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Tripler Guide 2015
Tripler Guide 2015


Behavioral Health

Frequently Asked Questions About Command Referrals

1. What is the difference between a Command Referral and a Self Referral?

A command referral is a one-time evaluation to help a commander determine the needs and problems of the soldier. The commander must fill out the required paperwork, and only the commander can schedule the appointment. After the appointment, the commander receives a formal answer that can be used for certain administrative purposes (e.g., Chapter 5-13 or 5-18). Other feedback may be given to the commander, such as recommendations for continuing treatment or restriction of duty.

When a soldier self refers, s/he must call and make the appointment. Though a commander can confirm attendance at appointments, no information will be released so long as the soldier’s disclosures do not fall under the Limits of Confidentiality. If the soldier desires a mental health appointment and the commander’s only concern is that help be available, consider letting the soldier self refer.

2. What are the limits of confidentiality?

If a soldier states during a therapy appointment that s/he has intent to harm self or someone else, the chain of command is informed in order to assist with the situation. The disclosure by a soldier of spouse or child abuse within the family will mandate a referral made to the Family Advocacy Program, which will inform the commander. "Fit for duty" issues can also be discussed with command. This includes disclosures that make a soldier unsafe on the job (e.g., a pilot complains of panic attacks, a rigger reports inability to concentrate, etc.)

Commanders are not automatically informed if a soldier is placed on medication or confesses to drug use or other UCMJ offenses.

3. What are common reasons to make a regular command referral?

The basic reason is to determine Fitness for Duty. If a soldier’s emotional or mental difficulties are interrupting his or her ability to be a productive member of the unit, consider a command referral. Some common examples of problems that impact a soldier’s work are inappropriate displays of anger, frequent tearfulness, refusal or inability to participate in daily activities.

The total picture must be considered when deciding to command refer a soldier. Take into account work performance (past and present), specific problems the soldier may be having, and the soldier’s own report of the current problems and his or her ability to cope with them.

4. What are the reasons to make an emergency command referral?

A commander can make an emergency referral if a soldier is an immediate threat to the safety of self or others. This means the soldier has been making statements or taking actions to this effect. Ensure that the commander has discussed this with the soldier and believes the soldier is in immediate danger. Rumors can not be used as a basis for an emergency command referral.

Another reason for an emergency command referral is the presence of psychotic symptoms (e.g., hearing voices or seeing visions) or if the soldier is otherwise unable to care for self.

5. What kind of answer can I expect back from my command referral?

The mental health officer will make an official answer on a DA Form 3822-R, Report of Mental Status Evaluation. The first page is a report of the soldier’s mental status, and may also include a diagnosis (e.g., Major Depression) and an assessment of the soldier’s potential for harm to self or others. The second page may include recommendations for the soldier’s continuing treatment, including any follow up appointments that have been made. It also may include recommendations for restrictions (e.g., no access to firearms or no contact with alcohol) that a commander may place upon the soldier to help with the problem. Finally, administrative recommendations may be made, such as separating the soldier from the military. A short summary of these will be included at the bottom of the page.

It is important that the commander ask specific questions and describe the concerns thoroughly on the initial TAMC Referral Form in order to guide the clinician in making an answer that is helpful to both the commander and the soldier. Incomplete referral forms may necessitate additional contact with the commander and will delay the process.

6. How long does this process take?

When a regular command referral is made, the soldier is given an appointment for an evaluation, usually within two weeks. The appointment may take anywhere from one to three hours. An answer will be available for command to pick up within twenty-four hours. A command representative, E5 or above, must sign for the 3822-R at the mental health clinic. In addition, the counselor will contact the commander by phone to explain the results and answer any questions that the commander may have.

An emergency command referral usually takes an entire morning or afternoon.

7. What should I do if I think I need to make an emergency referral and it is not during regular duty hours?

The soldier can be taken to the emergency room, where a counselor will do a risk assessment and initiate the necessary precautions to ensure the soldier’s safety. This does not constitute a command referral, and no 3822-R will be generated. Follow up with the mental health clinic on the next duty day if a command referral is appropriate.

8. Can I command refer a spouse?

A spouse can not be command referred or ordered into any type of counseling by the commander.