Mental health and operations

Deployments can be highly rewarding but they also require one to cope with multiple demands and unique stressors. There are many different sources of deployment stress. Operational stress results from the demand of working to accomplish mission tasks and encompasses all the physiological and emotional stresses encountered as a result of the danger and mission demands of operations, including exposure to adverse environments and events. Separation stress results from being away from home and family. Adjustment stress is the demand of adapting to new day to day environments where daily routines are changed. Finally, reunion stress results from the common challenges associated with transitioning from an operational environment to the environment and routine back home.

Reactions to sources of deployment stress can range from adaptive to maladaptive. The signs and symptoms related to deployment stress fall along the MHCM (page 8); and leaders’ responsibilities also fall along this continuum and include preventive actions (green zone — Shield), responding to stress reactions (yellow zone — Sense), and managing mental health casualties (orange-red zone — Support). This section will briefly review each of these areas.

Shielding Actions: Education and Prevention

As was discussed earlier in the document, there are some key leader actions that may play a protective role in preventing the development of combat/operational stress reactions or injuries. First, ensure adequate and realistic mission focused training, as well as specialized training on the development of key stress management skills (The Big 4). Further practice of the skills may ensure sailors/soldiers/air men and women use these skills during the operation. Next, strong leadership and unit cohesion are keys to managing stress and need to be fostered prior to any deployment and continue to remain essential throughout the mission. Third, preventive medicine is an important consideration in sustaining a fighting force and ensuring that CAF personnel are able to continue to perform during operations. In any operational plan, consideration needs to be given to such things as hydration, sleep and rest schedules (refer to sleep section of this guide), time zone acclimatization (jet lag), proper nutrition, sanitation concerns, hygiene issues, and disease or other threats to health.

Sensing Actions: Frontline Care for Stress Reactions

Combat/Operational stress reactions are not seen as an underlying psychiatric condition, but rather as a natural and appropriate response to the extreme stress of war-fighting. Some possible sources of C/OSR include sudden exposure to traumatic stress, cumulative exposure to repeated stressors, physical stressors that reduce one’s ability to cope (sleep deprivation, dehydration, overwork, physical illness, environmental stressors — such as noise, cold, heat), and home-front stressors. CSR symptoms would fall under the yellow phase of the Mental Health Continuum Model including such signs as fatigue, slower reaction times, indecision, disconnection from one’s surroundings and an inability to prioritize.

Under the “sense” leadership action, the Chain of Command has the responsibility to ensure that during the first 48 – 72 hours after symptoms emerge, supportive intervention is provided to reassure the subordinate, legitimize the stressors/emotional reactions and convey to him/her the expectation of recovery and resumption of functioning. This can be done through the application of PIES. The principles of PIES include:

1. proximity — treatment is administered as close to the front line as possible pending the tactical situation and preferably within unit lines,
2. immediacy — treatment is administered close in time to the symptoms’ onset as soon as symptoms appear
3. expectancy — the expectation is that the member will recover rapidly and resume functioning and this is clearly conveyed to them by their leadership
4. simplicity — the simplest interventions are provided that tend to the basic needs. Simple interventions are brief, non-medical methods that include the 5 R’s (COSC, 2006):
   • Reassure of normality of symptoms
   • Rest (respite from combat or break from work)
   • Replenish bodily needs (such as thermal comfort, water, food, hygiene and sleep)
   • Restore confidence with purposeful activities and contact with unit
   • Return to duty.

The idea is to provide temporary relief from stressors and exhaustion so that the soldier/ sailor/air man or woman can regain control and return to his/her duties.

Supportive Actions: Caring for Mental Health Casualties

After 48 – 72 hours, with support and rest, if a CAF member is still unable to return to active duty, or should there be any risk of harm to self or others or severe reactions (such as suicidal or homicidal ideation/gestures/attempts), a referral to a health care professional is required. The mental health resources available on deployment vary from mission to mission, however, can include:

• Chaplain
• Medic
• Physician Assistant
• Medical Officer
• Specialized mental health professionals