U.S. Army Medical Department, Office of the Surgeon General
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Command Directed Evaluation (CDE)

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Soldier and Unit Safety Comes First!

Leaders should be aware of emergency procedures to take in the event that a Soldier presents them with safety concerns. Emergency BH evaluations should be a part of every organization's SOP.

SOPs should include the use of escorts, proper form templates to execute command referrals, buddy watch protocols and weapons removal guidelines. If SOPs do not exist, consult with organic BH assets to establish policies that are compatible with the specific unit structure.

Confiscation of a Soldier's weapon should only be considered when it is clearly apparent that the Solider is unreliable and a safety hazard to themselves and others. Soldiers that have immobilized weapons systems should not be considered for participation in combat missions.

Distressed Soldiers perceived to be a danger to themselves or unit personnel should always be escorted until an evaluation is conducted by credentialed medical personnel. The escort should be sufficient in grade and quantity to successfully stabilize the Soldier if required.

Consult BH assets immediately in all matters concerning safety assessments and risk management of unit personnel.

Recognizing Severe Stress Reactions and making Command Directed Referrals for Soldiers in Distress

Although the more serious warning behaviors usually diminish with help from peers and small unit leaders, some do not. An individual usually improves when able to get warm food, rest and an opportunity to share his feelings with comrades or small unit leader. However, if the Soldier appears to be a danger to themselves, others, or the mission; or, if they do not improve within a day or two, or seem to worsen, get the individual to talk with the unit chaplain, medical officer or BH/COSC asset. Access to BH/Combat and Operational Stress Control specialists may be sought, if available. Do not wait too long to see if the Soldier's behavior is better with time. Specialized training is not required to recognize severe stress reactions. The small-unit leader can usually determine if the individual is not performing his duties normally, not taking care of himself, behaving in an unusual fashion, or acting out of character.

The leadership should know the extended resources available to them and the appropriate mechanisms to utilize them. Unit leaders have multiple levels of COSC support services available to them, some organic to their organizations, some attached and some area or garrison support. It is up to the small unit leader to identify what resources are available, in their local and extended area. The following assets are generally available to leadership, in all tactical environments:

  • Organic medical assets to include enlisted medics and medical officers.
  • Chaplains.
  • Behavioral health assets organic and attached to organization.
  • Combat stress control team working in unit's area of responsibility (AOR).

Voluntary referrals—when there are signs of distress that may be negatively impacting a Soldier's functioning, commands can encourage the individual to voluntarily seek help. Active duty Soldiers who voluntarily seek help will be evaluated and offered appropriate treatment. With some exceptions, information provided will be kept private. These exceptions include—

  • Removal from weapon-bearing duties or access to classified information is recommended.
  • Significant risk of danger to self or others is present.
  • The Soldier represents a significant security risk.
  • Hospitalization is necessary.
  • Domestic violence or child abuse is suspected or reported or a diagnosis of substance abuse or dependence is made (Family Advocacy Program restricted reporting policy may apply).
  • The Soldiers MH has deteriorated to the point that it may significantly affect work or family function.

Command Directed Evaluation (CDE) in accordance with (IAW) DODD 6490.1, commanding officers (CO) may direct Soldiers to undergo a MH evaluation. A CDE is appropriate whenever the CO believes that the Soldier's mental state renders them a risk to themselves or others or may be affecting their 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 pose include—

  • Does the Soldier have a MH condition that is contributing to current difficulty?
  • What is the potential for the Soldier to return to full functioning given successful treatment?
  • Is the Soldier suitable for carrying a weapon at the current time?
  • Is it appropriate for the Soldier to have access to classified information?
  • Is the Soldier qualified for deployment?
  • A CDE can be accomplished on a routine or an emergency basis.

