By Mr. Jerry Harben (Army Medicine)May 6, 2009
In May the Army joins the rest of the nation in observing National Mental Health Month. The mental health of Soldiers and Soldiers' Families has received great attention in the news media, and Army leaders are putting emphasis on programs to deal with psychological issues.
"Soldiers are getting comprehensive training to deal with stressors which they may encounter. An example is Battlemind training, a program with modules specific to the phases of the deployment cycle, as the types of stressors that Soldiers encounter are different when they are preparing to deploy, are in theater and upon return home. Battlemind also has training for spouses, as deployment has a significant impact on Families," said Col. C. J. Diebold, chief of psychiatry at Tripler Army Medical Center, Hawaii, and psychiatry consultant to The Surgeon General of the Army.
"In addition, suicide prevention is a very high priority, and the Army is being very aggressive in educating Soldiers through chain teaching from the senior level on down. The emphasis is on awareness of warning signs and risk factors of suicide, and being comfortable enough to ask if you are concerned about your buddy's safety and knowing how to get him the help he needs. The central theme of the program is 'ACE', which stands for 'Ask, Care and Escort,'" Diebold continued.
"An additional major initiative is emphasis on comprehensive Soldier fitness," Diebold said. "It's along the lines of taking a look at the entire person and assessing what their needs are - biological, psychological, social - to maximize the ability to function well throughout their entire military careers. It's proactive and based on a prevention-type model, in contrast to waiting to treat a problem after it occurs."
Brig. Gen. Rhonda Cornum, a physician and combat veteran, is leading a project to develop an assessment tool for all aspects of Soldier fitness.
"The best way to treat a death by heart attack is not CPR," Cornum recently told the Army News Service. "The best way is to prevent the heart attack. It's a lifestyle and culture change. And that's how we should look at mental health. Look at it with a preventative model and enhanced health model, not a 'waiting until we need therapy' model. That's what comprehensive Soldier fitness is setting out to do."
"The Army is very cognizant of the stigma with seeking mental-health care," Diebold said. "This issue is not unique to the military, but Soldiers have been reluctant to see a mental-health provider due to concern over potential negative impact on one's career and being identified as 'broken' by command and fellow Soldiers. The good news is that slowly but surely stigma in seeking mental-health care is decreasing. One very important reason is because leaders at all levels have taken the initiative mandate that no Soldier is to be denied access to mental-health care, there will be no reprisal for seeking care, and they will not be labeled as 'weak' or 'broken' for getting help."
The Office of The Surgeon General recently issued a fact sheet listing Army behavioral-health programs and initiatives. Included are:
* Some 250 new behavioral-health providers and more than 40 marriage and family therapists have been hired to work in military treatment facilities in the United States.
* Health-care providers receive post-traumatic stress training so that they can accurately diagnose and treat combat stress injuries.
* On average, 200 behavioral-health personnel from all military services are deployed in support of Operation Iraqi Freedom, and about 30 in Operation Enduring Freedom.
* All Soldiers receive a Post Deployment Health Assessment on re-deployment, usually in the theater of operations. The Post Deployment Health Reassessment some 90 days later provides Soldiers the opportunity to identify any new physical or behavioral-health concerns that may not have been present immediately after redeployment. This assessment includes an interview with a health-care provider. The fact sheet states this has been a very effective new program for identifying Soldiers who are experiencing some of the symptoms of stress-related disorders and getting them the care they need before their symptoms manifest into more serious problems.
* The Respect-Mil pilot program at Fort Bragg, N.C., integrates behavioral-health care into the primary-care setting, providing education, screening tools, and treatment guidelines to primary-care providers. It has been so successful at reducing the stigma associated with seeking mental-health care that 15 more sites have implemented it, and another 17 sites should implement it in 2009.
* Battlemind training is a strengths-based approach highlighting the skills that helped Soldiers survive in combat instead of focusing on the negative effects of combat. It has been expanded into programs for Soldiers and spouses. The Website www.battlemind.org explains the program.
* Mental Health Assessment Teams (MHAT) deployed into theater in 2003, 2004, 2005, 2006 and 2007. Never before had the mental health of combatants been studied in a systematic manner during conflict. Based on MHAT recommendations, the Army has improved the distribution of behavioral-health providers and expertise throughout the theater.
* Medical Command created a behavioral-health Web site (http://www.behavioralhealth.army.mil); a Behavioral Health Proponency Office; and a new PTSD training course.
* Two DVD/CDs that deal with Family deployment issues are now available: an animated video program for 6 to 11 year olds, called "Mr. Poe and Friends," and a teen interview for 12 to 19 year olds, "Military Youth Coping with Separation: When Family Members Deploy." Viewing the interactive video programs with children can help decrease some of the negative outcomes of Family separation. To access the programs, go to www.behavioralhealth.army.mil and click on children.
* In mid-July 2007 the Army launched a PTSD and mild traumatic brain injury Chain Teaching Program that will reach more than 1 million Soldiers, a measure that will ensure early intervention. The objective of the chain teaching package was to educate all Soldiers and leaders on PTSD and TBI so they can help recognize, prevent and treat these debilitative health issues.
* In 2008 the Defense Department revised Question 21 on the questionnaire for national security positions, regarding mental and emotional health. The revised question now excludes non-court ordered counseling related to marital, Family, or grief issues, unless related to violence by members; and counseling for adjustments from service in a military combat environment. Seeking professional care for these mental-health issues should not be perceived to jeopardize a person's professional career or security clearance. Failure to seek care actually increases the likelihood that psychological distress could escalate to a more serious mental condition, which could preclude a person from performing sensitive duties.
* In 2008, the Army began piloting Warrior Adventure Quest (WAQ). WAQ combines existing high adventure, extreme sports and outdoor recreation activities, such as rock climbing, mountain biking, paintball, scuba, ropes courses, skiing, and others, with a leader-led after action debriefing. This helps Soldiers transition their operational experiences into a "new normal", enhancing military readiness, reintegration and adjustment to garrison or "home" life.
* This year the Army conducted a "standdown" to ensure that all Soldiers learned not only the risk factors of suicidal Soldiers but how to intervene if they are concerned about their buddies. The "Beyond the Front" interactive video is the core training for this effort. It will be followed by a chain teach which focuses on a video "Should to Shoulder; No Soldier Stands Alone" and vignettes drawn from real cases.
Innovative approaches include the Restoration and Resilience Center at William Beaumont Army Medical Center, Fort Bliss, Texas; and the Warrior Combat Stress Reset Program at Darnall Army Medical Center, Fort Hood, Texas.
Beaumont's R&R Center uses techniques such as group counseling, biofeedback and Reiki massage to help Soldiers deal with post-traumatic stress disorder. It has graduated 80 Soldiers, with 64 percent being classified fit for duty.
The reset program at Darnall is designed to reduce hyper-arousal symptoms and inappropriate reactions to everyday events.
"We use a variety of body and mind health techniques along with group and individual counseling," said Maj. Lynette Heppner, officer in charge of the program.
"I visited Fort Hood recently and was very impressed by the program there. They have started treating specific symptoms of PTSD, using a wide array of therapies," Diebold said.
"There are excellent mental-health prevention and treatment programs across our Army installations. The Army is very sensitive to the mental well being of Soldiers and their Families throughout the deployment cycle, and has responded accordingly," he added.