FORT BRAGG, N.C. -- A unit of special operations soldiers here will soon have its first team-based behavioral health program, one borrowed from the airborne community.
The July hire of behavioral science officer, Maj. Terry Matz, by the 95th Civil Affairs Brigade (Airborne) signals recognition that special operations forces can also benefit from a mental health program to prevent suicides and other high-risk behaviors.
Formerly with the 82nd Airborne Division's 1st Brigade Combat Team, Matz brings with her the High Risk Management Team concept, which is based on a treatment-team model familiar to healthcare providers.
An HRMT is comprised of all the behavioral health resources available to a battalion commander, including a behavioral science officer (Matz), physician assistant, unit behavioral health advocate, master resiliency trainer, legal expert, chaplain, military family life consultant (MFLC), battalion leadership, and of course, a high-risk soldier's company commander and first sergeant.
At least once a month, the team meets for 2-3 hours so that the battalion and company commanders can have intelligent conversations about the needs and welfare of high-risk soldiers with subject matter experts present, and together they can develop a comprehensive mitigation plan.
WHY CIVIL AFFAIRS
"Civil affairs is unlike any other experience I've had in the Army," said 95th CA brigade surgeon, Lt. Col. John Maza, a West Point graduate and former artillery officer.
"By working by, with and through host-nation structures, civil affairs enables a joint/inter-agency effort that leverages the confluence of interests in U.S. government agencies and complementary capabilities. CA forces are uniquely able to leverage the critical juncture of the theater special operations command, U.S. embassy and host nation."
CA soldiers spend considerably more time deployed than at home, with a dwell-time ratio of 0.7:1, according to Maza, who came to the brigade in 2010. Additionally, CA soldiers typically deploy in four-person teams on missions of varying frequency, length and locale. Personally, Maza has been to 60 countries, mostly on deployments but sometimes on vacation, with the average trip lasting 1-2 months but occasionally up to a year.
While CA soldiers are generally older and tend to manage their own issues, they still are subject to many of the same stresses that occur in general-purpose forces, according to Maza.
"Everyone belongs to a family. Everyone has to deal with finances. There may be legal issues that go on with our soldiers. As a soldier gets older and gains more experience with increased number of deployments, they may have more medical issues to deal with," he said.
Faced with a frenetic pace, Maza was concerned there was a propensity to "lose someone in the cracks" without dedicated and active behavioral-health support within the brigade, he said.
By the Army's plan, the five-year-old 95th CA was not allotted a social worker until 2013. As with other units lacking a team approach to behavioral healthcare, mitigation for high-risk soldiers was "stove-piped" between various supports, making overall treatment difficult to track.
Due to the apparent need, Maza petitioned for and received Matz, and with Matz came HRMT.
"What impressed me most about the program was the commander's involvement," said Maza, who observed an HRMT meeting at Matz's former brigade, 1/82.
"They were actively managing high-risk soldiers to avoid negative incidents and to be aware of what was going on with all facets of that soldier's life -- medical, legal, family support, spiritual," said Maza. "This is what I mean by treating the whole soldier as a multi-faceted individual with many different things impacting on his or her life that commanders need to be aware of in total, versus stove-piping individual bits of information to the leaders. Company commanders were able to articulate all these to the battalion commander and command sergeant major. The battalion commander has 800 soldiers, but he knew who the company commander was talking about in each case. And all the support SMEs -- chaplain, legal, PA, social worker -- were all in one room ready to assist."
HISTORY OF HRMT
What began as a Suicide Risk Management Team program pushed down from the 25th Infantry Division on her unit's last deployment quickly morphed into a more-inclusive High Risk Management Team, said Matz, a self-described "Air Force brat" who has over 15 years of experience in social work.
"We found we had so many other risks that, if we can be effective at this level, why not just make mental health better," she said.
In particular, soldiers in the brigade were having a hard time transitioning from deployment settings to garrison, she said, and many company commanders didn't grasp what support systems were already in place. They were holding onto a lot of information at company and below level. The challenge for Matz was to get that pushed up to a level where all the brigade assets could be brought to bear for soldiers in need.
"It's the ones we identify at the lower level that have the best chance of getting better," she said.
Once HRMT was in place, the battalions began tracking all kinds of risk factors: who had a family advocacy case prior to deployment, who had or was expecting a new baby, who was having financial or legal problems. One battalion even put motorcycle riders in HRMT so they could track who had not had a safety course.
"What this forces people to do is to know their soldiers," said Matz. "We spend so much time taking care of our vehicles, and taking care of our weapons, and taking care of all these other things, but we are not taking care of each other."
First Sergeant Danny Boivin agrees. He is the senior noncommissioned officer of Headquarters and Headquarters Company of the 1st Battalion, 504th Parachute Infantry Regiment, one of 1/82's maneuver elements. With 21 years of service, he too sees the immediate stressor as pace of deployments.
"Things are going so fast that people aren't getting down to the lower enlisted and checking on them as much as we used to," said Boivin, who came to the 82nd in 2009. "We don't have time to grow these soldiers up to be proficient leaders like we once did."
The Army is changing that, with 9-month deployments and longer dwell times, but in the meantime, leaders must work with what they have, he said.
HOW HRMT WORKS
Boivin's battalion commander, Lt. Col. James R. Salome, is one who has seen firsthand the payload that can accompany mental health breakdown, and it's not always suicide.
