Military Working To Reduce Stigma Of Seeking Mental Help

What can the military do to improve its abilities to identify combat stress, and treat troops returning home from a war zone? We speak to the director of the Naval Center for Combat and Operational Stress Control in San Diego about the challenges servicemembers face when they return home from deployment.

Guest

Captain Scott Johnston, director of the Naval Center for Combat and Operational Stress Control in San Diego

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CAVANAUGH: President Obama's address to the nation tonight will no doubt be listened to with great attention at Camp Pendleton. Marines from Pendleton have been prominent in the U.S. force in Afghanistan especially in the dangerous Helmand province. And more marines return home from deployment, the military is trying to find new ways to help veterans cope with combat stress and take away the stigma from mental health services. Joining me now is captain Scott Johnston, director of the naval center for combat and operational stress control in San Diego. And thank you for joining us, captain Johnston.

JOHNSTON: Thank you. It's great to be here.

CAVANAUGH: It's speculated that the president will announce several thousand U.S. troops will be withdrawn from Afghanistan this year. Captain Johnston, what are some of the symptoms of combat and operational stress that returning troops may experience back home?

JOHNSTON: It's important to look at the transition they need to go through. There's a lot of squills our warriors learn in combat that are very helpful for them in that situation, being aware of their surroundings, looking for the differences in maybe the pavement, being aware of what other people may be up to. Of when they come back, those skills aren't important. They need to start making that transition to what a civilian life is like. Looking into your loved ones and making sure they're making that transition. And if they're not, that's what you want to look for.

CAVANAUGH: You're working on better ways to spot these signs and handle combat stress so it doesn't result in problems when the Marines and sailors return home. Why is this important to you?

JOHNSTON: It's really important. We realize that people are gonna have some kind of reaction. But most of the people that come back from combat actually do bounce back to the way they were before. With some kind of support, they can get back to that level of functioning. But there are a certain amount of people that aren't. Those are the people we need to identify. So we're trying to find the best way to screen and identify these people who need additional support.

CAVANAUGH: Why is it sometimes most difficult to treat this kind of stress than even severe physical injuries?

JOHNSTON: Partly because you can't see it. You can't give a blood test, it's not a wound that's visible. It's more by behavior and how the person is acting. You have to pay more attention to what's going on with the person, and what kind of feelings and reactions they may be having inside of themselves.

CAVANAUGH: In the introduction I mentioned stigma. Does that stigma, seeking mental health services still exist?

JOHNSTON: It does. But the military has made great strides in this over the last few years. We're looking at some great senior leaders that are coming forward and talking about their own stress reactions they had, and how they went forward and got help, and were able to get back to optimal functioning. So it's with role modeling appropriate behavior that can really start to educate people to help them realize they can come forward. Ask it's not gonna have negative effects on their career and person.

CAVANAUGH: What are some of the concerns you've heard from marines when they want to seek out mental health services for combat stress but they've waited or been reluctant to? Why have they waited this long.

JOHNSTON: We're finding that almost half of the people don't come forward to get that help. They'll be afraid that their fellow marines or sailors will see them as weak. And they're very close, very tight with the people that they've deployed with. And if they have a concern that their fellow may see them as week or not being strong enough to watch their back, that may be a concern. Actually with the research is showing this, actually the opposite is true. People are seeing it as a situation of strength or courage to come forward and get the help that they need.

CAVANAUGH: We've heard a lot on this show because we've talked about this subject more than once that to many there seems to be an inbuilt contradiction in training marines and sailors to be tough and being able to take it, and being able to take gruelling situations and then also expecting them to be sensitive to their own stress levels.

JOHNSTON: Yes. That's an older way of thinking about it. Upon what we're encouraging marines and sailors to do is to kind of embrace a newer warrior ethos, one that realizes that the psychological health of the individual is key in being able to carry out the missions they need to. They need to make sure their mind is fine tuned and ready to take on that mission the same way that their equipment does. If you frame it that way, and build in that resilience so people have optimal functions, then they can embrace it.

CAVANAUGH: Talk to us more about this warrior ethos, this new warrior ethos that does include the idea of basically how you're feeling, how you're coping.

JOHNSTON: There used to be this kind of idea that kind of a go or no go mentality, that either the person was fit and ready to get engaged in the fight or that there was somehow that they were broken and needed to go to medical. What we're finding is that there's this new ethos coming forward that leaders can embrace these very natural reactions people are gonna have. Obviously war is a transforming event. We realize it's gonna affect people and there's gonna be natural reactions that everybody's gonna have. What we can find is that the leaders can embrace these reactions and lose their leadership tools to make sure the person realizes this is normal and get them back to opt mill functioning.

CAVANAUGH: I want to invite people listening if they have taken advantage of any combat stress treatments or if they'd like to share their story with us, they can join us at 1-888-895-5727. I'm speaking with captain Scott Johnston know, director of the naval center for combat and operational stress control here in San Diego. You are involved with this project, with Camp Pendleton marines, to develop a better model for building resiliency before deployment and monitoring stress offer deployment.

