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DoD News Briefing with Assistant Secretary Casscells from the Pentagon

Presenter: Assistant Secretary of Defense for Health Affairs S. Ward Casscells
May 04, 2007 11:00 PM EDT
            DR. CASSCELLS: Good morning. Thanks for coming. My name is Ward Casscells. I'm the new assistant secretary of Defense for health. And I'd like to introduce the speakers this morning.   
 
            Army Major General Gale Pollock, the acting surgeon general of the Army, will lead this press conference and introduce the Army team that led MHAT-IV, the Mental Health Assessment Team in its fourth iteration. And then speaking on behalf of the Marines, Admiral Jeffries will speak, and then we'll take your questions. 
 
            Let me just say, as someone really new to the department -- just here now in my 13th day or something -- what a pleasant surprise it was to see that the Army had taken the initiative to go over to the theater and to inquire diligently about the stresses experienced by soldiers and Marines there. This was not their first rodeo; they'd been over there before. And this time was the first time to include the Marine Corps as subjects in their study, and they've worked closely together to analyze these findings and to brief Capitol Hill.   
 
            And on behalf of the department, I want to extend my thanks and gratitude to Colonel Castro and Major McGurk. They looked under every rock and what they found was not always easy to look at. And I want to commend Major General Pollock for taking an unblinking look at this. 
 
            I was over there at the time of their survey myself as an Army reservist in uniform. I remember well the stresses. I know the stresses on my family at that time, and I know my kids' grades suffered in school. And I spent a lot of the time looking over my shoulder. It's a tough go over there.   
 
            But what they're doing now is trying to find out how we can do better. There are ways we can do better, and we're determined to do that. 
 
            So without further ado, Major General Pollock. 
 
            GEN. POLLOCK: Good morning. I'd like to take this opportunity to tell you about the findings of the Fourth Mental Health Advisory Team, or MHAT-IV. 
 
            Sending mental health advisory teams into a combat theater of operation is really groundbreaking. These teams deployed to Iraq to assess how troops were doing on the ground and how well behavioral health services were working in theater. Extensive reports were produced that led directly to changes in the way that services are delivered in a combat theater. The findings released today reflect a snapshot of the morale and mental health of the deployed soldiers and Marines last fall in Iraq. 
 
            At the request of leadership in the theater, for the first time, in the fall, the team included Marines and examined the ethical behavior of U.S. troops. 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's a robust system in place to provide mental health care, but issues continue with the stress of a combat deployment. 
 
            We established the mental health advisory teams at the request of the commanding general, Multinational Force Iraq, several years ago.  MHAT-IV continued the precedent of deploying advisory teams to Operation Iraqi Freedom to assess the behavioral health care requirements of these soldiers. MHAT-I and II conducted their assessments in September and October of 2003 and '04, and MHAT-III deployed to Iraq during October and November of 2005. In August and September of 2006, the MHAT-IV Team surveyed 1,320 soldiers and 447 Marines. They surveyed behavioral health providers, primary health care providers and the chaplains and their chaplain assistants, which we consider the unit ministry teams. 
 
            They conducted focus group interviews with these various people. And at the request of leadership, they expanded their work to include the military transition teams. There are several types of the transition teams in Iraq, including border patrol and national police, and they serve as advisers and trainers for the Iraqi units.   
 
            The MHAT-IV team found that not all soldiers and Marines deployed to Iraq are at equal risk for screening positive for a mental health symptom. The level of combat is the main determinant of a soldier's or Marine's mental health status. For soldiers, deployment length and family separation were the top non-combat deployment issues. The Marines had fewer non-combat deployment issues, which the team hypothesized was due to their shorter deployment periods. The team recommended behavioral outreach efforts focused on units that are in theater longer than six months, and determined that shorter deployments or longer intervals between deployments would allow soldiers and Marines better opportunities to reset mentally before returning to combat.   
 
            Soldier moral was lower than Marine morale, but similar to soldier morale reported in previous surveys. Overall, soldiers experienced higher rates of mental health symptoms than Marines. However, when matched for deployment length and deployment history, the mental health rates of soldiers were similar to those of Marines. Multiple deployers reported higher acute stress than first-time deployers, and deployment length was related to higher rates of mental health concerns and marital problems. Marital concerns were higher than in previous surveys, and these concerns were related to the deployment length.   
 
