“The Department of Defense Suicide Event Report (DoDSER) is the system of record for health surveillance related to suicide ideations, attempts, and deaths. This assessment focused on decreasing the number of “don’t know” responses on suicide death submissions by identifying changes to policy, training, or oversight. We also examined the sharing of DoD medical information with the Department of Veterans Affairs (VA).  Inspector General Report, November 14, 2014.

We recommend the Department of Defense improve the processes for collecting DoDSER information and submitting DoDSER data:
• Submit final DoDSER data after the Armed Forces Medical Examiner has completed the death investigation.
• Establish a multidisciplinary team approach to data collection to ensure accuracy.
• Improve subject matter expert participation in DoDSER data collection process.
• Empower local commanders to use DoDSER data to produce reports specific to their units/locations.
• Authorize the VA’s Military Crisis Line staff to access relevant healthcare information.
• Provide appropriate DoDSER data to the VA to use in their public health surveillance.
• Update Service policies to specifically encourage participation of Military Criminal Investigative Organizations in the DoDSER submission process.”