By Regena Kowitz, NCCOSC Sr. Strategic Communications Specialist
In health care, we focus a lot on prevention. We’ve developed screenings to provide early detection for cancer, diabetes, and heart disease. We’ve put our efforts into teaching patients about the benefits of a healthier lifestyle including tobacco cessation, proper nutrition and the benefits of exercise. We even have Immunization Awareness Month to promote the benefits of vaccinations to stave off life-threatening and debilitating diseases.
These are all great initiatives, but what have we done for mental health care in terms of prevention? How do we screen for potentially life-threatening and debilitating psychological illnesses and injuries? What kind of prophylactic measures do we take when it comes to maintaining optimal mental health?
In Navy Medicine, we are making significant strides in developing screening tools, implementing prevention measures and educating Sailors and Marines about achieving and maintaining psychological health and well-being. After all, mental health is directly tied to individual readiness, which is tied to unit and mission readiness.
Behavioral Health Screenings
When it comes to mental health screenings, there are currently no blood tests, radiological exams or other biological markers to determine whether or not someone has, or will have, a psychological illness or injury. The best screening tools that we have in mental health are surveys (also known as assessments and questionnaires). If you’ve been in the military for any amount of time, it’s more than likely that you’ve taken at least one survey assessing your mental health.
The survey most service members are familiar with is the Pre-Deployment Health Assessment, which checks fitness to deploy and sets a baseline health status for individuals prior to deployment. Other assessment tools used by military providers include:
- Post Deployment Clinical Assessment Tool (PDCAT) – used to assess service members with post-deployment mental health concerns including PTSD, depression, anxiety and alcohol use
- Patient Health Questionnaire (PHQ) – three different versions of this survey screen for depression, anxiety and alcohol abuse among other concerns
- PTSD Checklist (PCL) – three versions of this survey assess trauma-related stress
- Generalized Anxiety Disorder Scale (GAD) – used to assess various signs of generalized anxiety disorder
These surveys provide important information to mental health professionals to determine whether or not a Sailor or Marine has any psychological health concerns that may require intervention and treatment. By identifying potential mental health illnesses and injuries in their early stages, as with any physical disease or trauma, we can improve outcomes by making sure that service members receive the appropriate support, diagnosis and treatment sooner, rather than later.
As we engage Sailors and Marines who are taking mental health surveys, it’s important to help them understand that the questions they’re being asked are part of a tool, much like any exam or diagnostic procedure they encounter in sick call, and that answering honestly and completely helps providers determine what, if any, mental health care they need.
Military service, while rewarding, is demanding in a way that no other job can be. The stressors service members face are unique – moving every few years, communal living aboard ship, extended working hours while underway or during an exercise. And, these are just the day-to-day stressors. Add to those the life-threatening situations many Sailors and Marines face during deployment and the amount of stress faced by the military is unparalleled.
As nice as it would be, there aren’t any vaccinations that can prevent mental injury or illness.
But that doesn’t mean there aren’t preventive measures that can safeguard the psychological health of our Sailors and Marines. Building skills that promote resilience can help mitigate stress injuries. The Naval Center for Combat & Operational Stress Control (NCCOSC) facilitates research and develops evidence-based programs that provide Sailors and Marines with the necessary tools to build and maintain resilience.
- Optimism. Maintaining positive thoughts and beliefs, having hope and positive expectations, helps individuals keeps a sense of perspective when faced with difficult situations. Optimism can be learned by finding something positive – the “silver lining” – in any situation.
- Flexible thinking. The ability to consider different outcomes and perspectives is a skill that helps reframe negative thoughts into positive one. When faced with uncertainty and unpredictability, flexible thinking allows adaptability.
- Behavior control. Being skilled at regulating thoughts and behaviors helps individuals react appropriately in any situation. This can be learned through employing various relaxation techniques including meditation, visualization, deep breathing, progressive muscle relaxation and yoga. These techniques help manage stress and improve focus, leading to optimized performance.
- Positive coping. An active and constructive approach to problem solving enables individuals to more effectively manage stressors. Strategies for building positive coping skills include maintaining physical health, strong social support and developing a fulfilling spiritual life.
While resilience isn’t a magic bullet, it can be effective in helping our active duty population manage operational and combat stress, and meet the challenges they face as 21st century Sailors and Marines.
Psychological Health Education
One of the most important components of prevention is education. First and foremost, dispelling myths and mis-perceptions associated with mental health conditions and treatment must be a key component of all education efforts. Education should focus on:
- Mental health reactions. Early identification of and intervention for psychological wounds is vital because left untreated, they can lead to long-lasting disability, whereas early treatment can result in a more complete recovery.
- Mental health injuries and illnesses. Include science-based information about causes of psychological illness and injury, symptoms associated with different diagnoses and when to seek professional help.
- Treatment options. Include information about varying levels of treatment from outpatient to inpatient, different types of providers who can treat mental health concerns, alternative and traditional treatments, and appropriate pharmacological interventions.
- Psychological wellness. Provide evidence-based information on how service members can build and maintain mental health.
- Career impact. Given the nature of military service and the emphasis on mission readiness, it is important to educate service members on how different mental health diagnoses and treatments may impact military service, short-term and long-term.
Fighting stigma is also an integral part of education. Sailors and Marines often don’t seek out help for mental health problems because of stigma – fear of being seen as weak or hurting their career. Those misperceptions are usually based on a lack of understanding. By providing education about all aspects of mental health, we can break down barriers to care and help service members understand that the sooner they seek help, the sooner they can heal.
Focusing on mental health prevention and early intervention is one of the best ways to improve force and psychological readiness. Through appropriate behavioral health screenings, psychological “prophylaxis” measures, and mental health education, we can create a culture that doesn’t stigmatize mental health treatment and encourages Sailors, Marines and leaders to be proactive in maintaining psychological wellness.