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By Andrew Devendorf, Ph.D. 

Losing a patient to suicide is among healthcare providers’ greatest fears. But most providers are not prepared for navigating this nightmare. This can worsen the aftermath of a suicide—making it more confusing, more chaotic, and more painful. Everyone loses in this situation: providers, their colleagues, their organization, and, of course, the surviving loved ones.

Over a series of posts, I aim to demystify this important yet underdiscussed area. My hope is to alleviate some anxieties by answering some basic questions. 

These include:

• How common is it for a provider to lose a patient to suicide? 
• What is it like to endure this nightmare? 
• What are some effective ways to cope with it? 
• How can organizations provide postvention support? 
• What are the potential legal concerns of losing a client to suicide (e.g., malpractice)?

This post will address the first 2 questions.

Statistics of Suicide Loss Among Providers
Suicide is a leading cause of death in the United States. It is the 2nd leading cause of death for people ages 10-44, and the 8th leading cause of death for people ages 45-64. Many providers know these statistics, and they recite them for public health awareness. But most do so without knowing that, they too, may be affected by these tragedies.

Unfortunately, losing a patient to suicide is not an uncommon experience. A systematic review of 41 studies, across 15 countries, found that 1 in 2 healthcare professionals experienced a patient suicide across their career. When broken down by specialty, 37% of psychologists, 73% of psychiatrists, and 87% of general practitioners lost a client to suicide over their career. Among trainees, about 1 in 6 psychologists reported losing a client to suicide during their one-year clinical internship, and about 1 in 2 psychiatrists reported losing a client to suicide during their residency.

I think it’s importance to contextualize these rates and their interpretation, as they can be scary. First, these rates represent suicide loss across a provider’s career—and providers may see hundreds or thousands of patients across their lifetime. The fact remains that the likelihood of losing a given patient is still very low, so providers need not be concerned when working with a patient with suicidal thoughts. Second, these rates do not capture the level of closeness or proximity of the patient-provider relationship. For instance, the high rate of patient suicides among general practitioners is likely related to their high case load. They are more likely to see patients in brief primary care appointments rather than a long-term psychotherapy context.

A Nightmare for Providers
A patient suicide can be a tremendous loss for a provider. Like any loss, there’s no right or wrong way to grieve a patient suicide, as each one is different. On a personal level, experiencing a patient suicide simply hurts because our patients matter to us. Particularly when we develop longstanding relationships with them, such as in psychotherapy, we get to know intimate aspects of their lives.

On a professional level, we strive to provide the best care. We see people when they are struggling, when they need our help. And, if a patient dies by suicide, we might perceive it as a personal failure. In fact, even among providers who are trained in suicide prevention, research shows that they may feel a sense of responsibility, or a lack of competency, after a patient suicide. Furthermore, providers may experience a storm of thoughts and feelings related to the tragedy. I outline some common reactions below.

Thoughts, Images, and Concerns: 
“I must have done something wrong.”
“I should have seen the signs.”
“Could I have prevented this?”
“Did I miss something?” 
Replaying sessions in one’s head
Doubting one’s competence
Concerns about not knowing what to do next

Feelings: 
Guilt, self-blame 
Shame, embarrassment 
Grief, profound sadness
Confusion, shock, disbelief
Anger (at self, client, or system)
Fear of judgment, litigation, and working with future suicidal clients

Behaviors:
Withdrawing from colleagues
Second-guessing oneself 
Avoiding suicide-related topics
Over-documenting future cases
Difficulty returning to work
Hypervigilance with other clients
Changes in sleep or appetite

While I have not experienced a patient suicide, I can identify somewhat with the nightmare. I lost my brother to suicide in 2017. This loss hit me with unrivaled pain, confusion, and self-doubt. I replayed every scene with him, especially the times that he confided in me about his chronic depression. I interrogated myself, asking, "Did I do enough?" “Did I say the right things?” and "Why didn’t he feel comfortable reaching out to me?” I was not his therapist, but I was about to embark on my training as a psychologist, and my mission was to specialize in suicide prevention. Losing him made me question my ability, “Would I be capable of treating suicidal ideation?” “Would I be able to handle it?” and “Would I be able to make a difference, or would I fail my patients?”

