joint professional military education psychological health training manual

8/10/2019 Joint Professional Military Education Psychological Health Training Manual

1/106

2345 Crystal DriveCrystal Park 4, Suite 120Arlington, Virginia 22202877-291-3263

1335 East West Highway9th Floor, Suite 640Silver Spring, Maryland 20910301-295-3257

www.dcoe.health.milOutreach Center: 866-966-1020

Joint Professional Military Education

Psychological Health Training Manual

An Overview for Leaders

Summer 2012


2/106

i

JPME Psychological Health TrainStandard Informa

Feedback

Feedback is vital for improving the quality of the Defense Centers of Excellence forPsychological Health and Traumatic Brain Injury education directorate training manuals.Instructor feedback (written or verbal) on the course and course materials is greatly appreciated.

Completed feedback should be directed to:

Defense Centers of Excellence for Psychological Health and Traumatic Brain InjuryEducation Directorate1335 East West Highway, 9th Floor, Suite 640Silver Spring, Maryland 20910Telephone: 301-295-3257FAX: 301-295-3322EMAIL: [email protected]


3/106

ii

JPME Psychological Health TrainTable of Conte

Table of Contents

1

Introduction ............................................................................................................. 1

Documents supporting Defense Centers of Excellence for Psychological Health and TraumaticBrain Injury instruction manual .................................................................................................. 1

2

Joint Professional Military Education Psychological Health Training ............... 1

3

Slide Presentation .................................................................................................. 3

Appendices .................................................................................................................. 73

Appendix A: Experiential Exercises ...........................................................................................74Appendix B: Evaluation Materials ..............................................................................................87Appendix C: Key Terms ............................................................................................................88Appendix D: Acronyms ..............................................................................................................95Appendix E: Icons .....................................................................................................................97Appendix F: Frequently Asked Questions (FAQs) .....................................................................99Appendix G: Sources ..............................................................................................................103


4/106

1

JPME Psychological Health TrainTraining Man

1 Introduction

This training manual is designed primarily for instructors, but may also be beneficial to coursesponsors, training leads or other individuals responsible for measuring performance related to

training and education. The Defense Centers of Excellence for Psychological Health andTraumatic Brain Injury (DCoE) clinical training manuals are designed to enhance consistentdelivery of training while also providing instructors the flexibility to tailor materials to the needs ofthe audience. DCoE professionals believe training is most effective when delivered by localinstructors who can use examples relevant to the audience and reinforce education after theinitial course is delivered. This manual does the following:

Incorporates adult learning principles

Equips instructors with tools to motivate learners to actively participate in the learningprocess

Uses interchangeable modules, allowing instructors to customize the course based onaudience needs

Includes tools that allow instructors and organizations to assess the impact of instructionon learner knowledge and behavior

DEFENSE DEPARTMENT DOCUMENTS SUPPORTING DCOEINSTRUCTION MANUAL EFFORT

This manual is one of a series DCoE developed in support of:

National Defense Authorization Act (NDAA) 110-181, TITLE XVI Sec 1621(c)(6) and1622(c)(6): Coordinate best practices for training mental health professionals withrespect to psychological health, traumatic brain injury (TBI) and other mental healthconditions

Mental Health Task Force (MHTF) 5.1.3.1, 5.1.3.3 and 5.1.3.4: Develop and implementcore curricula on psychological health and TBI for Defense Department health careproviders and leaders

Public Law (P.L.) 110-181 Sec. 1615(a) Uniform training standard among militarydepartments for training and skills of medical and non-medical providers of care

2 Joint Professional Military EducationPsychological Health Training

The Joint Professional Military Education (JPME) Psychological Health training was developed

to educate leaders on the prevalence of psychological health conditions within the joint forceand provide ways they can enhance Total Force Fitness (TFF). The training provides anoverview of psychological disorders to include posttraumatic stress disorder (PTSD), depressionand substance misuse, and includes information on co-morbidities. It also provides a list ofadditional resources that may provide information on the topics discussed.

This instructor manual is designed to help facilitators conduct this training within a one-hourtimeframe. It contains speaker notes for each slide, frequently asked questions (FAQ) and a


5/106

2


glossary of key terms and acronyms. The JPME training is subdivided into six sections that canbe taught independently.

It is also recommended that facilitators review the training objectives of each section with theiraudience after each section to ensure training objectives are met. The audience should be

encouraged to take notes during the training session and reference fact sheets as necessary.

Finally, a list of resources is provided in the FAQ section that facilitators are encouraged toreference for additional information.


6/106

3


3 Slide Presentation

This section includes the PowerPoint presentation and accompanying instructor notes.

The slide presentation is made up of six sections that may be used individually or collectivelybased on need:

Section I: Psychological Health - An Integral Component of Total Force Fitness

Section II: Psychological Health Challenges Facing the Joint Force

Section III: Confronting the Psychological Impact of Combat

Section IV: Signs and Symptoms of Psychological Distress

Section V: The Comorbidities of Psychological Disorders

Section VI: Reducing Stigma Associated with Confronting Psychological Health

Conditions


7/106

4


An Overview of Psych ological Health What Leaders Need to Know

Say:

No activities

Do:

No activities

Add it ional Points (i f any):

None

Customizable Content (if any):


8/106

5


Topics Covered

Say:

This training presents the knowledge and skills

combat leaders and line officers shouldpossess on the range of psychological healthconditions impacting deployed servicemembers, such as PTSD. Engaged andeducated leaders are empowered to enhancetotal fitness among service members.

This training is subdivided into six sections,which include:

Section I: Psychological health - anintegral component of Total ForceFitness

Section II: Psychological healthchallenges facing the joint force

Section III: Confronting thepsychological impacts of combat

Section IV: Signs and symptoms ofpsychological distress

Section V: The comorbidities ofpsychological disorders

Section VI: Reducing stigma associatedwith psychological health conditions

Do:

No activities


None



9/106

6


Objectives

Say:

By the end of this training, participants should

be able to:

Describe TFF

List six of the eight domains of TFF

List and describe the five components ofthe psychological health domain

List three psychological healthchallenges facing the joint force

List three negative impacts ofpsychological health conditions in themilitary

Identify two screening tools to aid earlydetection of psychological healthconditions

Identify two programs that supportservice members and health careproviders

Describe two methods to help leadersbuild a fit and resilient force

Describe the two most commontreatments for psychological healthconditions

Do:

No activities


None



10/106

7


Objectives (contd)

Say:

Participants should also be able to:

Describe three signs and symptoms ofgeneral distress

List four symptoms of depression

List four symptoms of PTSD

List four symptoms of substance abuse

Explain why comorbid conditions can bedifficult to treat

Identify two common symptoms for eachpair: PTSD/depression;PTSD/substance abuse; PTSD/mild TBI

(mTBI) Describe three different types of stigma

Describe the impact of stigma onservice members

Define harassment and discrimination inrelation to psychological health care andlist two examples of each

Describe Command Directed MentalHealth Evaluation (CDMHE) processand when to initiate it

Do:

No activities


None



11/106

8


Psycholo gical Health An IntegralComp onent of Total Force Fitness

Say:

Section one reviews the relationship betweenpsychological health and Total Force Fitness.

