Army Report: Civilian Psychologists Needed on OEF/OIF Battlefronts, Suicides Up, Stigma of Seeking Help Down
U.S. troops on the battlefield found it harder to get the mental health care they needed last year, when violence rose in Afghanistan and new tactics pushed soldiers in Iraq farther from their operating bases. A report the Army released Thursday recommends sending civilian psychiatrists to the warfront, supplementing members of the uniformed mental health corps.
Surveying a force strained by its seventh year of war, officials found that more than one in four soldiers on repeat tours of duty screened positive for anxiety, depression and other mental health problems. That was comparable to the previous year.
The report found more troops reported marital problems, an increased suicide rate, higher morale in Iraq, but a greater percentage of depression among soldiers in Afghanistan. "They do show the effects of a long war," said Col. Elspeth Ritchie, psychiatry consultant to Army Surgeon General Lt. Gen. Eric Schoomaker.
Added Maj. Gen. Gale S. Pollock, a deputy surgeon general: "I think the fact that they are doing as well as they are with the demands they are under speaks to a strength and resiliency of the men and women of America."
The report was drawn from the work of a team of mental health experts who traveled to the wars last fall. The experts surveyed more than 2,200 soldiers in Iraq and nearly 900 in Afghanistan.
In educational interest, article(s) quoted from extensively.
The recommendation of civilian mental health professionals for battlefield duty is unusual. But civilian contract employees are doing many other jobs in Iraq, from security to providing food service. The report also recommended longer home time between deployments, more focused suicide-prevention training and insurance coverage for marital and family counseling.
Among other findings were:
_More than 27 percent of troops on their third or fourth combat tour suffered anxiety, depression, post-combat stress and other problems. That compared with 12 percent among those on their first tour.
_Suicide rates "remained elevated" in both Iraq and Afghanistan. There were four in Afghanistan and 34 confirmed or suspected in Iraq. If all are confirmed, it would be the highest rate since the war began.
_The percentage of soldiers reporting depression in Afghanistan was higher than that in Iraq, and mental health problems in general were higher than they had previously been in Afghanistan. The adjusted rate last year for depression in Afghanistan was 11.4 percent, compared with 7.6 percent in Iraq.
Though U.S. troops suffered their highest level of casualties in both campaigns last year, that came as violence was decreasing in the five-year-old Iraq conflict and increasing in Afghanistan, now in its seventh year.
_As fighting against Taliban and al-Qaida fighters in Afghanistan worsened, 83 percent of soldiers there reported exposure to traumatic combat events — a key factor in the risk for mental health among the troops.
_Having troops spread out and more isolated over the rugged terrain in a less developed Afghanistan occasionally made it more difficult for them to get mental health treatment.
_About 29 percent of soldiers in Iraq said it was difficult to get to mental health specialists for help. That was among troops who had moved from bases to combat outposts set up so they could be closer to the Iraq population. The number among troops not at the outposts who had trouble getting help was only 13 percent.
_Soldiers who had special "Battlemind" training reported fewer problems than those who did not. The program teaches troops and families what to expect before soldiers leave for the wars and what common problems to look for when readjusting to home life after deployment.
_Progress was made toward reducing the fear and embarrassment that keeps soldiers from asking for help with mental health problems. In 2007, 29 percent of those surveyed in Iraq said they feared seeking treatment would hurt their careers, down from 34 percent the previous year.
_Eleven percent of those surveyed in Iraq said their unit's morale was high or very high, compared with 7 percent the previous year. Individual morale was reported high or very high among 20.6 percent, compared with 18.3 percent the previous year.
_In Iraq, some 72 percent of soldiers reporting knowing someone seriously injured or killed.
_Soldiers reported an average of 5.6 hours of sleep per day in Iraq — significantly less than needed to maintain their best performance — yet officers appeared to underestimate how it could have that effect.
_Nearly one-third of troops in Afghanistan were highly concerned that they were not getting enough sleep and about a quarter reported falling asleep during convoys last year. Sixteen percent reported taking mental health medications and about half of those were sleep medications.
U.S. Army Medical Command press release:
A team of Army behavioral-health professionals found the overall risk of mental-health problems among soldiers deployed to Iraq unchanged in 2007 compared to 2006. Soldiers serving their third or fourth deployment, however, were more likely to report such problems than those on their first or second deployments. Soldiers in Afghanistan, in contrast, reported significantly higher rates of mental-health problems in 2007 than in 2005, reaching rates similar to those in Iraq.
