Managing Stress in Theater

Getting enough sleep also is important for troops, officials said. In the survey, soldiers reported that a poor sleep environment and night duties were the main causes of their sleep interferences.

Schoomaker also said the military continues to be concerned about the pervasive incidence of sleep deprivation in theater and is looking at how deployed troops can get more sleep.

“We do have behavioral health experts that are starting to point out to us that the combination of exposure to combat and concussive injury in the presence of sleep deprivation makes for a real challenge to the human psyche,” Schoomaker said. “So, focusing on the commander’s role in enforcing good sleep discipline is going to be one of the things that we will look at very carefully.”

Another key finding of the report was that, while soldiers and marines reported high exposure to concussive events, they also reported low percentages of being evaluated by medical professions for a concussion in theater.

Schoomaker said one explanation could be that respondents might not have considered the medics and corpsmen who evaluated them as medical professionals when they responded to the survey but added that the military would look further into those responses.

In addition, he said that, because the survey was conducted, the military has fully implemented mandatory concussion evaluation and management protocols in theater and that recent reports suggest “better compliance with timely and appropriate concussion management.”

Diagnosing mTBI earlier in theater should have a “positive effect” on the later development of post-traumatic stress problems, Schoomaker said.

“Because we are tracking that, now we will be able to get our arms around those people who have had exposure to concussions who, later, if they exhibit behavioral health problems, we may be able to link back to that concussive event,” he said.

Key Findings from the Survey From Behavioral Health Providers

The majority of behavioral health personnel felt the standards of behavioral health care in theater were clear (76.2%), as were the standards for how much patient information they can share with commanders (82.1%).

The data showed that about 21.6% of the behavioral health (BH) personnel surveyed stated their pre-deployment training did not adequately prepare them for their mission. “During focus group interviews, BH staff described a variety of venues they attended prior to deployment; none was described as being adequate to prepare them for their Combat and Operational Stress Control mission,” the report stated. “Training schedules varied by service, with Air Force and Navy personnel expressing the most concern about training content.”

Survey participants cited concern that “there were a variety of mental health professional groups deployed, but there was no overarching authority to ensure they were optimally dispersed throughout theater.”

Travel within Afghanistan presents one of the biggest barriers to providing behavioral health services, survey participants said. “Although most 2010 personnel downplay the danger of travel (58.3% disagree or strongly disagree that travel is too dangerous), more than one-fourth of the respondents identified arranging travel (28.6%) and mission cancellation due to difficulty arranging travel (26.5%) as problematic.”

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