Psychiatric Care Provided in Theater Seeks to Contain Mental Health Issues

WASHINGTON — Mental health providers interviewed every single member of a 900-plus member Marine battalion that had sustained heavy losses in Afghanistan, as part of their reintegration upon return from deployment.

While the effort to interview every member was unusual, Cmdr. Charles Benson, a Navy psychiatrist, said the Marine Corps was interested in addressing mental health issues as early as possible for  members of the 3rd Battalion, 5th Marine Regiment. Officials were concerned about the military unit because 25 of its members were killed in combat, and it suffered more than 140 injuries with multiple amputees.

“U.S. Marine Corps decided we need to take a look at their particular reintegration program to try to understand how to better bring them back to the States and what we could do to, hopefully, decrease the later PTSD or tackle the problem early,” he said.

Benson was among the providers who spoke at a recent Defense Centers of Excellence (DC0E) webinar on treating troops in theater — an endeavor to prevent mental issues from spiraling out of control.

“This is important because of the need to ensure that, right from the beginning, we are giving people the care they need and deserve,” said DCoE Director Capt. Paul Hammer. “What do we do in theater? How do we help people in crisis? How do we address prevention, and how do we do things right up front and very early in the process?” — What we do in that respect is very important.”

Care in Theater

Benson, who spoke about his recent experience deployed to the Helmand Province in Afghanistan, said the Navy uses Operational Stress Control and Readiness (OSCAR) personnel to help provide care for marines in theater. These mental health providers deploy with their units in theater and stay with them until they return from the deployment. They are trained to help leaders build unit strength and to help servicemembers through prevention, early identification and intervention of stress-related problems.

As an OSCAR provider in theater, Benson said he developed a rapport with troops, which made it easier for the marines to ask for help. “They get to know me and that decreases the stigma,” he explained. The teams are augmented with the use of OSCAR extenders, who are physicians and other providers and chaplains who are trained to perform OSCAR duties appropriate to their expertise and experience. In addition, some OSCAR mentors are officers trained in responding to stress and monitoring the stress patterns throughout their units.

The idea to interview the returning members of the 3rd Battalion, 5th Marine Regiment came from Marine Corps leadership. Benson said interviewers did not uncover many issues with the 3rd Battalion, 5th Marine Regiment, despite the “large undertaking for Camp Pendleton” in which 10 providers did the screenings over five days and then spent another five days for full evaluations, if it was determined that was needed. The evaluations of those screenings still are being examined, and Benson said how effective the interview intervention was will not really be determined until later on, when mental health professionals can look back and see what the rates of problems and issues are among those marines. 

Addressing Challenges in Theater

Navy Capt. Lori Laraway, who serves as the coordinator for the Navy Operational Stress Control Program, said one of the challenges for the Navy is that sometimes the Navy’s servicemembers serving in Iraq and Afghanistan may be attached to a non-Navy unit. In order to reach them, the Navy has deployed both mobile-care teams and mobile-support teams.

“Keep in mind that there may be one or two sailors attached to an Army unit, so that infrastructure to support them from a Navy career or Navy standpoint sometimes was very challenging in the past,” said Laraway.

The mobile-care teams can travel throughout Afghanistan and provide services where providers are needed. These teams not only collect surveillance data on what the mental health needs are of Navy personnel, but also provide ongoing behavioral health care services.

Mobile-support teams, as opposed to mobile-care teams, were created to deal with noncombat-specific issues which can cause stress in theater. Among the members of those teams are pay and finance specialists who can help sailors sort out different administrative or pay issues they are facing.

Air Force Col. Christopher Robinson, deputy director of Psychological Health at DCoE, who previously served as the combat stress detachment commander for regional command east in Afghanistan, also spoke about his experience in theater. He said he and his fellow providers were deployed with troops and traveled to different areas of the country to provide care to them.

He said that depression and PTSD were the most common conditions seen, with depression being more prevalent. In addition, family/marital problems, suicidal and homicidal ideations, and sleep problems were common. The majority of the patients he and his colleagues saw in theater over a two-year period were able to return to duty after they were treated, he added.

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