UNITED STATES MARINE CORPS PRE-DEPLOYMENT RETURN AND REUNION PROGRAMS CDR THOMAS A. GASKIN, PHD

UNITED STATES MARINE CORPS

PRE-DEPLOYMENT RETURN AND REUNION

PROGRAMS

CDR THOMAS A. GASKIN, PHD

HQ USMC (MANPOWER)

MCB QUANTICO, VA

27 OCT 2003

CAPT ROBERT L. KOFFMAN, MD

2D MAW

MCAS CHERRY POINT, NC

LTCOL CHRISTOPHER A. SHARP

HQ USMC (MANPOWER)

MCB QUANTICO, VA

ODS Lessons: Learned?ODS Lessons: Learned?

• Lack of clear CSC doctrine• Rapidity of push into Kuwait made CSC

platoons logistically useless• “Half of the mental health officers assigned to

USMC units needed to be returned to CONUS before the ground war began” (Textbook of Military Medicine; pg. 230)

• PTSD rates for ODS estimated to be 8%• Lack of centralized data repository

DOD 6490.5DOD 6490.5

• DOD Directive 6490.5 “Combat Stress Control (CSC) Programs” directs all services to develop CSC programs to ensure prevention and management of combat stress casualties during war-time contingencies, small-scale contingencies and humanitarian operations other than war

• DOD 6490.5 mandates an integrated, SME-managed comprehensive theater-wide Combat Stress Control program to fall under the auspices of the Combatant Commander

• DOD 6490.3 Directs theater-wide surveillance for combat stress related conditions

OIF Mental Health AssetsOIF Mental Health Assets

• 1 organic psychiatrist (1st MARDIV)• 3 CSC Platoons with 1 psychiatrist, 2

psychologists, and 3 or 4 psych techs each (“C” Co. doubled by inclusion of “D” behavioral health staff)

• 1 psychiatrist and 1 psych nurse at EMF • 2 psychiatrists and 1 psychologist with TAH• 3 additional psychiatrists (Div Surgeon, IMEF

augment, and CATF surgeon)

COSR RatesCOSR Rates

• Initial assessment showed a very low rate among infantry

• Very few returned to CONUS for psych• Appreciable utilization of the combat stress

platoons by surgical company personnel• CONUS presentations of ASD and PTSD

markedly different from rates anticipated by utilization of organic mental health resources in-country

Why so few COSR casualtiesWhy so few COSR casualties

• Broad, non-specific term, lacking standardized definition.

• Lack of forward, integrated, Mental Health capabilities to assess and intervene

• Offensive v. Defensive OPS• Grunt Ethos. . . Many more consults from

Non-grunts . . .resistance and stigma

COSR Precipitants (“B” Co.) COSR Precipitants (“B” Co.)

• Pre-Existing Psych D/O (Axis 1) 26%• Pre-Existing Family Issues 23%• Exposure to Combat 20%• Combat Injury (Co-morbid) 12%• Peer Conflict 8%• Personality D/O 8%• Anticipation of Combat 4%

Sources of emotional trauma Sources of emotional trauma

• Presumed WMD, 22 days in MOPP

• Friendly fire incidents

• Lack of information: “asymmetric knowledge”

• Lack of mail and family contact

• Ill defined mission

COSC Recommendations COSC Recommendations

• Develop and fully implement Combat and Operational Stress Control doctrine

• Peer-based MH Integration (OSCAR)• Focus on Prevention, educate line,

improve credibility – Integration is key• Better pre-deployment screening (one

page per deployment versus four page post deployment)

One Solution: OSCAROne Solution: OSCAR

• 1998 OSCAR conceived to enhance division MH services (non-EAS attrition and suicide rates)

• 2000 OSCAR stood up with 1 psychiatrist, 1 psych tech, 4 SNCOs

• 2003 MROC approves 2 yr pilot program at the MSC

Return and Reunion StrategyReturn and Reunion Strategy

• Warrior Transition presentation– Developed by CREDO Chaplains– Provided to units and individuals prior to leaving

theater of operation– 3 components

• Where I’ve Been• Where I am About to Be• Where I’d Like to Be

Return and Reunion StrategyReturn and Reunion Strategy

• Warrior Transition Supplement

for Unit Leaders

– In theater training– Focused on Combat Stress Control (CSI)

• How to recognize• Resources to assist with treatment

– Enable leaders to deal with their own issues

Return and Reunion StrategyReturn and Reunion Strategy

• Return and Reunion Guide

for Marines and Families– Provided to Marines prior to their departure from

the theater of operations• Cargo pocket sized hard copy

– Available on-line for installation staff and family members

Return and Reunion StrategyReturn and Reunion Strategy

• Return and Reunion Guide

for Marines and Families– All aspects of return and reunion from different

perspectives• Single Marine and their significant others• Married Marines and their spouses• Marines with Children• Single Parent Marines• Reservists going back to civilian jobs

Return and Reunion StrategyReturn and Reunion Strategy

• Return and Reunion

for Spouses– Posted on the MCCS website

• For use by Installation staff• Commanders, chaplains and MCFTB Staff

– Wide promotion and presentation to families as early as 30 days prior to Marines return

– Narrated and annotated version on Navy Lifelines• http://www.lifelines2000.org/return/reunion.htm

Return and Reunion StrategyReturn and Reunion Strategy

• Caring for Caregivers– Modified Credo– 3-hour facilitated discussion for Key Volunteers

and Spouses• Provided support to units during deployment

– Available on-line • For use by installation staff and command

representatives to present

Return and Reunion StrategyReturn and Reunion Strategy

• Policy and Marketing– ALMAR

• Policy for the delivery of these services

– White Letter• Emphasizing importance of proper preparation of

Marines and their families during return and reunion

Return and Reunion

• Warrior Transition• Warrior Transition Supplement for Unit Leaders• Guide for Marines and Family• Presentation for Spouses• Presentation for Caregivers• Policy for Delivery - ALMAR • “White Letter” Emphasizing Importance• MCCS One Source Material and “Well Being” calls • Pre-deployment Presentations, Guides, Materials

Includes – Single, Married, Children

Questions?Questions?