The Need for Proactive Postvention Support
Postvention is a coordinated approach to providing support for people impacted by a suicide loss. The core components include psychoeducation, social support, and structural support (e.g., at the workplace). Postvention efforts (ideally) give a roadmap for navigating the personal (e.g., emotional), professional, legal, and administrative complications after a suicide. There should be risk management and communication protocols across all parties involved; this includes the provider, their supervisor, their team, their organization, and the patient’s loved ones.

Postvention should be proactive—not reactive. The immediate aftermath of a suicide loss can be an emotionally charged time. Preparing a plan prior to a loss can help decrease the anxiety associated with having to quickly determine necessary action steps following a suicide. It can also reduce administrative confusion and thus allow attention to be placed on the human impact.

It can be useful for providers to treat suicide postvention like fire preparation: fires are unlikely to happen, and yet, everyone should always be prepared for one. Like fire preparation, providers and their organizations should develop a proactive plan for a patient suicide. This can be a usable electronic document that is accessible to everyone in the organization. Plans could be organized into sections for the relevant audience (e.g., staff, trainees, leadership, family members) and by action items for the pertinent topics (e.g., “Communicating with Family,” “Supporting Oneself,” “Liability and Malpractice Information”). Of course, making a plan is just the first step. No different than a firedrill, organizations should hold re-occurring trainings and reminders about postvention protocols. Put simply, suicide postvention is an ongoing discussion.

Stay Tuned… 
Suicide postvention deserves more attention. And so, in later posts, I will get deeper on suicide postvention for providers.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.

Andrew Devendorf, Ph.D., is a Military Mental Health Psychologist with the Henry M. Jackson Foundation for the Advancement of Military Medicine. He serves as a subject matter expert in suicide prevention for the VA SAFEGUARD project.

References
Jupina, M., Mercer, M., Weleff, J., Hackett, L., Nunes, J. C., Sebastian, D., & Anand, A. 
(2024). Prevalence of patient suicide and its impact on health care professionals: A 
systematic review. Psychiatric Services, 75(10), 999-1008.
Spruch-Feiner, A., Labouliere, C. D., Brodsky, B., Green, K. L., Brown, G. K., Vasan, P.,
... & Stanley, B. (2022). Effects of patient suicide on professional practice among mental
health providers. Journal of Psychiatric Practice, 28(3), 184.

56.0% vs. 47.3%  
 

The percentage of veterans who report using mental health care versus non-veteran use, according to a study published in the journal Psychiatric Services -- Mental Health Care Use and Barriers Among Veterans and Nonveterans With Suicidal Ideation: Findings From a National Survey.

However, nearly one-third of both veterans and nonveterans reported unmet mental health needs. Veterans were less likely than nonveterans to endorse cost as a barrier to care (APR=0.65) but were more likely to endorse confidentiality concerns (APR=1.65). Fear of involuntary hospitalization and stigma were common in both groups.

By Kristyn Heins, Ph.D.  

The Suicide Prevention and Response Independent Review Committee (SPRIRC) identified a number of recommendations for improving suicide prevention efforts. Some of these included increasing suicide prevention training, improving access to resources, and promoting lethal means safety. The Consortium for Defense Psychology (CDP) has spent the past year targeting a few of these recommendations and increasing the effort to improve suicide prevention services.

One of the most notable efforts was the increase in offered trainings of Cognitive Behavioral Therapy-Suicide Prevention (CBT-SP). The CDP offered 69 CBT-SP trainings over the last 12 months. The two-day immersive training includes education on terms and theory, a specific focus on lethal means safety, and detailed review of the evidence based therapy. Participants engage in polls, small group discussions, and have opportunities to role play these new skills. Once someone has finished the two-day training, they are encouraged to engage in free CBT-SP consultation which is offered twice a week by CDP subject matter experts.