The Army Surgeon General has dispatched five Mental Health Advisory Teams (MHAT) to southwest Asia since 2003. In October and November last year, the latest team (MHAT V) surveyed 2,279 soldiers and 350 behavioral health, primary care and unit ministry team members in Iraq. In Afghanistan, they surveyed 889 soldiers and 87 care providers. They also conducted focus groups and examined records.
The teams were led by research psychologists from Walter Reed Army Institute of Research (WRAIR) and included officers and enlisted behavioral-health specialists. Heading the project was Lt. Col. Paul D. Bliese, chief of military psychiatry at WRAIR.
Major findings include:
* The percentage of soldiers screening positive for mental-health problems is similar to previous years, and similar in Iraq and Afghanistan. Unit morale was higher in Iraq in 2007 than in 2006.
* Combat exposure is down in Iraq, but up in Afghanistan, so that it is now similar in both theaters.
* Soldiers on their third or fourth deployment have significantly lower morale, more mental-health problems and more stress-related work problems.
* Suicide rates remain elevated in both theaters and are above normal Army rates.
* Soldiers who received Battlemind training before deployment reported fewer mental-health problems.
* There are barriers preventing soldiers from obtaining mental-health care they need. In Iraq, many soldiers were moved last year to small outposts where they could maintain close contact with Iraqi civilians and security forces. This placed them farther from care providers at large bases. In Afghanistan, dispersal of troops over a large area made access difficult. Commanders in Afghanistan have responded to the report's recommendations by moving providers closer to troops.
* Reports of unethical behavior by U.S. troops were largely unchanged from 2006.
Recommendations by the team included augmenting military behavioral-health providers in theater with civilian personnel, increasing time between deployments, providing marital and family counseling as a TRICARE benefit and more focused suicide-prevention training.
Bliese said Army leaders both in theater and at the Pentagon had been receptive to the team's recommendations.
"The issues are whether the recommendations are feasible and can be implemented. That doesn't mean every recommendation will be implemented, but Army leaders certainly are receptive to the ideas," he said.
Bliese said reported shortages of behavioral-health providers in Iraq "is a good news-bad news story."
"One reason they felt short of personnel is that commanders are relying on their providers to have very active preventive outreach programs. Additional outreach missions can lead to shortages of resources," he said.
To address these shortages, he said behavioral-health assets are reallocated within the theater to areas of greatest need. Also, combat medics, while not mental-health specialists, can receive more training to help them feel comfortable as first responders. Finally, he believes some civilian care providers can be hired to supplement the military personnel.
"There's no reason we can't send contractors or (government civilian employees) to the large forward operating bases, and let active duty personnel do outreach to the units. That would really help out. My impression is there is a number of retired military and some Veterans Affairs employees who would like to do this and get a feel for what that environment is like," Bliese said.
Pre-deployment Battlemind training tells Soldiers what they are likely to see, to hear, to think and to feel while deployed. The Army also has a post-deployment module for spouses, and several post-deployment modules to help soldiers adjust when they return home.
"It is now Army policy to give Battlemind training to everyone deploying. Some of the units we surveyed were in theater before that policy, so we had a distribution of troops that had and had not received the training," Bliese said. "There is a straight-forward question on the survey asking how well prepared the troops believe they were for deployment. Those who had Battlemind training thought they were better prepared. It's encouraging."
"I think (the training) helps because it gives the soldiers a realistic preview of what they will encounter and helps them prepare," he added. "It gives soldiers some common ground to talk about things and it takes some of the mystery out of deployment."
There appears to be a small, but steady, decrease in reports of soldiers reluctant to seek care because of stigma associated with mental-health care.
"I have the feeling this is a good-news story," said Bliese. "There now have been five years of consistent messages from the Army's senior leadership about the importance of getting mental-health care if needed. We're not seeing huge changes, but a trend of steady improvement. I think that is due to emphasis by military leaders."
In the first month of deployment, about 10 percent of married junior enlisted soldiers reported they planned a marital separation or divorce. By the 15th month of deployment this increased to 30 percent. NCOs and officers had lower rates, although also increasing over the deployment.
One recommendation is for TRICARE, the military health-insurance program, to cover marital counseling, so soldiers can go outside the military system and be reimbursed for the expense. "The Army has been active in getting family life counselors on posts. Anything that can be done to help the families is important," Bliese said.
Access to the full report.
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- Navy Psychologist Warns of Mental Health Provider, PTSD Training Shortfalls
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- Psychiatric News: Iraq and Afghanistan Combat Experiences Compared