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The 2012 report represents the latest assessment of the Army’s process that began in January 2009

Promoting Soldier Health & Discipline. The 2012 report represents the latest assessment of the Army’s process that began in January 2009 It provides a more focused review of the health and discipline of the Force after a decade of war

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The 2012 report represents the latest assessment of the Army’s process that began in January 2009

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  1. Promoting Soldier Health & Discipline • The 2012 report represents the latest assessment of the Army’s process that began in January 2009 • It provides a more focused review of the health and discipline of the Force after a decade of war • It provides analyses and assessments to inform commanders and leaders in their efforts to promote health, discipline and readiness January 2009 - July 2010 August 2010 – January 2012

  2. Report Overview • Chapter 1: Introduction • Chapter 2: Health of the Force: The At-Risk Population • Chapter 3: Discipline of the Force: The High-Risk Population • Chapter 4: Synthesis of Army Surveillance, Detection and Response to At-Risk and High-Risk Populations

  3. At-Risk and High-Risk Populations • The maze model (central to both reports) illustrates the relationship between at-risk and high-risk populations • At-risk represents help-seeking Soldiers; high-risk represents non help-seeking Soldiers whose behavior endangers themselves or others • Each concentric ring (approaching the center) represents a potential increase in severity of outcomes • The orb chart provides perspective of the population size of each concentric ring (red orb = base population) • The first 3 orbs represent the population of predominantly help-seeking (at-risk) Soldiers • Remaining orbs represent those Soldiers exhibiting high-risk behavior (e.g., criminal offenses, suicides) • Smaller orbs demonstrate the difficulty in identifying high-risk behavior from within the Army population • Reducing the size of the subpopulations associated with larger orbs may reduce the size of the smaller subpopulations—those whose high-risk behavior often leads to more serious outcomes

  4. Physical Injury (mTBI) • Physical injuries from concussive events can affect both the brain, as a physical injury, and the mind, as a psychological injury • mTBI can be treated, but a second event before the first has healed can be lethal • Most Soldiers with TBI—especially those with mTBI—fully recover • The Army implemented protocols to screen Soldiers for mTBI after experiencing a concussive event • There has been a dramatic increase in the diagnoses of mTBI as a result of improved training and screening • Diagnosed and treated over 126,000 cases of TBI since the beginning of the war • Of the 126,000 cases of TBI, 54% were diagnosed in the last four years

  5. Psychological Injury (PTSD) • PTSD represents a prevalent psychological injury (invisible wound) with ~70,000 Soldiers diagnosed by the Army since CY2003; increased diagnoses is due in part to improved screening • Non-combat traumatic stressors can predispose Soldiers to PTSD (e.g., childhood trauma) • PTSD, mTBI and Chronic Pain share common symptoms which can complicate diagnosis • There is a likelihood that a Soldier suffering from one may be suffering from two or all three • Treating symptoms without understanding the underlying conditions can be counterproductive • High-risk behavior (e.g., substance abuse or aggression) is linked to these conditions

  6. Warrior Transition Units • WTUs were established in 2007 to provide focused care for Soldiers requiring at least 6 months of complex medical management • There are currently 29 WTUs and 9 community based (CB) WTUs • The Army has averaged ~10,000 Soldiers under care since 2007 • There are currently ~47% AC and ~53% RC Soldiers enrolled in WTUs / CBWTUs • Average length of stay is 256 days in WTUs 420 in CBWTUs • 50% returned to the Force; 47% retired or medically separated • Probability of Soldier being returned to the Force decreases with time spent in WTU • Majority (95%) enrolled <2 years; however, there is an increasing trend for length of stay for both WTU / CBWTU since 2007 due to increased case complexity and rehab requirements

  7. Suicides by Calendar Year Army Suicides, CY08-11 • Overall suicides (combined categories) decreased by ~10% in CY11 from 350 to 315 • Active duty Soldiers increased from 159 to 164 in CY11 • ARNG and USAR both decreased in the same period • Increase in the number of hospitalizations associated with suicide ideation • Increase in ideation corroborates increase in suicide-related stressors • Non-primary diagnoses may indicate improvements in commander and health provider awareness • Indicates an increase in the number of Soldiers who receive early intervention and treatment * Includes Army Reserve and National Guard Soldiers on Active Duty ** Non-Mobilized USAR and ARNG Soldiers

  8. Improvements in Health Promotion • The Army is working with research partners to advance science to counter the effects of combat-related injuries and behavioral health conditions (e.g., mTBI, PTSD, depression) • Army has published and implemented campaign plans to deliver a comprehensive behavioral health system of care (5 touch points) and improve pain management • Clarified PHI policy and conducted training to enhance communication between commanders and healthcare providers • Improved medication management for Soldiers taking multiple prescriptions • The Army increased its outpatient behavioral healthcare access and delivery by more than 10% with 280,403 Soldiers receiving behavioral healthcare in FY2011 • Expanded tele-health to deliver behavioral healthcare to geographically isolated Soldiers • Army leaders have improved TBI screening measures with published mTBI protocols • Screened over 9,000 Soldiers for mTBI in theater since publication of mTBI protocols (Aug 2010) • Leaders have increased drug and alcohol referrals with over 24,000 Soldiers referred to ASAP in FY2011 • The Army has made progress in recent years to reduce the stigma associated with seeking and receiving help for behavioral health conditions • Increased behavioral healthcare providers, embedded them into brigades and primary care clinics, and expanded confidential treatment programs to encourage help-seeking behavior

