Leaders Guide - Mental Health Problems

Mental health is a critical component of personal and unit readiness. Mental health is more than just the absence of mental illness, it is mental resilience, flexibility, and the capacity to deal with problems as they occur (to adapt, innovate, and overcome). Some Marines are able to do this better than others. A large component of this is personality or character traits, which are fairly fixed in an individual from early adulthood onward. These traits are affected by a Marine's mental state, which can vary according to circumstances or illness. When mental health is in jeopardy a Marine may have ongoing problems getting along in the unit, may seem to be functioning below usual capacity, or may seem “weird” or “crazy.” Any of these problems can affect a Marines personal readiness as well as the overall readiness of the unit. Early identification, evaluation, and treatment are essential to all concerned.

Mental Health:: The psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment.
Mental Illness:: Any disease of the mind; the psychological state of someone who has emotional or behavioral problems serious enough to require psychiatric intervention.

Risk factors increase the probability that a Marine will develop mental health problems. The presence of risk factors does not automatically mean that mental health problems will occur, but it increases the possibility. Many of these risk factors can be modified, reduced, and even eliminated, others are inherent to the individual. The following risk factors have been associated with the development of mental health problems while in the Marine Corps:

To the extent that these factors can be identified and treated early, the risk of a Marine developing mental health problems can be minimized.

Marines may be reluctant to seek help because of fears that such help will negatively impact their careers. Unfortunately, this often means a Marine in distress delays seeking help until the problem becomes so big that it affects behavior both on and off work resulting in Page 11 entries, Letters of Reprimand, and NJPs.

The consequence of waiting too long to seek help is what damages careers. Getting help early does not. As leaders, you must combat the myth that seeking help early damages careers.

Another fear Marines have is that their Commander will have complete access to their mental health records. However, confidentiality is maintained for most Marines who self-refer to Mental Health. In cases where information is released, the cases either involve mandatory reporting or the unit leadership was solicited to be a resource for the member (with the Marine's consent).

Some Marines incorrectly believe mental health information is entered into their Military Record. Mental health information is recorded in the outpatient medical record and the appropriate mental health file but not the Military Record unless they are found unfit or unsuitable for duty.

Prevention of mental health problems includes recognizing symptoms and responding appropriately when they are evident. However, it begins with establishing a culture in which seeking help for small problems is not only acceptable but expected, to protect the readiness and effectiveness of the unit. This may be accomplished through a variety of protective factors within the individual and the command, which reduce the probability that difficulties will turn into serious behavioral or emotional health problems.

Local agencies and resources are available to help when someone comes to you with a problem. All of us have a responsibility to match the needs of our members with available resources. Each installation has a branch of Marine Corps Community Services (MCCS) called the Marine and Family Services (MFS) Center, which coordinates with representatives from each of the helping agencies on base. They routinely work with other agencies to identify base-wide needs and to coordinate the delivery and referral of services to meet these needs. Services at each base vary, but typical offerings by Marine and Family Services include:

MCCS One Source is another important resource for Marines in distress. The services of MCCS One Source supplement the existing support system for Marines and their families by providing assistance 24 hours a day, 7 days a week via toll free telephone and Internet access. In addition, MCCS One Source supports geographically dispersed Marines and their families (recruiters, Inspector and Instructor staffs, and mobilized reservists) who do not have traditional services available. Resources are available on topics to include parenting and childcare issues, education services, financial information and counseling, legal, elder care, health and wellness, crisis support and relocation.

Every person is at a different level of risk for experiencing difficulties, based on their balance of protective and risk factors. One key to good mental health is to increase the protective factors and to decrease the risk factors. This is not just focusing on eliminating negative factors, but also on increasing positive factors that will improve the quality of life for Marine Corps members. As a Marine Corps leader, whether enlisted or officer, you contribute to the presence of these positive factors.

National Institute of Mental Health http://www.nimh.nih.gov/
This web site has helpful information on the most common mental illnesses and disorders. See especially the section on “Real Men, Real Depression” (http://menanddepression.nimh.nih.gov/).

MCCS One Source The services of MCCS One Source supplement the existing support system for Marines and their families by providing assistance 24 hours a day, 7 days a week via toll free telephone and Internet access. In addition, MCCS One Source supports geographically dispersed Marines and their families (recruiters, Inspector and Instructor staffs, and mobilized reservists) who do not have traditional services available. Resources are available on topics to include parenting and childcare issues, education services, financial information and counseling, legal, elder care, health and wellness, crisis support and relocation.

Marines or family members seeking assistance can call 800-869-0278 in CONUS, or 800-8690-2788 OCONUS. MCCS One Source Online can be visited at www.mccsonesource.com, userid: marines, password: semperfi.