The CDP has also worked to engage adjacent providers, not just training therapists. The suicide prevention training for mental health technicians (MHTs), which is an interactive, instructor-led course, includes role play activities to reinforce learning in each of the key skills. The course provides an overview of the basic components of CBT-SP and how a MHT can support a patient engaged in CBT-SP. Additionally, a separate training tailored to prescribers provides education on the essential skills associated with suicide prevention. This includes safety planning and LMSC, while also providing modules on DOW recommendations and best practices for prescribing medication to patients experiencing increased suicide risk.

The CDP continues to evolve in how we are reaching providers. Over the past year a number of CDP Presents, our monthly webinar series, focused on suicide prevention. Inspiring presentations included navigating suicide in context of romantic relationships, Dialectical Behavioral Therapy for suicide prevention, and prevention of harmful behaviors. One of the most engaging methods of reaching providers is through the Practical for Your Practice podcast. Episodes included topics like navigating multiple presenting problems that contribute to suicide risk, personal experience of suicide loss, and firearm safety.

The CDP considered how various presenting concerns can contribute to suicide risk. Knowing that suicidal thoughts do not develop in a vacuum, we considered what other diagnoses we should be addressing. This year marked the re-launch of CBT for Chronic Pain. There were nine Cognitive Behavioral Therapy-Chronic Pain offerings this past year, each with a substantial number of actively engaged participants. The CDP has also incorporated training on Posttraumatic Stress Disorder evidence based therapies, understanding that traumatic experiences can contribute to the development and maintenance of suicidal thoughts.

We are excited for the next year and our continued push to train providers in evidence based therapies. In addition to our current efforts, we are incorporating a number of alternative learning opportunities including asynchronous training and microlearnings. We look forward to working towards the goal of expanding suicide prevention efforts and supporting our service members and veterans.

Interested in our work? Ready to join the effort? See our training calendar for a complete list of course offerings at https://cdp.usuhs.edu/training-schedule

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.

Kristyn Heins, Ph.D., is a Licensed Professional Counselor serving as a Military Mental Health Counselor for the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she supports the CDP’s efforts of training clinicians in evidenced-based practice focused on suicide prevention.

19,000   

The approximate number of child care workers employed by he Department of Defense (DOD), according to a report from the Government Accountability Office (GAO) -- Military Child Care: Services’ Use of Worker Recruitment and Retention Incentives.

These workers care for nearly 172,000 children of service members and DOD civilian employees (as of fiscal year 2024). The military services face challenges recruiting and retaining child care workers, contributing to lengthy waitlists and wait times for child care.

By: Heather Tompkins, Ph.D., MS-ATR, MA, LCMHC

Military life is synonymous with change. While change can be positive, it also can bring stress. The concept of normative military stressors- unique stressors that are an inherent part of military life- is central to military life. A primary example of a normative military stressor are Permanent Change of Station (PCS) moves. Relocation is an anticipated part of military life, with service members and their families moving on average every 2-4 years. Military families move more often and longer distances than civilians. On average, a military family will move 6-9 times between when a child starts kindergarten and graduates from high school. Currently, PCS season is in full swing for many military families (including my own), with peak volume occurring during the summer months from mid-May to mid-September.

A PCS move brings a unique blend of personal, family, and logistical challenges. “Life as usual” consists of managing house packouts, finding childcare/changing schools, career/employment transitions, and adjusting to a new duty station/environment, among other things. As a military spouse who has experienced numerous PCS moves (not counting temporary housing or moves between), I feel fairly versed in the process, the challenges, and the relief the end of each move brings. While moving to a new duty station brings the potential for new personal and professional opportunities, a prolonged or complicated PCS can tax or overwhelm the most adaptable military families. The relocation process presents a dual burden: 

• Logistical Challenges: Managing packing/HHG delivery, travel coordination, housing transitions, expenses, and physical establishment in a new location. 
• Psychological Strain: Exerting cognitive and emotional energy to adapt to new environments, settle into new workplaces or school systems, navigating medical/healthcare, managing loss of local support networks.