            As mentioned earlier, for the first time the MHAT team looked at ethics. The most critical finding was relative to battlefield ethics. Mistreatment of non-combatants is a very serious matter. And the military leadership directed, specific training be conducted on ethics.   
 
            You'll read in the released report that approximately 10 percent of soldiers and Marines report mistreating non-combatants or damaging property when it was not necessary. Only 47 percent of the soldiers and 38 percent of Marines agreed that non-combatants should be treated with dignity and respect.   
 
            Well over a third of all soldiers and Marines reported that torture should be allowed to save the life of a fellow soldier or Marine. And less than half of soldiers or Marines would report a team member for unethical behavior. 
 
            Mistreatment includes damaging or destroying property when not necessary or hitting or kicking a non-combatant when not necessary. The team found that soldiers with high levels of anger, who experienced high levels of combat, or who screened positive for a mental health symptom, were nearly twice as likely to mistreat non- combatants; as those who reported low levels of anger, low levels of combat or who screened negative for a mental health symptom. 
 
            Although demographic differences between the soldiers in Iraq and the broader Army population make comparison difficult, 2003 to 2006, Operation Iraqi Freedom suicide rates are higher than the average Army rate. The team found that suicide prevention training was not designed for a combat or deployed theater. Training has been revised to include theater-specific scenarios that describe actions that soldiers or Marines can take to help one another. 
 
            The team reported that behavioral health providers would benefit from additional combat and operational stress-controlled training before deploying to Iraq. Very few had attended this course at the Army Medical Department and Center, and our former surgeon general, Lieutenant General Kiley, mandated this training for all deploying behavioral health personnel and a revised course began in February. 
 
            Based on MHAT-IV findings, then-Secretary of the Army and now- Acting Secretary of the Army Geren directed action. We have revised the schoolhouse curriculum and operational training to include more focus on Army values, suicide prevention, battlefield ethics, and behavioral health awareness in all the junior leader development courses. 
 
            In summary, the MHAT program provides valuable information that leaders can use to improve the overall behavioral health of military members and their families. Our efforts in education, prevention and early treatment are unprecedented. Our soldiers are a testament to these efforts. The majority of soldiers, because of superb training and leadership, will adapt to the structures of war, but we must support our soldiers' health needs, both physical and mental. 
 
            These advisory teams help us to know how and where we can better serve those needs. 
 
            We'll continue to review the recommendations from the team and further improve behavioral health care for the soldiers deployed to Iraq and their families here. Our goal is to ensure that every deployed and returning soldier or Marine receives the health care they need. 
 
            Thank you very much. We're happy to take your questions. And I believe that, AP, you have the first question. 
 
            Q     Yes. This recommendation for shorter deployments and the one for longer dwell time is directly in contrast to the direction that you're moving in with the 15-month deployments and that sort of thing. What are the possibilities that anything like that can be put into place? 
 
            GEN. POLLOCK: I think there's two components to that question that I'd like to address. One, because we recognize that a longer dwell time, time at home with family and friends, is important to the mental reset of the soldiers, that was a factor when we extended the current operations, because that would allow the units that were going to go into the next rotation to have at least a year of downtime at home with their families. 
 
            It also stresses a point that our former chief of staff, General Schoomaker, has made repeatedly to Congress: that the Army is spread very thin, and we need it to be a larger force for the number of missions that we were being asked to address for our nation. 
 
            We have authority now from Congress to grow the Army, but that doesn't happen overnight. It will take us time to be able to build to that. But this is one of the factors that helps them to know how important it is, so that we can take better care of all of the service members that are deploying and the families that have to support them during those deployments as well. 
 
            Q     Did you assess -- just to follow up -- when the deployment lengths were extended to 15 months, about how long you'd have to keep that policy in effect? (Off mike.) 
 
            GEN. POLLOCK: I'm going to defer that question, because that was made by Army leaders senior to me, and I don't have all the information that they did when they made those decisions. 
 
            Q     So you think -- do you think that eventually you can follow through on those recommendations, or you don't have an idea of when? 
 
            GEN. POLLOCK: Oh, I believe that with the increased number of service members, we are going to be able to increase the dwell time, yes. 
 
