U.S. soldiers' morale down in Afghanistan
Obstacles to getting mental health care cited in Army survey

By Ann Scott Tyson
Washington Post Staff Writer
Saturday, November 14, 2009

Morale has fallen sharply among U.S. soldiers in Afghanistan, with repeated combat deployments taking a toll on their psychological health and marriages, according to an Army mental health survey released Friday.

The percentage of soldiers who rated their unit's morale as high or very high fell from 10.2 percent in 2007 to 5.7 percent in 2009, according to the survey. Individual morale rates remained steady, with about 16 percent saying their morale was high or very high.

Meanwhile, soldiers in Afghanistan are having greater difficulty getting help for psychological problems, for a variety of reasons, including a shortage of psychiatrists and other mental health workers, the survey showed.

The Army had about 43 behavioral health personnel in Afghanistan when the survey was conducted from April to June, or about one for every 1,100 soldiers. The Army is working to improve that ratio to one for every 700 soldiers, and to assign more mental health providers to brigades and battalions.

As part of that effort, the Army has activated some reserve combat stress units, including one that was preparing to deploy from Fort Hood, Tex, when Army psychiatrist Maj. Nidal M. Hasan allegedly went on the Nov. 5 shooting rampage there. Hasan was scheduled to deploy to Afghanistan before the end of the year to serve with a combat stress unit.

Lt. Gen. Eric B. Schoomaker, the Army's surgeon general, said that the Army is short by about 25 percent of its overall goal for hiring more behavioral health specialists, but stressed that the service would not cut corners in order to fill the slots. "We would never compromise quality simply to get a body out in the field," he said at a Pentagon news conference.

Officials said the obstacles to soldiers receiving mental health care include being spread out in smaller outposts as part of the counterinsurgency effort and Afghanistan's rugged landscape, making travel difficult.

"Even with an optimal ratio" of providers to soldiers, "the terrain and weather makes it quite difficult for us," Schoomaker said.

About 21 percent of soldiers in Afghanistan reported psychological problems such as acute stress, depression or anxiety, which is about the same as in 2007. The findings come as soldiers in the country today face greater exposure to combat than two years ago, the survey showed.

The survey confirmed earlier findings that mental health problems increase along with the number and length of soldiers' combat zone deployments. About 30 percent of soldiers reported marital problems such as infidelity or divorce during the third deployment, compared with less than half that during the first and second deployments.

Similarly, about 30 percent of soldiers who have deployed three times or more meet the criteria for having a psychological problem, compared with about 14 percent on the first deployment and 18 percent on the second deployment, the survey showed. In turn, the usage rates for behavioral health medications including those for combat stress and sleep "increased significantly by the third deployment," the report said. Still, those treating the soldiers complained of a lack of availability of "appropriate psychiatric medication" at all levels of care facilities in Afghanistan.

There were five confirmed suicides among soldiers in Afghanistan this year through the end of May, compared with seven for all of 2008, despite the vast majority of soldiers having undergone suicide prevention training, the report said.

On Friday, the Army also released monthly suicide data for October, during which there were 16 possible suicides, not all of which have been confirmed by medical examiners. There were 133 reported active-duty Army suicides from January through October this year, compared with 115 for the same period last year, according to Army data.

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