Re-establishing and managing a household, career, and family life, while simultaneously absorbing these emotional demands can require substantial physical and mental bandwidth. From my own PCS experiences, I’ve learned a few strategies to help manage the stress and help my family adjust to whatever each new duty station brings.

Three Practical Ways to Manage Stress During Transitions
1. Practice Self-Awareness and Reflection
Self-awareness is the ability to see and understand your own thoughts, feelings, actions, and how you fit into the world. It can be internal (feelings, triggers, core values, and habits) and/or external (how other people see you and how you affect them). Practicing self-awareness allows us to be aware of and manage strong feelings, guides our choices, and helps us to keep how we live in-line with our values. One tool that I frequently use when engaging in self-awareness is metaphor. The water depth metaphor (swimming, treading or sinking) has become my go to when assessing where I am at and how I’m coping amidst military life’s normative stressors.

Normally, I’m swimming along, think Dory (just keep swimming, swimming, swimming), fulfilling my day-to-day personal and professional activities. However, during periods of stress or transition, such as our current PCS, my “normal swimming along” shifts and oscillates between swimming steadily and treading water.

• Swimming: Feeling grounded, moving forward with purpose and on solid footing, comfortably managing and adapting to current demands and challenges.
• Treading Water: Exerting continuous effort to stay in place and keep your head above water to keep up with day-to-day tasks, working hard but not moving (forward or back), “surviving” a busy period, stress, challenges without making progress.
• Sinking: Experiencing acute overwhelm where overlapping stressors feel unmanageable, loss of energy to stay afloat, failing or dropping below the surface.

No matter how prepared, organized, or experienced we are, it is normal for our stress levels to rise as we manage the logistics and psychological strain that come with the transitions of a military move. Engaging in a self-awareness check is a healthy way to gauge where your mental and emotional well-being are during both normal and heightened periods of stress. Likewise, during a prolonged or complicated transition, a simple pause and asking yourself: Am I swimming, treading, or sinking in water? Can provide the opportunity to evaluate whether we are coping and managing these stressors or do we need additional support and resources.

2. Utilize Resources and Supports
I have found over the 15 years of military life, navigating military stressors and transitions does not have to be done in isolation. We each have our supports, whether it is family, friends, neighbors or a combination of that we can turn to during life’s stressors. Likewise, turning to military-informed professionals ensures that the support received is anchored in an understanding of the nuances and realities of military life. Specialized support and resources help bridge gaps in care during times of change, transition, and geographic relocation. As a military family, we are fortunate to have numerous resources both on and off installation that exist to support well-being through every stage of relocation and service. A few examples include (not exhaustive list):

• Star Behavioral Health Providers (SBHP): SBHP helps bridge the gap in specialized behavioral health care by connecting military-connected clients with civilian providers specifically trained in military culture and evidence-based treatments. starproviders.org 
  https://starproviders.org/find-support/
• Military OneSource: A comprehensive 24/7 service offering confidential non-medical counseling, relocation tools, and practical support for every aspect of military life. https://www.militaryonesource.mil/
• inTransition Program: For service members currently receiving mental health care, inTransition provides coaching and support to ensure continuity of care during transitions, PCS moves, or separation from service. https://veteran.com/intransition-program/
• Military Family Life Counselors (MFLC): Provides free and confidential counseling to service members, their families (including children), and survivors on or near installations. In addition, military leaders can request briefings and grief counseling for their units. https://www.militaryonesource.mil/resources/tools/mflc-locator/

These are just a few of the many resources available to military service members and their families that are easily accessible and can provide a variety of support services across the various stressors and stages of transition in military life.

3. Prioritize Re-adjustment, Stability, and Self-Care
PCS impacts the entire family unit. Relocation leads to disruption to routine, stability, and support networks, requiring constant adaptation and flex. Thus, regaining stability after a PCS requires deliberate, structured effort. Military families can foster adjustment and stability by actively prioritizing the following:

• Restoring Routines: Re-establishing predictable household rhythms, daily schedules, and family activities to rebuild a sense of safety and normalcy.
• Connecting with Resources: Securing medical/behavioral healthcare providers, establishing childcare/ school enrollment, identifying both on/off installation supportive resources.
• Building Community: Proactively seeking out local support networks, school/childcare contacts, and peer connections both on and off installation to build your “village”.

