Australian Military Abandons Stratified Suicide Risk for Collaborative Safety Planning

Rethinking Suicide Risk Assessment in Military Populations

Suicide remains a leading cause of death among active-duty military personnel, driven by unique occupational stressors such as frequent relocations, extended family separations, and operational demands [1]. While specialized mental health services are available, identifying individuals at imminent risk remains a clinical challenge, as traditional risk assessment tools often yield high rates of false positives that limit their practical utility [2]. Current preventive efforts frequently focus on individual-level psychotherapy or crisis response planning in emergency and primary care settings [3, 4, 5]. However, there is a growing recognition that effective suicide prevention requires broader, community-based interventions rather than relying solely on isolated psychiatric facilities [6]. A recent large-scale initiative now offers insight into how dismantling traditional risk stratification in favor of collaborative safety planning can transform suicide prevention across an entire military organization.

Moving Away from Stratified Risk Categories

Military suicide remains an urgent global concern, driven by a complex array of occupational stressors. Service members routinely face frequent relocations, postings to remote and regional locations lacking external healthcare facilities, reduced social connections, extended family separations, and intense operational demands that heighten psychological strain. To address these compounding vulnerabilities, the Australian Department of Defence partnered with SafeSide Prevention in 2021 to enhance its Suicide Prevention Program. The resulting Defence SafeSide Project aimed to embed a contemporary clinical framework and develop a system-wide approach to modernize policy, practice, and workforce education across the entire military organization. A central component of this modernization effort was a fundamental shift in how clinicians and military leaders assess and manage acute distress. The project implemented the CARE Model, which replaces traditional stratified risk categorization (the practice of assigning patients to rigid low, medium, or high risk tiers) with collaborative risk formulation. This alternative technique is a patient-centered approach where providers and service members jointly identify specific distress drivers to build a personalized safety plan. To support this transition, health and military personnel policies were revised to officially remove low, medium, and high suicide risk classifications. Instead of assigning a static risk tier, the CARE Model tailors support to each member's specific circumstances. This clinical shift requires providers to work directly with the service member to understand their unique vulnerabilities, moving away from standardized risk buckets that often fail to predict acute crises.

The CARE Model and System-Wide Training Rollout

To operationalize the shift away from stratified risk categories, the partnership implemented the SafeSide Framework for Suicide Prevention. For military application, the researchers adapted this framework into the CARE Model, which stands for Connect, Assess, Respond, Extend. This structured approach guides clinicians and military personnel through engaging with the service member, evaluating their specific distress drivers, intervening appropriately, and ensuring ongoing support. To ensure the framework was adopted effectively across different levels of the organization, the project developed role-specific customized trainings tailored to the distinct responsibilities of medical providers, command leadership, and general service members. The comprehensive educational initiative required a massive logistical effort across the military. The training rollout commenced in August 2024. Over the subsequent year, between August 2024 and August 2025, the organization recorded approximately 72,050 completions of the Defence Suicide Awareness annual training, establishing a baseline understanding of the prevention-oriented approach across the force. Leadership engagement was also substantial, with approximately 19,250 completions of the CARE-Leaders and Managers course. For personnel requiring more specialized clinical and support skills, the initiative tracked approximately 1,010 completions of the CARE-Risk Formulation course and approximately 1,600 completions of the CARE-Support course. These metrics reflect a system-wide integration of the CARE Model, embedding suicide prevention responsibilities beyond isolated mental health clinics and into the broader military community. For practicing physicians, this widespread training means that patients in distress are more likely to be identified and supported by their peers and commanders before they ever reach a clinic.

Cultural Transformation and Clinical Takeaways

A critical component of the initiative was ensuring that clinical protocols reflected the realities of military service. To achieve this, lived experience perspectives were integrated throughout the implementation of the project. The researchers identified several key lessons learned from the rollout, specifically highlighting the importance of collaborative governance structures and the integration of lived experience voices to guide systemic changes. Another key lesson is the importance of addressing challenges when shifting from risk stratification to member-centered safety planning. For clinicians, this highlights the practical friction that occurs when moving away from familiar, rigid risk categories toward dynamic, individualized safety plans. This transition requires ongoing support and education for providers adjusting to the updated framework. While the implementation of the Defence SafeSide Project is ongoing, the early data provide a roadmap for large-scale clinical interventions. The project demonstrates that synchronized changes in policy, systems, and training can propel cultural transformation in military suicide prevention. By aligning clinical practice with organizational policy, the initiative avoids the common pitfall of isolated training programs that fail to alter daily workflows. Ultimately, preliminary outcomes suggest successful adoption of a prevention-oriented approach that extends suicide prevention beyond mental health settings to become a whole-of-Defence responsibility. For practicing physicians, this underscores the value of distributing suicide prevention efforts across the broader community, ensuring that primary care providers, unit leaders, and peers all play an active, coordinated role in identifying and supporting individuals in distress.

References

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3. Walter KH, Khandekar PR, Kline AC, et al. Comparison of crisis response planning and treatment as usual for active duty service members at risk for suicide: Study protocol for a stepped-wedge cluster randomized trial in a military treatment facility.. Contemporary clinical trials communications. 2024. doi:10.1016/j.conctc.2024.101407

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5. Bryan CJ, Khazem LR, Baker JC, et al. Brief Cognitive Behavioral Therapy for Suicidal Military Personnel and Veterans: The Military Suicide Prevention Intervention Research (MSPIRE) Randomized Clinical Trial.. JAMA psychiatry. 2025. doi:10.1001/jamapsychiatry.2025.2850

6. Rostami M, Rahmati-Najarkolaei F, Salesi M, Azad E. A Systematic Review of Suicide Prevention Interventions in Military Personnel.. Archives of suicide research : official journal of the International Academy for Suicide Research. 2022. doi:10.1080/13811118.2020.1848669