Major Hilario Pascua

An Army medical detachment hit hard by the shootings at Fort Hood, Texas, last November, is now in Iraq providing mental health support to deployed soldiers.

The 1908 Medical Detachment (Combat Stress Control), a U.S. Army Reserve unit from Topeka, Kan., was at Fort Hood preparing for deployment when Maj. Nidal Malik Hasan killed 13 soldiers and wounded 30 others inside the Soldier Readiness Center. Two of the CSC soldiers were killed, and five were injured.

Having dealt with that traumatic experience, the unit is now deployed to Camp Taji, Iraq, assisting other soldiers who need help handling stressful situations.

The CSC is working in the Taji Warrior Resiliency Campus, a facility that addresses the five dimensions of a soldier’s health: physical, emotional, spiritual, social, and family. The campus was built by the Enhanced Combat Aviation Brigade, 1st Infantry Division with the goal of emphasizing Comprehensive Soldier Fitness, the Army’s program that provides tools to help soldiers cope with stress and deployment, as well as develop the ability to bounce back from adversity.

The CSC is comprised of a psychologist, nurse practitioners and mental health technicians headed by Maj. Hilario Pascua. The unit provides treatment to maintain the mental and behavioral health of Soldiers, and helps prevent future problems. Mental health falls under the “emotional” pillar of Comprehensive Soldier Fitness.

Pascua said that soldiers mostly visit the CSC for help with problems related to home, like marital and child issues, work related issues involving leadership, and difficulty adjusting to life in a deployed environment. The CSC also treats Soldiers with problems stemming from their experiences in combat on previous deployments.

Some leaders are reluctant about Soldiers going to the CSC believing that after visiting the center, their soldiers will not finish the deployment, said Pascua.

“Our role is not to take soldiers away,” said Pascua. “Our role is to strengthen soldiers to keep them here.”

Many Soldiers are also worried about going to the CSC, fearing there will be no confidentiality. Anyone who voluntarily visits the CSC and are not diagnosed as being a danger to themselves or others, have complete confidentiality.

While everyone is encouraged to visit the CSC if they need to, Pascua said soldiers can also turn to Family, friends, and their chain of command for help with stress.

“Our strategy is to strengthen their social support,” said Pascua.

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Story by Capt. Efrem Gibson

Maj. Larissa G. Coon developed several stress coping programs as the occupational therapist officer at the Patriot Clinic on Joint Base Balad, Iraq. Photo by Spc. Brian Barbour

In order to be successful in their missions, Soldiers deployed throughout Iraq deal with combat stress daily whether they perform their duties inside or outside the wire.

The 1835th Medical Detachment (Combat Stress Control) helps Soldiers find positive ways to cope with that combat stress and reduce incidence of suicide through their work at the Patriot Clinic here.

Maj. Larissa G. Coon, Patriot Clinic occupational therapist officer describes combat stress as “dealing with one of the top life stressors while in a combat or deployed environment.”

“This combat stress can be identified through dramatic changes in habits or routines,” Coon said.

Coon, a resident of Goodland, Kan., designed and implemented many of the stress coping programs available here.

She said some of the top stressors that people deal with in their lives are: a job change, a divorce or marriage, the birth or adoption of a child, the death of a family member or close friend, or major purchases like a house or a car.

Coon said these stressors are challenging for anyone to cope with, but when the stressor is combined with a deployment, the stressor for a Soldier is magnified many times over.

When these triggers occur, the affects on a Soldier can be seen in several areas. Soldiers may become angry at everything, have a change in sleeping habits or become withdrawn from contact with family, friends, or coworkers, Coon said.

The combat-stressed Soldier may have a change in eating habits, or may no longer be interested in activities that once brought them pleasure, she said.

Coon said battle buddies and unit leaders need to watch for any dramatic and significant changes in a Soldier’s behavior; it could indicate the need for a “buddy check.”

“Change is the main clue – the key,” she said.

Coon explained that combat stress should not be mischaracterized as Post-Traumatic Stress Disorder. PTSD is a long-term mental health diagnosis where dramatic changes in a person’s habits or routines continue for six months or longer.

A 2003 Army Medical Command report on mental health indicated that forward deployed behavioral health units experienced more than a 95% rate of return to duty status for Soldiers who sought combat stress treatment. The report indicated that almost half of the Soldiers surveyed reported not knowing how to obtain their mental health unit’s services.

The presence of combat stress control units here in Iraq now reflects the efforts the Army has taken to make these services readily available to service members.

There are currently five clinics that offer stress coping programs to service members needing them. These clinics in Iraq are located at Joint Base Balad, Contingency Operating Base Speicher, Camp Liberty, Camp Taji and Forward Operating Base Diamondback.

There are behavioral health assets dispersed across Iraq in more than 25 locations.

Coon said an overwhelming majority of the service members visiting the clinic come voluntarily with only 1 percent of Soldiers being command referred.

When a battle buddy accompanies a fellow Soldier to the Patriot Clinic for assistance, the clinic has no obligation to report the visit to the Soldiers command. The only time this happens is when there is a fear for the immediate safety of the Soldier.

Coon said that Soldiers exhibiting combat stress do not all need to be treated as being a risk of suicide.

“Sometimes they just need someone, like their battle buddy, to offer some help,” she said. Coon said the help a Soldier needs might not be anything more than hearing a buddy’s offer of advice or guidance to some of the resources to help them handle an issue.

The Soldier talking about the stressors they are experiencing can do a lot to relieve some of the pressure they are dealing with alone, Coon said.

If a Soldier needs additional help, Coon listed some other resources besides the clinic where Soldiers can turn to. Such resources are the Judge

Advocate General’s office for legal issues; the finance office for pay issues; the chaplain for spiritual guidance; the Army Emergency Relief fund for unexpected financial shortfalls; the Veterans of Foreign Wars or American Legion for support to loved ones back home; and Military OneSource as a gateway to numerous other agencies and organizations who provide military support, counseling, and assistance in the states.

Coon said: “I have the best job in the Army as I get to supply the activities to make people forget about their stress!”

The 1835th Med. Det. is an Army Reserve unit from Aurora, Colo. The fifty Soldiers of this unit will return to the Fitzsimmons Reserve Center in the spring of 2009 at the end of their deployment.

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Story by Maj. Christopher Emmons