Whether you are swimming steadily or working hard to stay afloat, remember that self-awareness is one of the first steps toward well-being. You do not have to endure change, transition, and stress in isolation. There are resources and supports available. As my family’s current PCS comes to an end, my oscillation between swimming steadily and treading water is beginning to move to calmer water. What about you? Take a moment and notice where you are today (swimming, treading, or sinking) and what supports can help bring you back to swimming.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.

Heather Tompkins, Ph.D., MS-ATR, MA, LCMHC, is a Military Behavioral Health Psychologist with the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this role, she provides oversight and fosters collaboration for creative arts related research projects in partnership with the Defense Intrepid Network.

Roughly 1/2  

The proportion of women veterans served by VHA who are aged 45-64, "the age range most likely to experience menopause, or the permanent cessation of menstruation," according to a report from the Government Accountability Office (GAO) -- VA Menopause Care: Actions Needed to Help Ensure Quality Care and Patient Education.

Nearly half of women veterans who receive VA health care are at an age when menopause—the permanent end of menstruation—is most likely to occur. VA offers care for menopause symptoms, like hot flashes and issues with memory, mood, and sleep.

VA is developing recommendations for providing menopause care, as well as measures to assess how clinicians adhere to them. But the recommendations aren’t complete, and VA couldn't confirm that they plan to monitor clinicians' adherence to them.

Also, VA has menopause educational materials for patients. But 60% of women veterans we surveyed had never seen them.

By Sebastian Preilipper  

When we talk about sleep, we often focus on the hours we do or do not get. But the true foundation of healthy sleep lies in a complex biological system: your circadian rhythm.

Your circadian rhythm is your body's internal clock, operating on a daily 24-hour cycle. This clock is responsible for governing a wide range of complex biological processes.

Some of these processes include:

• The release of hormones
• Appetite regulation
• Fluctuations in body temperature
• Natural sleep-wake cycles

Understanding how this clock works and learning how to keep it synchronized is one of the most effective ways to optimize your sleep, which can in turn support your physical and emotional well-being.

The Biology Behind the Internal Clock
To get the most out of your sleep, it helps to understand the biology driving it. Deep inside the brain's hypothalamus sits a small control center called the suprachiasmatic nucleus (SCN) (Vetter et al., 2022).

• The Cue for Melatonin Release: The SCN regulates the production of melatonin, the key hormone that signals your body when it is time to fall asleep and stay asleep.
• The Value of Light Exposure: The SCN is directly influenced by the light you receive throughout the day. Depending on when you are exposed to light, your ideal melatonin production can shift significantly, directly impacting your overall sleep quality.

Why Your Circadian Health Matters
Maintaining a synchronized circadian rhythm supports critical biological functions that dictate
how you feel and perform every day (Baron & Reid, 2014):

• Peak Functioning: Supports optimal physical and cognitive performance.
• Recovery: Facilitates physical recovery and healing.
• Mood: Plays an essential role in emotional regulation.

Whether you are navigating a standard routine at home or facing challenging, unpredictable environments (such as a military service member in barracks or on deployment), keeping your internal clock synchronized optimizes your body’s functioning. The key is consistency. Knowing the science is only the first step; building simple, daily habits ensures your clock stays aligned with the 24-hour cycle.

Actionable Tips for Optimizing Your Sleep
Optimizing your circadian health is simpler than you might think. By focusing on two critical periods of your day, the hours before bedtime and the minutes after waking up, you can drastically improve your sleep quality (Ballesio et al., 2021).

1. Your Wind-Down Routine (Before Bedtime)
The hours leading up to your sleep are crucial for cueing melatonin production.

