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New Programs Aim to Reduce Combat Stress, Prevent Suicide

By Paul Stone
American Forces Press Service

WASHINGTON, June 9, 1999 – President Clinton and DoD announced June 7 two new Defense Department initiatives aimed at improving the mental health of service members.

The first, called the "combat stress control" program, seeks to help identify and manage stress during deployments before it adversely impacts service members' coping skills and effectiveness. The second initiative, aimed at suicide prevention, will take the existing Air Force suicide prevention pilot program and expand it throughout DoD by the end of this year. The Air Force program has been particularly successful, achieving a 50 percent reduction in suicides in only three years.

The president announced the initiatives in conjunction with the first-ever White House Conference on Mental Health, held June 7 at Washington's Howard University and chaired by Tipper Gore, wife of Vice President Al Gore. The president and Mrs. Clinton also participated in the all-day conference aimed at reducing the stigma associated with mental health disease and treatment and improving care throughout the nation.

"DoD must 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," Clinton said in a press release. He ordered DoD to report within six months on how it plans to implement the combat stress control program.

Dr. Sue Bailey, assistant secretary of defense for health affairs, and one of the White House conference participants, said both initiatives are "part of DoD's emphasis on a fit and healthy force."

"Mental health, just like overall physical health, is an important component of service members' ability to serve, as well as overall unit effectiveness," Bailey said during an interview at the conference. She said DoD has already begun addressing the combat stress initiative and in February released a directive that requires:

  • Each of the military services to develop and implement plans to reduce combat stress.
  • A combat stress consultant be assigned to every unified command surgeon.
  • Every service member from senior level to junior enlisted receive training on combat stress control.
  • Adaptation of combat stress casualty management techniques to warfighting strategies.
  • Mental health care providers train with their operational units on a periodic basis.

The combat stress control program will also be addressed in a DoD-wide conference scheduled for October. The conference will focus on shifting attitudes about mental health treatment away from what Gore called "the last stigma of the 20th century," and toward an accepted and integral part of health care in general.

"We are stressing educating the military leadership that in our culture, which emphasizes strength, mental health is a part of our strength," Bailey said. "As an organization, we have to understand that stress is a normal response to abnormal events, such as long deployments, especially those involving conflict."

Equally important, she added, "We have to let our service members know that it's OK to feel stressed and it's OK to seek help if that's what they need to function within their units."

Bailey said the program also aims at getting mental health care "out of the clinics and out to the units," making it an integral part of deployed assets. Currently, DoD assesses troop mental health before and after deployments, but help is not always available during them, Bailey said. She said assessments and having regular access to mental health care are important because "if you don't ask about such things as depression, you may not find out. It's not going to be volunteered."

Beyond the cultural barrier of seeking mental health treatment within the military is the issue of privacy. Bailey said DoD is working to improve privacy for service members seeking mental health treatment, but added that DoD also has to respect those times when national security concerns come into play.

DoD has proposed changes to the Manual for Courts-Martial that would create a limited patient-psychotherapist privilege of confidentiality. The changes are still in coordination among federal agencies and must receive final approval by the president.

The Air Force has already created a limited patient- psychotherapist protection as part of its suicide prevention program. It only applies to service members charged under the Uniform Code of Military Justice. The Air Force reports its experience has been "very positive with a decrease in suicides among personnel with pending charges and good acceptance of the change by Air Force lawyers."

The Air Force suicide prevention program to be instituted DoD- wide later this year emphasizes "a community approach" requiring involvement by senior leadership, line officers and a broad coalition of military community agencies, such as mental health providers, family support and youth development centers and chaplains.

Like the program for controlling combat stress, Bailey said, the suicide prevention program also emphasizes integrated care.

"What the Air Force pilot program showed us was the importance of linking mental health providers with primary care physicians," she said. Additionally, she said, the program also trains primary care physicians to look for signs that the need for mental health treatment may be manifesting itself in physical symptoms, such as anxiety, difficulty sleeping, sexual dysfunction or loss of appetite.

"We have to be able to recognize, pay attention to and be respectful of what our patients are telling us," she said.

Once fully developed and implemented, the DoD-wide suicide prevention program will incorporate the following strategies:

  • Public service messages by senior leaders
  • Debriefing of individuals and units following traumatic events.
  • Annual suicide prevention training for all service members.
  • Integration of services from six agencies: mental health, family advocacy, health and wellness centers, family support centers, child and youth programs, and chaplains.
  • Suicide prevention training in all professional military education programs.
  • Development of a database of risk factors for suicide, as well as trends so preventative measures can be taken.
  • Unit risk assessment surveys and intervention, as required.

Both the combat stress control program and the Air Force suicide prevention program take advantage of years of research into the mental health of service members, Bailey said. They also exploit advances in the medical community's understanding of and treatment options for mental health problems.

Participants at the White House conference repeatedly emphasized that advances in science, research and medicine have demonstrated that the connections between mental health and physical well-being are real and, in most cases, as easily treated as physical complaints.

"It is time," Gore said, "to bring mental health care into the 21st century and end the stigma and discrimination that have for too long prevented people from seeking the treatment that can help them live healthy, productive lives."

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