DOD INSTRUCTION 6490.08
C
OMMAND NOTIFICATION REQUIREMENTS TO DISPEL STIGMAS
IN
PROVIDING MENTAL HEALTH CARE TO SERVICE MEMBERS
Originating Component: Office of the Under Secretary of Defense for Personnel and Readiness
Effective: September 6, 2023
Releasability: Cleared for public release. Available on the Directives Division Website
at https://www.esd.whs.mil/DD/.
Reissues and Cancels: DoD Instruction 6490.08, “Command Notification Requirements to Dispel
Stigma in Providing Mental Health Care to Service Members,” August 17,
2011
Approved by: Gilbert R. Cisneros, Jr, Under Secretary of Defense for Personnel and
Readiness
Purpose: In accordance with the authority in DoD Directive 5124.02 and pursuant to Section 704 of
Public Law 117-263, this issuance:
• Establishes policy, assigns responsibilities, and prescribes procedures for health care providers for
determining command notification requirements as applied to:
o Service members’ involvement in mental health care, overriding command disclosure provisions
usually followed for non-mental health care pursuant to DoD Manual 6025.18 and Parts 160 and 164 of
Title 45, Code of Federal Regulations.
o Service members who voluntarily seek substance misuse education services, evaluation, or
treatment in accordance with DoD Instruction (DoDI) 1010.04.
• Promotes reducing stigma in obtaining mental health care services by balancing patient
confidentiality with a commander’s need to know certain information for military operational and risk
management decisions, ensuring, except in a case in which there is an exigent circumstance, the
confidentiality of mental health care services provided to members who voluntarily seek such services.
DoDI 6490.08, September 6, 2023
TABLE OF CONTENTS 2
TABLE OF CONTENTS
SECTION 1: GENERAL ISSUANCE INFORMATION .............................................................................. 3
1.1. Applicability. .................................................................................................................... 3
1.2. Policy. ............................................................................................................................... 3
SECTION 2: RESPONSIBILITIES ......................................................................................................... 4
2.1. Assistant Secretary of Defense for Health Affairs (ASD(HA)). ....................................... 4
2.2. Director, Defense Health Agency (DHA). ........................................................................ 4
2.3. DoD Component Heads. ................................................................................................... 4
2.4. Secretaries of the Military Departments. .......................................................................... 4
SECTION 3: EXIGENT CIRCUMSTANCES AUTHORIZING COMMAND NOTIFICATION .......................... 6
3.1. Health Care Providers. ...................................................................................................... 6
3.2. Commander Designation. ................................................................................................. 8
3.3. Commanders. .................................................................................................................... 8
3.4. Reports and Assessments. ................................................................................................. 9
GLOSSARY ..................................................................................................................................... 12
G.1. Acronyms. ...................................................................................................................... 12
G.2. Definitions. ..................................................................................................................... 12
REFERENCES .................................................................................................................................. 13
FIGURES
Figure 1. Reporting Template. ..................................................................................................... 10
DoDI 6490.08, September 6, 2023
SECTION 1: GENERAL ISSUANCE INFORMATION 3
SECTION 1: GENERAL ISSUANCE INFORMATION
1.1. APPLICABILITY.
This issuance applies to:
a. OSD, the Military Departments, the Office of the Chairman of the Joint Chiefs of Staff
and the Joint Staff, the Combatant Commands, the Office of Inspector General of the Department
of Defense, the Defense Agencies, the DoD Field Activities, and all other organizational entities
within the DoD (referred to collectively in this issuance as the “DoD Components”).
b. Health care provider disclosures to command authorities in accordance with DoD
Manual 6025.18, providing greater confidentiality as a means to encourage voluntary help-
seeking behavior and dispel stigma in seeking mental health care.
1.2. POLICY.
a. DoD fosters a culture of support and strives to create an environment that promotes help-
seeking behaviors and reduces the stigma for help-seeking in the provision of mental health care
and voluntarily sought substance misuse education to Service members, in order to dispel the
stigma of seeking mental health care or substance misuse education services. Unrestricted, non-
stigmatizing access to mental health care services, which includes voluntarily sought substance
misuse education, is essential to maintaining the health and readiness of the total force.
b. A Service member’s use of military health system mental health care resources, to include
substance misuse education services, will not be reported to their commander except under the
exigent circumstances defined in this instruction.
(1) The use of military health system resources includes substance misuse education
services and results of any drug testing incident to such mental health care services.
(2) Unless the presumption of confidentiality is overcome by one of the notification
standards listed in Section 3, there will be no command notification.