• Reduce Blue Light Exposure: Blue light tricks your brain into thinking it is daytime. Avoid blue-light-emitting devices (cell phones, laptops, televisions, and bright nightlights) before bed. If you must use screens, apply blue light filters in your device settings or wear blue-light-blocking eyewear.
   
• Optimize Your Sleep Environment:
  ○ Reserve your bed strictly for sleep. Avoid studying, working, or eating in bed.
  ○ Emulate a dark cave by installing blackout curtains or using an eye mask.
  ○ Block noise disruptions using earplugs or a white noise machine.
   
• Establish a Consistent Bedtime: Going to bed at the same time every night anchors your circadian rhythm, making it easier to fall asleep naturally.

2. Your Morning Routine (After Waking Up)
Great sleep hygiene actually begins the moment you open your eyes!

• Seek Out the Sun: Getting a strong dose of light first thing in the morning signals your SCN that the day has begun. Going outside for natural sunlight is ideal. If the weather doesn't permit, a specialized light lamp is an excellent alternative.
• Establish a Consistent Wake Time: Just like your bedtime, waking up at the exact same time every day is crucial to keeping your internal clock anchored.

Sleeping Under Challenging Conditions (Military & Barracks)
Managing your sleep quality is highly dependent on your environment. For example, military service members living in barracks or on deployment often face numerous sleep disruptors, including unregulated room temperatures, shift work, unpredictable light exposure, loud noises, and sudden disturbances.

If you find yourself in a challenging sleep environment, researchers (Good et al., 2020; Ballesio et al., 2021) suggest evidence-based, tactical adjustments to protect your circadian health,
including:

1. Wearing an eye mask to block out sudden or unpredictable light.
2. Using earplugs or a white noise machine to minimize the impact of excess sounds and disturbances.
3. Avoiding blue light devices entirely before bed to maximize natural melatonin production.
4. Prioritizing consistency by keeping your bedtimes and wake times as steady as possible, even amidst varying schedules.

Takeaways
Investing in your circadian health through small, consistent habit changes is a fundamental investment in your overall well-being. If you consistently apply these habits and still do not see a significant improvement in your sleep quality, consider seeking professional guidance and care. Pursuing a clinical sleep study may help determine if there are underlying medical or physiological issues affecting your sleep.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.

Sebastian Preilipper is a Research Assistant for the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences (USUHS). He received his Bachelor of Science in Psychology, Bachelor of Arts in Philosophy, and Master of Professional Studies in Clinical Psychological Science from the University of Maryland, College Park.

Citations:
Vetter, C., Pattison, P. M., Houser, K., Herf, M., Phillips, A. J. K., Wright, K. P., … Glickman,
G. (2022). A review of human physiological responses to light: Implications for the development
of integrative lighting solutions. LEUKOS, 18(3), 387–414.
https://doi.org/10.1080/15502724.2021.1872383
Ballesio, A., Lombardo, C., Lucidi, F., & Violani, C. (2021). Caring for the carers: Advice for
dealing with sleep problems of hospital staff during the COVID-19 outbreak. Journal of Sleep
Research, 30(1), e13096. https://doi.org/10.1111/jsr.13096
Baron, K. G., & Reid, K. J. (2014). Circadian misalignment and health. International Review of
Psychiatry, 26(2), 139–154. https://doi.org/10.3109/09540261.2014.911149
Good, C. H., Brager, A. J., Capaldi, V. F., & Mysliwiec, V. (2020). Sleep in the United States
military. Neuropsychopharmacology, 45(1), 176–191. https://doi.org/10.1038/s41386-019-0431-7

4.8 million   
 

The number of veterans who have used psilocybin, LSD, or MDMA in their lifetime, according to a RAND Corporation report -- U.S. Veterans and Psychedelics: Prevalence of Use and Policy Preferences.

• Nearly one in four veterans supported the legal use of psilocybin mushrooms. The rates for LSD and MDMA were 11 percent and 9 percent, respectively.
   