Specific topics discussed include:

What is TFF?

What are the eight domains of TFF?

The role of psychological health in TFF

The five components of thepsychological health domain

Do:

No activities


None



12/106

9


ObjectivesSection 1

Say:

At the end of this section of training, you should

be able to: Describe TFF

List six of the eight domains of TFF

List and describe the five components ofthe psychological health domain

Do:

No activities


None



13/106

10


In t roduct ion

Say:

Former chairman of the Joint Chiefs of Staff,

Admiral Mike Mullen, identified psychologicalhealth awareness as a special area ofemphasis for leaders across the joint force.Mullen has said that for service members to befit, they must be healthy in mind and body,resilient and ready to complete their missions.He also stated that he believes that engagedand educated leaders may help to minimize thelong-term impact of psychological healthconcerns upon the force, and improve theoverall fitness of service members [1].

To meet this goal, Mullen listed six topic areas

related to psychological health that should beincluded in Joint Professional MilitaryEducation. The six areas are:

1. Psychological health and TFF

2. Prevalence of psychological healthchallenges facing the joint force

3. Ways to minimize the psychologicalimpact of combat on service members

4. How to identify signs and symptoms ofpsychological distress

5. The comorbidities of PTSD, mTBI,

anxiety, depression and substanceabuse

6. Ways to reduce stigma associated withpsychological health conditions

Do:

No activities


None



14/106

11


What is Total Force Fitness?

Say:

In a statement to attendees at the Total Fitness

for the 21st Century conference, Mullen definedtotal fitness as a state where mind and bodyare seen as one. The sum total of the manyfacets of individuals, their families, and theorganizations to which they serve.

Total Fitness is a state in which theindividual,family and organization can sustain optimalwell-being and performance under allconditions.

Total fitness includes eight interrelatedelements: social fitness, physical fitness,environmental fitness, medical and dentalfitness, spiritual fitness, nutritional fitness,psychological fitness, and behavioral fitness.

Do:

No activities


None



15/106

12


The Eight Domains of Total Force Fitness

Say:

The eight domains of total fitness are

subdivided into two categories: mind and body.Total fitness domains relating to the body:

Physical fitnessdefined asaccomplishing all aspects of the missionwhile remaining healthy/uninjured [2]

Nutritional fitnessto provide andconsume food in appropriate quantities,quality and proportions in order topreserve mission performance andprotect against disease and/or injury [3]

Medical/Dental fitnessmaintaining

mental and physical well-being [4] Environmental fitnessbeing able to

perform mission-specific duties in everyenvironment and endure the multiplestressors of deployment and war [4]

Total fitness domains relating to the mind:

Social fitnessto have healthy socialnetworks in the unit, family and societythat support optimal performance andwell-being [5]

Behavioral fitnessrelationshipbetween ones behavior and theirpositive or negative health outcomes [6]

Psychological fitnessthe integrationand optimization of mental, emotional,and behavioral abilities along withcapacities to enhance performance andresilience [7]

Spiritual fitnesspositive and helpfulbeliefs, practices and connectingexpressions of human spirits [8]

Do:

No activities


None



16/106

13


The Psychologic al Domain of Total Force Fitness

Say:

While the military has a long tradition of

emphasizing physical fitness and medicalfitness, other domains have not beenspecifically targeted for improvement. One veryimportant domain is psychological fitness.

Psychological fitness has five components:

Coping

Awareness

Beliefs/appraisals

Decision making

Engagement

Do:

No activities


None



17/106

14


The Five Components of Psych ological

Health

Say:

To be fit in all five areas of psychologicalfitness:

Coping: The ability to cope withadversity and challenges

Awareness: How you are doing mentallyand emotionally

Beliefs/appraisals: Being able toformulate and articulate values andbeliefs and make accurate and oftenfast appraisals of situations

Decision making: The ability to make sound

decisions that not only affect yourself butthose you lead

Engagement: Being able to be engaged andattentive to the mission at hand

Its important to understand psychologicalhealth and how it relates to the joint force

Do:

No activities


None



18/106

15


Psycholo gical Health Challenges Facing the

Joint Force

Say:

Section II discusses psychological health andTBI challenges facing the joint force.Knowledge of these challenges would empowerleaders to enhance total force fitness.

First, we will give an overview of psychologicalhealth challenges in the joint force

Then, we will look at some of the keypsychological health disorders in the DefenseDepartment.

Specifically, we will review:

Prevalence of depression

Prevalence of suicide

Prevalence of PTSD

Prevalence of substance use and abuse

The co-morbid physical injury, mTBI

Do:

No activities


None



19/106

16


ObjectivesSection 2

Say:

At the end of this section of training, you should

be able to:

List three psychological healthchallenges facing the joint force

List three negative impacts ofpsychological health conditions in themilitary

Do:

No activities


None Customizable Content (if any):


20/106

17


In t roduct ion

Say:

**Note to instructor: Read this slide only if this

section is your first lesson of the series. Skipslide if you are continuing from previoussection.

Former chairman of the Joint Chiefs of Staff,Admiral Mike Mullen, identified psychologicalhealth awareness as a special area ofemphasis for leaders across the joint force.Mullen has said that for service members to befit, they must be healthy in mind and body,resilient and ready to complete their missions.He also stated his belief that engaged and

educated leaders can help to minimize the long-term impact of psychological health concernsupon the force and improve the overall fitnessof service members [1].

To meet this goal, Mullen listed six topic areasrelated to psychological health that should beincluded in Joint Professional MilitaryEducation. These six areas are:



3. Ways to minimize the psychologicalimpacts of combat on service members


5. The comorbidities of PTSD, mTBI,anxiety, depression and substanceabuse

6. Ways to reduce stigma associated withpsychological health conditions

Do:

No activities


None



21/106

18


Overview of Psych ological Health Challenges

Facing the Joint Force

Say:

As shown in this graph, psychological healthdisorders have increased dramatically acrossthe joint force within the last several years. Therise in disorders is happening despite numerousprograms and initiatives in place to reducepsychological health issues.

We are also losing personnel to medical boardseparations because of psychological healthdisorders, and are experiencing high rates ofadministrative separations for behavioralproblems related to psychological health

conditions and to suicide.Depression, suicide, PTSD and substance usedisorders are psychological health issues thatare of particular concern to the DefenseDepartment.

