Division mental health in the new brigade combat team structure: part I. Predeployment and deployment

OBJECTIVE: Recent Army transformation has led to significant changes in roles and demands for division mental health (DMH) staff members. This article focuses on predeployment and deployment. METHODS: Surveillance of Combat and Operational Stress Reactions data, review of DMH implementation plans, and observations by staff members, providers, and soldiers were reviewed. RESULTS: During the course of the deployment, the Task Force Baghdad DMH unit had >22,000 soldier encounters with 5,542 clinical encounters. The duration of the deployment and increased levels of threat later in the deployment resulted in increased stress problems but not a substantial or sustained increase in mental health casualties. CONCLUSIONS: Predeployment education and communication probably eliminated some problems during deployment, and communication among mental health and command units during deployment resolved most problems encountered.     

Early mental health intervention in combat situations: the USS Stark

The United States Army Europe Stress Management Team (USAREUR SMT) is designed to assist victims of hostage, terrorist, and disaster situations. Early intervention is intended to prevent the development of chronic posttraumatic stress disorder. This paper describes the operation of the SMT following the missile attack on the USS Stark in the Persian Gulf. Therapeutic approaches as well as some observation on the group process are described. The therapeutic principles and organizational flexibility necessary for early mental health intervention in disaster situations are illustrated.     

Assessment of changes in mental health conditions among sailors and marines during postdeployment phase

Previous research regarding the mental health ramifications of military deployments focused on the U.S. Army population. As part of its deployment health surveillance mission, Navy and Marine Corps Public Health Center conducted a study of the Department of Navy population to identify reported mental health effects associated with Operation Iraqi Freedom, describe mental health care utilization by returning service members previously deployed in support of Operation Iraqi Freedom, and examine the relationships between self-identified risks and provider referral practices. Despite a considerable number of self-reported mental health concerns, referral for mental health consultations and health care utilization were rare. The psychological well-being of service members is essential to the military's optimum functionality and operational readiness; therefore, continued research in this area has significant bearing on future force health protection efforts. Additionally, this study highlights the need for further research on deployment-related mental health concerns.     

The formation and application of an overseas mental health crisis intervention team, Part II: Application

In the preceding article, the authors described the formation of an overseas mental health crisis intervention team. In this paper, the application of the United States Southern Command Crisis Intervention Team in the aftermath of a recent tragedy in Panama is described. A chronology of the disaster, involving two helicopter crashes which left 11 dead, is presented. The intervention that followed is described in detail. The emphasis is on four main areas: education, identification, process, and follow-up. The authors present their experience in an effort to provide an intervention strategy for other isolated mental health providers.     

Changing the face of Abu Ghraib through mental health intervention: U.S. Army mental health team conducts debriefing with military policemen and Iraqi detainees

A critical incident stress debriefing (CISD) was conducted with two U.S. Army military police officers (MPs) and 11 Iraqi detainees who experienced the untimely death of a detainee. The CISD was conducted by a psychiatrist and a psychologist, who used the seven-step debriefing model created by Jeffrey Mitchell in 1983. A primary goal of CISD is to diminish the impact of a traumatic event and ultimately to prevent the onset of post-traumatic stress disorder. An unexpected finding was that the debriefing provided an opportunity for the MPs and detainees to clear preconceived notions about each other, enhancing mutual collaboration. The purpose of this article is to describe how a mental health team used a CISD as an intervention in treating MPs and detainees who experienced a common tragic event.     

Op Telic--a field mental health team in the general support medical setting

The recent conflict in the Gulf saw the large-scale deployment of Field Mental Health Teams (FMHT), in support of 1 UK Division and its constituent brigades. This article describes the activities and findings from a FMHT deployed alongside a General Support Medical Regiment covering the divisional rear area. The rate of psychiatric casualties was much lower than anticipated, but the expected bias towards less experienced personnel and reservists was noted. The article covers all stages of the operation from pre-deployment training, reception, staging and onward integration, operations, redeployment and homecoming, describing the core activities of the FMHT at each stage.     

Communicating in organizations, part II: Tips for leaders when starting a team

Team projects are an important part of the innovative work done in large organizations. Individuals from various portions of the department or organization are chosen who have different areas of expertise, backgrounds, and personalities. In a properly functioning team, the group decisions made will be superior to those made by any individual on the team. There are many different conversations that are necessary during a team project to make sure that all goes optimally, and this article will focus on communication tips for leaders when starting a team.     

The formation and application of an overseas mental health crisis intervention team, Part I: Formation

The creation of an overseas mental health crisis intervention team is described. The authors discuss the unique aspects of an overseas low intensity conflict environment and the importance of immediate mental health responses to disaster situations in such theaters. Key elements in the formation of the team are the use of local resources, command endorsement, and an emphasis on education of commanders and team members. Examples are cited of other military response team deployments. The authors present their experience in Panama as a model for other providers in similar environments.     

The effects of mental health symptoms and organizational climate on intent to leave the military among combat veterans

Frequent deployments to Iraq and Afghanistan have placed a strain on military retention. There is a need to determine contributing factors predicting intent to leave the military. The purpose of this study was to determine to what extent soldiers' mental health symptoms and perceptions of organizational climate are associated with intent to leave the military. Participants (n = 892) were soldiers of one infantry brigade combat team stationed in the United States, anonymously surveyed approximately 6 months after returning from a combat deployment to Iraq. The survey assessed overall deployment experiences, mental health symptoms, and perceptions of organizational climate. Results showed that soldiers reporting higher perceived organizational support were significantly less likely to report intent to leave and those screening positive for anxiety were significantly more likely to report intent to leave than those not screening positive. Implications of these results for Army clinicians and career counselors are discussed.     

