Wanting to kill yourself feels normal in the moment. One cause of the high suicide rate in the Air Force is simple: Airmen, like me, do not trust the command-driven mental health system.
What does not feel normal about having a mental health problem is telling someone else about it. Then, on top of that, having your supervisor find out, and eventually, your commander. Then, the coup de grâce – suffering negative career consequences as the result of your decision to seek help.
Simply put, there are multiple disincentives and penalties written into Air Force policies that — whether intended or not — make life difficult for Airmen who seek mental health treatment.
I started noticing that I was struggling when I first became a member of the Judge Advocate General’s (JAG) Corps — a job that is similar to a civilian in-house counsel position. I was dealing with risk factors that are common to service members: I was stationed overseas away from my extended family; I had to learn how to become an attorney and an officer simultaneously; the workload was heavy; integrating into the local community was challenging, and I had recently become a father. The constant stress made me feel burned out.
After an overseas deployment and placement into a highly sought-after assignment, my self-confidence, stress, and depression became more intense.
Fortunately, my wife insisted that I go see a therapist. As a JAG, I had observed the lapses of confidentiality and the built-in conduit between the medical community and command, so I did not want to risk my career by seeking help in-house. So, I chose to talk to a civilian therapist, went after work hours, paid out of pocket, and told no one about it.
My mental health improved greatly once I found someone whom I trusted that I could talk to. However, during my second assignment, I went to Squadron Officer School for six weeks and felt discouraged and isolated. Despite the fast friendships I had made with the other class members and two wonderful instructors, I hit a low point; I remember walking alone on the riverfront and feeling like I should kill myself. A few weeks later I graduated in the top 3% of my class.
And that’s the rub when it comes to mental health: a person can be doing really well, but also really bad at the same exact time. For me, it was difficult to even recognize that anything was wrong.
During another overseas deployment, things got bad for me again. Certain elements in my workplace were extremely toxic, the coronavirus pandemic was raging, and the operational tempo was high. After those long work hours, I had to finish the Air Force’s mandatory education program.
So, four months into my deployment, I knew I had to seek help so that I would not choose to end things. Fortunately, I had maintained the relationship with my therapist, whom I trusted, and together, we made a plan that wound up saving my life.
The first step was to make the “I’m calling for a friend” phone call to the base mental health provider to determine the limits of confidentiality. As a JAG, this was easy since much of what we do is calling experts to better understand regulations.
What she told me was disheartening: Confidentiality was limited. If I were to take medication, my command would find out because I would be put on a medical profile – a status report that my higher-ups would see. She also told me that before an Airman can hold certain specialty jobs, the Air Force reviews their medical and mental health records.
Despite the obvious downsides, I chose to go see her anyway. Indeed, the process was not all that confidential. I sat in a waiting room in a popular building where anybody could pop in and see me. I had to fill out a mountain of paperwork that I knew would be added to my permanent medical record.
I got back stateside and was labeled a Code 31, which meant I was unable to deploy for 90 days. That information was then emailed to my commander, deputy commander, my supervisor, the senior enlisted member in my office, and the unit deployment manager. I was mortified.
Unless you show up to work with a broken arm or a scheduled surgery, a Code 31 is really a code for a mental health problem. Even worse, I was being penalized for taking care of my mental health, because I now had a black mark on my record that prevented me from deploying.
What I have learned since that initial notification is that if I were to increase, decrease, or stop taking my commonly prescribed antidepressant, I would be labeled as a Code 31 again. New notifications would be issued to my command team and supervisors — the very people who write my annual evaluation.
Seeking help is even harder if you fly a plane, carry a firearm, or hold a nuclear position. Those positions fall under special programs that allow commanders to access their subordinate’s sensitive medical and mental health information under the guise of ensuring readiness for those billets.
That is a shame. Since I started seeing my therapist and taking a simple anti-depressant, I feel like a new person. I have more energy, more resolve, more strength, and I am a better employee.
So, what can be done to fix the disincentives in the Air Force’s mental health system? On Jan. 6, 2022, Chief Master Sergeant of the Air Force JoAnne S. Bass teased that the Air Force will be formally announcing a new team to study barriers to resilience and mental health. This is a welcome announcement, especially since she previously said, “We can’t impact [suicides] at our level.” The working group will be called Fortify the Force Initiative Team. At a minimum, the following items should be reviewed and executed:
- The Fortify the Force Initiative Team should review and propose changes to Air Force regulations to enhance confidentiality and reduce disincentives for Airmen seeking mental health treatment.
- The Fortify the Force Initiative Team should identify all Department of Defense regulations that prevent changes to Air Force Instructions and refer them to the Department of Defense for immediate action.
- The Fortify the Force Initiative Team should be tasked with determining to what extent — if any — commanders should be involved in the mental health and medical system. Currently, there are nine explicit exceptions to confidentiality where command can receive mental health information regarding an Airman, not including notifications on deployment readiness and discharging Airmen for mental health reasons.
- The Air Force should create a mental health Bill of Rights that is widely publicized, specific, informative, and written in clear language that the average Airman can understand. If, as a JAG, I cannot figure out how, when, and why my medical information will be shared, then the average Airman won’t be able to either.
“To be or not to be — that is the question.” This famous line from Shakespeare’s Hamlet sums up what it’s like to contemplate taking one’s own life. Indeed, our Airmen, like Hamlet, sometimes reason that it is easier “not to be” than to seek mental health treatment. The fact that life or death is even a question for our service members means the answer is simple: Get rid of the disincentives in our regulations so seeking mental health treatment feels like the normal thing to do.
Editor’s Note: If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. Call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press “1” to reach the Veterans Crisis Line.
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Major Spencer R. Nelson is an active duty member of the Air Force JAG Corps. His views do not reflect those of the Department of Defense, the Air Force, or the JAG Corps.
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