Suicide Prevention in the US Military: Assessing the Impact of the Brandon Act

OBJECTIVE: To evaluate whether the Brandon Act, a 2021 legislation establishing confidential, self-initiated mental health referral pathways for US military service members, was associated with reductions in medically attended suicide attempts among active duty service members (ADSMs). STUDY SETTING AND DESIGN: We employed an interrupted time series design using person-quarter panel data from the Military Health System (MHS) from 2018 to 2024. Segmented regression and event study specifications estimated immediate and trajectory effects of the Brandon Act on suicide attempt rates. DATA SOURCES AND ANALYTIC SAMPLE: Data were drawn from the MHS Data Repository, comprising 39.1 million person-quarters from 2.5 million ADSMs aged 18-64. Suicide attempts were identified from inpatient, outpatient, and emergency department claims. PRINCIPAL FINDINGS: Prior to the Brandon Act, suicide attempt rates increased by 4.29 per 100,000 per quarter (95% CI: 3.56, 5.02). Enactment in December 2021 was associated with an immediate reduction of 6.51 per 100,000 (95% CI: -10.54, -2.47) and a downward trajectory shift of 2.25 per 100,000 per quarter (95% CI: -3.81, -0.70). Official implementation in May 2023 was associated with a further immediate reduction of 21.19 per 100,000 (95% CI: -26.83, -15.55) relative to the projected trend, with a compounding decline of 1.50 per 100,000 per quarter (95% CI: -2.34, -0.66). The policy was associated with approximately 3800 prevented suicide attempts over 3 years. Effects were largest among junior enlisted, female service members, and Army and Marine Corps personnel. CONCLUSIONS: The Brandon Act is associated with a sustained, compounding decline in medically attended suicide attempts among ADSMs. Immediate reductions upon enactment suggest a signaling effect, while intensifying effects following implementation underscore the role of confidential pathways in addressing structural barriers to care-seeking. These findings highlight the importance of non-financial policy levers in military mental health and offer a replicable model for other health systems where stigma limits care utilization.