Routine command directed evaluation. Once a decision has been made to request a routine and non-emergency CDE, CO's are required to—

  • Consult with a privileged MH provider. Commanding officers should communicate the behaviors that they believe warrant the evaluation and what information they would like from an evaluation. The MH provider will make recommendations about whether a CDE is appropriate and if the situation warrants an emergency CDE. The MH provider will also discuss other options that may be appropriate. If a CDE is necessary, CO should inform the provider as to when the Soldier will be notified about the referral so that a time and date for the evaluation can be determined.
  • Provide a written letter or counseling statement to the Soldier. This should be provided to the Soldier at least two business days prior to the evaluation. The letter must include—
    • The date, time, and location of the evaluation.
    • The name and grade or rank of the MH professional who will be conducting the evaluation.
    • The name and grade or rank of the MH 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 Soldiers rights.
    • The names and telephone numbers of the resources on-base that can assist Soldier.
    • The name and signature of the CO.
    • Soldier's acknowledgement of receipt of letter or command's annotation of Soldier's refusal.

Most BH assets will have copies of template sample CDE request forms. Leaders should contact their supporting BH asset to request a copy of this form. Forward a request for a CDE to the provider. It is vital for the Soldier's command to provide all available documentation concerning the 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. Provide a copy of the letter to the BH provider conducting the CDE. 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. The provider conducting the evaluation will provide both written and verbal feedback on the results of the evaluation. Be aware the evaluation may require more than one appointment to complete.

Emergency CDEs are conducted upon recommendation of the MH provider or when in the judgment of the command an emergent situation exists. In general the following constitute grounds for an emergency referral—

  • A severe mental or substance use disorder.
  • Intent to inflict harm to self or others.
  • Actual, attempted, or threatened violence.

When an emergency CDE is determined to be necessary, the following steps need to be followed to ensure safety of Soldier and others.

  • Do not leave the Soldier alone.
  • Take all reasonable precautions to notify and protect others who have been identified as intended targets of violence or harm.
  • Consult with BH or other privileged healthcare provider prior to sending a Soldier for an emergency CDE if at all possible. If the circumstances do not permit such a consultation, contact an on call BH provider as soon as possible.

Take action to safely transport the Soldier to the nearest BH care provider, or if unavailable, another privileged healthcare provider, as soon as is practical—

  • Provide Soldier with a letter stating the reasons for emergency referral as soon as practical. If the Soldier is seen before the letter can be provided, the letter and statement of rights must be provided as soon as is practical. If a BH provider was not consulted prior to ordering the CDE, the reason why should be explained in the letter to the Soldier.
  • Provide a letter to the evaluating provider. A letter requesting a CDE must be sent to the treating BH provider documenting command concerns, the Soldier's circumstances, and the observations that led to refer emergency referral. This should be done as soon as possible.

Legal protections for the rights of Soldiers prohibit a command from improperly referring for a CDE. It is improper to refer a Soldier for a CDE to buy time, as a disciplinary tool, or as a reprisal for the individual's attempt or intent to make a lawful communication (see DODD 6490.1, paragraphs 4.3.1-4.3.5). When referred for a non-emergency CDE, the Soldier has the following rights prior to the evaluation—

  • A two business day waiting period between the CDE notification and evaluation.
  • Consultation with the Area Defense Counsel.
  • The right to consult with the Inspector General (IG) if they believe the CDE violates policy.
  • A second MH evaluation by another MH provider, of the Soldier's own choosing, and at their own expense.
  • Communication with the IG, his/her attorney, Members of Congress, or others.
  • What commands can expect from the MH provider following a CDE request—
    • Provider may request documents supportive of the request for a CDE (documentation of problem behaviors, letters of reprimand or counseling, Article 15s, past performance reports).
    • Provider may request interviews with unit leaders, immediate supervisors, or other appropriate personnel to obtain collateral information on the individual.
    • Provider may perform psychological testing or conduct clinical interviews with the Soldier.
    • Notification of required hospitalization if one is required.
    • Notification of medical evaluation board if one is initiated by the medical treatment facility (MTF). Notification of short or long-term limitations on duty status.
    • Verbal and written reports summarizing findings and recommendations to be discussed with both command and the Soldier. Recommendations may include suggestions for support, changes in special duty status, and/or separation from the military.