(3) In making a disclosure pursuant to the notification standards, health care providers
will provide the minimum amount of information to the commander concerned as required to
address the exigent circumstance that overcomes the presumption of confidentiality.
DoDI 6490.08, September 6, 2023
SECTION 2: RESPONSIBILITIES 4
SECTION 2: RESPONSIBILITIES
2.1. ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS (ASD(HA)).
Under the authority, direction, and control of the Under Secretary of Defense for Personnel and
Readiness, the ASD(HA):
a. Develops policy for health care providers for determining command notification
requirements as outlined in Section 3.
b. Oversees compliance with this issuance through the review of reporting requirements that
assess the effectiveness of this issuance.
2.2. DIRECTOR, DEFENSE HEALTH AGENCY (DHA).
Under the authority, direction, and control of the Under Secretary of Defense for Personnel and
Readiness, through the ASD(HA), and in addition to the responsibilities in Paragraph 2.3., the
Director, DHA:
a. Publishes guidance necessary to implement this issuance that is:
(1) Applicable to DoD health care providers.
(2) Comparable to those in Section 3 for applicability to non-DoD health care providers
in the context of mental health services provided to Service members under the private sector
care component of the TRICARE Program, to promote compliance with communication
standards regarding mental health and substance misuse education.
b. Reviews compliance and effectiveness of command notification for DoD and non-DoD
health care providers when a Service member meets one of the exigent circumstances provided
in Paragraph 3.1.b.
c. Evaluates the effectiveness and compliance with this issuance, and recommends
improvements to the Office of the ASD(HA), as requested, or at least every 2 years.
2.3. DOD COMPONENT HEADS.
The DoD Component heads will publish guidance necessary to implement this issuance.
2.4. SECRETARIES OF THE MILITARY DEPARTMENTS.
In addition to the responsibilities in Paragraph 2.3., the Secretaries of the Military Departments:
a. Provide procedures to:
DoDI 6490.08, September 6, 2023
SECTION 2: RESPONSIBILITIES 5
(1) Carry out requirements as provided in Section 3.
(2) Review compliance and effectiveness of command notification when a Service
member meets one of the exigent circumstances provided in Paragraph 3.1.b.
b. Monitor guidance provided by the DHA applicable to non-DoD health care providers in
the context of mental health services provided to Service members under the private sector care
component of the TRICARE Program.
c. Evaluate the effectiveness and compliance with this issuance, and recommend
improvements to the Office of the ASD(HA), as requested, or at least every 2 years.
DoDI 6490.08, September 6, 2023
SECTION 3: EXIGENT CIRCUMSTANCES AUTHORIZING COMMAND NOTIFICATION 6
SECTION 3: EXIGENT CIRCUMSTANCES AUTHORIZING COMMAND
NOTIFICATION
3.1. HEALTH CARE PROVIDERS.
a. Command notification by health care providers is prohibited for protected health
information when a Service member voluntarily requests mental health care or substance misuse
education, unless the Service member authorizes the notification or the disclosure is authorized
for one of the exigent circumstances listed in Paragraphs 3.1.b.(1) through 3.1.b.(9).
b. Health care providers will notify the commander concerned in any of these exigent
circumstances:
(1) Harm to Self.
(a) The provider believes there is a serious risk of self-harm by the Service member.
Considerations for risk to harm self that require notification include, but are not limited to:
1. Modifying the Service member’s daily activities to lower the risk of harm;
2. Soliciting changes in activities from the patient in order to ensure safety; or
3. Perceiving a concern about the Service member having access to lethal means.
(b) As a general rule for providers, if it is believed that the Service member is at an
elevated risk of harm sufficient to require a member specific safety plan, then it is wise to
assume that the situation has risen to a level where the command needs to know as well. If the
provider is uncertain whether or not command notification is warranted, then consultation with
another health care provider is highly recommended. Ultimately, ensuring the Service member’s
safety and well-being should be the overriding priority.
(2) Harm to Others.
(a) The provider believes there is a serious risk of harm to others. This includes any
disclosures concerning child abuse or domestic violence consistent with DoDI 6400.06.
Considerations for risk to harm others that require notification include, but are not limited to:
1. Modifying the Service member’s daily activities to lower the risk of harm;
2. Soliciting changes in activities from the patient in order to ensure safety; or
3. Perceiving a concern about the Service member having access to lethal means.
(b) As a general rule for providers, if it is believed that the Service member is at an
elevated risk of harm sufficient to require a member specific safety plan or notification to a
named target of a threat, then it is wise to assume that the situation has risen to a level where the
command needs to know as well.