Do:

No activities

Add it ional Points (i f any): None



22/106

19


Prevalence of Depression Within the Joint

Force

Say:

Another prominent mental health disorderchallenge facing the joint force is depression.

What is depression?

Depression is a clinical disorder that is oftenmisunderstood. Clinical depression is far morethan a period of being sad; it is a seriousdisorder that affects all aspects of a personslife. Because of the risk of suicide, depressioncan be life-threatening if not treated.

In 2008, up to 21 percent of service members

met the threshold for additional depressionevaluation during the Defense Departmentsurvey of health-related behaviors amongactive-duty personnel [12].

Do:

No activities


None



23/106

20


Suicide Challenges Facing the Joint Force

Say:

What is suicide?

Suicide occurs when a person intentionallyinflicts bodily harm to himself/herself that resultsin loss of life [27].

The total number of suicides and the suiciderate have been increasing in the DefenseDepartment since 2001 [12], with the highestrate in the Army and Marine Corps.

Suicide isnt only a military issue. In fact, theDefense Department has traditionally had alower rate of suicide compared to the civilian

population. In 2007, more than 34,000 civilianscommitted suicide, and approximately 8.3million adults had serious thoughts of suicide in2008 [14] [15].Because of several factors,including the stress of multiple deployments onthe force, the Defense Department rate hasincreased and in 2007 the age-adjusted suiciderates of the Marine Corps and the Armyexceeded the civilian populations rate.

Suicides continue to be a concern for theDefense Department and leaders must employ

every effort in helping to prevent suicide withinthe force.

There are numerous resources that servicemembers can reach out to if they need help.However, leaders must create an environmentthat encourages service members to seek helpearly, and be vigilant in identifying servicemembers who may have psychological healthconcerns.

Do:

No activities


None



24/106


25/106

22


Substance Use and Abu se Within the Joint

Force

Say:

Alcohol abuse and drug abuse are significantproblems for the Defense Department.

A 2008 Defense Department survey of self-reported, health-related behaviors showed thathigh numbers of personnel were engaging inheavy alcohol use across the joint force. Thegraph depicts a breakdown among the services:The Marine Corps had the highest rate at 28percent; the Army Coast Guard and Navy rateswere close to 20 percent; and the Air Force wasthe lowest at 14 percent.

Alcohol abuse results in tremendous costs tothe department both financially and in lostproductivity [13].

The use of illicit drugs and abuse of prescriptiondrugs are also a problem for the joint force.

Abuse of prescription drugs more than doubledbetween 2005 and 2008. Studies show thatservice members will use prescription drugsand/or alcohol to treat or suppress symptoms ofpsychological health conditionsthis is referredto as self-medication. While this may seemlike a short-term remedy, it costs more to bothservice members and the department in thelong run.

Do:

No activities


None



26/106

23


Military vs. Civil ian

Say:

Compared to the civilian sector, the heavy use

of alcohol and abuse of prescription drug useappears to be higher in the military. TheDefense Departmentsdrug deterrenceprogram appears to encourage the military illicitdrug use to remain at 2 percent; however, thismay be an underreporting of actual illicit druguse.

As leaders in the department, we have to workto decrease the rates of heavy alcohol use andprescription drug abuse, as such abuse thwartsTFF efforts and compromises overall missioncapability.

Do:

No activities


None



27/106

24


The Costs of Psycho logical Health Concerns

Say:

Psychological health concerns are very costly

to service members and the Department. Onevery important cost is the loss of personnel bysuicide. Additionally, service members areexperiencing high stress at home (reflected byincreased divorce rates and higher levels ofspousal abuse), increased attrition from themilitary and higher numbers of referrals forDepartment of Veteran Affairs (VA) disability.

Besides the toll these issues take on theservice members themselves, these factorsalso affect overall mission capability making the

joint force less able to fulfill its roles.

Do:

No activities


None



28/106

25


Reducing the Psychologic al Imp acts of Combat

Say:

Almost a decade of high operational tempo has

resulted in a stressed force. As good order anddiscipline in a garrison environment appears tohave atrophied within some units, servicemembers are more likely to engage in high-riskbehavior. Policies, structures and programsmay not always be adequate or be regularlyused to meet the demands of a strained force.

Section III highlights the tools and programsthat leaders have at their disposal and waysthey can help minimize the psychologicalimpacts of combat. Specifically, we will discuss:

Early detection and referral of servicemembers with psychological healthconcerns

Leadership roles

Psychological health and resilienceprograms across the joint force

A strong emphasis on evidence-basedtreatments for psychological healthissues

Do:

No activities


None



29/106

26


ObjectivesSection 3

Say:

At the end of this section, you should be able to:

Identify two screening tools to aid earlydetection of psychological healthconditions

Identify two programs that supportservice members and providers

Describe two methods to help leadersbuild a fit and resilient force

Describe the two most commontreatments of psychological healthconditions

Do:

No activities


None



30/106

27


In t roduct ion

Say:



Former chairman of the Joint Chiefs of Staff,Admiral Mike Mullen, identified psychologicalhealth awareness as a special area ofemphasis for leaders across the joint force.Mullen has said that for service members to befit, they must be healthy in mind and body,resilient and ready to complete their missions.The retired chairman also believes thatengaged and educated leaders can help to

minimize the long-term impact of psychologicalhealth concerns upon the force, and improvethe overall fitness of service members [1].

To meet this goal, Mullen listed six topic areasrelated to psychological health that should beincluded in Joint Professional MilitaryEducation. The six areas are:


2. Prevalence of psychological healthchallenges facing the joint forces




6. Ways to reduce stigma associated withpsychological health conditions presentin the joint force

Do:

No activities


None



31/106

28


Early Detection and Screening Efforts

Say:

Research has shown that there are enormous

benefits from early detection and treatment ofbehavioral health concerns. Early treatment canprevent conditions from getting worse or lastinglonger than necessary, and may restore servicemembers to a healthier state more quickly.Hence, the Defense Department has designedseveral screening programs to help identifyservice members with psychological healthconcerns.

Some of the most prominent include:

Defense Department policy requires all services

to screen deploying service members forpsychological health problems in four phases:two months prior to deployment; three to sixmonths after deployment; seven to 12 monthsafter deployment; and again 16 to 24 monthsafter deployment.

