USA — Army Works to Expand Combat Stress Detection

WASHINGTON, July 22, 2010 — Since 2003, the Army med­ical com­mu­ni­ty has worked fever­ish­ly to estab­lish process­es that will improve the speed at which post-trau­mat­ic stress among mil­i­tary mem­bers is diag­nosed, the Army’s sur­geon gen­er­al said here today.

As many as 30 per­cent of troops rede­ploy­ing from Iraq and Afghanistan could devel­op post-trau­mat­ic stress symp­toms, and ear­ly detec­tion is key to their treat­ment, Army Lt. Gen. Eric B. Schoomak­er said in a round­table dis­cus­sion with reporters.

Ear­li­er wars have taught us that you need to be very aggres­sive and very close to the bat­tle when treat­ing and diag­nos­ing psy­cho­log­i­cal impacts of deploy­ment and com­bat expo­sure,” Schoomak­er said. “You can actu­al­ly cre­ate more prob­lems for the indi­vid­ual sol­dier by delay­ing the treat­ment or evac­u­at­ing them out of the­ater.”

Some symp­toms of post-trau­mat­ic stress, Schoomak­er not­ed, are avoid­ance of peo­ple, a sense of inter­nal pan­ic, intru­sive thoughts and sleep prob­lems, as well as drug and alco­hol abuse.

Soon after the start of Oper­a­tion Iraqi Free­dom, the Army began send­ing men­tal health advi­so­ry teams to Iraq and Afghanistan to study behav­ioral health among troops exposed to com­bat, the gen­er­al said.

The bat­tle­field teams’ work enabled the mil­i­tary med­ical com­mu­ni­ty to refine how behav­ioral and men­tal health issues among troops was dis­trib­uted, Schoomak­er said. The teams also helped to val­i­date the men­tal health community’s efforts, he added.

Ini­tial treat­ment for sol­diers on the spot, rather than wait­ing until they rede­ploy, has proven to restore the major­i­ty of diag­nosed troops to oper­a­tional per­for­mance lev­els, the gen­er­al said. It also con­tributes to long-term health, he said.

How­ev­er, many troops still are return­ing home with post-trau­mat­ic stress, com­pound­ed by trau­mat­ic brain injuries, Schoomak­er said. Until recent­ly, he added, ser­vice­mem­bers exposed to bat­tle­field vio­lence or attacks had the option to seek imme­di­ate health care. But many troops, he said, weren’t com­ing for­ward for care.

If you give the sol­dier the option of self-iden­ti­fy­ing, what we’ve learned the past cou­ple of years is that sol­diers won’t do that,” he explained. “How many foot­ball play­ers are will­ing to come off the field [vol­un­tar­i­ly]? Many of our sol­diers and Marines are the same way. They brush them­selves off, try to recov­er from what’s going on, and they go back into the fight.”

But now poli­cies are in place that force sol­diers to be eval­u­at­ed based on cer­tain events, Schoomak­er said.

We’re push­ing our pro­to­cols aggres­sive­ly down to the bat­tle­field [lev­el], and tak­ing it out of the hands of the sol­dier and tak­ing them out of the fight,” he said. “If we report an attack …, then every­body with­in a 50-meter range of that event is going to take a knee. They don’t have a choice.”

Research and data pro­vid­ed by the men­tal health teams has helped the Army to devel­op addi­tion­al sur­vey ques­tions, and dis­cov­er oth­er caus­es of post-trau­mat­ic stress, Schoomak­er said.

The Army began look­ing hard­er at deploy­ment lengths and the amount of time troops had between deploy­ments.

Dwell time plays a very impor­tant role,” Schoomak­er said. Few­er than 24 months does not allow ser­vice­mem­bers enough time to restore to a “base­line lev­el” of psy­cho­log­i­cal health, he said.

Short dwell [times] between deploy­ments were con­tribut­ing to some of the prob­lems we’re see­ing,” Schoomak­er said. “Before [troops] had time to recon­nect with fam­i­ly, recon­nect with their com­mu­ni­ty and get back to a nor­mal ground state, they were get­ting out the door again.”

Over the years, mil­i­tary med­ical pro­fes­sion­als also have deter­mined that post-trau­mat­ic stress is a nor­mal, treat­able mal­a­dy, the gen­er­al said.

To illus­trate a pos­si­ble symp­tom of post-trau­mat­ic stress, Schoomak­er cit­ed the exam­ple of a sol­dier who may be ner­vous and “jumpy” at loud nois­es after a lengthy deploy­ment. Such a reac­tion, he said, is much like some­one who was in a car acci­dent who after­ward maybe quick to use the brakes in traf­fic.

Jump­ing on the table when you hear a loud noise is not a sign that [a troop] has lost his mind,” he said. “It’s a nor­mal reac­tion to a stress­ful envi­ron­ment.”

Last fall, the Army began tran­si­tion­ing men­tal health assess­ments with­in a unit’s deploy­ment life­cy­cle, Schoomak­er said. For years, sol­diers have received pre- and ‑post deploy­ment men­tal health screen­ings, he said. But they now receive addi­tion­al screen­ings 90 to100 days after rede­ploy­ment, the gen­er­al said.

How­ev­er, stud­ies show that troops’ post-trau­mat­ic-stress symp­toms could be sup­pressed because they’re excit­ed about return­ing home, Schoomak­er said.

What we are attempt­ing to do is tie togeth­er what we know about sol­diers’ health, well being and men­tal issues, emo­tion­al issues before they deploy, the state of the fam­i­ly; any prob­lems they may have before they deploy, what occurred to them in the deploy­ment that may have trig­gered reac­tion, and then tie that to their return,” the gen­er­al said.

Schoomak­er said return­ing sol­diers now meet one-on-one with a coun­selor, which he said is well-received by the troops. The coun­sel­ing ses­sions are con­duct­ed via video con­fer­ence or in per­son, he said, not­ing that about 60 per­cent of sol­diers say they’d rather do their inter­views online.

They find that hav­ing the screen and the video gives them what I call an elec­tron­ic buffer,” the gen­er­al said. “It makes them more com­fort­able even talk­ing about very inti­mate prob­lems they may have.”

This approach, along with the deployed men­tal health teams and the series of screen­ings has become stan­dard now in the Army, Schoomak­er said. These meth­ods, he added, will help to ensure symp­toms are found ear­ly and treat­ed.

“Expe­ri­ence has taught us that if you can find these symp­toms ear­ly, you can pre­vent the devel­op­ment … of post-trau­mat­ic stress,” Schoomak­er said. “If we find those symp­toms ear­ly, we think that 95 per­cent of the peo­ple can be returned to [nor­mal duty].”

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)