DoDI 6490.08, September 6, 2023
SECTION 3: EXIGENT CIRCUMSTANCES AUTHORIZING COMMAND NOTIFICATION 7
(3) Harm to Mission.
(a) The provider believes there is a serious risk of harm to a specific military
operational mission. Serious risk may include disorders that significantly impact impulse
control, insight, reliability, and judgment.
(b) The provider must distinguish that a symptom is impacting the Service member’s
specific occupational specialty affecting their ability to perform the full range of duties, resulting
in potential harm to the mission; thus, the provider must be familiar with the patient’s military
duties.
(c) Any provider who treats Service members will make every effort to understand
the military duties of those patients and the mission of their respective units.
(4) Special Personnel.
The Service member is in the Nuclear Weapons Personnel Reliability Program as
described in DoDI 5210.42, is in a position that has been pre-identified by Service regulation, or
the command as having mission responsibilities of such potential sensitivity or urgency that
normal notification standards would significantly risk mission accomplishment.
(5) Inpatient Care.
The Service member is admitted or discharged from any in-patient mental health or
substance use disorder treatment facility, as these are considered critical points in treatment and
support nationally recognized patient safety standards.
(6) Acute Medical Conditions Interfering with Duty.
The Service member is experiencing an acute mental health condition, a substance
misuse induced condition, or is engaged in an acute medical treatment regimen that impairs the
Service member’s ability to perform assigned duties.
(7) Problematic Substance Use Treatment Program.
(a) The provider has determined the Service member requires treatment for a
substance misuse disorder. Any Service member being treated for drug abuse, any Service
member who is a danger to self, others, security, or mission, or any Service member in a higher-
level (American Society of Addiction Medicine Level 2 or higher) treatment program for the
treatment of a substance use disorder, should be formally enrolled in mandatory care.
(b) Service members that do not meet the criteria for mandatory enrolled substance
misuse treatment may voluntarily receive behavioral health care. The provider will inform the
Service member of the criteria for command notification and the recommendation for substance
misuse treatment during the initial evaluation.
DoDI 6490.08, September 6, 2023
SECTION 3: EXIGENT CIRCUMSTANCES AUTHORIZING COMMAND NOTIFICATION 8
(8) Command-Directed Mental Health Evaluation.
The mental health services are obtained as a result of a command-directed mental health
evaluation consistent with DoDI 6490.04.
(9) Other Special Circumstances.
The notification is based on other special circumstances in which proper execution of the
military mission outweighs the interests served by avoiding notification, as determined on a case-
by-case basis by a health care provider (or other authorized official of the medical treatment
facility involved) at the O-6 or GS-15 civilian equivalent level or above, or a military medical
treatment facility commanding officer at the O-6 level or above.
c. In making a disclosure pursuant to the circumstances described in Paragraphs 3.1.b.(1)
through 3.1.b.(9), health care providers will provide the minimum amount of information
necessary to satisfy the purpose of the disclosure. In general, this will consist of:
(1) The diagnosis; a description of the treatment prescribed or planned; impact on duty
or mission; recommended duty restrictions; the prognosis; any applicable duty limitations; and
implications for the safety of self or others.
(2) Ways the disclosing health care provider determines that command can support or
assist the Service member’s treatment.
3.2. COMMANDER DESIGNATION.
Commander notification pursuant to this instruction will be directly to the Service member’s
commander, or other person(s) specifically designated in writing by the commander for this
purpose.
3.3. COMMANDERS.
a. The commander should aim to interact and cooperate with the provider in a manner that
does not breach confidentiality as described in this instruction. This interaction should occur
with the intent of building partnerships, enabling, and encouraging Service members to feel
comfortable in obtaining care via self or medical referrals while furthering the successful
accomplishment of the military mission.
b. When requested by Service members or providers, commanders are strongly encouraged
to share with treating providers any information that they believe may be pertinent to the health
and welfare of their Service members or mission accomplishment. In a case of command-
directed mental health evaluations or self-initiated voluntary command referred mental health
evaluation, commanders can request acknowledgement of care from providers for the purposes
of conveying information, even if circumstances would not otherwise require this
acknowledgement. Commanders will not receive additional information unless disclosure is
authorized for one of the reasons listed in Paragraph 3.1.b.