Pre-Deployment Health Assessments

The Post-Deployment HealthAssessment (PDHA) andReassessment (PDHRA)

Afterdeployment.org provides online

screening tools that highlight symptomsconsistent with mental health conditions.These tools do not provide a diagnosis,but give service members an indicationof symptoms that may reflect a need forfurther assessment

RESPECT-Mil is a treatment modeldesigned by the Deployment HealthClinical Center (DHCC) to screen,assess and treat active duty servicemembers with depression and/or PTSD

Do:

No activities


None



32/106

29


Important Role of First-Line Supervisors and

Other Leadership

Say:

Supportive leadership is important in helping tofight against the stigma of seeking help forpsychological health concerns. Unfortunately,many supervisors and other leaders believethat conditions such as PTSD aren't real, andare hesitant to refer their members for care.This hesitation directly contributes to creating abarrier to care, causing service members tothink that seeking help will have negativeconsequences. Its important for leadership toset the tone in encouraging service members toseek help without fear of being seen in a

negative way.Leadership must play an active role in earlydetection of potential behavioral health issues.By identifying potential issues early, leadershipcan prevent other problems from developing,including loss in productivity.

Do:

No activities


None



33/106

30


Psycholo gical Health and Resi l ience Programs

Acro ss the Joint Force

Say:

The Defense Department has investedenormous resources to meet the psychologicalhealth care demands resulting from almost adecade of high-operational tempo. Thedepartment sponsors resources that leaderscan use to enhance service members health,such as:

Yellow Ribbon Program

TRICARE Assistance Program

Force Health Protection and Readiness

National Intrepid Center of Excellence(NICoE)

DCoE

Do:

No activities


None



34/106

31


Psycholo gical Health and Resi l ience Programs

Acro ss the Joint ForceArmy

Say:

Army resilience training programs targetproviders as well as service members.Comprehensive Soldier Fitness (CSF) wasinitiated as a central element of wellness.Elements of the CSF program include:

The Global Assessment Tool (GAT)

Master Resilience Training (MRT)

Comprehensive Resilience Modules(CRM)

Institutional Training

Do:

No activities


None



35/106

32


Resil ience Programs Ac ross th e Joint ForceNavy and Marines

Say:

The Marine Corps Combat Operational StressControl (COSC) program is dedicated tomaintaining a ready fighting force and toprotecting and restoring the health of Marinesand their family members.

Navy Operational Stress Control (OSC)provides a comprehensive approach to prevent,identify and manage the adverse effects ofoperational stress and stress injuries on thehealth and readiness of sailors.

Family Overcoming Under Stress (FOCUS) is afamily-focused program that addressesconcerns regarding parental combat operationalstress injuries and combat-related physicalinjuries. The program provides resiliencetraining to military children and families.

The Navy and Marine Corps Public HealthCenter is the proprietor of the Navy SystematicStress Management Program and the MindingYour Mental Health program. Both programsare geared to address Sailors and Marinesbehavioral health concerns.

Do:

No activities


None



36/106

33


Resil ience Programs Ac ross th e Joint ForceAir Force

Say:

In addition to promoting Defense Department-sponsored programs, the Air Force has initiatedseveral new programs to address thepsychological health concerns of Airmen. In2010, the Air Force initiated Total ForceResilience, a program that addresses the rootcauses of suicides and teaches Airmen theskills they need to deal with psychologicalhealth concerns [27].

Other Air Force programs include:

Total Force Resilience

Comprehensive Airman Fitness

The Air Force Wingman Program

Do:

No activities


None



37/106

34


How Leadership Can Help B uild a Fit and

Resilient Force

Say:

How can leaders help build a fit and resilient force?There is no magical answer, but research suggestsfour fundamental ways.

Unit CohesionResearch shows thatunit cohesion can serve as a bufferagainst psychological health concernssuch as PTSD, depressive symptomsand stress symptoms [28]. Servicemembers are more likely to feel hopefulabout their career and their future if theyfeel supported by their unit. By fosteringunit cohesion, leaders can give service

members a sense of belonging.

Trust in LeadershipWhen servicemembers have a sense of trust in theirleadership, they are more likely to havea better outlook on life and adopt newstrategies to successfully cope withchallenges and adversities. In addition,service members are more likely todiscuss family or financial challengeswith leaders with whom they feel asense of trust.

Good Order and DisciplineResearchshows that leadership can sway aservice members perception of andadaptation to stressful environments.Service members are likely to beinfluenced by the examples set by theirleaders.For example, if leaders fail toenforce policies against DUIs, servicemembers may be more likely to engagein alcohol abuse. Or, if service membersbelieve their medical or personal privacyis not respected, they may be less likely

to seek help for their personal problems.

[continued on next page]



38/106

35


Supportive EnvironmentLeadersshould seek to create an environmentthat promotes help-seeking behaviors.Many service members delaypsychological health care for fear that it

may impact their careers. Leaders mustdo more to foster help-seekingbehaviors by discouragingdiscrimination and harassmentsurrounding psychological health issues,educating service members about thefacts regarding psychological healthcare, and promoting healthy habits.

Do:

No activities


None


39/106

36


Treatment for Psycholog ical Health Concerns

Say:

Several effective evidence-based treatments exist,

all of which have been extensively tested andproven to work for depression, thoughts of suicide,PTSD and substance abuse.

The two general categories of treatment are:

Psychotherapywhich involveslearning about the disorder andpracticing proven ways of making itbetter

Medicationswhich are effective formanaging symptoms of depression andanxiety disorders like PTSD

Do:

No activities


None



40/106

37


How to Identi fy Service Memb ers With

Psycholo gical Distress

Say:

To ensure Total Force Fitness, leaders must beable to recognize the signs and symptoms ofpsychological distress.

Section IV discusses the signs and symptomsof psychological distress, and also provides abasic overview of what a leader may see if aservice member has one of these commonpsychological disorders:

Depression

PTSD

Substance abuse

Do:

No activities


None



41/106

38


ObjectivesSection 4

Say:

At the end of this section, you should be able

to:

Describe three signs and symptoms ofgeneral distress

List four symptoms of depression

List four symptoms of PTSD

List four symptoms of substance abuse

Do:

No activities


None



42/106

39


In t roduct ion

Say:



Former chairman of the Joint Chiefs of Staff,Admiral Mike Mullen, identified psychologicalhealth awareness as a special area ofemphasis for leaders across the joint force.Mullen said that for service members to be fit,they must be healthy in mind and body, resilientand ready to complete their missions. He alsostated that engaged and educated leaders canhelp to minimize the long-term impact of

psychological health concerns upon the forceand improve the overall fitness of servicemembers [1].







6. Reducing stigma associated withpsychological health conditions

Do:

No activities


None



43/106

40


General Signs of Distress

Say:

Any of these signs or symptoms can indicate some

degree of psychological distress. Generallyspeaking, the more signs there are and the morethey interfere with a persons performance, themore likely there is some sort of significant problemthat needs to be addressed.