• Veterans’ support for the legal use of psilocybin mushrooms, LSD, and MDMA was generally similar to nonveterans’ support. However, veterans were slightly more likely to support the legal use of psilocybin mushrooms and LSD than nonveterans of a similar age, gender, race, and ethnicity.
   
• Veterans were slightly more likely to have used LSD in their lifetime than nonveterans.
   
• Less than 1 percent of veterans had used ibogaine or iboga in their lifetime. About 5 percent of veterans who had never used ibogaine or iboga were willing to try it.
   
• Nearly half of veterans were unsure whether a veteran would risk losing VA benefits if they spoke to their VA doctors about the use of psilocybin mushrooms (48 percent) or MDMA (46 percent).
   
• About half of veterans supported VA providing or paying for psilocybin-assisted therapy (54 percent) or MDMA-assisted therapy (45 percent) if approved by the U.S. Food and Drug Administration.

By Allison Hannah, MSW, LCSW    

For more than 20 years, my life has been defined by change.
 

As a service member, I transitioned from the Reserves to active duty and back again. I went
from serving as an enlisted soldier to commissioning as an officer. I readjusted to life in the
United States after both a 12-month combat deployment and later a two-year assignment in
South Korea, not to mention the endless moves for new assignments and training. Eventually, I
hung up my uniform and transitioned into veteran status.

But my experience with military transitions did not end when my own service did.

I went from being the service member to supporting one. Our family moved from duty station to
duty station as we PCS’d around the country. I moved from job to job, repeatedly searching for
meaningful employment wherever the military sent us. Along the way, I helped our children
adjust to new homes, schools, communities, friendships, and routines.

Sometimes, it feels like the only constant throughout the past two decades has been knowing that
another change was coming in one form or another.
 

At the end of 2025, my husband retired from the military, and our family made what we believed
would be our final transition. We moved into our forever home, settled into a community, and
enrolled our children in what we hoped would be their last new school district.

There was a great deal of excitement at first. We had anticipated this chapter for years. We
imagined the relief of no longer planning our lives around orders, report dates, school transfers,
and temporary homes.
 

But after years of becoming skilled at leaving, we’ve suddenly had to learn how to stay.
The quiet that was supposed to feel like relief suddenly felt unnerving. Without another
assignment on the horizon, quiet questions started to creep in:

• Will we be content here?
• What does it mean to build a life when no one else is determining where we go next?
• How do we create a sense of permanence after years of knowing that every home, job,
  school, and community might be temporary?

This experience has also reminded me that the “final” move is not one transition shared equally
by the entire family. The retiring service member, spouse, and children may each experience it
differently. One person may feel relieved while another feels restless. One may be ready to put
down roots while another is grieving the loss of military life, familiar resources, friendships, or a
community that understood their experience.

There is still a great deal for us to discover in the years ahead. For now, though, I want to share
five reminders that have helped me through the first part of learning how to stay.

1. Give yourself a full year before deciding how settled you feel.
You do not have to feel completely settled after the moving truck leaves or even after the first
few months.
 

Retirement, separation, and relocation involve much more than changing an address. You may
also be adjusting your routines, relationships, finances, identity, expectations, and sense of
purpose. Even familiar tasks may feel different when they are no longer connected to an
installation, unit, or military community.
 

Give yourself permission to live through all four seasons before deciding if this place is right for
you.
 

A year allows time for the initial excitement to fade, new routines to develop, relationships to
grow, and the reality of the transition to become clearer. It also gives everyone in the family time
to adjust at their own pace.
 

2. You do not have to unpack your new life all at once.
This applies to both the boxes in your home and the emotions you carried with you.
There is no prize for having every room decorated within the first week. Take your time deciding
how you want your new home (and your new life) to feel.

After years of setting up temporary spaces, it may take time to believe that you are finally
allowed to settle in. You may also find that making a house feel permanent brings up more
emotions than expected. Some boxes may contain reminders of past duty stations, friendships,
deployments, accomplishments, losses, and earlier versions of your family.
 

There is no rush. Unpack what you are ready for, both physically and emotionally.
 