DoDI 6490.08, September 6, 2023
SECTION 3: EXIGENT CIRCUMSTANCES AUTHORIZING COMMAND NOTIFICATION 9
3.4. REPORTS AND ASSESSMENTS.
a. Military Departments and the DHA will evaluate the effectiveness of, and compliance
with this instruction, and recommend improvements to the Office of the ASD(HA) as requested,
or at least every 2 years. The metrics established for providing these assessments and
recommendations are outlined in Figure 1, and will be sent through the Office of the Deputy
Assistant Secretary of Defense for Health Readiness Policy and Oversight to the ASD(HA).
b. The Office of the Deputy Assistant Secretary of Defense for Health Service Policy and
Oversight will review submitted reports and metrics to evaluate the effectiveness of, and
compliance with this instruction and provide recommendations for updating reporting
requirements, as necessary.
c. Reports must follow the format shown in Figure 1.
DoDI 6490.08, September 6, 2023
SECTION 3: EXIGENT CIRCUMSTANCES AUTHORIZING COMMAND NOTIFICATION 10
Figure 1. Reporting Template.
[Component letterhead]
[month, day, year]
MEMORANDUM FOR ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS
SUBJECT: Report on Command Notification to Dispel Stigmas in Providing Mental Health Care to
Service Members
1. DoD Component. [Army, Navy, Air Force, DHA].
2. Reporting Period. Calendar year(s) XXXX - XXXX (January 1 through December 31).
3. Policies and Guidelines. [Narrative summaries describing current practices and procedures, additional
attachments enclosed as needed]
a. Policy and guidance references:
(1) DoD health care providers.
(2) Non-DoD health care providers.
(3) Commanders.
b. Description of practices and procedures:
(1) DoD health care providers.
(2) Non-DoD health care providers.
(3) Commanders.
4. Data Reporting. Assessment of a select sample size, which provides a 95 percent confidence level for the
evaluation of provider documentation of command notification.
a. Provider documentation, indicating “when” notification was provided, and the criteria that resulted in the
notification:
(1) Percent of records reviewed that documented date of notification.
(2) Percent of records reviewed that documented the criteria described under Paragraph 3.1.b. of DoD
Instruction 6490.08, that resulted in notification to the commander.
(3) Percent of records reviewed that documented both the date of notification and the criteria that resulted
in notification.
DoDI 6490.08, September 6, 2023
SECTION 3: EXIGENT CIRCUMSTANCES AUTHORIZING COMMAND NOTIFICATION 11
Figure 1. Reporting Template, Continued
5. Lessons Learned [As appropriate, narrative summaries describing benefits, challenges, and recommendation for
consideration associated with current policy]
a. Lessons Learned:
b. Emerging Data:
c. Metrics Recommendations for Consideration:
d. Policy Recommendations for Consideration:
[Signature Block]
Attachment(s)
As stated
2
DoDI 6490.08, September 6, 2023
GLOSSARY 12
GLOSSARY
G.1. ACRONYMS.
A
CRONYM
M
EANING
ASD(HA)
Assistant Secretary of Defense for Health Affairs
DHA
Defense Health Agency
DoDI
DoD instruction
G.2. DEFINITIONS.
These terms and their definitions are for the purpose of this issuance.
T
ERM
D
EFINITION
exigent
circumstances
As defined in Section 704 of Public Law 117-263, a circumstance in
which, under the criteria set forth in Paragraph 3.1.b. the need to
prevent serious harm to an individual or essential military function
clearly outweighs the need for confidentiality of information obtained
by a health care provider incident to mental health care services
voluntarily sought by a member of the Military Services.
DoDI 6490.08, September 6, 2023
REFERENCES 13
REFERENCES
Code of Federal Regulations, Title 45
DoD Directive 5124.02, “Under Secretary of Defense for Personnel and Readiness
(USD(P&R)),” June 23, 2008
DoD Instruction 1010.04, “Problematic Substance Use by DoD Personnel,” February 20, 2014,
as amended
DoD Instruction 5210.42, “DoD Nuclear Weapons Personnel Reliability Assurance,” April 27,
2016, as amended
DoD Instruction 6400.06, “DoD Coordinated Community Response to Domestic Abuse
Involving DoD Military and Certain Affiliated Personnel,” December 15, 2021, as amended
DoD Instruction 6490.04, “Mental Health Evaluations of Members of the Military Services,”
March 4, 2013, as amended
DoD Manual 6025.18, “Implementation of the Health Insurance Portability and Accountability
Act (HIPAA) Privacy Rule in DoD Health Care Programs,” March 13, 2019
Public Law 117-263, Section 704, “James M. Inhofe National Defense Authorization Act for
Fiscal Year 2023,” December 23, 2022
