Background

Asking for help can be challenging for anyone but there are particular concerns that may prevent service members and veterans from seeking support or care for invisible wounds Surveys have consistently shown that some service members believe that seeking care for psychological health concerns will negatively impact their career and may cause their command andor unit to lose confi dence in them

The Mental Health Advisory Team (MHAT) established by the Offi ce of the Army Surgeon General assesses deployment-related psychological health concerns of service members and provides recommendations on their psychological health care and support In 2010 the assessment expanded to become a joint effort across the Offi ces of the Air Force Army and Navy Surgeons General as well as the Offi ce of the Marine Corps Medical Offi cer to create the Joint Mental Health Advisory Team (JMHAT) According to MHAT and JMHAT assessments factors that discourage members of the military from seeking psychological health services include

MHAT II 2004 1

OIF

MHAT V 20072

OIF

MHAT V 20072 OEF

MHAT V 20072 OEF

It would be seen as weak 65 522 567 489

My unit membership might treat me differently

63 537 556 46

Members of my unit might have less confi dence in me

59 449 478 418

My leaders would blame me for the problem

51 402 439 339

It would harm my career 50 317 312 292

It would be too embarrassing

41 32 351 286

These concerns may be particularly relevant for those individuals most in need of psychological health care or support According to a study by the American Psychological Association the proportion of service members who expressed anxiety about reaching out for care was approximately two times higher among service members who met screening criteria for a psychological health concern in comparison with those who did not3

It has also been proven that there is an increased risk of experiencing psychological health concerns with each additional deployment The MHAT VII survey showed that3

bull 143 percent of service members experience psychological health concerns during their fi rst deployment

bull 218 percent of service members experience psychological health concerns during their second deployment

bull 325 percent of service members experience psychological health concerns during their third or fourth deployment

Since September 11 2001 approximately 24 million military personnel have deployed to Iraq and Afghanistan according to the US Department of Veterans Affairs4 Of these more than 40 percent of service members have deployed more than once5

Deployments have a signifi cant impact on military families While many military families successfully adapt to the challenges of the military lifestyle the cumulative impact of deployments can lead to increased emotional and psychological health concerns among military children and spouses Within the US military 55 percent of service members are married and 40 percent have two children6 More than 700000 children have experienced one or more parental deployments7

The 2010 Report to Congress The Impact of Deployment of Members of the Armed Forces on Their Dependent Children noted that young children (ages 0ndash5) are likely to exhibit anger and attention diffi culties while school-age children (ages 6ndash12) demonstrate increased ldquoanxiety and fear sensitivity to media coverage and reduced school performancerdquo Among adolescents (ages 13ndash18) the report cited an increase in ldquodeclining academic performance depressive symptoms and behavioral problems in response to emotional stressrdquo

The effects of deployment on children are among the primary concerns reported by military families in the Blue Star Familiesrsquo 2012 Military Family Lifestyle Survey Other top concerns include pay and benefits military spouse employment and issues surrounding posttraumatic stress disorder (PTSD) and combat stress

wwwrealwarriorsnet 866-966-1020

The post-deployment experience of National Guard and reserve members can be especially isolating The National Guard and reserve have been called on to serve at an unprecedented level in support of the most recent conflicts in Iraq and Afghanistan In a 2010 survey conducted by the Department of Veterans Affairs 94 percent of National Guard respondents have served since September 11 2001 compared to only 27 percent in the preceding ten years

Several factors contribute to the unique challenges faced by the National Guard and reserve following deployment including

bull Experiencing less social and community support when they are no longer surrounded by the unit withwhich they served8

bull Resuming their civilian careers immediately upon their return leaving little time to readjust and decompress from the stressors of deployment9

bull Dealing with the perception by employers and co-workers that their service was ldquotime offrdquo from their

ldquorealrdquo lives and civilian jobs and10

bull Living further away from military installations and treatment facilities which can create barriers to receiving care and increase susceptibility to adjustment issues and psychological health concerns11