            In the third row, please. 
 
            Q     General, could you talk a little bit about how -- your concerns about how a 15-month deployment now is going to affect the mental health of soldiers and Marines on the ground? 
 
            GEN. POLLOCK: Well, we know that it's going to be a stress, and I think that's why it's very important that the behavioral health team was visiting with them. We've got more attention now on the importance of leadership, and I think that's one of the strengths that the team really identified, is that with good leadership, even when people may have a bad thought, they don't act on that thought. So it's very important that we ensure that the young leaders have the training so they know how to support the troops that depend on them. 
 
            Please. 
 
            Q     Did you recommend 18 to 36 months between combat tours as a -- 
 
            GEN. POLLOCK: That was the team's recommendation. 
 
            Q     And you mentioned 12 months at home; it's really not 12 months, is it, because for a portion of that time, they're away on training (at the schoolhouse ?) and so forth. So for a junior officer, I'm told, it's really eight or nine months at home, not 12 months. 
 
            GEN. POLLOCK: Well, we're describing "home" as back at home station. You're correct in that part of being at home includes other training. And so, no, your head might not be on your pillow at home that night, but the fact that you're in the United States and with your family for the majority of that time is considered that 12 months of dwell time that we're looking for. 
 
            Ideally, it would be -- you know, as -- ideally, the war would be over, that wars around the world would stop. But we serve as an instrument of the nation, and when the nation calls, we will serve. 
 
            Sir, please. 
 
            Q     What percentage of the deployed force screened positive for these mental health issues? And what are the mental health issues that they're screening positive for? 
 
            GEN. POLLOCK: I'd like to bring the two experts -- because these two gentlemen are the ones that did the survey. They were the MHAT-IV team, so I would like to address your specific questions to them, and I'll moderate for them. 
 
            COL. CASTRO: A very good question. One of the things it's important to note, that we focused our assessment on soldiers and Marines that were either in brigade or regimental combat teams. So when you say percent of the force, our numbers really only speak to soldiers and Marines at that level, the brigade and regimental level and below. And those rates were approximately 15 to 17 percent, which is what we've seen since the war started in Iraq. So those rates have been fairly steady. 
 
            And the three things that we really focus on in terms of mental health, specifically mental health, is we look at post-traumatic stress disorder, which we call acute stress when we assess it in a combat environment, and also anxiety and depression. But it's also important to note that we're not doing any diagnoses in how we do these assessments. It's just those who are symptomatic and would receive a diagnosis based on a clinical interview. So it's really just soldiers who have high symptoms in those categories. 
 
            Q         Do you have a breakdown on PST and anxiety and depression? 
 
            COL. CASTRO: We do. PTSD was the rate that I gave you, 15 to 17 percent. And for the other ones, it's much lower. It's much lower. And there's a lot of cross -- co-morbidity, so it's possible for a soldier to screen positive in anxiety, depression and PTSD. 
 
            Q     General Pollock, do you -- I'd like to ask you about the battlefield ethics questions that were put to these soldiers and Marines. Is there any comparative data in regard to were there earlier questions about battlefield ethics involved in the Iraq war or compared the data to previous conflicts? 
 
            GEN. POLLOCK: That's an excellent question, and thank you for raising that. This is the first time that questions of this nature have ever been asked soldiers or Marines in combat. So this -- when I spoke earlier about it being a groundbreaking look at the health of our soldiers, we were very sincere. It has never been done. There is no research out there that has gone out and asked these questions to the soldiers and Marines that are really on the line. 
 
            Q     Well, let me ask you this. As a person in uniform, what was your reaction of these results? Is it something that you expected? Was it surprising, alarming?   
 
            GEN. POLLOCK: How to answer that question, the way that I thought about it when I read it was, if someone killed or injured my husband, would I be angry? Yes. If all of you thought about the people that you care the most about, if someone hurt them or killed them, would you have a response? Would you be displeased?   
 
            These men and women have been seeing their friends injured, and I think that having that thought is normal. But what it speaks to is the leadership that the military is providing, because they're not acting on those thoughts. They're not torturing the people. And I think it speaks very well to the level of training that we have in the military today.   
 
            Q     But I mean, the numbers themselves indicate that a good percentage would condone mistreatment of either detainees or civilians.   
 
