To Successfully Execute the Mental Health Mission in Afghanistan

Disclaimer: The opinions or assertions are those of the author and do not necessarily reflect those of the Army Medical Department or the Department of Defense

Mental Health or Combat and Operational Stress Control (COSC) Teams have been deploying with infantry units to Afghanistan in support of Operation Enduring Freedom (OEF) since 2001. Consideration of the following seven areas will help future providers develop a comprehensive plan to successfully execute the mental health mission in Afghanistan.

The prospect of deployment tends to elicit an array of emotional responses. Investing energy in sound deployment planning will not only blunt this normal situationally-induced anxiety, but, perhaps more importantly, it will pay future dividends as the process forces one to develop a preliminary concept of operations for the mission.

* Know the mission. Participate in the pre-deployment site survey either by attending the actual visit or contacting the representative from your command to ensure that specific issues are investigated on your behalf. Obtain previous after action reviews and directly communicate with providers recently or currently assigned to your projected area of operations. Immediately establish relations with your future chain of command.

* Know the resources. You may be pleasantly surprised to identify personnel assets in theater that you were not expecting. Or, perhaps, there may be additional populations that you will unexpectedly inherit. Prepare for both scenarios.

* Know your team. If possible, assemble and work with your team prior to deployment. This will help build professional and personal relationships, while identifying areas of concern, potential personality conflicts or clinical training deficits prior to deploying.

* Procure psychoeducational materials and relevant training. If you have pamphlets, seminars and power-points already prepared, bring them. The Army Medical Department School at Fort Sam Houston offers the most up-to-date training in combat and operational stress control and a comprehensive DVD on a myriad of military specific mental health issues. Another useful resource for presentations and handouts is the US Army Center for Health Promotion and Prevention.

* Sharpen your skills. Many officers and enlisted technicians find themselves fulfilling non-clinical roles in garrison. Rest assured, you will be a clinician first in theater. You may negatively distinguish yourself if you arrive unprepared to do an intake, perform a command directed evaluation or maintain a modest case load. Expect the vast majority of clinical work to revolve around occupational discord, relationship problems, sleep difficulties, somatic complaints, and acute stress reactions, along with preexisting anxiety, mood and personality disorders. Take steps to improve or refresh your clinical skills, and the requisite supporting documentation to support same, before departure.

* Military basics. We often marginalize certain military tasks in garrison that are everyday activities in theater. To avoid embarrassment, understand command and rank structure, and become fluent in the negotiations needed between different branches of service. Arrive in good physical condition, qualified on your weapon with good command of clearing and cleaning procedures, and with a solid foundation of terminology, equipment and basic tasks, such as assembling body armor and protective gear.

2. Command Delineation

Mental health missions in the deployed environment are ever-increasingly joint service endeavors. Further contributing to a convoluted chain of command, your unit may relinquish various elements of command to different agencies. For example, in OEF VII, the Division Mental Health Service (DMHS) from the 10th Mountain Division, Fort Drum, NY arrived in theater for a 12-month deployment in early February 2006. The company to which DMHS was assigned maintained administrative control, but ceded operational control to the 14th Combat Support Hospital. Shortly thereafter, an Air Force combat stress team arrived in theater, followed by a small Brigade mental health team. Three mental health officers in-charge and four chains of command often confused units and providers downrange, not to mention the teams themselves. Establishing clear roles and expectations is vital. Do not wait for others to complete this essential task for you - chaos can result if these relationships are not clarified early in your deployment.

3. Combat and Operational Stress Control

The current concepts of combat and operational stress control comprise the foundation of mental health services in OEF. The country of Afghanistan has a larger geographic area and population than Iraq. Further, the climate and geography vary considerably. From scalding desert, and high plains and insulated valleys, to rugged mountainous terrain, the theater itself presents an array of novel challenges. To cover large areas of logistical and operational importance, rustic forward operating bases and firebases are strategically placed throughout the theater. Due to mission demands and personnel limitations, it is impossible to staff each outpost with mental health providers. Hence, the concept of the mobile mission, stressing resiliency and preventative services at forward locations, was born. Mobility is critical to mission success in OEF.