Active Listening:

Active, effective listening is the foundation of effective communication. Active listening intentionally focuses on who you are listening to in order to understand what he or she is saying. As the listener, you should then be able to repeat back in your own words what they have said to their satisfaction. You do not have to agree with, like, or fix the problems that you are hearing. Your job is simply to convince the other person that you understand what they're trying to say. A good web site on this technique can be found at: http://www.taft.cc.ca.us/lrc/class/assignments/actlisten.html

Adjustment Disorder:

A psychological response to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms. The clinical significance of the reaction is indicated either by marked distress that is in excess of what would be expected given the nature of the stressor or by significant impairment in social or occupational functioning. Note: Although combat stress reactions could be considered adjustment disorders, they are in practice not classified this way at first, in order to keep them from being treated as mental health problems until it is clear that they can not respond adequately to pre-mental health interventions.

Administrative Actions:

Any alcohol related misconduct or unsatisfactory performance will be subject to prompt and appropriate administrative action. Charges of intoxicated driving in violation of local legal blood alcohol content (BAC) will be treated as an alcohol related incident.

Anxiety:

There are many different kinds of anxiety disorders but anxiety is generally described as an emotional state characterized by fear, apprehension, and physiological arousal.

Career Consequences:

Many Marines worry that seeking help will make them appear "weak" or "defective" to their peers or leaders. In the past there has probably been some basis for this worry, and the stigma associated with seeking help may still be a problem in some units. Current Marine Corps policy is for commands to create a climate where seeking help is encouraged to promote maximum personal and unit readiness. If a Marine were drowning, they would not hesitate to ask for help, and peers and leadership would do everything in their power to help, regardless of the reason for the distress. It needs to be the same way for Marines "drowning" in personal problems or distress. Our readiness and their lives may depend on it. It is important for Marines to be confident they can ask for help without prejudice to their careers. It is especially important for them to understand that what is more likely to affect their careers is not seeking help, and waiting until problems affect their job performance or mental health. But at any point, seeking help should be welcomed and encouraged as the right and courageous thing to do, for the benefit of not only the Marine involved, but also team-mates who depend on him/her to be there when needed.

Chaplain:

Provides spiritual guidance, personal counseling, and life issues counseling in a confidential setting. Chaplains are protected by the Uniform Code of Military Justice, which ensures confidentiality. Under military law, chaplains must keep conversations confidential when service members seek their spiritual guidance, either as a formal act of religion or a matter of conscience. Chaplains do not have to keep conversations confidential when a service member speaks with them for reasons other than spiritual guidance. When it is in the best interest of the person involved, the chaplain is expected to assist the individual in identifying the appropriate means of self-disclosure without violating the individuals trust. For additional information of the Chaplains confidentiality guidelines, contact the base legal office or the installation chaplain's office.

Command Directed Evaluation (CDE):

When a Marine will not go for a Mental Health Evaluation for suicide risk, and there is good cause to suspect the Marine is at risk, the unit commander will have to initiate a Command-Directed Mental Health Evaluation and order the Marine to submit for evaluation. This requires specific sequence of actions due to the legal issues involved.

Depression:

A low, sad state in which life seems bleak and its challenges are overwhelming. Symptoms to look for include, a persistent sad, anxious, or empty mood. Feelings of hopelessness, pessimism, feelings of guilt, worthlessness, helplessness, restlessness, irritability. Loss of interest or pleasure in hobbies or activities that were once enjoyable. Decreased energy, fatigue, being slowed down, difficulty concentrating, remembering or making decisions. Insomnia, early morning awakening, or oversleeping. Changes in eating patterns, either overeating or loss of appetite.

Helping Agencies:

The following agencies offer the services listed.

Marine and Family Services – Personal counseling, stress management, family/relationship counseling
Chaplains – Spiritual guidance, personal counseling, life issues counseling
Military OneSource – Anonymous personal, financial, and other advice, brief face-to-face counseling
Navy/Marine Corps Relief Society – Financial counseling and monetary assistance
Legal Services – Legal assistance and advice
Medical – Mental Health evaluation and treatment, health promotion strategies

Hospitalization:

Psychiatric hospitalization (also known as inpatient treatment) is necessary when a Marine is evaluated for suicide risk and found to be at high enough risk for self-harm that it would be unsafe to treat them as an outpatient. Inpatient treatment is usually done in a locked ward, where the patient can be contained for their own safety, and monitored 24/7 by specially-trained staff an appropriate level (one-on-one, line of sight, or safety checks at prescribed intervals) depending on the level of risk determined by their mental health provider. Further, their behavior can be assessed in more detail and in a more continuous and controlled manner to see if they are truly depressed, mentally ill, suicidal, or manipulative. More intensive, daily therapy is also available in the inpatient environment than in outpatient services. However, such services are also exceptionally expensive, and so are generally reserved for c ases where outpatient services are unlikely to be enough to keep them from harming themselves, or in cases where a suicide attempt or gesture has just occurred and further evaluation, treatment, and monitoring are advised, at least overnight, to ensure their ability to be treated safely on an outpatient basis.