            GEN. POLLOCK: And I think that's why I tried to make the connection between you and someone that you love. If you thought that doing that, allowing those behaviors to someone who had just contributed, or that you think contributed, to the injury of someone that you loved would help, I'm not sure that it's not a normal response. The issue is, they didn't act on it, so it's reflective of the training.   
 
            Ms.   
 
            Q     Statistically speaking, people who self-report tend to under-report. I think that's a known fact. Do you -- so when you say, one in 10 people self-report that they have mistreated people, do you have a sense of how much worse this might actually be statistically? And do you know that this might be deeper?   
 
            GEN. POLLOCK: (Inaudible) -- question like that to the folks who did the research and the statistics.   
 
            COL. CASTRO: Well, we don't -- we can't predict from that. But we probably should point out that this survey that we conducted were done anonymously, so there was no names or a way for us to know who it was. And generally you get under-reporting of bad things, if you will, when, well, you would know it was me. So that's the reason why the survey was anonymous, because we wanted to get as honest assessment as we could for the soldiers and Marines.   
 
            Q     Do you have a feeling that there may be some under- reporting involved?   
 
            COL. CASTRO: You know, I don't. In the focus groups that Major McGurk and I conducted, soldiers and Marines are very, very astute. They know that if they mistreat the non-combatants, the next time they go out in sector, that that would put them at increased risk.   
 
            So they know there's nothing gained for them to do that. And so they said, "You know, yeah, we may think it, we may want to do it, but we don't do that, because that jeopardizes ourselves or the selves of our other teammates." 
 
            So I think it's fairly accurate in terms of an honest assessment, based on how we conducted the surveys. 
 
            GEN. POLLOCK: Because this is not just an Army survey, we didn't just survey Army personnel. I'd like to bring up Admiral Jeffries, so that if you have questions for the Marine and his colleague, please. 
 
            ADM. JEFFRIES: Thank you. 
 
            I'm Rear Admiral Rich Jeffries, medical officer of the Marine Corps, and with me is Captain Nash, who is from the combat operational stress control at Manpower and Reserve Affairs, who is our subject matter expert in the area.   
 
            I just want to make mention that we are very pleased to be part of this survey and find it very important to have another tool that gives us information that the Marine Corps can do better for its most important people, their Marines. 
 
            We will participate as needed in future ones, as they come available. And we will continue to use it, along with all the other means and tools that there are available, to make sure that we're doing the very best we can for our Marines and sailors and all troops, in any theater. 
 
            General Pollock had to catch a plane, so I'm going to moderate with the team here, try and answer your questions. Yes, sir? 
 
            Q     Admiral, in the survey, when respondents were asked if a unit member injured or killed an innocent noncombatant, would you report it, only 40 percent of Marines said they would report it. The number was a little higher for the Army. So that means 60 percent, presumably, would not report it.  
 
            Now presumably Marines are trained that they should report when something like that happens. Were you shocked by that figure? What's your reaction? And does that figure suggest that the majority of Marines would not report the intentional or unintentional injury or killing of innocent bystanders? 
 
            ADM. JEFFRIES: Well, again, these were the first time that these questions came out, that have ever been done. And how does the individual interpret how that question is -- would he likely report or not report? A majority of them said they would not report. We don't know what went into their thought process of why or why not.   
 
            In the mental health field, I don't have a good answer for that. 
 
            That may be better answered in the ethics field with ethicists about how they put that kind of a thought process in and make a decision on that.  
 
            We would be concerned. I know the Marine Corps is concerned that this may be of some significance, and they're looking very closely at this with several groups and several teams that have now taken in consideration to see what this means and what we may do differently if there is a problem here. 
 
            Q     To follow up, though, you said you're not sure what went into their thought process, but their answer was, the majority said they would not report. I mean, how concerned are you that the majority say they would not report that kind of incident? 
 
            ADM. JEFFRIES: Well again, it's what kind of reporting we're talking about how they interpret that. I don't know at what level they may be considering that and how they interpret that. We would like -- one incident is too many. And so we would like to have reporting appropriately at any level of any incident that's unethical. But again, I don't know in the majority of the minds how they were interpreting that, what kind of reporting they were talking about. That's for further study. 
 
            Yes, sir? 
 
