schools, work sites, and community facilities in addition to usual care at the member agency facilities. Representatives from member agencies and senior military installation commanders form the Community Action Information Boards that manage collaborative efforts among Delivery System agencies and between the Delivery System and their respective communities (USAFMS, 2000).
After epidemiological research regarding suicide among Air Force personnel demonstrated that situations such as legal investigations increased suicide risk, the Air Force suicide prevention program spear-headed policy changes to encourage help-seeking in these contexts. Specifically, the Air Force initiated a “hand-off” policy requiring that anyone facing legal issues be released to a supervisor or, minimally, only after notification of the supervisor, to ensure that an authority figure would be ready to refer the individual to helping agencies if deemed necessary (USAFMS, 2000). The Air Force implemented an additional measure that departs from military tradition by extending limited patient privilege to those under legal investigation. Thus, Air Force personnel receiving mental health treatment know that what they share with their mental health provider will not be used against them in military court or to characterize their service at the time of their separation from the military.
After implementing its comprehensive suicide prevention program, the Air Force saw a significant decrease in suicide rates among its active-duty personal, from 16.4 per 100,000 to 9.4 per 100,000 (p< 0.002) between 1994 and 1998 (Litts et al., 2000). By 1999, the rate dropped to 5.6 per 100,000. These rates represent a 78 percent decline in the suicide rate among active duty Air Force personnel over the last 5 years (Staal, 2001). In contrast, over the same period, suicide rates in other branches of the United States military (Navy, Army, and Marines) have not shown the same sustained decline (Litts et al., 2000). As with the other programs reviewed here, despite apparent success, the Air Force has not established that this reduction in suicide follows directly from LINK’s implementation (Litts et al., 2000; USAFMS, 2000).
An external evaluation of the program is currently under way at the University of Rochester School of Medicine’s Center for the Study and Prevention of Suicide. The Air Force also plans to continue analyzing its data to determine the effects of its suicide prevention efforts (Staal, 2001; USAFMS, 2000), and has established an epidemiological database and surveillance system. This system collects psychological, social, behavioral, economic, and relationship factors surrounding suicide attempts and completions among active and non-active duty cases. This database operates independently from other Air Force databases to enhance the confi-