Privileged Communications of Military Chaplains and Mental Health Professionals: Case Law of Military Rules of Evidence 503 and 513

Alarmingly high rates of post-traumatic stress disorder (PTSD) and suicide among Service members returning from military action1 has increased focus within the United States military about effectively providing mental health services.2 Concerns include problems related to an insufficient mental health workforce, military culture, and delivery of services.3 Within this context, how sensitive personal information is handled while seeking mental healthcare is a major concern for service members. The Department of Defense (DoD) and the U.S. Department of Veterans Affairs (DVA) recently partnered to examine opportunities for chaplains to have a role in improving mental health efforts, largely because of their well-respected place within military culture, and the absolute confidentiality they enjoy with communications.4 This initiative—the Integrated Mental Health Strategy—recognizes the important potential chaplains have to promote mental healthcare.5 However, it generates a need to address important practical concerns. A primary issue is how chaplains and mental health providers can work—separately or together—to handle sensitive mental health information of servicemembers.6 This is a major concern because many servicemembers fear that disclosure of mental health issues can jeopardize their military careers if they are perceived as being unfit.7 At the same time, the appropriate handling of such information can be instrumental in helping servicemembers obtain assistance if needed. This raises the question of what the current legal landscape is for the treatment of confidential information by either chaplains or mental health providers within military courts. Military rules regarding privileged communications are currently the primary sources of guidance on these issues. This article provides an overview of applicable military case law on the treatment of privileged communications for both chaplains and mental health professionals. After the introduction in Part I, Part II provides an overview of military chaplaincy, their potential role in addressing mental health needs among servicemembers, and a summary of the mental health landscape. Part III focuses on a review of military cases concerning Military Rule of Evidence 503: Communications to clergy. It identifies the policy rationale behind the clergy privilege, and outlines major military appellate cases which have examined privileged communications under this rule for chaplains, many of which are relevant to situations involving instances of self-harm or harm to others. Part IV outlines case law concerning Military Rule of Evidence 513: Privileged Communications and Psychotherapists. This section identifies the policy rationale of the psychotherapist privilege, and discusses major military appellate cases which have arisen since the privilege was created by presidential order in 1999. Finally, part V discusses the implications of this case law within the framework of the wider policy goals of each rule of evidence, and offers suggested guidance for those working in this area

Early Warning Signs of Suicide in Service Members Who Engage in Unauthorized Acts of Violence

Despite the importance of both suicide and violence prevention in the military, little is known about how these behaviors relate to one another. The current research sought to elucidate the relationship between early warning signs for suicide and violence in a military population. This study included a review of 200 military law enforcement records maintained by the Naval Criminal Investigative Service (NCIS) and identification of early warning signs that may be observable to military law enforcement personnel. Statistical analyses tested for differences in warning signs between cases of suicide, violence, or both suicide and violence. The suicide-only and suicide/violence groups were more likely than the violence-only group to show early warning signs for: (1) psychological issues of depression, anxiety, hopelessness, a mental health diagnosis, and participation in treatment, (2) physical changes and impulsive behaviors, particularly substance abuse, (3) social warning signs, specifically social withdrawal, and (4) occupational issues, including diminished performance and interest at work. By contrast, the suicide/violence group was more likely than the other groups to show early warning signs of anger and aggression. Our findings suggest that Service members at risk for both suicide and violence are similar to those exclusively at risk for suicide, and they each differ from those solely at risk for violence. Our findings also suggest that the emotional trajectory that those who are both suicidal and violent follow is more aggressive, hostile, and angry than those who are either strictly suicidal or violent. The findings from this effort may enhance the ability of law enforcement and command personnel to prevent further acts of suicide and violence among military personnel. Recommendations for policy and future research are discussed

Early Warning Signs of Suicide in Service Members Who Engage in Unauthorized Acts of Violence

Despite the importance of both suicide and violence prevention in the military, little is known about how these behaviors relate to one another. The current research sought to elucidate the relationship between early warning signs for suicide and violence in a military population. This study included a review of 200 military law enforcement records maintained by the Naval Criminal Investigative Service (NCIS) and identification of early warning signs that may be observable to military law enforcement personnel. Statistical analyses tested for differences in warning signs between cases of suicide, violence, or both suicide and violence. The suicide-only and suicide/violence groups were more likely than the violence-only group to show early warning signs for: (1) psychological issues of depression, anxiety, hopelessness, a mental health diagnosis, and participation in treatment, (2) physical changes and impulsive behaviors, particularly substance abuse, (3) social warning signs, specifically social withdrawal, and (4) occupational issues, including diminished performance and interest at work. By contrast, the suicide/violence group was more likely than the other groups to show early warning signs of anger and aggression. Our findings suggest that Service members at risk for both suicide and violence are similar to those exclusively at risk for suicide, and they each differ from those solely at risk for violence. Our findings also suggest that the emotional trajectory that those who are both suicidal and violent follow is more aggressive, hostile, and angry than those who are either strictly suicidal or violent. The findings from this effort may enhance the ability of law enforcement and command personnel to prevent further acts of suicide and violence among military personnel. Recommendations for policy and future research are discussed