Irritability or having a "short fuse," beingfrequently sarcastic or mean, orcriticizing others for no reason

Excessive worry or fearfulness, or fearand concern about dangers or potentialproblems that cannot be controlled,perhaps leading to increased fear andconcern about others in the unit

Difficulty falling asleep or staying asleepor lying awake for hours without sleep,even though tired, or waking up tiredafter only a few hours of sleep andbeing unable to fall back asleep

Tardiness, or late for work with anunkempt appearance

Feeling persistently keyed up,aninability to relax, calm down or slowdown even when there is sufficient time

to do so

Loss of interest or ability to feel pleasurein activities that used to be enjoyable

Difficulty concentrating or sustainingmental focus

Excessive and persistent feelings ofguilt or hopelessness

Avoidance of others; isolation fromothers

Thoughts or impulses to harm oneself,

peers or leaders

[continued on next page]



44/106

41


A person can have one or more of these signs andnot have a psychological health disorder, but youshould note that many of these signs andsymptoms of distress will be the only clue that yourservice member has a psychological disorder, as

most people hide psychological problems frompeople at work. What you see as a leader isfrequently the tip of the iceberg related to what isgoing on with the member.

Do:

No activities


None


45/106

42


What Leaders May See - Depressio n

Say:

When someone begins suddenly acting in an

uncharacteristic manner, there are usuallyunderlying problems that are causing theunexpected change in behavior.

Many service members will deny or hide theirdepression, and some may not even know theyhave depression, but they may just feel differentlythan they usually do.

The leader may see their subordinate making moremistakes, being late for work more frequently, andshowing a poor attitude or irritability. All of thesebehaviors may be a result of the service memberbeing depressed.

A service member who cannot concentrate and hasdifficulty remembering things will make moremistakes. If they are unable to sleep more thanthree to four hours a night, they will likely beirritable, and more likely to arrive late to workbecause of oversleeping.

If the person has no energy and feels tired all thetime, it may seem like they have a bad attitudewhen tasked with assignments.

For someone who is hopeless about their futureand even contemplating suicide, doing their best at

work may be the last thing on their minds.The challenge for leaders is to recognize thesebehaviors when they occur, and ask the member ifthey might be having other symptoms ofdepression. If the members behavior is changingpossibly as a result of depression, you need toencourage the person to seek help.

Do:

No activities


None



46/106

43


What Leaders May See - PTSD

Say:

PTSD is prevalent among service members,

especially following combat experiences.Because of stigma, many service members willnot come forward, or simply may not recognizethat what they are going through is a medicalissue.

While service members may hide symptoms orbe unaware of their PTSD, as a leader, you willlikely be able to spot several changes inbehaviors.

The symptoms of PTSD are listed here andexplain a persons change in behavior.

Someone with PTSD has difficultiesconcentrating (much like depression),and may have severe sleep problems,especially if they are having nightmaresrelated to the trauma.

They may be irritable, and even havebouts of intense rage in response towhat seem like minor issues to others.

They may be constantly on guard,scanning their environment, appearingtense and easily startledthis is calledhypervigilance.

They may avoid things that triggerunpleasant memories or emotions.Examples may be large crowds ordiscussions about combat experiences.

They may dissociatelook like theyappear to be in a daze or look lost inthought.

Effective leaders are in touch with those theycommand. Therefore, leaders are in a betterposition to recognize changes in the behaviors oftroubled personnel and may be more successful at

encouraging them to seek the help they need.

Do:

No activities



47/106

44



None


48/106

45


What L eaders May SeeSubstance Abuse

Say:

As we covered earlier, substance abuse

(alcohol and other drugs) is a serious issue forthe Defense Department.

Supervisors might observe a service memberwho is misusing substances arrive late for work(especially on Mondays), has an unkemptappearance or is often sick or injured.

Symptoms of substance abuse or dependenceinclude:

Failure to fulfill important roles orresponsibilities, such as parenting tasks

Illegal or harmful behavior, such as

continued drinking after a DUI

Continued use of substance despiteharmful effects, such as continuedalcohol use with severe liver damage

Unsuccessful in efforts to stop using thesubstance

Increased tolerance to substanceeffects, and needing more and more ofthe substance to get the same effect

Physical withdrawal symptoms when thesubstance is removed (mild to severe),

such as shaking or seizures after theremoval of alcohol from a person whohas been chronically abusing it

Do:

No activities


None



49/106

46


Overlapping Symptoms in Psycholog ical

Disorders

Say:

Research shows that people who experienceone disorder are more likely to have a second.Service members may become substancedependent as they rely on substances tomanage other behavioral health concerns.Section five discusses the comorbidities ofpsychological disorders. Specifically, we willdiscuss:

The comorbidities of PTSD anddepression

The comorbidities of PTSD andsubstance abuse

The comorbidities of PTSD and mTBI

Do:

No activities


None



50/106

47


ObjectivesSection 5

Say:

At the end of this section, you should be able to:

Explain why comorbid conditions can bedifficult to treat.

Identify two common symptoms ofPTSD and depression, PTSD andsubstance abuse, and PTSD and mTBI.

Do:

No activities




51/106

48


In t roduct ion

Say:



The former chairman of the Joint Chiefs ofStaff, Admiral Mike Mullen, identifiedpsychological health awareness as a specialarea of emphasis for leaders across the jointforce. Mullen stated that for service members tobe fit, they must be healthy in mind and body,resilient and ready to complete their missions.He also stated that engaged and educatedleaders can help to minimize the long-term

impact of psychological health concerns uponthe force and improve the overall fitness ofservice members [1].








Do:

No activities


None



52/106

49


Overlapping Symptoms in Psycholog ical

Disorders

Say:

When someone has two or more disorders at thesame time, their disorders are comorbid.

There are several psychological health disordersthat often occur together, such as:

PTSD and depression

PTSD and substance abuse

In addition to having more than one psychologicalhealth condition, service members may often havesustained mTBI.

Do:

No activities


None



53/106

50


Overlapping Symptom s in PTSD and

Depression

Say:

Both PTSD and depression are fairly commondisorders in the Defense Department and VApopulations, and these two disorders have severalsymptoms in common. For instance, patients withboth depression and PTSD may have insomnia andirritability.

The important point to understand is that comorbidconditions are often more difficult to treat. Forexample, one of the best things a depressedperson can do is to get out of the house and bearound people. However, if they also have PTSD,they may avoid leaving the house because they

want to avoid things that trigger memories of thetrauma.

Do:

No activities


None



54/106


55/106

52


Overlapping Sympt oms in PTSD and mTBI

Say:

Many studies show that PTSD often co-occurs

with mTBI following some combat trauma,such as an impact from an exploded improvisedexplosive device (IED) [21].

TBI is a traumatically-induced structural injury and/orphysiological disruption of brain function as a resultof an external force that causes an individual to loseconsciousness, or have an alteration in consciousnessor memory. The injury may result in physical,cognitive-behavioral and emotional symptoms. A TBImay be classified as mild, moderate or severe. Themajority of TBIs that occur each year in the militaryand civilian communities are mTBIs, also known as

concussions. Like all injuries, TBI is most appropriatelyand accurately diagnosed as soon as possible afterthe injury.

