By Mr. Paul Boyce (FORSCOM)March 6, 2008
The Department of the Army announced March 6 the results of the Army's fifth Mental Health Advisory Team (MHAT) report: MHAT V. This assessment examined the morale and mental health of Soldiers deployed to Iraq and Afghanistan in the fall of 2007. MHAT V continued the precedent of deploying advisory teams to Iraq and Afghanistan to assess behavioral healthcare requirements of Soldiers.
MHAT assessments are established by the Army Surgeon General, and have deployed to Iraq every year since 2003 at the request of the Commanding General, Multi-National Force-Iraq. The Army uses the results of these studies to shape programs, policies and procedures and to allocate resources to better meet the Mental Health needs of our Soldiers. Since the first MHAT, the Army has conducted chain teaching, implemented Battlemind training, expanded training for health care providers, redistributed mental health assets in theater, and hired additional mental health providers.
In 2007, MHAT V also deployed to Afghanistan at the request of the Service Chief, Army Central Command (ARCENT). Army leaders in Iraq, Afghanistan and at home began implementing MHAT recommendations upon completion of the assessment.
In Iraq, the MHAT collected 2,279 anonymous surveys from Soldiers, and 350 anonymous surveys from behavioral health, primary care and unit ministry team members. In Afghanistan, 889 Soldiers completed the anonymous Soldier survey, and 87 anonymous surveys were completed by behavioral health, primary care and unit ministry team members.
Soldiers in Iraq reported an increase in unit morale in 2007 relative to 2006. The percent of Soldiers screening positive for mental health problems was similar to previous years, although the report found that Soldiers on their third or fourth deployment reported higher mental health and work-related problems than Soldiers on their first or second deployment. Soldiers who received pre-deployment Battlemind training reported fewer mental health problems. The Army-wide implementation of Battlemind training was an MHAT IV recommendation made in 2006 (http://www.battlemind.org).
Overall, Soldiers in Afghanistan reported rates of mental health problems similar to rates observed among Soldiers in Iraq. The one exception was that reports of depression were higher in Afghanistan in 2007 than in Iraq during the same timeframe. Rates of mental health problems in Afghanistan in 2007 were higher than rates of mental health problems reported in the last Afghanistan assessment in 2005.
In Iraq, an increase in the number of months deployed was directly related to a variety of outcomes. Reports of work-related problems and plans for Soldiers to pursue divorces or separations increased with each subsequent month deployed. Reports of mental health problems increased over time, but showed an improvement in the months immediately before returning home; this is most likely due to redeployment optimism.
In Iraq, overall levels of combat exposure in 2007 declined relative to 2006 although levels of combat exposure varied significantly among units. Soldiers in Afghanistan reported significant increases in combat exposure relative to the Afghanistan assessment in 2005. The sub-sample of 282 Soldiers in Brigade Combat Teams (BCTs) in Afghanistan reported levels of combat exposure similar to or higher than levels reported by BCT Soldiers in Iraq.
Soldiers deployed to Iraq in 2007 reported lower rates of stigma associated with accessing behavioral health care, but more difficulty accessing health care than in 2006. Access to care was impacted by the increase in smaller outposts in Iraq in 2007. Behavioral health personnel reported conducting more command consultations than in 2006 indicating that commanders are increasingly relying on behavioral health personnel for a variety of behavioral health support missions. Behavioral health personnel also indicated a need for more personnel.
In Afghanistan, Soldiers reported significant barriers to mental health care, and behavioral health personnel reported difficulties getting to Soldiers.
For the first time, MHAT personnel examined sleep patterns in theater. Sleep problems are a strong predictor of work-related performance and are associated with other mental health problems such as depression and post-traumatic stress. Soldiers in OIF reported an average of 5.6 hours of sleep, too few to maintain optimal performance; however, self reports of sleep are not always objective. Therefore, a need to look at sleep patterns more objectively was indicated.
MHAT IV and MHAT V showed that Soldiers who screen positive for mental health problems and anger are significantly more likely to report engaging in unethical behaviors. In OIF, reports of unethical behaviors were largely unchanged from 2006.
Annual suicide rates for Soldiers in both Iraq and Afghanistan were elevated relative to historic Army rates. The OIF MHAT found that self reports of suicidal thoughts peaked around mid-deployment then dropped off, and there was also some evidence suggesting that suicides increased after being deployed 6 months or more. As for frequency of deployments, the MHAT found no evidence to suggest that multiple deployments were associated with increased suicidal thoughts.
In Iraq and Afghanistan, the teams made a number of recommendations that Army leaders began reviewing or implementing as soon as the assessment was completed.
* Allow government civilian or contracted behavioral health personnel to fill select positions in theater to augment military personnel.
* Create and fill behavioral health officer and enlisted positions in aviation brigades as these personnel are not organic to the units.
* Ensure that all combat medics receive Battlemind Warrior Resiliency training before deploying in support of OEF or OIF so that they can augment behavioral health personnel.
* Move division psychiatrists from sustainment brigades to a division surgeon cell, and move brigade mental health officers from brigade support battalions to brigade surgeon cells. These moves will allow mental health officers to serve as special staff to Commanders on mental health issues.
* Update the Combat Operational Stress Course (COSC) to ensure it stays relevant to division and brigade combat team behavioral health assets.
* Increase number of Family-life providers to work with spouses and Family members.
* Enhance training for Non-Commissioned Officers on their role in maintaining Soldier resiliency through counseling & mentorship training.
* Develop and implement senior leader Battlemind training.
Theater Specific to Iraq
* Modifying the position of the theater mental health consultant and senior mental health Non-Commissioned Officer in Charge (NCOIC) to allow broader overview of the theater.
* Hold quarterly behavioral health conferences to enhance networking, communication, coordination and to increase personnel morale and well-being.
* Ensure use of COSC Workload and Activity Reporting System throughout the theater of operations.
* Develop suicide prevention action plan at the operational and tactical levels.
* Develop consistent policies for evaluation after a concussive event and standards for return to duty.
Theater-Specific to Afghanistan
* Appoint a Behavioral Health Consultant to the Command Surgeon who understands the mental health needs within theater, and can advise the Commander on optimal allocation of mental health resources.
* Redistribute behavioral health assets and conduct an aggressive outreach program.
The complete MHAT V report is available on the Army Medicine website at http://www.armymedicine.army.mil/news/news.html
For more information contact Cynthia Vaughan Cynthia.Vaughan@us.army.mil