3. Do not let the word “forever” become a source of pressure.
 Military families often place enormous pressure on the final move.

This is supposed to be the forever home, the forever community, the last school district, and the
place where everything finally falls into place. After years of uncertainty, it is understandable to
want the next decision to feel permanent.

But “forever” can also feel intimidating.
 

Choosing a destination today doesn't trap you into a cage tomorrow. You can give your new
home and community an honest chance without treating every decision as irreversible.

Being open to future change does not mean you are failing to settle down. It simply means you
are allowing yourself the same flexibility that helped you navigate every transition that came
before this one.
 

4. Expect everyone to experience the transition differently.
Even if your family has moved many times before, this move may bring up entirely new
emotions.

The retiring service member may be adjusting to the loss of rank, structure, responsibility,
identity, and a built-in professional community. The spouse may feel excited about new
possibilities while also recognizing how much of their own life has been shaped by the military.

Children may welcome the stability of remaining in one school while grieving friendships,
traditions, and the sense of belonging that came with being part of a military community.
 

One person may feel relieved while another feels restless. Someone may feel excited one day and
deeply uncertain the next.

There is no single correct way to feel about a major transition.

Make room for everyone’s experience, including your own. Talk openly, check in with one
another, and resist the urge to assume that the family member who appears to be adjusting well is
not carrying something beneath the surface.

5. Build a new support system before you urgently need one.
Military families are often surrounded by built-in networks, even when we do not fully recognize
them at the time. There may be installation resources, military treatment facilities, family
readiness programs, unit contacts, spouse groups, schools familiar with military children, and
neighbors who understand the realities of military life.

After retirement or separation, those supports may no longer be nearby.
 

That can make it especially important to intentionally build a new network. Reach out to friends,
family members, Veterans, military spouses, neighbors, community organizations, and others
who have already navigated the process.

Sometimes their support will come through a meaningful conversation. Other times, it may be
something practical, such as reminding you to enroll in new health coverage, transfer medical
records, update important documents, or locate services in your community.

Professional mental health support may also be an important part of that network.
 

Major transitions can bring up grief, anxiety, relationship stress, changes in identity, loneliness,
or emotions that were difficult to anticipate. Seeking counseling does not mean you are handling
the transition poorly. It may simply mean that you recognize the significance of what you and
your family are experiencing.

Finding professional support can feel more difficult when you are no longer surrounded by
military resources or living near a local installation. However, military-culturally aware care may
still be available in your community.

Wherever you have landed, you can visit the Star Behavioral Health Providers Directory at
starproviders.org to search for a mental health professional who is trained in military culture and
the experiences of service members, veterans, and military families.

You do not have to wait until the transition becomes overwhelming before reaching out.

Learning to Stay
Perhaps the greatest lesson I have learned is that settling down is still a transition.

It deserves the same patience, flexibility, support, and grace as every deployment, homecoming,
PCS, career change, school transfer, and military milestone that came before it.
 

For years, we mastered the art of leaving well. We learned to pack up a life in boxes, adapt on the
fly, rebuild routines, and bloom wherever we were planted.
 

This next chapter may be about learning something entirely different.
 

It may be about learning how to stay.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of War.

Allison Hannah, MSW, LCSW, is a Military Behavioral Health Social Worker for the Consortium for Defense Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. She assists in the implementation and expansion of Star Behavioral Health Providers (SBHP). SBHP trains civilian behavioral health providers to work with service members, veterans, and their families. The mission is to expand the availability of high-quality behavioral health services, especially for those in the reserve components.

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The proportion of "US adolescents and young adults aged 12 to 21" who "used artificial intelligence (AI) chatbots for mental health advice," according to a study published in JAMA Pediatrics -- AI Chatbot Use and Disclosure for Mental Health Among US Adolescents and Young Adults.

This national survey including more than 42 million US youth (population-weighted) found that almost a fifth of adolescents and young adults reported using AI chatbots for mental health advice, representing an increase by almost half from 1 year prior. Most users told no one that they used AI chatbots for this purpose.