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Mental Health Advisory Team IV Findings Released
by Jerry Harben
A team of Army experts who studied the mental health of Soldiers and Marines in Iraq between August and October last year concluded that there is a "robust" system in place to provide mental health care, but issues continue with the stress of a combat deployment. This was the first time Marines had been included in this Mental Health Advisory Team study.
At the request of the leadership in theatre, this team for the first time examined the ethical behavior of U.S. troops so that battlefield ethics training can be improved. They recommended training based on the Army Chief of Staff's "Soldiers' Rules," and such training is being developed by the U.S. Army Training and Doctrine Command as well as by the Marine Corps' Training and Education Command.
"Previous MHATs found that deployment lengths and multiple deployments impact on Soldiers' mental health," said Col. Carl Castro, chief of military psychiatry at Walter Reed Army Institute of Research, who led the Mental Health Advisory Team (MHAT) IV. COL Castro also said that suicide rates in theater remain high.
Castro and his team (psychologist Maj. Dennis McGurk and behavioral health specialist Spec. Matthew Baker) interviewed 1,320 Soldiers and 447 Marines and conducted focus-group sessions with Soldiers, Marines and behavioral-health providers.
The team recommended Soldiers and Marines receive the Army's "Battlemind Training" both before and after deployment. This training helps them identify signs and symptoms of mental distress and access the programs that provide help.
The central findings of the report are:
1. Not all Soldiers and Marines deployed to Iraq are at equal risk for screening positive for a mental-health problem. The level of combat is the main determinant of a Soldier's or Marine's mental-health status.
2. For Soldiers, deployment length and Family separations were the top non-combat deployment issues; due to shorter deployment lengths, Marines had fewer non-combat deployment concerns. The team recommended behavioral-health outreach efforts focus on units that had been in theatre longer than six months. Shorter deployments or longer intervals between deployments would allow Soldiers and Marines better opportunities to "reset" mentally before returning to combat.
3. Only 5 percent of Soldiers reported taking in-theatre rest and relaxation (R&R), even though the average time deployed was nine months. Policies need revision to ensure that those who work "outside the wire" receive R&R opportunities.
4. Soldiers and Marines reported general dissatisfaction with the creation and enforcement of garrison-like rules for such things as uniform appearance in a combat environment.
5. Soldier morale was lower than Marine morale, but was similar to Soldier morale in previous surveys.
6. Overall, Soldiers had higher rates of mental-health problems than Marines. When matched for deployment length and deployment history, Soldiers' mental-health rates were similar to those of Marines.
7. Multiple deployers reported higher acute stress than first-time deployers. Deployment length was related to higher rates of mental-health problems and marital problems.
8. Good NCO leadership was the key to sustaining Soldier and Marine mental health and well-being.
9. Marital concerns were higher than in previous surveys, and these concerns were related to deployment length.
10. Although demographic differences between the Soldiers in Iraq and the broader Army population make comparison difficult, 2003-2006 Operation Iraqi Freedom suicide rates are higher than the average Army rate, 16.1 versus 11.6 Soldier suicides per year per 100,000.
11. Suicide prevention training was not designed for a combat/deployed environment. Training has been revised to include theatre-specific scenarios that describe actions Soldiers or Marines can take to help each other.
12. Approximately 10 percent of Soldiers and Marines report mistreating non-combatants (damaged/destroyed Iraqi property when not necessary or hit/kicked a non-combatant when not necessary). Soldiers that have high levels of anger, experienced high levels of combat or screened positive for a mental-health problem were nearly twice as likely to mistreat non-combatants as those who had low levels of anger or combat or screened negative for a mental health problem.
13. Transition team members, those who advise and train Iraqi forces, have lower rates of mental-health problems compared to Soldiers assigned to U.S. brigade combat teams, although there was an unmet behavioral health care need. The transition team members tend to be more experienced.
14. Behavioral-health providers require additional Combat and Operational Stress Control (COSC) training before deploying to Iraq; very few attended the Army Medical Department Center and School's COSC Course. The Army Surgeon General now has mandated this training for all deploying behavioral-health personnel.
15. There is no standardized joint reporting system for monitoring mental-health status and suicide surveillance of service members in a combat/deployed environment.
"Each service now has its own system. In a joint command, a rollup of the force is difficult to get, because everyone is reporting something different," Castro said of the reporting system.
Besides assessing the state of the force's mental health and capabilities of the mental-health providers, this survey found that line leadership, especially team and squad leaders, had a great influence on their troops' mental condition.
"We used a leadership checklist of what were positive things they wanted leaders to dosuch as treat everybody fairly, protect them from unnecessary taskingsand things they don't want leaders to dosuch as not taking the same risks as the troops," Castro said.
The team recommended that all junior leader development courses should include behavioral health awareness training.
Recommendations also included giving commanders the same kind of information on their troops' mental health that is provided about physical wounds, and conducting Battlemind Psychological Debriefings to replace current debriefings after deaths, serious injuries and other significant events.
This was the fourth MHAT to study troops deployed for Operation Iraqi Freedom. Together, the surveys constitute an unprecedented attempt to measure troops' mental health and improve mental-health services during combat operations rather than waiting to evaluate after the war.