            Q     These ethical questions have some fairly interesting results. And you were saying this was the first time these questions have been asked in these reports. What was the thought behind putting these questions into the study this time, and how come they haven't been incorporated in the past? 
 
            ADM. JEFFRIES: I'll have to ask the team who did the MHAT. 
 
            COL. CASTRO: Well, I think it's important to note that it was the commanding general of the Multinational Forces Iraq who specifically requested that we include battlefield ethics questions in this MHAT. And I would be completely speculating if I said why he requested that.  
 
            Q     Would that have been General Chiarelli or the current -- which commanding general? 
 
            COL. CASTRO: General Casey. 
 
            ADM. JEFFRIES: Yes, sir. 
 
            Q     Can I ask, in the survey you asked about mistreatment. What was the definition of "mistreatment"? What were the range of actions that would qualify as mistreatment so that one in 10 would respond positively to that? 
 
            COL. CASTRO: Well really two things. Either stealing from combatants, damaging their property, or hitting and kicking them in situations that the soldier or Marine thought was unnecessary. 
 
            ADM. JEFFRIES: Yes, sir. 
 
            Q     In the past there have been some very helpful appendices to these reports that have been posted online. Will the appendices be posted online in this case? 
 
            ADM. JEFFRIES: The redac is set to be online I believe today is when it's supposed to come out with the report.   
 
            I don't know about appendices, do you? 
 
            COL. CASTRO: Yes, there's about a hundred and some pages of appendices that probably should be posted with the report. 
 
            Q     They will be? 
 
            COL. CASTRO: That's my understanding. But the -- 
 
            ADM. JEFFRIES: Yes, sir. 
 
            Q     For Colonel Castro, please. Colonel, since the group recommended 18 to 36 months between combat tours and since that seems to be impossible at this time, is there any thought given to maybe holding the Marines and soldiers off the line at certain points? I think now they have in their tour -- they have two weeks off in the middle of their tour. Any thoughts or -- you know, after three -- 60 days, 90 days in combat, pulling them off for a certain number of days -- any way, you know, around those lines as to give them a little more time off? 
 
            COL. CASTRO: Yes. In the -- well, as you know, that when the -- Marines deploy for different weeks, and when Marines deploy for seven months, they don't get mid-tour leave that you referred to. So that's -- but only if they're deployed 12 months or longer. 
 
            And yes, we did make the recommendation that, after about three or four months, for soldiers being on the line, continuously going outside the wire, conducting the missions -- to be pulled back as a unit, sort of, if you will, reset or recover while in theater but sill being there if necessary. So we do discuss that, actually, in the full report and make that recommendation. 
 
            ADM. JEFFRIES: Yes. 
 
            Q     Could we get the specialties or backgrounds of Major McGurk and Colonel Castro, please? 
 
            ADM. JEFFRIES: Sure. 
 
            MAJ. MCGURK: I'm a research psychologist -- Major McGurk. Sorry. My background as a research psychologist -- I have a Ph.D. in experimental psychology. 
 
            Q     Your first name? 
 
            MAJ. MCGURK: Dennis. 
 
            ADM. JEFFRIES: Colonel? 
 
            COL. CASTRO: My background's similar to Major McGurk's. 
 
            ADM. JEFFRIES: Yes, ma'am. 
 
            Q     I have a copy of the report here, and it says dated November 17th of 2006. Well, why did it take six months to publicly release it? 
 
            ADM. JEFFRIES: Well, it was a CENTCOM -- for the Multinational Force commander for Iraq -- it was his report, and it was reported to him on the 17th of November for him to use as he saw it fit in his theater. 
 
            Q     I mean, at this point we've had a new CENTCOM commander for six weeks now, at least, right?   
 
            ADM. JEFFRIES: Yes. 
 
            Q     So why wasn't it released a month ago? 
 
            ADM. JEFFRIES: We can't answer for the Central Command about what they did in terms of the responsibility on the report. The decision by OSD was to present this this year, and it came out that we were doing it this week. That was in the Office of the Secretary of Defense and the Office of the Army Secretary to make that decision. But the original report was for the -- was a Central Command and for the Multinational Force commander, and that report was given to him in November. 
 
            Yes, sir? 
 
            Q     Admiral, what changes have been made or are being made to respond to the concerns raised in this report? 
 
