The Officer - Fall 2016 - 40

into civvies, see a civilian therapist and pay with a personal check to escape being identified within the military system as a person getting mental health care. The current system fails to adequately detect mental health issues because of this stigma and the incentive for service members to lie about their condition out of fear it will be held against them. Service members could instead be the beneficiaries of the military's advanced health care resources, dealing with their issues. The proposed change to the PULHES ratings would show that PTSD is a condition that service members and others can often function with and be great members of their teams. In fact, being with their teams and battle buddies has been shown to often help. Assessing for triggers This form of preventive care should focus on events or environments known to trigger behavioral health conditions within service members. The archetypal environment known to trigger mental health care problems is participation in combat. People who work in environments with toxic chemicals or who are exposed to dangerous biological agents are screened and assessed to see if they have picked up any dangerous material. In the same manner, combat zones should be seen as potentially psychologically toxic environments. (We also know that the stress of combat can build inner strength and resourcefulness, although combat-type stress experienced over lengthy durations or repeatedly is rarely generative.) Service members participating in these environments should be assessed upon departure to identify any signs of problems. There should be follow-up mental examinations. Like conditions caused by toxic chemical or biological agents, the symptoms of mental health problems are not always immediately apparent. Currently, the law does not require the secretary of defense to give a mental health assessment to service members who have deployed when they are discharged or leave the military. Without these follow-up examinations, a worsening mental health issue will not be caught by a medical professional and could exacerbate until the service member becomes suicidal. There needs to be awareness on the health care provider's part to assess the condition of service members who have experienced likely stressors to identify any signs of mental illnesses. For this to occur, DoD, VA and private medical providers must have greater coordination to eliminate gaps in mental health care coverage. 40 THE OFFICER / FALL 2016 Recognizing stress on and off the battlefield Regarding mental health as a readiness issue can provide innovative approaches to help service members contend with the stress. Great complexity often faces combatants as they increasingly engage in counterinsurgency conflict; this involves distinguishing between the enemy and "innocent" civilians. Frequently, U.S. combatants must make morally charged decisions in unclear situations, made more difficult by the enemy's use of civilians or protected sites, such as mosques, as shields. These difficult situations, exacerbated if a decision proves wrong, can plague troops long after they leave their war. Often, their war never leaves them. The military trains service members for these situations in scenarios. While such training has vastly improved since the beginning of the present war, it cannot possibly resolve all the difficulties troops will face when making tough decisions under enormous stress. It has, however, proven effective, as reflected in the lowered instances of casualties inflicted by U.S. forces among innocents. The assumption that only combat breeds PTSD is unfortunate, and addressing solely those whose service is associated with combat is insufficient to deal with mental health issues and the resultant military suicides. According to the DoD 2013 suicide event report, more than half the service members who attempted suicide had never been on a combat tour. The problems identified as triggering suicide attempts included the end of a romantic relationship, or financial or legal troubles. Such common emotional stressors can aggravate mental health issues just as sharply as combat for military personnel. In addition, it has been found that service members who served outside combat could experience problems similar to those faced by personnel who served in combat. For example, service members stationed at the Pentagon may make daily decisions affecting the lives of comrades participating in overseas contingency operations. These decisions have an impact on the course of war and sometimes result in the deaths of GIs. Consequently, many in such stateside or "rear area" staffs who make these critical decisions carry regret or guilt. Under existing law, there is no requirement for them to get the same level of mental health assessment as service members who served in contingency operations. There should be. Training can be designed to resolve both combat-related and personal stress. Besides combat simulation, training can focus on increasing service members' coping skills to build resilience. Coping skills help people develop perspectives that make them feel better about how they handled a certain situation. According

Table of Contents for the Digital Edition of The Officer - Fall 2016