Transcatheter interventions for the treatment of peripheral atherosclerotic lesions: part II.

Transcatheter endovascular procedures are increasingly used to treat symptomatic peripheral atherosclerosis. This second part of a two-part review assesses the existing supportive evidence for the application of recently introduced transcatheter treatments for lesions that cause cerebrovascular ischemia and stroke. Studies were identified via MEDLINE (January 1993 through April 1999) and reference lists of identified articles. When multicenter prospective randomized trials or other high-quality studies were unavailable, studies with at least 50 patients per treated group and a minimum follow-up duration of 6 months were included. For each application, the authors assessed the quality of evidence (efficacy, safety, and, where available, cost-effectiveness) and made recommendations with appropriate caveats. Although recommendations based on proven efficacy and cost-effectiveness cannot be made in general, the use of transcatheter therapies can be supported in specific circumstances based on expected reduction in procedure-related morbidity and/or mortality. It is hoped that the identification of deficiencies in the literature will inform and inspire critically needed research in this area.     

Exercise and mental health in the pediatric population

Although the generally accepted belief in the psychological benefits of exercise for children has very little documentation by well controlled studies, the risk:benefit ratio nonetheless tends to favor exercise when competition is sensibly controlled. The field is a fertile one for longitudinal and developmental investigations employing more sophisticated psychological measures and appropriate physiological assessment. Studies using self-concept measures in very young children may find less change after exercise than those using a more age-specific developmental scale, such as the Vineland Social Maturity Scale or human figure drawings. Exercise programs for childhood research may be more informative when natural exercise patterns are observed than when artificial regimens are imposed. The mechanism through which exercise effects psychological change remains unidentified; the beta-endorphin theory suggested by Carr was not documented when Markoff, Ryan, and Young discovered that naloxone, an endorphin antagonist, failed to reverse the mood elevation associated with running. The important effects of exercise on the immune system recently reported in adults have not been investigated in children. The possible implications of my recent finding of a significantly reduced level of absolute lymphocytes among a large group of hospitalized depressed adults remain to be assessed but suggest directions for research. Having treated a 10-year-old Little League player with a generalized anxiety disorder; a 7-year-old Pony League outfielder terrified over the possibility of being hit in the head with a baseball; and a 9-year-old with peptic ulcer associated with a Little League all-star selection, I plead for the encouragement of sports for pleasure rather than glory, while at the same time recommending regular and age-appropriate exercise for children. Using our research findings, we have developed a profile of psychosomatic fitness, an optimal state of health in which there is an accurate balancing process involving mind, body, and spirit through attention to how we live and regard others. No one may possess all the characteristics of this profile, but it is an ideal. The extent to which one may achieve psychosomatic fitness may vary from time to time, depending on one's unique circumstances, but its attainment seems to be related to will power, motivation, and respect for the dire consequences of failure.     

Women in the Gulf War: combat experience,exposures, and subsequent health care use

The expanding role of women in the military raises questions related to the military experiences of women serving in major conflicts. We assess the military experiences and postwar health care use of women who served during the Gulf War. Data from a population-based survey of military personnel serving between August 1990 and July 1991 assessing military preparedness, combat experience, occupational and other service-related exposures, and health care use were analyzed. Deployed women were more often in the Army, single, without children, college educated, and reported fewer vaccinations. Deployed men and women had similar military experiences; however, men more often participated in combat. Deployed women had more outpatient and inpatient health care use 5 years after deployment and more often received Department of Veterans Affairs compensation than men. If these important differences in exposures and health care use are confirmed in other studies, optimal training and deployment preparedness strategies should be reconsidered.     

Outpatient care use among female veterans: differences between mental health and non-mental health users.

We examined the influence of mental health service use on outpatient health service use among female veterans. We conducted a retrospective and correlational study of treatment-seeking women and their pattern of health service use and the relationship between mental health and somatoform symptoms and service use. Data were obtained from a self-report measure designed to screen for mental and somatoform symptoms and from a federally maintained database of all outpatient contacts. Women who used mental health services were more likely to have a greater number of non-mental health visits than women who did not. The most commonly endorsed somatoform symptoms were feeling tired or having low energy and pain in extremities and joints. These symptoms were correlated with non-mental health service use, as were back pain, menstrual pain or problems, and trouble sleeping. We conclude that a history of somatoform symptoms might increase rates of health service use despite treatment for mental problems.     

Multi-institutional analysis of computed and direct radiography: part II. Economic analysis

PURPOSE: To compare economic aspects of equipment configurations, productivity levels, and patient waiting times in the performance of computed radiography (CR) and direct radiography (DR). MATERIALS AND METHODS: The study received internal review board exemption status, without the need for informed patient consent. Data from four study sites were used to calculate the CR-DR crossover point (defined as the point at which the cost-effectiveness of DR equals that of CR) and CR-DR annual cost differentials. Analyzed variables included equipment and operating costs, examination volumes, and productivity. A program was developed to simulate patient arrival times, number of patient examinations, and patient waiting times on the basis of average annualized parameters for each of the four clinics. Sensitivity analyses were conducted to assess utilization rates and determine cost optimization. Utilization rates were compared with the number of excess long-stay CR patients (ie, patients who spent more than 30 minutes waiting in the radiology department prior to CR examination) and with the cost (per excess long-stay CR patient who waited more than 60 minutes) averted by using DR. RESULTS: Excess annual costs for DR over CR at the four sites ranged from $50,757 to $75,303. At extrapolated levels of economic penalties for long waiting times, the crossover point at which the DR cost became justifiable was when CR capacity utilization rates approached or exceeded 80%. CONCLUSION: In the current practice environment, with capacity utilization rates well below 80%, CR is likely to be a more cost-effective technology for the majority of general radiography providers.