NATO Human Factors and Medicine Panel Activities Psychological Health and Mild Traumatic Brain Injury/Concussion 2 Octo

1. NATO Human Factors and Medicine Panel Activities Psychological Health and Mild Traumatic Brain Injury/Concussion 2 October 2009 John F. Glenn, Ph.D. Human Factors and Medicine Panel Member

2. Psychological Health and Mild Traumatic Brain Injury Completed HFM-RTG-081Stress and Psychological Support in Military Operations HFM-RLS-167Psychological Support Across the Deployment Cycle In Progress HFM-RLS-137Force Health Protection HFM-RTG-164 Psychological Aspects of Health Behaviors on Deployed Military Operations HFM-RTG-179 Moral Dilemmas and Mental Health Problems Exploratory Teams HFM-ET-100 Mild Traumatic Brain Injury HFM-ET-103 Suicide in Military HFM-ET-104 Mental Health Training

3. HFM-RTG-081 Stress and Psychological Support in Military Operations • Area Code: HP UK6 Taxonomy Code: • Chairman: Bruign (NLD) • PfP Participation: Yes • Classification: NATO Unclassified • Objective: • Provide military leaders with information and practical guidelines on stress and psychological support to enhance effectiveness in modern military operations based on international collaboration.

4. Developed A Leader’s Guide to Psychological Support Across the Deployment Cycle, which included the following chapters: Military Leaders’ Role in Psychological Readiness What Unit Members and Leaders Expect Individual Psychological Fitness Morale and Unit Effectiveness Military Family Readiness What to Do When Things Go Wrong Working with Psychological Support Professionals Reports on best practices in psychological support before, during, and after operations included: Inventories of instruments used to survey unit morale An inventory of clinical tools used across NATO and PfP nations for assessment, intervention, and education with individuals and groups before, during, and after deployments in routine and crisis situations Presented as a lecture series (HFM-RLS-167) in Spain and Estonia. HFM-RTG-081 Stress and Psychological Support in Military Operations

5. HFM-RLS-167 Psychological Support Across the Deployment Cycle • Area Code: HP UK6 Taxonomy Code: • Chair: Cuvelier (BEL) • PfP Participation: Yes • Classification: NATO Unclassified • Objective: • Lecture series based on A Leader’s Guide to Psychological Support Across the Deployment Cycle (developed as part of HFM-RTG-081), including topics on psychological support across the deployment cycle in military training and education. • Short Report: Completed lecture series in Madrid, Spain, and Tartu, Estonia (October 2008).

6. HFM-RLS-137 Force Health Protection • Area Code: HP UK6 Taxonomy Code: • Chair: Roedig (DEU) • PfP Participation: GEO, MDA • Classification: NATO Unclassified • Objectives: • Provide special expertise furthering exercises and training. • Achieve high levels of medical standards, interoperability, and cooperation for working well in multinational coalitions in crisis and conflict. • Short Report: Lecture series covered state-of-the-art knowledge of all current aspects of Force Health Protection in NATO, including mental health casualty prevention. Presented in Herzliya, Israel (November 2008).

7. HFM-RTG-164 Psychological Aspects of Health Behaviors on Deployed Military Operations • Area Code: HP UK6 Taxonomy Code: • Chair: Verrall (GBR) • Meeting Dates: September 2009, Amsterdam, Netherlands • PfP Participation: Open • Classification: NATO Unclassified • Objectives: • Prioritize the impact of health-related behaviors on operational readiness. • Evaluate the effects of military operations on health-related behaviors across all phases of the deployment, and explore novel strategies for their amelioration. • Examine the relationships between military-relevant stressors and health-related behaviors that affect the performance of military personnel. • Identify the key covariates for health-related behaviors relative to deployment, with special attention to the psychology of risk.

8. HFM-RTG-164 Psychological Aspects of Health Behaviors on Deployed Military Operations Short Report: The group explored a number of possible behaviors and their relationship to deployment (Tallinn, Estonia, November 2007; Ottawa, Canada, June 2008). By evaluating this against a series of criteria (e.g., strength of evidence of a relationship to deployment), the group selected three main behaviors to focus on: risky driving, tobacco use, and risky drinking. The most recent meeting (Washington, DC, January 2009) focused specifically on these behaviors, with attention to three areas: 1. Review of existing literature on relationship with deployment, 2. Review on emerging research by panel members and others on these, and 3. More in-depth review of the psychology and epidemiology of these behaviors. The next meeting will synthesize these findings into a coherent model of deployment and health behaviors, with a particular focus on the psychology of risk.

9. HFM-RTG-179 Moral Dilemmas and Mental Health Problems • Area Code: HP UK6 Taxonomy Code: • Chair: Verweij (NLD) • Panel Mentor: Wade (USA) • Meeting Dates: October 2009, Netherlands • PfP Participation: Open • Classification: NATO Unclassified • Objectives: • Investigate, analyze, and describe the relation between the confrontation with moral dilemmas and mental health problems. • Recommend good practices in coping with moral dilemmas, and develop awareness of tragic dilemmas (choosing between two negative alternatives). • Advise on the development, creation, and implementation of moral dilemma training/education.

10. HFM-RTG-179 Moral Dilemmas and Mental Health Problems • Short Report: Results presented (Toronto, Canada, June 2009) included: • Operational stress on 600 military personnel: Royal Air Force (RAF)support helicopter aircrew, non-helicopter RAF personnel, helicopter front crew (pilots), rear crew (winchmen and loadmasters).The groups showed no statistically significant differencein general physical symptoms, depression, post-traumatic stress disorder, or alcohol misuse. • Preliminary observations from interviewswith 24 Dutch military participants in the International Security Assistance Force in Afghanistan resulted in the development of a tentative model of possible relationships between moral professionalism and mental health problems. Moral Professionalism Risk Factors: Isolation, Fear, Anger Mental Health Protective Factors: Leadership, Training, Unit Cohesion

11. Exploratory Teams HFM-ET-100 Mild Traumatic Brain Injury • Objectives: • Review the available evidence regarding mild traumatic brain injury from blasts. • Discuss the feasibility of coordinating research activities to study epidemiology, natural history, prevention, diagnostic modalities, and optimal treatment strategies. • Consider establishing best practices for diagnosis and management of mild traumatic brain injury. HFM-ET-103 Suicide in Military • Objective: Identify relevant environmental and genetic factors that could be used for vulnerable personnel identification so that better prevention can be provided more selectively during and after stress exposure. HFM-ET-104 Mental Health Training • Objective: Identify military mental health training principles and skills. • This exploratory team will link to RTG-179 (Moral Dilemmas) and ET-103 (Suicide in Military) to develop mental health training that will sustain service members throughout their military careers and prepare them for the rigors of military operations, including combat.

12. Backup Slides

13. Current HFM Leadership Chairman Bernd de Graaf, Ph.D. (NLD) Vice Chairman Prof. Eric Fosse, M.D. (NOR) Panel Executive Ron Verkerk, LTC RNLA (NLD)