Preparing Mental Health Support for Multi-domain, Large-scale Combat Operations: Current Progress and Future...

Projected limitations during multi-domain and large-scale combat operations suggest that mental health support from specialized personnel (e.g., psychologists, psychiatrists, and social workers) may not be readily available, necessitating management of mental health conditions by nonspecialized personnel in far-forward environments for extended periods of time. Because of these limitations, updated models for combat and operational stress control are needed.

At the direction of the Joint Staff Surgeon, the Assistant Secretary of Defense for Health Affairs, and other senior leaders in the DoD, several initiatives have been undertaken to expand the capability of medics, general medical practitioners, unit commanders, and front-line service members to enable the delivery of supportive mental health care in the absence of specialized medical personnel.

Taken together, these recent innovations fit into a comprehensive model for organizing non-specialty mental health resources around the point of injury in a large-scale combat environment, identifying gaps in current capabilities and highlighting potential interventions to address these gaps. In particular, an emphasis on self-aid through resilience training, specific peer-based interventions, in-depth training for medics, and greater command involvement may sufficiently overcome projected limitations in future combat scenarios.

Full implementation of this model at scale to address capability gaps will require a concerted effort by stakeholders throughout the Military Services and Combatant Commands. Requirements must be put in place to ensure that training in these interventional models is included in initial entry training and Tactical Combat Casualty Care.

An adapted model of combat and operational stress control for large-scale combat operations has the potential to overcome limitations in the future battlespace that may limit the interventions that have been employed for the past several decades.