TBI is not a mental health condition. It is a physicalinjury. That being said, many symptoms that anindividual may experience following a mTBI are similarto the symptoms in an individual whohas PTSD, depression, chronic pain or substance usedisorder (as illustrated in the diagram).

While many of the symptoms of each disorderoverlap, each also has symptoms unique to thedisorder. So, it is quite possible for an individual tohave PTSD only, PTSD and a mTBI, or have sustaineda mTBI and not have a co-occurring psychologicalhealth disorder.

Do:

No activities


None



56/106


57/106

54


ObjectivesSection 6

Say:

By the end of this section, you should be able to:

Describe three different types of stigma

Describe the impact of stigma amongstservice members

Define harassment and discrimination inrelation to psychological health care andlist two examples of each

Describe the CDMHE process and whento initiate it

Do:

No activities


None



58/106

55


In t roduct ion

Say:



The former chairman of the Joint Chiefs ofStaff, Admiral Mike Mullen, identifiedpsychological health awareness as a specialarea of emphasis for leaders across the jointforce. Mullen has said that for service membersto be fit, they must be healthy in mind and body,resilient and ready to complete their missions.He also stated that engaged and educatedleaders can help to minimize the long-term

impact of psychological health concerns uponthe force, and improve the overall fitness ofservice members [1].








Do:

No activities


None



59/106

56


What is Stigma?

Say:

What is stigma?

Stigma is defined as being marked orbranded. Individuals who suffer frompsychological health conditions are sometimesstigmatized because their peers or supervisorslack information about how commonpsychological health struggles are. Further,leaders may underestimate the ability ofpersons struggling with psychological healthissues to continue to provide meaningfulcontributions to the mission. Potentially, thesemisconceptions may perpetuate negativestereotypes about psychological disorders.

We know that ignorance about the benefits ofseeking help for psychological concerns is anationwide problem.

Stigma towards psychological health is alsocommon throughout the military and often leadsto harassment and discrimination. In a recentsurvey of service members, members statedthey would avoid behavioral health care toescape being labeled as a person who cannotbe relied on in a pinch, or worse, to avoid thelabel of one who uses or exaggerates an illnessto malinger and avoid duty or deployment.

Do:

No activities


None



60/106

57


Three Types of Mental Health Stigm a

Say:

There are three types of mental health stigma: self-

stigma, organizational stigma and peer stigma. Self-stigma happens when someone

unfairly blames themselves for theircurrent problems/challenges afterhaving absorbed negative attitudes fromthose around them.

Organizational stigma is based onpolicies, procedures and informal rulesabout a persons worthiness tocontribute to the mission.

Peer stigma refers to the language and

behaviors that groups use to include orexclude members.

All these forms of stigma are based on ignoranceand can be defeated with knowledge, awarenessand understanding. Teaching about how to reducestigma is the responsibility of all military leaders.

Do:

No activities




61/106

58


Harassment and Discrimin ation When Seeking

Care

Say:

Many service members have experiencedharassment and discrimination because theydecided to seek psychological health care.While many refer to this as part of the stigmaof mental health its actually no different fromharassment or discrimination based on otherdifferences, such as religion or race.

Harassment is a behavior targeted at agroup or individual, and the impact ofthat behavior results in creating anintimidating or hostile work environmentfor the targeted individual.

Discrimination is behavior or policy of agroup, individual or system that resultsin the recipient perceiving unfairtreatment based on uniquecharacteristics of the individual, typicallyrace, religion, ethnicity, etc., but canalso involve medical conditions.

In a recent study, the DefenseDepartment Suicide Task Forceconcluded that some leadershipenvironments result in discriminatory

and humiliating treatment of servicemembers who seek help forpsychological concerns. Such behavioraffects morale, discipline and unitcohesion. Service members shouldsupport their buddies who do the rightthing, and seek professional care if theyhave psychological concerns

There is no place for harassment ordiscrimination in our military. We havezero tolerance policies on discriminationand harassment of any kind.

Do:

No activities


None



62/106

59


Identi fy ing Harassment and Discrim ination

Say:

Some common examples of harassment and

discrimination that a service member seekingpsychological care may face are:

Negative comments about a personscondition

Calling a service member crazy

Implying the service member is malingering

Negative comments about the servicemember not being tough enough or non-hacker, etc.

Examples of discrimination:

Unwarranted negative evaluations based onpsychological disorder

Removed from leadership roles due topsychological disorder

Assigned to task below ones rankdue topsychological disorder

Blocked from promotion, and notrecommended for promotion because ofpsychological disorder

Each service member plays a critical role to

eliminate stigma surrounding psychologicalcare, by understanding that stigma can causeservice members who need help to delay care,or never seek care at all.

Do:

No activities


None



63/106

60


Stigm a Can Lead to a Delay in Care

Say:

Stigma is one of the biggest problems facing

the military when it comes to preventing suicideand other negative events.

In a recent Defense Department Suicide TaskForce report, service members claimed todespise the thought of going to a behavioralhealth clinic primarily because of the likelihoodof harassment and discrimination. Myths andstereotypes about psychological healthcontribute to harassment and discrimination.

Stigma can lead to service members choosingto delay seeking help for their psychologicalconcerns. For some service members, by thetime they are convinced to finally come in forhelp, their careers and personal lives arealready damaged.

Delay of care can worsen psychological healthconditions, may make recovery more difficult,and increase the likelihood of adverse eventsand unsatisfactory outcomes.

Adverse events, such as a DUI or spousalabuse, can lead to loss of rank, money andsocial status. These and other losses make itmore difficult for the member to recover from

conditions such as depression or PTSD. Itsmuch harder to focus on getting overdepression or PTSD if the member is in themiddle of a divorce or in legal trouble.

The delays and losses are preventable if wecan eliminate the stigma of seeking care anddispel the myths and stereotypes surroundingpsychological health.

Do:

No activities


None



64/106

61


What Does NOT Consti tute Discrim ination?

Say:

While it is true that one should not be blocked

from promotion for having PTSD or otherbehavioral health concerns, behaviors relatedto psychological disorders, such as DUIs ordomestic violence can affect a servicemembers career.

Because many service members experiencingPTSD or other behavior health concerns do notseek care until after they have experienced oneor more adverse events (DUI, domestic abuse,insubordination, etc.), many of these membersare also blocked from promotion or loseleadership positions.

Unfortunately, the misconception is establishedthat the service member is being punished ordemoted because of psychological disorders,rather than because of the behaviors that led tothe DUI or domestic violence incident. Noteveryone with PTSD or alcohol abuse chooseto treat their spouse violently or drive whiledrunk. Such stories may get passed aroundsuch as Sgt. Jones saw psych and now he isnot getting that platoon sergeant billet.Rumors may contribute to the belief thatmembers who seek care dont get promoted

in many cases the damage was done BEFOREthey decided to come in for care.

