F e a t u r e s
seems implausible, since within the UK Armed Forces it is regular combat troops who carry out the majority of the combat-orientated duties; the majority of reservists carry out less risky work, often fulfilling specialist roles; such as media handlers, medical personnel and Force Protection duties. It is therefore more likely that some reservists perceived themselves to have been exposed to higher levels of combat experiences because of their lack of prior experience of such situations.
Multiple deployments Another difference to the US is that, although many UK military personnel have now experienced multiple deployments to either one or both operational locations, the latest research found no association between multiple deployments and the reporting of mental disorders. This may be owing to the Healthy Warrior Effect; this is when those who are struggling to cope with deployment as a result of physical injury and illness or mental health problems are made temporarily non-deployable, thus those deploying more than once are likely to be more psychologically robust.
The finding of no association with multiple deployments supports the utility in moderating psychological injury of the UK military’s Harmony Guidelines, which outline the recommended number of deployments and length of time between deployments for the UK Armed Forces. Other research has also shown that it is the actual length of time deployed over a three year period, rather than number of deployments, which is a more important determinant of mental health.
Another issue which had vexed the US military was their consistent finding that the rates of psychological disorder, in particular PTSD, appeared to continue to rise over the year following return from deployment. This finding was somewhat perplexing since the majority of prior PTSD research had reported decreasing levels of traumatic stress symptoms over time. There is no clear explanation for these differences given the similarities in exposure, background, threat and so on.
www.raf-ff.org.uk
Delayed PTSD is in most studies unusual, although this is often confused with delays in presentation, which is far from unusual in both countries. It may also reflect some personnel finding it increasingly difficult to deal with the transition from an operational theatre to life as usual or concern about forthcoming future deployments, which may possibly explain the higher rate of increasing symptoms in US personnel as they deploy for longer than UK troops (12 months v 6 months) and more frequently. Whatever the nature of the increase, the US and UK findings suggest that it may not be safe to consider the effects of singular traumatic incidents as being the same as exposure to multiple incidents over many months whilst deployed in a high threat environment.
Contemporary approaches of supporting
Because of evidence which suggests that operational deployment may impact upon the psychological health of troops, especially those with a combat role, military planners implemented a variety of operational stress management strategies. Interestingly, nations who contribute personnel to current operations have approached the provision of mental health support differently.
The UK military stance is that the psychological welfare of troops is primarily a chain of command responsibility whereas other nations place the role of the leader as the paramount determinant of the mental health status of a military unit. Other nations place more responsibility for personnel’s mental health with healthcare providers.
Use of decompression One of the UK approaches to supporting the mental health of military personnel, not used by US forces, is the use of third location decompression (TLD). TLD is a pause in a third location, that is neither in theatre nor back at home, to allow troops who have fought together to ‘unwind’ together before returning to their home base areas. For UK personnel, the TLD process takes place over 24-36 hours in Cyprus in a dedicated military facility. The recreational activities on offer are aimed to promote social support and allow informal discussions, both of which have been previously found to be beneficial for mental health. Personnel also receive psycho-education briefings which focus on the management of traumatic stress, risky driving and adjustment issues.
Although there has been relatively little robust research into whether these briefings are useful, what evidence there is suggests
that they may well be helpful for some. A substantial survey of more than 11,000 troops found that whilst the majority had been ambivalent or reluctant to engage in TLD before they arrived, 90% of troops reported finding their time in Cyprus to have been helpful. However, although it is encouraging that many find it acceptable, this does not ipso facto mean that it does reduce the incidence of post deployment mental health problems.
Another mechanism for supporting troop’s mental health is the use of a peer delivered psychological first aid process called trauma risk management (TRiM). The aim is to provide personnel, who ordinarily carry out non-medical roles, with the skills to enable them to monitor how colleagues are coping with the psychological effects of being exposed to potentially traumatic events. Research confirms that the TRiM process is also highly acceptable to military personnel. One intended aim is to reduce the stigma known to be associated with seeking help.
Conclusions
Whilst the mental health of Service personnel remains a much debated topic, it is often forgotten that the majority of Service personnel are not detrimentally affected by their time in uniform; in fact in many cases the opposite may be true.
Modern research methods have allowed a more detailed understanding of the factors that influence the mental health of Service personnel. Mental health problems in personnel over the last hundred years of warfare were, and remain, a balance between vulnerabilities acquired before a person joins the Armed Forces and exposure to traumatic, and other stressful, events during their military service. Whilst more research will undoubtedly increase our understanding of why it is that the majority of personnel remain resilient to the potentially detrimental effects of deployment, it is inevitable that some Service personnel will become damaged as a result of doing their duty today as they have been in previous wars.
Note from the FF: The RAF FF welcomes increasing research into the mental health of serving personnel and continues to press for further investment in researching the impact of operational deployment on the mental health of other family members.
To read more about this topic go to:www.
kcl.ac.uk/kcmhr ‘publications’. See also
www.battlemind.co.uk
Autumn 2010 19
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