Perceived Impacts of a Public Health Training Center Field Placement Program among Trainees: Findings from a Small Group Externship Experience

There is heightened interest in identifying the impact of the federally-funded Public Health Training Center (PHTC) program. Although evaluation studies have been conducted of public health training in general, evaluations of PHTC programs are rare. Field placement components are Congressionally-mandated requirements of PHTCs. Field placements are typically intensive, supervised externships for students to gain public health experience with local health departments or non-profit organizations. We have found no published evaluations of PHTC field placement components. This may be because of their small size and unique nature. We designed and evaluated a 200-hour field placement program at an established Public Health Training Center. The evaluation included pre/post surveys measuring public health core competencies, and post-experience interviews. We found significant increases in three competency domains among trainees: policy development and program planning, communication skills, and community dimensions of practice. These outcomes contribute to an evidence base on the efficacy of PHTC field placement programs, and underscore their role in public health training

Confidentiality and Mental Health/Chaplaincy Collaboration

Confidentiality can both facilitate and inhibit working relationships of chaplains and mental health professionals addressing the needs of service members and veterans in the United States. Researchers conducted this study to examine opportunities for improving integration of care within the Department of Defense (DoD) and Department of Veterans Affairs (VA). Interviews were conducted with 198 chaplains and 201 mental health professionals in 33 DoD and VA facilities. Using a blended qualitative research approach, researchers identified several themes from the interviews, including recognition that integration can improve services; chaplaincy confidentiality can facilitate help seeking behavior; and mental health and chaplain confidentiality can inhibit information sharing and active participation on interdisciplinary teams. Cross-disciplinary training on confidentiality requirements and developing policies for sharing information across disciplines is recommended to address barriers to integrated service delivery

Perceived impacts of a Public Health Training Center field placement program among trainees: findings from a small group externship experience

There is heightened interest in identifying the impact of the federally funded Public Health Training Center (PHTC) program. Although evaluation studies have been conducted of public health training in general, evaluations of PHTC programs are rare. Field placement components are congressionally mandated requirements of PHTCs. Field placements are typically intensive, supervised externships for students to gain public health experience with local health departments or non-profit organizations. We have found no published evaluations of PHTC field placement components. This may be because of their small size and unique nature. We designed and evaluated a 200-h field placement program at an established PHTC. The evaluation included pre/post surveys measuring public health core competencies, and post-experience interviews.We found significant increases in three competency domains among trainees: policy development and program planning, communication skills, and community dimensions of practice. These outcomes contribute to evidence based on the efficacy of PHTC field placement programs, and underscore their role in public health training

Perceived impacts of a Public Health Training Center field placement program among trainees: findings from a small group externship experience

There is heightened interest in identifying the impact of the federally funded Public Health Training Center (PHTC) program. Although evaluation studies have been conducted of public health training in general, evaluations of PHTC programs are rare. Field placement components are congressionally mandated requirements of PHTCs. Field placements are typically intensive, supervised externships for students to gain public health experience with local health departments or non-profit organizations. We have found no published evaluations of PHTC field placement components. This may be because of their small size and unique nature. We designed and evaluated a 200-h field placement program at an established PHTC. The evaluation included pre/post surveys measuring public health core competencies, and post-experience interviews.We found significant increases in three competency domains among trainees: policy development and program planning, communication skills, and community dimensions of practice. These outcomes contribute to evidence based on the efficacy of PHTC field placement programs, and underscore their role in public health training

Evaluation of a Multistate Public Engagement Project on Pandemic Influenza

Program evaluation of public engagement processes is important in understanding how well these processes work and in building a knowledge base to improve future engagement efforts. This program evaluation examined a CDC initiative in six states to engage the public about pandemic influenza. Evaluation results indicated the six states were successful in engaging citizens in their processes, participants became more knowledgeable about the topic, citizens believed the process worked well, and projects were successful in influencing opinions about social values. Lessons learned from the evaluation included the importance of communicating evaluation expectations early in the process; creating a culture of evaluation through technical assistance; ensuring resources are available for on-site evaluation collaboration; and balancing the need for cross-site data with the interests of local projects to capture evaluation data relevant to each unique project

Nebraska’s Drug Courts Evaluation

The Nebraska Public Policy Center conducted an evaluation of Nebraska’s Problem-Solving Courts for the Administrative Office of the Courts. The evaluation was conducted from March – September of 2007 and covered eight probation problem-solving courts in Nebraska, including three adult drug courts (Midwest Nebraska, Northeast Nebraska, Sarpy County), four juvenile drug courts (Scottsbluff, Lancaster County, Douglas County, Sarpy County) and one young adult problem-solving court (Douglas County). The goal of the Nebraska’s Problem-solving (Drug) Court evaluation was to understand how well drug courts work, examine offender characteristics, examine current practices and procedures, and determine outcomes for offenders entering problem-solving courts