It is critical that service members get help earlyto decrease the odds of future adverse eventsrelated to their psychological disorder.

Do:

No activities




65/106

62


Knowing the Leaders Role in Reducing Stigma

Say:

As stated previously, leaders play a critical role

in the task of reducing the stigma surroundingpsychological health:

The psychological health of your peopleis a critical piece of your units ability tomeet its mission.

It is important that you identify any formof harassment and/or discrimination inyour unit and act to prevent thesebehaviors.

Military leaders must create anenvironment where service members

are willing and able to get help early forpsychological health issues to preventnegative effects on their careers andlives.

Leaders who have psychological healthissues and dont seek care because ofstigma are actually setting a poorexample for their subordinates, one thatdiscourages their subordinates fromgetting help.

Do: No activities


None



66/106


67/106

64


Resources for Psych ological Health

Say:

You can encourage service members to reach

out for treatment information and resources.These resources include several websites andoff-base programs including face-to-facecounseling in confidential settings.

Military chaplains are available to assist servicemembers in distress and will often providecounseling services.

A service member with a psychological healthissue can go to their primary care manager forscreening for depression, substance abuse orPTSD without having to go first to the

behavioral health clinic.Treatment with specialists in behavioral healthclinics is also available.

Remember that anytime someone is suicidal orhomicidal, they should be escorted via anemergency commander-directed mental healthevaluation to the behavioral health clinic duringthe day or to the nearest emergency room if thebehavioral health clinic isnt open.

We will briefly cover some of these resources.

Do:

No activities


None



68/106

65


Knowing t he Off-base Resources

Say:

These are some of the off-base resources

services member can access to addresspsychological health concerns. Most of theseresources provide 24-hour service over severalmediums (phone, internet or face-to-face).

The DCoE Outreach Center serves allservices members, veterans and theirfamilies. The Outreach Center isavailable 24-hours and information isprovided by phone, online chat or email.

Afterdeployment.org serves all branchesof the military along with their familiesand provides online information

targeting PTSD, depression, anger,sleep, relationship concerns and othermental health challenges.

The SuicideOutreach.org websitesupports all veterans, families andproviders. It is a comprehensiveresource where you will find access tohotlines, treatments, professionalresources and other resources designedto link you to others.

Military OneSource supports all eligible

service members by providing access toconsultants in person, online and byphone, as well as online resources forwebinars and other resources.

Do:

No activities


None



69/106

66


Knowing Command Resources

Say:

Service members have the option to seek careat their local military treatment facility (MTF), orto talk to a chaplain.

The chaplain is a good first-stop if the servicemember just wants to talk and is unsure aboutwanting to get formal medical help. Allconversations held with a chaplain areconfidential, and no diagnosis is made. Achaplain can refer the service member totreatment if the member is willing to go.

MTFs provide world-class treatment to servicemembers seeking help for psychologicalconcerns. The service member is cared for by a

primary care manager or a behavioral healthcare provider skilled in providing evidence-based treatments.

Medical diagnosis is recorded in servicemembers medical records.

Providers seek to keep all careconfidential. However, because of legaland ethical requirements, a providermay have to violate confidentiality inrare cases like when a service memberis a danger to themselves or others and

needs to be hospitalized, admits toabusing a child or their spouse, or whenthe chain of command needs to knowabout a duty restriction such as notbeing able to carry a weapon.

Do:

No activities


None



70/106

67


Comm and Directed Referrals for Mental Health

Evaluations

Say:

Sometimes leaders are faced with a servicemember who has a psychological healthconcerns, but refuses to seek help. For thisreason, leaders must be familiar with how tomake a command-directed referral.

There are regulations that should be followedwhen making a referralsome of the mainpoints to remember are:

Commanders must discuss theirconcerns with a behavioral healthprovider to determine if referral isnecessary. Not all issues can justify acommand-directed referral. Onlycommanders on orders can make acommander directed referral, using thespecific process outlined in DoDI 6490.1and 6490.4.

If the behavioral health providerrecommends referral, commanders canthen formally request a command-directed mental health evaluation andmake an appointment for the servicemember.

Commanders must directly informservice members of their rights inwriting, and often escort is needed onthe day of appointment.

Note that for emergency evaluations (i.e., if themember is an imminent danger to self orothers), this process can be shortened in orderto ensure a personssafety. The commander isstill expected to discuss the situation with amental health provider first. Then the servicemember should be escorted immediately to abehavioral health clinic or to the emergency

room (depending on the advice of the provider).The required paperwork can be completedlater. Defense Department Directive 6490.1outlines the specific requirements of bothroutine and emergent referrals.

Do:

No activities



71/106

68



None


72/106

69


References

Say:

No slide notes

Do:

No activities


None



73/106


74/106


75/106

72


End of slide presentation portion


76/106

73

Append

Appendices

The following appendices are intended to provide the facilitator with:

Appendix A: Experiential Exercises

Appendix B: Evaluation Materials

Appendix C: Key Terms

Appendix D: Acronyms

Appendix E: Icons

Appendix F: Frequently Asked Questions

Appendix G: Sources


77/106

74

Appen

APPENDIX A:EXPERIENTIAL EXERCISES

Utilization of experiential exercises (e.g., small group activities, simulation and role play)optimizes the potential impact of instruction. All materials and instruction necessary for

successfully conducting these exercises is included in this section.

Screening for JPME Role Play: Instructor Overview

Before the role play begins:

Discuss the following objectives with learners:

o Identify when unit members exhibit symptoms consistent with psychological

health conditions and/or mild TBI.

o Foster unit cohesionby encouraging group connectivity/buddy care.

o Build or maintain trustby sharing personal stories, demonstrating genuine care

for unit members.

o Demonstrate good order and disciplineby enforcing a zero-tolerance policyrelated to discrimination and harassment.

o Cultivate a supporting environmentby educating service members about the

facts surrounding psychological health, promoting healthy habits and

encouraging service members who need medical care to seek help.

Engage learners in discussion of why objectives are important.

Ask learners to divide into groups of two:

o One learner will serve as the line leader.

o Other will serve as a subordinate member of the unit.

Provide each group with the instructions specific to their "role"(four scenarios are

provided within this manual).

During th e role play:

Move among groups and provide assistance as needed.

Stop interactions after 10 minutes.

After the role play

Ask one or more groups to de-brief and answer the following questions:

o Which of the objectives were met?

o What else could the leader have done to minimize potential for stigma?

o

Would these be difficult conversations to initiate in real life? Reinforce why these objectives are important, and encourage learners to strive to meet

them.


