The Army Training System - AskTOP

Younger Age GroupImpulsive, lacks coping skillsPoor adjustment to military settingsSituational stressorSuicidal behavior happens with little forethoughtImmatureEngages in acting out behavior that is often hard forsuperiors to missFirst term of enlistment—not that concerned about careerimpactWill often confide to anyone who is interestedOften lives in barracks and eats in dining facility; used tosuperiors being aware of details of his “personal life”Usually a facilitating “gatekeeper” helps him get to MH(chain of command or others)Goes to MH with little thought of negative ramifications ifdirected or suggested by chain of commandEarly intervention may prevent acting out behavior and mayfacilitate development of more mature coping skillsCommand is already aware of the problem since MH contactwas either command directed or encouraged by a memberof chain of command—a dialogue with MH is alreadyunderwayFor the younger cohort, this tension (confidentiality vs.command’s need to know) is less of an issue; commandusually already knows; in those cases where they don’t, thesoldier is usually close to getting into some kind ofdifficulty, thus making it in his best interest to be proactiveand letting his superiors know that he is addressing theunderlying issues, before real trouble hitsFor this cohort, MH contact, in actual practice, looks almostlike ADAPCP and Family Advocacy, which are commandprogramsOlder Age GroupMDD (Major Depression) or serious heavy ETOH (alcohol) useGood previous adjustment to ArmyMajor loss or transition issueContemplating suicide for some time as part of a biological diseaseprocessMature person whose biology or complicated past (or often both) hascaught up to himQuietly withdraws from those who might notice; behavior of socialwithdrawal and his accompanying internal feelings of shame are easyto missCareer soldier; concerned that MH contact will be seen as weaknessand will hurt his careerShame, a symptom of MDD and often of ETOH dependence, makes itdifficult to tell anyone and magnifies fears about “the Army” finding outLives in housing or off base; has erected certain barriers between hisduty day and his personal lifeAssurances of confidentiality and assurances that getting treatment fora MH problem is not career damaging (stigma) become very importantin combating the shame (which is part of the biological diseaseprocess) and thus allowing the soldier to feel it is “safe” to comeforward and get help.It is important that these beliefs are in place before the soldier getsdepressed (thus the importance of this campaign which promotes botha culture change from above and a training component which gets theword out below). Once the soldier is clinically depressed thesymptoms of shame and social withdrawal make it very difficult toreach him.Usually self referred to MH; may have conferred with a colleague; tendsto tell chain of command as a last resort or not at allHas viewed MH as a place where problem soldiers go—often tofacilitate separation from the serviceEarly intervention prevents progression from mild depression toserious biological depression; both depression and early alcoholdependence, particularly in those who have previously made a goodoccupational and social adjustment; are usually very responsive totreatmentCommand is often not aware of the problem up front; if the problem isserious, the MH professional needs to inform command either with thepatient’s consent (which he is usually willing to give after he hasovercome his shame and entered into treatment) or via a profileIf it is a mild depression, the patient may choose to keep it confidential(like any other medical problem that is not going to interfere with hisperformance of duty)For the older cohort MH patient, here is a built in tension between thesetwo essential components:Command’s need to know (which is always there in the seriouscases; it is the MH professional’s responsibility to inform command—by profile if necessary)vs.Assurances of confidentiality(so important in countering the shame of clinical depression: makes itsafe for the soldier [or for his colleague in whom he may haveconfided] to believe it is safe to “self refer” early in the process and getthe needed care for a very treatable condition)SH-2-41