Facing far forward: Mental health in large-scale combat operations

Large-Scale Combat Operations (LSCO) present unprecedented challenges to the provision of medical and mental health care on the battlefield. Characterized by restricted mobility, contested logistics, disrupted communication, drone attacks, subterranean environments and the necessity for prolonged field care, the LSCO environment will severely disrupt traditional models of combat and operational stress control (COSC) that rely on far-forward specialty providers and fixed facilities. This article introduces a special issue of Military Psychology dedicated to reviewing mental health in LSCO. By outlining the anticipated psychological demands of future near-peer conflicts, the goal of this special issue is to facilitate a shared and comprehensive understanding of possible threats and lay the groundwork for a way ahead to manage mental health in LSCO. Specifically, to maintain warfighter readiness and operational effectiveness, foundational COSC principles - Proximity, Immediacy, Expectancy, and Simplicity - must be reimagined. We highlight possible shifts in conceptualizing mental health care, including relying on leader-led interventions, peer-to-peer support and the training of non-specialty medical personnel (e.g. medics and corpsmen) to manage acute combat stress reactions using evidence-informed, rapid-intervention protocols. Ultimately, the goal is to synthesize current research, lessons learned from global operations, and conceptual frameworks to establish priorities for mental health training, intervention development, and policy in preparation for managing mental health in LSCO environments.