78/106


79/106

76

Appen

Leader Role

Instruct ions: The participant acting in the leader role will be assigned to engage in a role playexercise with one member of his or her unit, either unit member A, B, C or D. The "leader"

should prepare for the discussion by reading the history or background of the unit memberscoming to speak with him or her.

These scenarios are designed to provide two different perspectives. For scenarios involving unitmembers A, B and C, the leader should apply his or her own perspective to the discussion. Thescenario involving unit member D is characterized as a leader-to-leader discussion. To ensurethis scenario has divergent viewpoints, a "leader perspective" is specified for this scenario only.

An overview of each scenario follows:

Scenario involving unit member A: Unit member was arrested for driving under the

influence; has had difficulty sleeping following recent deployment.

Scenario involving unit member B: Unit member has been irritable and was in a recent

physical altercation; behavior changed following recent motor vehicle accident.

Scenario involving unit member C: New unit member has been harassing other members

of the unit who have had frequent medical appointments.

Scenario involving unit member D: This is the only scenario which takes place in theater.

As unit member D is a non-commissioned officer, he or she is serving in a leadership

capacity, although the "leader" role is the battalion commander. So that this role play

involves two different perspectives, information is included on the "leader's" perspective.

Unlike the previous scenarios, unit member D requested this meeting with the "leader."

After the exercise, the group will engage in discussion about their role play experience. Pleasebe prepared to discuss any issues or key points you think are important based on the trainingprovided today. Be honest about your attitudes towards psychological health and identify anychallenges or obstacles that may still exist at the unit level. The goal of this exercise is to meetthe following objectives, as applicable:

Identify when unit members exhibit symptoms consistent with psychological health

conditions and/or mTBI.

Foster unit cohesionby encouraging group connectivity/buddy care.

Build or maintain trustby sharing personal stories, demonstrating genuine care for unit

members.

Demonstrate good order and disciplineby enforcing a zero-tolerance policy related to

discrimination and harassment.

Cultivate a supporting environmentby promoting healthy habits, encouraging servicemembers who need medical care to seek it.


80/106

77

Appen

Unit Member A History

Service member A is a 22-year-old active-duty Marine who has recently returned with his

unit from his first deployment. He is single and lives in the barracks. He is very outgoing and

has many friends, both in the unit and in town. He has always been a top performer and hasno record of any disciplinary issues. Recently, he has been routinely late for work, and has

been found sleeping at work. During the weekend he was arrested for driving under the

influence on base. You called him into your office to discuss this serious matter.


81/106

78

Appen

Unit Member B History

Service member B is a 24-year-old Army E-4. He has had some difficulty with his work

performance in the past, (he is slower to learn new tasks compared to others in his unit). He

has long-standing diagnosis of a learning disorder, but has been otherwise healthy and fit.He has always been extremely motivated to stay in the military and has worked very hard to

compensate for his learning challenges.

He has not been deployed, but was recently involved in a serious motor vehicle accident; his

car was broadsided by a drunk driver and a close friend was killed in the accident. He was

not hospitalized following the accident, although he was given three days of convalescent

leave by the medical provider. Since the accident, he has been very irritable at work and has gotten into several verbal

altercations with co-workers about playing loud music. The most recent incident resulted in a

physical fight, which was stopped immediately.

You have asked him into your office to discuss his recent physical altercation.


82/106

79

Appen

Unit Member C History

Service member C is a 20-year-old Army E-4 who completed a single combat deployment

with another unit, where he was awarded a Purple Heart. He is single and currently lives in

the barracks. He has recently joined the unit and knows few people, but people have overheard him

calling co-workers lazy and weak because of frequent medical appointments.

You have asked him into your office today to discuss his behaviors and the potential effects

of his comments on unit morale and cohesion.


83/106

80

Appen

Unit Member D History

Service member D is a 32-year-old Marine first sergeant, currently deployed at Forward

Operating Base (FOB) Dela Ram, Afghanistan. He has completed four combat deployments

and experienced heavy action, especially in Iraq in 2004. He has several documentedconcussions. Although he has recovered, he is often an advocate for his Marines on matters

related to psychological health issues and concussion.

The first sergeant has requested a meeting to discuss his concerns related to overall unitreadiness and issues related to psychological health conditions and concussion. Thisdiscussion takes place in-theater.


84/106

81

Appen

Leader Perspective

As the leader, you are currently deployed with first sergeant D at FOB Dela Ram, Afghanistan,and are in charge of several artillery units. As the battalion commander, you are acutely aware

of the high operational tempo and need for a fully staffed unit. As the operational tempo hasincreased, more and more of your unit members have been going to medical appointments forminor bumps and bruises that are typical in a day's work. You are concerned they aremanipulating the system to get out of work. When they are away from the unit, the workload isheavier for the remaining unit members. You have asked several unit members to describe whathappened and after talking to you they have cancelled their appointments. You take this asproof that you exposed their manipulation of the system.


85/106

82

Appen

Unit Member Role

Instruct ions: The participant acting as the unit member will be assigned the role of either unit

member A, B, C or D. The participant serving in the unit member role should prepare for thediscussion by reading your history or background and concerns. These scenarios are designedto provide two different perspectives. The scenario involving unit member D is characterized asa leader-to-leader discussion. To ensure this scenario has divergent viewpoints, a "leaderperspective" is specified for this scenario only. An overview of each scenario follows:

Scenario involving unit member A: Unit member was arrested for driving under the

influence; has had difficulty sleeping following recent deployment.

Scenario involving unit member B: Unit member has been irritable and was in a recent

physical altercation; behavior changed following recent motor vehicle accident.

Scenario involving unit member C: New unit member has been harassing other members

of the unit who have had frequent medical appointments.

Scenario involving unit member D: This is the only scenario which takes place in theater.

As unit member D is a non-commissioned officer, he or she is serving in a leadership

capacity, although the "leader" role is the battalion commander. So that this role play

involves two different perspectives, information is included on the "leader's" perspective.

Unlike the previous scenarios, unit member D requested this meeting with the "leader."

The leader should behave in ways that are consistent with the following objectives, asapplicable:

Identify when unit members exhibit symptomsconsistent with psychological health

conditions and/or mTBI.

Foster unit cohesionby encouraging group connectivity/buddy care.Build or maintain trustby sharing personal stories, demonstrating genuine care for unit

members.

Demonstrate good order and disciplineby enforcing a zero-tolerance policy related to

discrimination and harassment.

Cultivate a supporting environmentby educating service members about the facts

surrounding psychological health and TBI issues, promoting healthy habits, encouraging

service members who need medical care to seek help.

After completing the exercise, the group will engage in discussion about your experience duringthe role play. Please be prepared to discuss any additional issues or key points you think are

important based on the training provided today. Be honest about your attitudes towardpsychological health conditions and identify any challenges or obstacles that may still exist atthe unit level.

8/10/2019 Joint Professional Military Education Psychological H