JOHNSTON: We used to wait until people had symptoms of psychological illness and treat them. And we realized that is too late in the game. We can really help people in theatre by getting mental health providers with the units deployed in Afghanistan and Iraq. And more recently, we're developing resiliency programs making the person the strongest warrior they can be before they deploy to minimize the possible effects of psychological illness.

CAVANAUGH: How is this going over with marines?

JOHNSTON: They're really bracing it. There is this kind of war ethos we talked about, and this desire to be the optimal performers they anybody. What we're realizing from sports medicine and 134 other Chinese models that there's this warrior ethos, the person needs to be the strongest they can be, and their psychological conditioning can affect that.

CAVANAUGH: How does the change the counselors themselves?

JOHNSTON: In which regard?

CAVANAUGH: In the regard of attending to marines before deployment, after deployment. What do you guys have to learn differently?

JOHNSTON: What we have to reason differently is that they're gonna come to us already with some of these skills, that they have some of those preventative skills with them already. They know that proper hygiene is important, getting rest and nutrition. So they're coming in with some kind of basic level of resiliency tools already. Then we can work with them on that to further support their recovery or building of further resilience.

CAVANAUGH: I remember we did I think a couple of programs about the members of the third battalion 5th regiment when they come home and when they were preparing to come home from Afghanistan. There was a concern because the 35, as it's known, suffered more casualties than any other similar sized unit in Afghanistan. Down how they're doing?

JOHNSTON: That has been a great example. That's one that directed all the way up to the commandment of the Marine Corps, we need to have special attention because of what they saw. We're finding that that unit cohesion that was developed with this great leadership and tight bonds really was a protective factor for them. They are getting through this difficult time because of that strong leadership, that unit cohesion. It's helped them not develop yours of psychological illness.

CAVANAUGH: Bill is on the line from Carlsbad. Welcome to Midday Edition, bill.

NEW SPEAKER: I just got back from Afghanistan a week ago, and I was listening to your program. I'd like to suggest that a muscle memory related stress reliever like racquetball is gonna put you in that same type of tense mind set is definitely working.

CAVANAUGH: Thank you for the call. How would you like to respond captain Johnston?

JOHNSTON: If I heard him correctly, he's saying that physical activity is helping him with that transition?

CAVANAUGH: Especially stressful physical activity like racquetball.

JOHNSTON: He's absolutely correct. The highly kinetic environment of the combat situation is difficult to just kind of throw the switch off and come back and spend the time going to a mall and a movie. We're finding we need to help them with this transition. Sometimes the more adrenalin producing activities can help them make that transition back to a civilian life.

CAVANAUGH: That's fascinating. What do you think the larger community of San Diego should be aware of, the kind of things returning troops are dealing with when they come back to live among us as San Diegans again?

JOHNSTON: The biggest thing that I come away with, and I deal with warriors returning, I have a sense of just feeling proud about the work that they're doing for our country and willing to put their life on the line for all of our deals. So being thankful about that I think is a huge step that we can do. Also justice being aware that they are gonna be going through this transition, and if they jump when hay door slams or have other kind of reactions, we realize they're just making that challenging transition from combat to being back in garrison.

CAVANAUGH: We often hear that perhaps some of this stress is worked out on our roads. Is there any increased danger to the community because of people dealing with postcombat stress.

JOHNSTON: We're aware of that your. There's a lot of education that comes goes into safety management. Driving in the streets in Afghanistan is different than driving on the streets in San Diego. So they certainly get lots of education about that, and we make sure that they're ready before they get back on the streets.

CAVANAUGH: How much money is the military investing in handling combat stress better?

JOHNSTON: There's a lot of money. Ten years ago when we started getting involved in a different war, Congress made it a point to really address this. They've started hundreds of different initiatives, the native center for combat and stress control, trying to address this multitude of issues that people are coming back with so we can provide that support network for our returning warriors.

CAVANAUGH: I imagine you're looking at this as sort of a long-term commitment?

JOHNSTON: We're going to have thousands of more warriors returning. We need to do our best to make sure they get the support and treatment they need if that's what they need. But also to take the time and resources to make sure that we are training them ahead of time. Even if we do back off from combat operations, we still want to train our force to be the most resilient and the most optimum performing they can be.

CAVANAUGH: How will you begin to know if this new approach is working? And I mean working in a sense that's better than the other things that used to be tried by the military to help returning veterans?

JOHNSTON: There's a lot of great ideas out there. More and more we're trying to make sure we're bringing science to bear with all of these issues. There's a variety of different databases we track. Their utilization of services, medical services, indicators, use of alcohol or incidences out in town. There's a lot of different areas. How well they're positively functioning. We we're looking at a lot of these metrics that we can follow to see which of the interventions we're doing are more effective.

CAVANAUGH: I know you don't want to comment on what the president might talk about tonight, if indeed he does talk about more troops returning from Afghanistan, you think you're gonna be ready?

JOHNSTON: Yes. What I can say is that we're ready to handle these troop when is they come back. They come back over a period of time, and we have a wide variety of services that we're really ready to support them and help them with that transition to garrison.

CAVANAUGH: I've been speaking with captain Scott Johnston director of the naval center for combat and operational stress control in San Diego. Thank you very much.

JOHNSTON: Thank you.