From January 2021 to January 2022, the ship reported about 2,600 mental health patient encounters with the psych boss, the behavioural health technician and two substance abuse rehabilitation programme counsellors. It was unclear how many sailors sought mental health services, as a “patient encounter” could mean one sailor was seen multiple times.

Of the three Washington sailors who died by suicide in April, only 24-year-old Natasha Huffman was a patient of the Washington mental health team.

The psych boss and psych tech reported a “significant backlog” for initial appointments despite each seeing as many as 20 patients a day. According to the investigation, this means it could take up to six weeks for a sailor to get a non-emergent (no threat to life) initial mental health appointment.

“(Senior medical officer) and Psych Boss had considered switching from individual-based therapy to group therapy in order to handle the high volume, but chose not to because group therapy ‘hadn’t worked well in the past’,” the report reads.

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Long Covid-19 patients struggle with suicide risk more than 2 years into the pandemic

Long Covid-19 patients struggle with suicide risk more than 2 years into the pandemic

Leadership aboard the Washington added to the demand for mental health services.

The Navy has sponsorship and mentorship programmes available to connect sailors with leadership who will guide them through their assimilation into a new command. But according to the investigation, multiple sailors reported a lack of mentorship aboard the carrier and said leadership did not want to talk about or were uncomfortable discussing mental health issues with junior sailors.

“Psych Tech stated that ‘leadership,’ and specifically leading petty officers (LPOs), ‘don’t have time’ to deal with mental health issues of their subordinates and want to refer them to Psych Boss and Psych Tech to deal with,” the report reads.

While the medical team aboard the Washington was overwhelmed, the deployed resiliency counsellor was “underutilised.”

The resiliency counsellor, at an off-site location 3 miles from the carrier, only saw 46 patients from January 2021 to January 2022. Deployed resiliency counsellors are civilian clinicians that offer confidential, non-medical counselling on a short-term basis while sailors are deployed or in port.

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“Sailors interviewed were generally not aware that the deployed resiliency counsellor is an available resource who does not readily share patient information, and any information shared with the DRC is not entered into the sailor’s military health record,” the report said.

Additionally, multiple sailors interviewed during the investigation did not know who the deployed resiliency counsellor was or where they were. But those who knew the counsellor was 3 miles from the carrier were “hesitant to take that much time off to go there (or don’t believe they can)”, the report said.

Following the suicides, the Navy assigned an additional resiliency counsellor to the Washington, this time placing them on board the carrier. The ship also has three chaplains who can provide emotional and spiritual guidance.

The investigation included a slew of suggestions, some of which already have been implemented.

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“Recommendations, such as adding additional mental health counsellors and refining the welcome aboard process for new sailors, are under way. We are also improving our team-building programme to ensure every sailor knows they are a critical component of our Navy team,” said Captain Dave Hecht, spokesperson for US Fleet Forces.

According to the first investigation, the Navy is also considering reviewing the adequacy of mental healthcare and practitioner manning for ships entering a complex refuelling and overhaul to better balance manning with demand, as well as requesting the Military Entrance Processing Command review the Navy’s initial accession screening process for psychological suitability.

“This process should not be intended to prevent individuals from entering the Naval service, but is designed to identify those that may be at risk for psychological hardship. This review should be focused on proactive measures to identify unresolved and/or untreated disorders, and to develop a treatment plan to help sailors better assimilate to the arduous environment of Naval service,” the report read.

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The psychological suitability screening recommendation was modified to suggest the Navy coordinate this effort with the Marine Corps’ High Risk Sailor Identification Initiative to develop a risk management tool for commanding officers to use in order to define, identify, manage, and oversee high risk sailors more effectively and transparently within their command and during transfer processes.

But those recommendations, as well as others meant to enhance mental health and support resources, recreational programmes, and command mentorship initiatives, are being evaluated as part of a second, broader investigation that evaluates the command climate and quality of service challenges unique to the shipyard environment is ongoing.

“The findings from this quality of service investigation will be released in the coming months, which we anticipate having a positive impact on our sailors and their families,” Hecht said.