  9. Discipline in the Force • The Army has reduced total crime from its highs in FY2007-09 as measured by offenders per 100,000 • FY2011 crime broken down: 4% violent felony crime; 36% non-violent felony crime; and 60% misdemeanors • The Army recognizes violent felonies have a far reaching impact on Soldiers, Families and readiness • 1.5% uptick in FY2011 was primarily due to Failure to Obey a General Order and drug-related incidents • Criminal activity and high-risk behavior may have reduced the readiness of ~18,000 Soldiers (felony subjects / victims = 2.6% of the Army) • Junior Soldiers (E1-E4) make up 43% of AD Army but committed 68% of crime in FY2011 • Army leaders will select and retain the most professional Soldiers for continued service as a part of the strategic reset • The Army continues to examine and refine policy to close gaps in criminal surveillance, detection and response

  10. Drug Crimes • The Army is closing surveillance and detection gaps • Streamlining drug crime reporting by referring positive urinalyses to both commanders and CID • Increase in drug offenses was due largely to leaders’ efforts to decrease gaps in law enforcement reporting • Increased drug suppression teams and unit drug testing; mandated CID purview over all drug crimes • Potential shift from street drugs to pharmaceutical drugs due to the proliferation of prescription drugs • Changes in pain management and drug testing should reverse this trend • Increase in use of synthetic drugs (e.g., spice, bath salts); over 3,500 incidents in FY2011 • Army has recently enacted a blanket ban on designer drugs; use is UCMJ violation • Drug abuse often transmitted horizontally (to other Soldiers) and vertically (use of other drugs) • 36% of first-time drug offenders will commit a 2d drug offense; of those, 47% will go on to commit 3 or more

  11. Sex Crime Trends • Sex crimes have increased by 32% in offender rate per 100,000 from FY2006-11 • Violent sex crime offender rate increased by 64% from FY2006-11 (75 to 123 per 100,000) • Other sex crimes have remained relatively flat • Analyses have identified the following risk factors involved in violent sex crimes: • 63% involved known alcohol use; 54% occurred in high density housing (e.g., barracks) • Of female AD victims, 56% were 18-21 years old and 64% in first 18 months of service • 97% of victims at least casually knew their attacker • Mitigation strategy • Aggressive sponsorship and integration of Soldiers (especially young, female Soldiers) • Greater leader oversight in barracks • MTT for 17,000 SHARP personnel (2010)

  12. Domestic Violence and Child Abuse • From FY2006-11, domestic violence increased by 33% (293 to 383) and child abuse increased by 43% (201-287) per capita • An increase in referral numbers to the Family Advocacy Program from 2008-11 • Soldier offenders of domestic violence increased by 50% (4,827 to 7,228) • Soldier offenders of child abuse increased by 62% (3,172 to 5,149) from FY2008-11 • Alcohol associated with [physical] domestic violence increased by 54% and with child abuse by 40% from FY2001-11 • This may be associated with research linking increased alcohol consumption with partner aggression among veterans suffering from combat-related wounds, injuries and illnesses • Analysis reflects a potential gap in the visibility of prior domestic violence as Soldiers PCS / relocate • The Army will increase information sharing among installation program managers and commanders

  13. CID Death Investigations • Of the 312 drug toxicity deaths from FY2006-11, 69% (214) involved prescription medication. Of these 214, 48% (103) were not prescribed • Deaths related to high-risk behavior and drug abuse may mask the victims’ intent • Nationally, 20-30% of suicides inaccurately classified as accidental or undetermined • Growing concern regarding prescription medication abuse and related deaths • The Army is working to develop a drug take-back program to reduce the available quantity of unused medication • A new policy increasing drug suppression teams on the largest installations will reduce drug-related incidents • A new policy limiting the duration of authorized use of prescription medication to 6 months will increase surveillance of illicit use

  14. Discipline and Administrative Accountability • Commanders at all levels are rebalancing unit readiness through appropriate administrative and disciplinary actions • Administrative separations have increased dramatically since their low in FY06 • Primarily driven by misconduct separations • The Army has dramatically decreased the number of accession conduct waivers • Drug/Alcohol waivers peaked in FY07 at 1,307, dropping to 337 in FY09 and 0 in FY10/11 • The Army continues to reduce the number of Soldiers who committed multiple felonies • 21% reduction from a high in FY08

  15. Improvements in Discipline • The Army dramatically reduced its felony conduct accession waivers by 81% from FY2007-11, while it increased its Soldier misconduct separations by 57% from FY2006-11 • This accounted for a reduction of over 40,000 Soldiers (who committed crimes) who could have entered or been retained in the Force • HQDA is reducing policy / program gaps; commanders are enforcing Army standards. • The Army has reduced multiple felony offenders on active duty by 21% from its high in FY2008 of 6,181 to 4,877 by mid-FY2011 • Although the overall crime rates rose in FY2011 (from a low in FY2010), rates remained below those from FY2007-09 • Homicide (murder and non-negligent manslaughter), aggravated assault and robbery remain below national averages • Despite an increase in FY2011, drug crimes (per 100,000) declined by 19% from FY2006-11 • Commanders Report of Disciplinary or Administrative Action (DA Form 4833) reporting for felony offenses has an average compliance rate of 95% • The Army has identified numerous sex crimes risk factors (alcohol, high density housing, weekends, gender / age of victim) and is implementing mitigation strategies • The Army directed training for over 17,000 personnel on sexual assault prevention across commands Army-wide

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