WASHINGTON, DC—The Army said that it is increasing the number of mental health providers being sent to Afghanistan in order to help servicemembers deal with combat stress.

The Army is planning to send 60 to 65 new mental health providers to Afghanistan to reach a ratio of one mental health provider to 700 servicemembers. As of November, the ratio was one mental health provider to 1,124 servicemembers. Army officials spoke about the increase at a press conference last month, in which they released findings from the newest Mental Health Advisory Team report. The MHAT found that the ratio of behavioral health providers to troops in Afghanistan was not as robust as it needed to be. The team recommended maintaining a 1 to 700 behavioral health provider to soldier ratio.

The Army Mental Health Advisory Team’s recommendations were part of its report evaluating the psychological health of troops and availability of mental health services available in Iraq and Afghanistan. The newest report, released last month, is the MHAT’s 3rd assessment for Afghanistan, and its 6th assessment for Iraq since 2003. Army Surgeon General Lt Gen Eric Schoomaker told reporters that the findings of the team “reflect a snapshot of the morale and behavioral health of soldiers.”

Survey Findings

This year’s MHAT team went to Iraq from February to March, and to Afghanistan from April to June. The team surveyed 1,260 soldiers from 51 maneuver platoons and 1,182 soldiers from 47 support platoons in Iraq. In Afghanistan, the team surveyed 638 soldiers from 27 maneuver platoons and 744 soldiers from 25 support platoons.

The team found that in Afghanistan, soldiers reported higher combat exposure and lower unit morale compared to previous years. In addition, the survey found that the percentage of soldiers reporting psychological problems was the same as in 2007, but was much higher than the 2005 survey: 21.4% in 2009, 23.4% for 2007, and 10.4% in 2005, according to the report.

The team also found that servicemembers in Afghanistan who had experienced three or more deployments reported higher rates of marital problems than those who deployed fewer times. For example, rates of marital problems for those who had deployed three or more times was 30.8%, versus 14.3% for first time deployers. In addition, the team found that barriers to behavioral health care were reported to be higher in Afghanistan than in previous years.

While combat exposure and lower unit morale increased in Afghanistan compared to previous years, the opposite was true in Iraq. There, the MHAT team found that combat exposure levels were lower than every year except 2004, and that troops experienced a lower number of psychological problems than every year except 2004. The 2009 statistics found that 13.3% of soldiers were suffering from mental health problems, compared to 18.8% in 2007 and 22% in 2006. However, reports of marital problems among deployed servicemembers in Iraq have increased compared to previous years, with more than 16% of respondents reporting plans to separate or divorce.

The report examined the link between dwell-time—that is, time at home between deployments—and behavioral problems. The team found that the longer the dwell time, the fewer the mental health problems reported in theater. The team found that in Iraq, behavioral health problems in maneuver units returned to near garrison rates (about 10% with problems) after 24 months of dwell time.

Reducing Stigma and Increasing Care

In Afghanistan, officials acknowledged that rough terrain and weather make it difficult to deliver care to servicemembers there. “Because of the terrain issues in Afghanistan we are leveraging as many opportunities as we can to use technology and other means by which we can deliver diagnostic and therapeutic resources to our soldiers. Even with an optimal ratio of behavioral health specialists to soldiers and other combatants, the terrain and weather makes it quite difficult for us,” said Schoomaker.

In addition to recommending a 1–700 behavioral health provider–soldier ratio in Afghanistan, the team recommended that in both a Iraq and Afghanistan, a dual-provider model be used within brigade combat teams. This would allow for one provider to travel to remote units, while the other covers the forward operating base. Historically, each BCT has had only one provider, so a dual-provider system would help provide coverage when BCTs are widely dispersed. The report also recommends establishing behavioral health positions for National Guard Brigade Combat teams, and validating new resiliency training for small unit leadership to ensure that the training that is provided has been tested and is effective.

Schoomaker said that, overall, the Army has a “very aggressive” plan to hire behavioral health specialists, but that they are still short of what their goals. For example, he said that the Army is using technology to expand mental health care. A pilot study at Tripler Army Medical Center is using Internet assistance diagnostics and counseling to meet the mental health needs of servicemembers.

In general, Schoomaker noted that stigma surrounding mental health care is still a deterrent for servicemembers who need help. “In this group of folks, there is a perceived weakness in coming forward with problems they may be experiencing.” He said leaders in DoD want soldiers to understand that they are not weak, nor should it reflect poorly on them if they seek help.

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