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APA Report 07


The Office of The Surgeon General (OTSG) established the Operation Iraqi Freedom (OIF-ll) Mental Health Advisory Team (MHAT) in July 2004 to follow up on the OIF-I Mental Health Advisory Team, to assess OIF-ll related mental health (MH) issues, and to provide recommendations. The MHAT-II conducted a comprehensive assessment of the OIF-ll behavioral healthcare (BH) system, focusing its assessment and recommendations on three broad areas and the OIF-ll Suicide Prevention Program (see below).

(1) The BH needs assessment of the OIF-ll area of operations (AO)
(2) The BH delivery system of the OIF-ll area of operations
(3) The BH training requirements of the OIF-ll area of operations
(4) Implementation of the MHAT-I recommendations for the OIF-ll area of operation Suicide Prevention Program


The MHAT-II found that like OIF-I Soldiers, OIF-ll Soldiers are experiencing numerous combat stressors. However, noncombat deployment stressors related to quality of life have shown considerable improvement since OIF-I. Deployment length remains a top concern for OIF-ll Soldiers. Fifty-four percent of OIF-ll Soldiers reported their unit morale as low or very low. However, unit morale was significantly higher in OIF-ll compared with OIF-I, when 72% of Soldiers reported low or very low unit morale. Mental health and well-being improved from OIF-I to OIF-ll, reflected by a lower percentage of Soldiers who screened positive for a MH problem in OIF-ll compared with OIF-I (1 3% vs. 18%, respectively). Acute or posttraumatic stress symptoms remain the top MH concern, affecting at least 10% of OIF-ll Soldiers. Soldiers in transportation and nonmedical combat service support (CSS) National Guard and Reserve units had significantly higher rates of MH problems and lower perceptions of combat readiness and training than Soldiers in other units.

The OIF-ll behavioral healthcare system has improved compared with OIF-I. Most BH personnel in theater report conducting outreach on a regular basis. Coordination is occurring between BH personnel, Unit Ministry Teams (UMTs), and primary care providers (PCPs). The BH return-to-duty (RTD) rates are high and comparable to OIF-I. Both the number of BH personnel in theater and the ratio of BH personnel to Soldiers are higher in OIF-ll than in OIF-I. Behavioral health personnel are more evenly distributed in OIF-ll than in OIF-I. Combat stress control (CSC) units, medical companies with MH sections, and combat support hospitals (CSHs) can manage routine and surge period demands for holding Soldiers with BH problems.

Forty percent of Soldiers with MH problems reported receiving professional help during the deployment. This was significantly higher than the 29% of Soldiers with MH problems who received professional help in OIF-I. Stigma and organizational barriers to receiving care remain concerns for Soldiers. Forty-one percent of Soldiers surveyed reported that they had received adequate training in handling the stressors of deployment. This was significantly higher than the 29% of Soldiers who reported receiving adequate training during OIF-I.

There was no significant difference between the prevalence of BH disorders among Soldiers in custodial positions in detainee operations and those of other Soldiers surveyed in OIF-ll. Custodial staff members shared stressors in common with OIF-ll peers. Behavioral health care was conducted in accordance with combat and operational stress control (COSC) doctrine. Insufficient training in correctional BH diminished optimal support for custodial staff.

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