            ADM. JEFFRIES: I think we can turn to our experts. There's a lot going on. There has been, even before these reports, from the previous report, especially in the mental health field. And I think they can each give what they're doing.  
 
            Colonel Castro.   
 
            COL. CASTRO: Just a comment. The report that you have, it's important to really note that the Army began making changes immediately upon the findings of the report, and so a lot of the changes that have already happened, General Pollock already mentioned. We have now battle mind training, which is really mental health training that occurs throughout every phase of the deployment cycle. So that's predeployment training for junior leaders, it's predeployment training for leaders, it's training for spouses and families. It's also a program in place during theater to help soldiers, sustain soldiers throughout the deployment, to keep them sort of focused on the battle, keep them in the fight, so to speak. There's post-deployment training immediately when soldiers come home to help them with that transition process. And then there's follow-up training that also takes place.   
 
            And as many of you know, we already had in place the post- deployment health assessment, the post-deployment health reassessment programs, that's actually a screening program where every service member talks to a medical professional for any issues that they might have. In addition, the suicide prevention training has been revised and updated and handed off, so that can be implemented. And the battlefield ethics training is -- we already had battlefield ethics training, and it is being revised and updated to take into consideration the new findings, particularly the findings in behavior that's acceptable and not acceptable, and also specifically how to report violations when they occur. 
 
            Q
 
            What about that three to four months in combat and then pulling them off the line? Has that been put into effect? 
 
            COL. CASTRO: No, or not to my knowledge it has not been. 
 
            Q     Do you know why not? 
 
            COL. CASTRO: No, I do not. I do not. 
 
            MR.
 
             :   One or two more, please. 
 
            ADM. JEFFRIES: Captain Nash, do you want to answer on the Marine Corps? 
 
            CAPT. NASH: Yes. Thanks. I'm a psychiatrist working with the Marine Corps. I had the combat stress programs for the Marine Corps. And I don't think there's a lot in the study that has prompted us to do something new, because we've been working on many of these things for a long time now and I think the findings have reinforced for us the importance of those things. 
 
            And that includes deployment cycle training, which we have been developing since 2003 -- before deployment, before coming home, three to six months after -- separate training for all Marines, for Marine leaders, for families and getting training in identifying, managing and preventing mental health problems in all our schoolhouses, from the basic school for brand new Marine Corps officers all the way through the commanders course, and for enlisted from schools infantry all the way through.   
 
            Now obviously the behavioral -- the battlefield ethics pieces of this are not just about mental health. They're about many other things, and I can't speak to the parts that are not mental health. But I know that the commandant is very serious about this, and he realizes, as Admiral Jeffries said, one incident is too many. So what we have is a coordinated effort to teach, in all these training programs, both battlefield ethics, law of war, leadership and the mental health piece of how to identify when a Marine or sailor is so stressed or so injured by stress that they're not able to follow that leadership as well.   
 
            ADM. JEFFRIES: Yes, sir.   
 
            Q     Is another survey being planned?   
 
            ADM. JEFFRIES: From what I have as knowledge, and I'll turn to the team, again, they're at the request of the Multinational Force, Central Command, Iraq commanders and all. Until they ask for it, there will not be an actual survey. However, based on any good survey process, and this has been the fourth one, we are looking at the questions and looking at the aspect of it, of how it could be improved and what we might do when requested again. Our anticipation is, there will be another survey.   
 
            One more question, one more.   
 
            Q     Just as mental health professionals, how concerned are you all about the effect of extended and repeated deployments on the mental health --  
 
            ADM. JEFFRIES: Well, I'm not a mental health expert, but I'll have Colonel Castro --  
 
            COL. CASTRO: Well, we know that the longer a soldier's deployed, the more likely they are to have a mental health issue, and that's in the report. We also know that soldiers who are on their second deployment or their third deployment are more likely to have a mental health issue than those soldiers on their first deployment.   
 
            So, of course, we're very, very concerned about it, and that's why what we try to do is have a very robust process in place to facilitate the resetting and also the early identification of soldiers, and while they're there in theater to do the behavioral care outreach to those units who have been there the longest and have the highest sort of combat experiences as those units that are doing the outside-the-wire missions. 
 
            ADM. JEFFRIES: Thank you.
 
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