CAMP VICTORY, IRAQ — U.S. troops in Iraq, facing the stress of multiple, extended combat tours, are increasingly willing to seek mental health counseling while they're in the field, according to military medical experts.
Combat stress experts from the 785th Medical Company, an Army Reserve unit from Fort Snelling, Minn., that originally deployed to Iraq in 2004 and redeployed in August after two years in the United States, say they’ve noticed a substantial change in attitudes toward mental health treatment, which has long been stigmatized.
"There hasn't been that challenge of having to go out and kind of sell ourselves to make sure people know that we're here and this is an important part of the combat experience for everybody," said Capt. Troy Fiesel, the company's operations officer.
"Now we've got people walking in and saying, 'Hey, I know I have got this issue,' or 'I had this problem last time and I need to keep working on it.'"
The willingness to seek help comes as the Pentagon pushes mental health care as some troops enter their third or fourth deployments in a war with no front lines and no safe rear areas and as the first tours of duty that were extended to 15 months grind to an end.
Modern communications — phone and Internet service are available on many bases in Iraq — also can add to troops' stress levels because they take on the pressures their families are under back home, too.
"A lot of what we do is educating people that they've got to be here, not here and at home, too," Fiesel said. "If you try to incorporate both worlds and the stresses associated with both, you've going to burn out whatever coping skills you have."
An Army survey released late last year indicated that soldiers serving multiple combat deployments were 50 percent more likely to experience acute combat stress. Other studies have found that up to 30 percent of troops sent to Iraq suffered from depression, anxiety or post-traumatic stress disorder.
Another Army report, released in August, said the suicide rate for soldiers in 2006 was the highest in 26 years and that nearly a third of the 99 victims had killed themselves in Iraq. The report said that failed relationships, financial and legal problems and the stress of their work fueled the problem.
That report said there was at least some evidence of a relationship between suicide and the length of deployments.
Soldiers with the 785th Medical Company said they've seen evidence of that in their most recent rotation.
"Before, people might have said, 'Well, I can do this for 12 months,'" Fiesel said. "But now that extra few months can influence the lack of coping skills. Sometimes it's just enough to push it past the limit."
In 2004, the 785th was the only unit fielding combat stress reduction teams, which are units as small as two or three people that are based with combat troops at forward operating bases. Now, the Pentagon has fielded two similar units.
The stress reduction teams are spread all over Iraq. The 785th has people in 14 locations.
By treating problems early and as close to combat as possible, the military hopes to reduce the number of "psychiatric casualties" that have to be sent home, said Col. C.J. Diebold, the U.S. military's psychiatry consultant in Iraq.
Putting the teams among the troops helps erode the stigma by making them an everyday part of the deployment, said Col. Elspeth Ritchie, a psychiatry consultant to the Army surgeon general.
"If you're just two tents down and they're seeing you in the chow line every day, it make it a lot easier for them to approach you," she said.
All told, about 200 troops in Iraq work with combat stress control units, Ritchie said. Chaplains and health care workers also are trained to identify troops with stress-related or mental health problems and help them.
In the earlier deployment, Fiesel said, the teams were more apt to run into resistance from commanding officers.
"There was this fear in some cases that, 'Hey, you're going to take this soldier away from us,'" he said. "The education piece is, no, we're here to prevent that from happening. We're here to equip your soldiers with adequate coping skills so they can get through this challenging time."
Most commanding officers now understand the importance of mental health care, or at least are going along with the Pentagon push to make it a routine part of military life, said Lt. Col. Peggy Miller.
Miller oversees the 785th's walk-in and appointment clinic that serves troops in the Baghdad area and is in charge of the "restoration" center. Troops come to the center when they need more careful assessment and just plain rest.
There are three such facilities in Iraq now, she said.
The treatments for stress can be simple: A much-used therapy is simply regular meals and sleep.
"Sleep is huge, "Fiesel said. "Having a lot of adrenaline and not being able to relax and get good sleep is common. The majority of folks we see, no matter what they are presenting with, sleep is an issue."
Beyond the treatment itself, the 785th works to make it feel OK for soldiers to seek treatment.
The 785th offers classes on stress and holds focus groups with soldiers to determine how a unit could adjust its operations to reduce stress on the troops.
It also helps, Diebold said, when troops see how mental health professionals can be effective in a crisis, such as during the rocket attack on Camp Victory earlier this month that left two soldiers dead and 40 people wounded.
"They were out doing the complete combat stress control mission, and that I think helps bolster the concept around here," Diebold said. "It builds credibility. It helps a commander who may have been reluctant in the past to refer soldiers."
Capt. Russell Bacon, the 785th's executive officer, said overcoming commanders' resistance to mental health counseling has been a major change.
"In 2004, there were a lot of people that were like, 'We're here, we'll get through this, we can take care of our own,'" he said. "But then as the war has gone on, when something bad happens and you have your opportunity to show them how well you can do, what you can do to support the soldier and the command, then you win them over. They see you as an asset."
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(Price reports for The News & Observer in Raleigh, N.C.)