Salome was the operations officer of the 101st Airborne Division's 1st Battalion, 502nd Infantry Regiment when it was deployed just southwest of Baghdad, Iraq, in 2006. That March, a handful of soldiers posted at a remote and dangerous checkpoint, feeling isolated and abandoned by their leadership, raped a 14-year-old Iraqi girl and murdered her family in an incident known as the Mahmudiyah killings.
According to Salome, his battalion commander cared for his soldiers immensely but didn't have a good way to demonstrate that care.
"While in garrison, we teach people to shoot, move and communicate so they know how to do it when they deploy, right?" he asked. "How do I demonstrate how I care for them and their families? I have to show them now."
Now commander of 1-504, Salome's HRMT meets twice a month. His high-risk list is color coded: soldiers new to the list are in yellow, the difficult-to-remove are red; greens are success stories. From August 2010 to March 2011, he and his team moved 67 soldiers into green.
"One of the things lacking in that unit in Mahmudiyah was trust," said Salome. "Getting that many people into the green builds trust. The soldiers know the command cares. If you know people are there to help you solve your problem, maybe you are more apt to come and say, 'I need some help.'"
HRMT is about increasing resiliency and preventing soldiers' issues from degrading their own readiness, while doing so in the most efficient and productive manner, he said.
Prior to HRMT, a company commander and first sergeant could spend 15 minutes with each expert independently; now they spend 15 minutes with all six experts in one room. Additionally, because battalion leadership is present, they don't have to guess whether they're doing the right thing, said Salome.
The team considers what's best for the soldier and for the Army.
"We had a soldier who had issues for a very long time," Salome explained. "We considered options that were best for him, best for the Army, and best for both: we could try to get them into an advanced treatment program in Bethesda, pursue legal action, or assign him to the Warrior Transition Unit, which is what we ultimately did."
The team is careful not to violate a soldier's legal rights. For instance, chaplains and MFLCs cannot disclose their conversations with a soldier. Names are kept on a separate, secured list from mitigation plans.
"I believe anyone can do their job if they are focused," said Salome. "I can eliminate distractions for the company commander, first sergeant, platoon leader, platoon sergeant and squad leader by focusing on high-risk soldiers. For the energy I put into it, it is worth that investment."
TRACKING RESULTS
As a preventive program, the success of HRMT as a preventer of suicide is difficult to track, but what healthcare professionals can do is to track negative incidents such as positive urinalysis, DUIs, addiction treatment program enrollments, and legal issues. One of Matz's first tasks at 95th CA was to measure baselines for these high-risk indicators.
No soldier in 1/82 identified as high risk has committed suicide. On the other hand, a medic who was not identified did. The system isn't perfect, Matz concedes, but for most soldiers, it seems to work.
Capt. Brian James, commander of 1-504th's Company B, said the program has tangibly helped at least 10 of his soldiers and by extension, their families, in the last six months.
For James, the fight is personal. His grandfather, a war veteran who suffered terrible pain for many years, intentionally overdosed on pain medication, leaving bitterness and anger in James' father to this day, he said.
"For me as a commander to be able to, on a biweekly basis, have the concentrated efforts of all of our enablers -- my boss, the chaplain and PA -- all focused in one spot has really been great because everyone's on the same page. For every soldier who's been on there, we've come up with a good plan of action and gotten them taken care of in what's best for the paratrooper and what's best for the unit."
FIRST SERGEANT REALITY CHECK
As a company first sergeant, HHC's 1st Sgt. Boivin is at times like a father to his men, but as with all good fathers, there is no shortage of tough love.
"I believe the program that Maj. Matz intended was a great thing," said Boivin. "I think we've morphed it a little too much. When people get an Article 15 [disciplinary action], we put them on the HRMT worksheet. I don't think that's necessary. I want to put the right people in that program and watch them closely.
"For instance, we have a domestic violence kid," explained Boivin. "People may give him a clinical diagnosis. I will tell you straight up, in this case, he's just an immature kid who doesn't have a clue, and he needs to be brought up because he probably didn't have a father that taught him anything. He just needs one-on-one counseling, a big brother. That's my opinion."
"Maybe we sit him down one on one and talk to him as a man, not as a soldier. No, he doesn't address me by my first name -- I can't let that happen. When he leaves, sometimes I think he's gotten more out of that than going to see a psychologist."
Boivin is first to admit that companies just don't have the time or resources to fix every soldier, and that the HRMT is a useful tool in their suicide prevention arsenal. Awareness is the primary tool, he said, and on that, everyone agrees.
"Recently we had a soldier who was contemplating suicide," he said. "The great thing was, his friends were picking up the vibes based on what the Army taught them. It worked. It was perfect."
EVERYONE NEEDS MAINTENANCE
Matz describes herself as an Army wife (her husband is an Apache pilot in the 82nd Combat Aviation Brigade), mother of two teens, and a "stress baker" who makes lots of cookies and breads when she is stressed.
"I'm a little bit of an old lady," she admitted. She enjoys being a member of the Garden Club of Raeford and likes quiet things away from work. No one is exempt from learning the life lesson of balancing stress, she said.
Matz began her career with the elderly, many of whom were chronically ill. Many were veterans.
"Working with the elderly, I could certainly see where people 'go.' I saw how important relationships are to us in old age, and if we don't have those relationships built, how that can affect who we are as a person, not just with anger, but also depression and other mental illnesses," said Matz.
HRMT is ultimately about identifying those soldiers whose nurturing bonds are flagging and doing something about it with concentrated effort, she said.
"We have maintenance meetings for our stuff. This is maintenance for people. That's all it is."
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