidence through his or her chain of command to the next higher level of the referring commanding officer.

5. The provider conducting the evaluation will provide both written and verbal feedback on the results of the evaluation that include diagnosis, treatment recommendations, and any administrative management recommendations. Be aware the evaluation may require more than one appointment to complete.

Emergency CDE

Emergency CDEs are conducted upon recommendation of the mental health provider or when in the judgment of the CO an emergent situation exists. In general the following warrants an emergency referral for a CDE:

  • A severe mental or substance use disorder (e.g., hallucinating, delusional, etc.)
  • Intent to inflict harm to self or others or by virtue of dangerous behavior it may be reasonably assumed that they will unintentionally cause harm
  • Actual, attempted, or threatened violence

When an emergency CDE is determined to be necessary, the following steps need to be followed:

  • Ensure safety of Sailor and others. Do not leave the Sailor alone. Take all reasonable precautions to notify and protect others who have been identified as intended targets of violence or harm.
  • If at all possible, consult with mental health or other privileged healthcare provider prior to sending a Sailor for an emergency CDE. If circumstances do not permit such a consultation, contact an on-call mental health provider as soon as possible.
  • Transport to care. Take action to safely transport the Sailor to the nearest mental health care provider, or if unavailable, another privileged healthcare provider, as soon as is practical. Depending on the circumstances the Emergency Department or Security may need to be involved in the transportation process.
  • Provide Sailor with a letter stating the reasons for emergency referral as soon as practical. If the Sailor is seen before the letter can be provided to the Sailor, the letter and statement of rights must be provided as soon as is practical. If a mental health provider was not consulted prior to ordering the CDE, the reason for this must be explained in the letter to the Sailor.
  • Provide a letter to the evaluating provider regarding request of a CDE. The letter must be sent to the treating mental health provider documenting your concerns, the patient's circumstances, and the observations that led to refer emergency referral. This should be done as soon as possible.

The Sailor's Rights

Legal protection for the rights of the Sailor prohibits a command from improperly referring for a CDE. It is inappropriate to refer a Sailor for a CDE to buy time, be utilized as a disciplinary tool, or as a means of reprisal for the individual's attempt or intent to make a lawful communication (see DoD 6490.1, 4.3.1 - 4.3.5). When referred for a non-emergency CDE, the Sailor has the following rights prior to the evaluation:

  • Entitled to a waiting period of two days between the CDE notification and evaluation.
  • Consultation with legal representative.
  • The right to consult with the Inspector General (IG).
  • Communication with an attorney, members of congress, etc.
  • A second mental health evaluation by another mental health provider of the service-member's choosing (expenses are to be paid by the service-member).

What Commands Can Expect From the Mental Health Provider

Following a CDE Request:

  • Providers can request documents supportive of the request for a CDE (e.g., documentation of problem behaviors, Letters of Reprimand or Counseling, Article 15s, past performance reports).
  • Providers can request interviews with unit leaders, immediate supervisors, or other appropriate personnel to obtain collateral information on the individual.
  • Providers can perform psychological testing or conduct clinical interviews with the Sailor.
  • The service member may be hospitalized by a licensed mental health provider.
  • Notification of Medical Evaluation Board (MEB) if one is initiated by the Military Treatment Facility (MTF).
  • Notification of short or long-term limitations on duty status. Recommendations concerning flying status are deferred to the Flight Surgeon with input by the mental health provider.
  • Verbal and written reports summarizing findings and recommendations to be discussed with both command and the Sailor. Recommendations may include suggestions for support, changes in special duty status, and/or separation from the military.

Checklist for Command Directed Mental Health Referrals

To ensure the legality, efficiency, and integrity of the mental health evaluation process, the DoD and SECNAV Instructions require that several steps be taken by the member's Commanding Officer in conjunction with a mental health provider to determine whether a mental health referral is appropriate. This authority may not be delegated.

Commanding Officer: Review SECNAVINST 6320.24A, DoD Directive 6490.1, and DoD Instruction 6490.4 for a discussion of the member's rights and pitfalls to avoid in making command directed mental health referrals, and for sample letters.
Commanding Officer: Consult with the mental health provider about making a referral. There will be some instances where a referral may not be clinically indicated.
Commanding Officer: Send to the mental health care provider a formal, written request for mental health evaluation. For emergency referrals, this letter shall detail the circumstances and observations that led to the emergent referral and should be sent to the treating provider within 48 hours of the mental health evaluation.
Commanding Officer: Give the member a signed letter detailing behaviors of concern, the mental health provider consulted, notification of rights, the date, time, and place of the appointment, and contact information for attorneys, IGs, chaplains, and others who can provide assistance.
  • Routine referrals - at least 48 hours in advance of the evaluation
  • Emergency referrals - as soon as possible
Mental Health Provider: Remember that the mental health care provider must ensure that these steps have been followed properly, or a full mental health evaluation may not be conducted.

The above-mentioned Directives and Instructions may be found at the following links:

* SECNAVINST 6320.24a

  • See enclosure (2) for sample of the Request for Routine Mental Health Evaluation letter.
  • See enclosure (3) for sample of the Service Member Notification letter.

* DoD Directive 6490.1

* DoD Instruction 6490.4

REMEMBER: A PATIENT IN IMMINENT DANGER OF HARM TO SELF OR OTHERS MUST BE TAKEN TO MEDICAL OR THE NEAREST EMERGENCY ROOM IMMEDIATELY. IF PROPRER REFERRAL PROCEDURES HAVE NOT YET BEEN FOLLOWED FOR A FULL EVALAUTION, A BRIEF SAFETY ASSESSMENT WILL STILL BE CONDUCTED.

References

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