1. 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

2. 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

3. DOD 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

4. OIF Mental Health Assets 1 organic psychiatrist (1 st 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)

5. COSR 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

6. Why 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

8. COSR Precipitants (“B” Co.) Pre-Existing Psych D/O (Axis 1) 26% Pre-Existing Family Issues23% Exposure to Combat 20% Combat Injury (Co-morbid)12% Peer Conflict8% Personality D/O8% Anticipation of Combat4%

9. 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

10. 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)

11. One 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

12. Return 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

13. Return 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

14. Return 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

15. Return 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

16. Return 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

17. Return 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

18. Return 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

19. 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

20. Questions?