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Release No: 283-99
June 07, 1999


Assistant Secretary of Defense (Health Affairs) Dr. Sue Bailey unveiled the details of two major policies announced by President Clinton today concerning a plan to implement a combat stress control program and an initiative to expand the community approach to a suicide prevention program. Bailey discussed the plans during a breakout session entitled "Primary Care, Prevention and the Life Cycle" at the White House Conference on Mental Health: "Working for a Healthier America" being held today at Howard University in Washington, DC.

Combat Stress Control Program Implementation Plan

At today's White House conference on mental health, President Clinton directed the Department of Defense (DoD) to take steps to improve the military services' ability to control combat stress among servicemembers. Increased military deployments, especially to areas of conflict, can generate stress among our service personnel. DoD will emphasize the critical importance of leadership and education and make military leaders more aware of the effects of combat stress on individuals and the military unit. To this end, the Department has begun planning to enhance training for its leadership to help them recognize the signs of combat stress and to help them provide assistance before a situation becomes overwhelming. The President directed the Department to report in 180 days on how the plan will be fully implemented throughout the military health system.

DoD will host a combat stress conference in October of this year to hasten the cultural shift in emphasizing the leadership role in preventing combat and operational stress. The conference will bring together active, reserve and veteran line officers, medical personnel, mental healthcare providers, chaplains, and other professionals, to address critical issues of delivering optimal care for our troops during military operations.

Combat stress reactions are normal, expected responses to abnormal, sometimes horrific or terrifying events and situations. Severe stress reactions occur when an individual is overwhelmed psychologically, cognitively and/or physically by actual battlefield experiences-being fired upon, sustaining wounds, witnessing death of buddies, the enemy, or local civilians. Mild to moderate stress reactions may occur when deployment conditions are less severe-such as exposure to harsh environments, long duty hours, separation from family and anticipation of horrible events associated with battle.

In Bosnia and Southwest Asia, the Army and the Air Force assess deployed service members upon arrival and upon redeployment home using self-reported screening tests. Approximately 20 percent of personnel indicate a sufficient level of distress to warrant evaluation by a healthcare provider. Approximately 3 percent are referred for full mental health evaluation, and 0.5-1.0 percent require immediate attention.

Historically, during World War II, the rate of combat stress casualties to wounded service members was approximately 25 percent in the European Theater. In Vietnam, the rate was about 10 percent-lower, by comparison, because of the type of fighting during the conflict. While less than 2 percent of Persian Gulf War veterans meet the criteria for Post Traumatic Stress Disorder, approximately 33 percent were symptomatic for distress as measured by the Global Severity Index, a self-reported screen.

The DoD-coordinated plan will reinforce a culture shift within the military, and will incorporate advances in understanding of combat stress.

Community Approach to Suicide Prevention Program Expanded

President Clinton also announced expansion of the Air Force Suicide Prevention pilot program throughout the military by the end of 1999. Every suicide prevention program, military or civilian, hopes to produce a drop in suicide rates but this has rarely been achieved. The Air Force pilot program showed a drop in the suicide rate from 15.8/100K in fiscal 1996 to below 3.5/100K for the first six months of fiscal 1999. This is more than fifty percent less than the lowest rate on record prior to 1995 and an 80 percent drop from the peak in the mid-1990s.

The pilot program demonstrated a community approach to building stronger individuals and resilient communities. The community approach to suicide prevention is successful because it requires active involvement by senior leadership, line officers and a broad coalition of military community agencies, including mental health, family support, child and youth, and chaplains.

The Department of Defense-wide program will incorporate recommendations aimed at mitigating risk factors and strengthening the protective factors for suicide. These recommendations include:

Widely distribute public service messages by DoD senior leaders that express concern about suicide and the importance of encouraging and protecting members who seek help.
Debrief individuals and units following traumatic events.
Establish annual suicide awareness and prevention training for all military service personnel.
Integrate delivery of preventive services from six agencies: mental health, family advocacy, health and wellness centers, family support centers, child and youth centers, and the chaplains.
Include suicide prevention training in all professional military education programs.
Develop a more robust database of those who commit and attempt suicide so that risk factors and trends can be analyzed and preventive measures taken.
Conduct unit risk assessment surveys and unit intervention as required.

The program employs a data-driven prevention model that was based on input from military functional communities, experts from the Centers for Disease Control and Prevention, and academics. The prevention model uses nine risk factors that are frequently associated with suicide victims and three factors believed to be protective. The risk factors include a history of mental health problems, substance abuse, relationship problems, poor coping skills, legal problems, previous suicide attempts, financial problems, poor job performance and social isolation. The protective factors include establishing social support in units, teaching individual coping skills, establishing the belief among military personnel that seeking mental healthcare is acceptable and ensuring privacy protection.

The President pointed out that this program may have applicability to other governmental agencies, especially the law enforcement and intelligence communities, which share many cultural characteristics with the military.

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