Transitioning to civilian life can be challenging for veteransVeterans who experienced emotional or physical trauma while serving are at the greatest risk of having difficulties readjusting to civilian life According to the Pew Research Center survey Difficult Transition fromMilitary to Civilian Life ldquothe probabilities of an easy re-entry drop from 82 percent for those who did not experience a traumatic event to 56 percent for those who didrdquo

Another Pew report War and Sacrifice in the Post-911 Era The Military-Civilian Gap found that nearly half of all post-911 veterans say they have experienced

ldquostrains in family relationsrdquo since separating from the military and nearly four-in-ten believe they have expe-rienced symptoms of PTSD whether or not they were formally diagnosed Sources of stress for veterans after returning may include understanding their bene-fits and accessing care as well as finding post-military employment

Reaching out is a sign of strength The Real Warriors Campaign seeks to connect service members military families members of the National Guard and reserve and veterans to resources that help address the unique challenges

of military life and promote psychological health and resilience The campaign is an integral part of the Defense Departmentrsquos overall efforts to encourage help-seeking behavior for invisible wounds and raise awareness of the available resources Additional efforts by the Defense Department and Department of Veterans Affairs to encourage the use of available psychological health care resources include

bull Adjusting the National Security background questionnaire (SF-86) which asked security clearance applicants to indicate whether they had ever received psychological health care to exclude counseling related to service in combat

bull The National Guard has implemented state directors of psychological health (DPH) and aligned one with each of the 54 Joint Force Headquarters Each DPH is the focal point for coordinating psychological support for National Guard members and their families

bull The Military Crisis Line a toll-free confidential resource that connects service members in crisis and their families and friends with qualified caring responders For confidential assistance call 1-800-273-8255 and press 1 chat online at wwwMilitaryCrisisLinenet or send a text message to 838255 to receive free confidential support 24 hours a day 7 days a week 365 days a year

bull Make the Connection is a public awareness campaign sponsored by the Department of Veterans Affairs that connects veterans and their families with information and resources to help them cope with transitions physical and psychological health concerns and challenging life events Visit wwwMaketheConnectionnet for more information

1 Hoge C and others ldquoCombat Duty in Iraq and Afghanistan Mental Health Problems and Barriers to Carerdquo New England Journal of Medicine Vol 351 pages 13-22 Published July 2004

2 ldquoMental Health Advisory Team (MHAT) V Operation Enduring Freedom 8 Afghanistanrdquo Office of the Command Surgeon and Office of the Surgeon General US Army Medical Command page 173 Published Feb 14 2008

3 ldquoJoint Mental Health Advisory Team 7 (MHAT IIV) Operation Enduring Freedom 2010 Afghanistanrdquo Office of the Surgeon General US Army Medical Command Office of the Command Surgeon HQ CENTCOM and the Office of the Command Surgeon US Forces Afghanistan Published Feb 22 2011

4 ldquoVA Medical Article Discusses Specialized Iraq and Afghanistan Veteran Health Care Needsrdquo Department of Veterans Affairs Published June 12 2012

5 ldquoNumber of Deployments for Those Ever Deployed for Operation Iraqi Freedom and Operation Enduring Freedomrdquo Defense Department Contingency Tracking System Information as of Dec 31 2010

6 Flake EM and others ldquoThe Psychosocial Effects of Deployment on Military Childrenrdquo Journal of Developmental and Behavioral Pediatrics Vol 30 No 4 pages 271-278 Published August 2009

7 ldquoStrengthening Our Military Familiesrdquo Department of Defense Published January 2011

8 Brim William ldquoWho is watching a Guard memberrsquos mental healthrdquo Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Published July 28 2010

9 ldquoAdjusting to Civilian Life after Combat Duty with the Guard or Reserverdquo Military One Source Last accessed Nov 21 2012

10 ldquoReturning to Workrdquo Employer Support of the Guard and Reserve Last accessed Nov 19 2012

11 ldquoAn Achievable Vision Report of the Department of Defense Task Force on Mental Healthrdquo Defense Department Published June 2007

wwwrealwarriorsnet 866-966-1020