Page 52 - Biobehavioral Resilence to Stress

Resilience and Military Psychiatry 29

surveyed did not meet screening criteria for behavioral health functional
impairment. Behavioral health units in the combat zone reported that more
than 95% of service members who presented for psychological evaluation
were subsequently returned to duty (Medical Health Advisory Team, 2003).
The second MHAT team (MHAT-II) evaluated service members deployed

during the second year of the Iraq War (2004) and found that the percentage of
service members who screened positive for a mental health–related problem
had decreased from 18% to 13%. Ten percentage (10%) of service members
then screened positive for symptoms of acute or posttraumatic stress. Th e
U.S. Army National Guard and reserve units whose members performed
transportation and nonmedical combat service support demonstrated higher
rates of mental health problems and held less positive perceptions of com-
bat readiness and training than did service members in other units ( Mental
Health Advisory Team, 2005). Reports for Operation Enduring Freedom
(Afghanistan) and a 1995 follow-up survey (Iraq) are pending.

Combat and Operational Stress Control

Military behavioral and mental health care includes intervention and
treatment of stress symptoms, maladaptive behavioral responses to extreme

environments, and mental illnesses that can affect mission capability and
individual function. Military mental health personnel are trained in the
principles of combat and operational stress control (COSC), which empha-
size the goal of preventing maladaptive operational and combat stress reac-
tions. Each branch of military service has adopted its own doctrine and

programmatic effort by which these principles are applied as well as any

service-specific organizational or cultural issues that might relate to their
implementation. For example, the U.S. Navy and Marine Corps currently
apply the same principles under the program heading, operational stress
control and readiness (OSCAR). For the purpose of maintaining consistency
throughout this chapter, we focus primarily on U.S. Army doctrine and

practice. The Department of Defense (2001) has determined a need to update
this doctrine across the services. An updated directive for COSC is currently
under development.

Combat and Operational Stress Reactions

The purpose of COSC doctrine is to promote service member and unit readi-
ness by enhancing adaptive stress reactions, preventing maladaptive stress
reactions, assisting service members to control combat and operational
stress reactions, and assisting service members who present with behavioral

12/13/2007 6:09:37 PM
CRC_71777_Ch002.indd 29 12/13/2007 6:09:37 PM
CRC_71777_Ch002.indd 29