News & Information - News

by Jerry Harben
U.S. Army Medical Command Public Affairs

A good system is providing effective mental-health support for Soldiers deployed to Iraq. Still, those Soldiers will experience stress and some will have difficulty coping, because that is the nature of war.

This is a short summary of the conclusions of the Army's third mental-health advisory team (MHAT III) to visit the southwest Asia combat zone during Operation Iraqi Freedom (OIF).

"Overall, there is a good mental-health system in place. It is doing good things for Soldiers," said Col. Edward Crandell, Chief, Department of Behavioral Health, at Womack Army Medical Center, Fort Bragg, N.C., and leader of MHAT III. "We confirmed increased availability of behavioral-health care in theater, and a decrease in stigma by Soldiers and commanders for accessing care."

"It is not surprising that Soldiers react emotionally to the prospect of their deaths or causing the death of someone else. What our Soldiers are experiencing are the inherent stressors of combat that we would expect. It is therefore essential to identify and treat combat and operational stress on the battlefield. Literature and lessons from previous conflicts clearly show that if we don't do this, Soldiers are at greater risk for developing serious problems later," Crandell added.

The MHAT was composed of 12 people, including subject matter experts in psychiatry, research psychology, clinical psychology, psychiatric nursing, occupational therapy, chaplain, social work and enlisted mental-health specialties. They were in Iraq during October and November 2005. Previous MHATs worked in 2003 and 2004.

MHAT III conducted surveys and focus-group interviews with Soldiers and with health-care providers. Altogether, 1,461 Soldiers, 172 behavioral-health providers, 172 primary-care providers and 94 unit ministry team members participated.

This assessment for the first time included Soldiers of the Multinational Security Transition Command-Iraq (MNSTC-I) engaged in advising and training Iraqi forces. The sample also included for the first time Soldiers who had previously deployed to Iraq. The team recommended several policy, staffing and reporting improvements, and that initiatives to improve care and reduce stigma be continued.

One recommendation is to field a standardized Unit Needs Behavioral Health Needs Assessment Survey throughout the theater. The team trained a combat stress control unit in Iraq to use this standardized tool to determine the morale and well-being of a unit.

Key findings included:

-- Soldiers were more likely than those in previous studies to report more intense and predictable combat experiences as a result of the use of improvised explosive devices (IED).
-- The top non-combat stressors were deployment length and Family separation.
-- Participants reported their units' morale was higher than in previous studies, while their personal morale was higher than reported on MHAT I and similar to that of MHAT II.
-- Fourteen percent of the Soldiers surveyed indicated they experienced acute stress and 17 percent indicated a combination of depression, anxiety and acute stress. These were similar to the rates found in 2003 and higher than in 2004.

-- Soldiers serving a repeat deployment reported higher acute stress than initial deployers.
-- The suicide rate among Soldiers in support of OIF (Iraq and Kuwait) during 2005 was 19.9 per 100,000 Soldiers—similar to the 18.8 rate per 100,000 Soldiers in 2003 and higher than 2004. Soldiers reported receiving suicide prevention training before and during deployments, but the number who perceived this as useful in identifying fellow Soldiers at risk declined from 60% in 2004 to 55% in 2005.The study determined that leading suicide risk factors were relationship issues at home and in theater, followed by legal actions, problems with fellow Soldiers and command and duty performance.
-- Soldiers received suicide-prevention training before and during deployment. The number of Soldiers who perceived this training to be useful in identifying fellow Soldiers at risk declined from 2004.

"We need a more focused suicide-prevention program for deployed Soldiers. We need to help Soldiers engage in psychological buddy-aid to identify Soldiers who are having difficulty. This is one of our key recommendations," Crandell said.

-- Soldiers reported that they have better access to behavioral health care when it is needed, and more Soldiers report receiving care. Efforts to reduce stigma attached to receiving behavioral health services have evidently borne fruit. The number of Soldiers reporting items such as avoiding care to avoid being seen as weak have significantly decreased compared to earlier rotations.

"Reduced stigma and increased access is very much a good-news story," Crandell commented.

-- Behavioral health providers were confident in their ability to treat combat and operational stress reactions among Soldiers.
-- Soldiers generally reported high job satisfaction and good support facilities. They were unhappy with tour lengths and reported a more dangerous combat environment than during OIF I. Multiple deployers said they were better prepared due to improved predeployment training, but also said their Families are experiencing more stress and the time between deployments is too short.

"Everyone who comes back from a combat environment experiences change," Crandell said. "When Soldiers return home, the U.S. Army screens them on at least two different occasions for mental health issues. Soldiers also take part in Battlemind Training, which is designed to inform them about common signs and symptoms they may experience when readjusting after a combat deployment," Crandell said.

For immediate release, December 18, 2006.