Limited Duty:

Limited Duty status allows a Marine to remain on active duty when they are not currently fit for full duty, but there is high likelihood that, with appropriate treatment, they can be restored to ongoing full and productive duty in a reasonable amount of time (defined as 6-14 months). This status will usually prevent them from being deployable and has some other administrative ramifications

Malingering:

Deliberately faking symptoms of a disorder, including suicidal thoughts, personality disorder, etc, for secondary gain, such as getting out of military service obligations.

Marine Corps Community Services (MCCS):

Enhances unit and family readiness by delivering programs such as Marine Corps Family Team Building (MCFTB), Military One Source Information and Referral Service, Counseling Services and New Parent Support. The programs are designed specifically for Marines and families to increase their awareness of relevant readiness issues, while offering creative ideas to build a healthy family. Through proactive education, training, coordination of support services, materials and tools, MCCS promotes personal and family readiness that can be applied in everyday situations. Military One Source is also able to coordinate counseling services for Marines and families in need of counseling support to help cope with deployment related issues, reunion concerns, parenting, childcare and other everyday issues. Marines and family members are allowed six face-to-face counseling sessions per incident with a civilian mental health practitioner for free. A Marine or family member will call a One Source consultant who will determine if there are on base resources readily available to assist the caller. If on base resources are not available, the One Source consultant will provide the caller an immediate referral to counseling assistance, and using their nationwide network of providers, will find a licensed mental health practitioner near the caller. Utilizing Military One Source is ideal for Marines and Marine Reservists (and families) needing counseling services but who are not located near an installation. Marine and Family Services (MFS) counseling is available to those units and families in need of counseling support in the areas of combat stress, stress reduction, anger management, new parent support, and couples counseling.

Marine and Family Services (MFS) Center:

The EFMP Coordinators are located at the MFSCs. MFSCs also offers a wide variety of counseling services for families who may need some help in coping with the emotional side or caring for a family member with special needs. The MFSCs also have financial counselors who can assist families who need help achieving their financial goals or when they need guidance when problems arise. Click here for more details.

Medical Retirement:

Medical Retirement is an option for Marines who are not in Entry Level status (>180 days active duty), are suffering from a problem that did not exist prior to enlistment, and are not suffering from a problem that requires administrative separation instead.

Military OneSource:

The services of Military OneSource supplement the existing support system for Marines and their families by providing assistance 24 hours a day, 7 days a week via toll free telephone and Internet access. In addition, Military OneSource supports geographically dispersed Marines and their families (recruiters, Inspector and Instructor staffs, and mobilized reservists) who do not have traditional services available. Resources are available on topics to include parenting and childcare issues, education services, financial information and counseling, legal, elder care, health and wellness, crisis support and relocation. Marines or family members seeking assistance can call 800-342-9647. Military OneSource Online can be visited at www.militaryonesource.com.

Personality Disorder:

A maladaptive and enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individuals culture, which is pervasive and inflexible across situations, has onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment in social, occupational, or other important areas of

Protective Measures:

Commanders can expect to be informed promptly when dangerousness issues arise in the course of a mental health evaluation or treatment. If the Marine was referred for a formal Command-Directed Evaluation, both oral and written feedback will be given to the commander addressing the specific issues raised by the commander. The provider may recommend duty restrictions such as removal from weapon-bearing duties or temporary change in flying status. Commanders can also help ensure the individuals duties do not involve significant time alone which there would be opportunity for dwelling on problems and potentially attempting suicide. Commanders may also be directly advised to take steps to reduce access to weapons at the individuals home. While it is impossible to limit a persons access to all potential suicidal means, it is important to take reasonable steps to ensure safety when possible. Firearms pose the greatest risk as a readily available means of self-harm and should always be removed from a suicidal individuals home when legally possible. When this is not possible, counseling the Marine, family, or friends, about the dangers of keeping a firearm available to the suicidal Marine so that it is voluntarily removed, should accomplish weapons removal. Security Forces will generally secure personal firearms in the armory.

Psychosis:

Any severe mental disorder in which contact with reality is lost or highly distorted.

Trying to Manipulate:

Occasionally a Marine may feign suicidal thoughts or behavior for secondary gain, such as to get out of the Marine Corps. Even if you think this is the case, the liability is too high not to take appropriate action, so you must get the Marine evaluated by Medical for suicide risk whether you think they are faking or not. Medical is qualified and licensed to determination the level of suicide risk and will let you know what to do with the Marine, including possible administrative actions to hold a manipulative Marine accountable, if appropriate.