While the mental health and morale of Soldiers in Iraq is improving, according to the latest study, more behavioral-health providers are needed in Afghanistan.

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The sixth Mental Health Advisory Team, or MHAT 6 report, provides a "snapshot" of the morale and behavioral health of Soldiers deployed last spring and during the early summer in Iraq and Afghanistan, said Lt. Gen. Eric B. Schoomaker, Army surgeon general and commander of the U.S. Army Medical Command. 

A total of 2,442 Soldiers were surveyed in Iraq between December and March for MHAT 6, along with 154 mental-health providers. In Afghanistan, 1,549 surveys were collected from Soldiers between April and June of this year, along with 31 from mental-health providers. In addition, teams of research psychologists, social workers, nurses and other mental-health professionals conducted focus-group interviews and examined data in theater.

Iraq improving, Afghan trend opposite

The MHAT 6 study found the mental health of Soldiers in Iraq better than at any time since the first such survey there in 2004, Schoomaker said during a media roundtable Nov. 13. He added, however, that marital problems were increasing, especially among Soldiers with multiple deployments. Moreover, morale issues and mental-health problems in Afghanistan had increased significantly since 2005, he said, along with an increased exposure to combat there.

Only three such MHAT studies have been conducted in Afghanistan, Schoomaker said, and this year's report indicates unit morale rates there are lower than in 2005 and 2007.

About 14 percent of Soldiers deployed in Afghanistan had psychological problems, according to the report. Just under 12 percent of the Soldiers in Iraq reported psychological problems such as acute stress, depression and anxiety. 

A "normal" rate of psychological problems would be about 10 percent among a non-deployed population, Schoomaker said, noting this was based on a study in the New England Journal of Medicine.

More providers needed

The MHAT 6 study calls for an increase in mental-health providers, especially in Afghanistan. Currently there is one mental-health provider for every 1,123 Soldiers deployed in Afghanistan. Schoomaker said he would like the ratio to be one provider for every 700 Soldiers.

"In Afghanistan, we're finding a tyranny of terrain and weather makes it difficult to move Soldiers to where care can be delivered," Schoomaker said. 

The dispersion of Soldiers to remote forward operating bases makes it difficult for mental health-care providers to reach the troops, said Lt. Col. Paul Bliese, the director for the Division of Psychiatry and Neuroscience at Walter Reed Army Institute of Research and the officer who led the MHAT VI study.

He said now there is typically one mental heath-care provider in Afghanistan for each brigade combat team. If that provider travels to remote combat outposts to administer care, it leaves the big FOB uncovered, he said. Thus MHAT 6 recommends a "dual provider" model which would assign an additional behavioral health-care provider to each BCT.

The study recommends each battalion be assigned a behavioral health advocate - an NCO who has been trained in the basics of behavioral health. In addition, it recommends a senior NCO behavioral-health technician at the brigade level, and the assignment of behavioral-health professionals to National Guard BCTs.

Stigma: Maneuver vs. Sustainment

Significant differences were found between Soldiers in maneuver units and sustainment units. While combat units were more likely to have a higher rate of mental-health problems, sustainment units had a higher rate of marital problems.

Soldiers in combat units were also less likely to seek mental-health care and were more likely to perceive a stigma associated with it, according to the study.

"Stigma is a resistant problem," Schoomaker said, "and a tough problem to tackle." He said there's a certain culture among combat troops that makes stigma "a tough nut to crack." 

Overall, there's been a small but steady decrease in stigma over the past five years, Bliese said. "This year, unfortunately, we didn't see the trend hold out," he said.

Marital problems, dwell time

Marital problems overall have been increasing each year since the first MHAT study in 2004. This year 16 percent of Soldiers surveyed reported plans to divorce or separate.

Dwell time at home between deployments is a significant factor when it comes to both marital and mental-health problems, according to the study. 

MHAT 6 states that two years between deployments will return a unit to almost the normal rate of mental-health issues. With a dwell time of 30-36 months, a unit will be completely normal, Schoomaker said. 

Resiliency improves mental health, morale

The MHAT 6 teams also identified coping skills that help build resiliency during deployments. The Battlemind training has improved coping skills, officials said. 

The study found that two hours of Internet connectivity or gaming in off-duty hours was likely to improve morale and mental health, while excessive gaming did just the opposite. The one thing that could be done in excess and still improve mental health was physical-fitness training, according to the study.

The availability of gyms, morale-welfare and recreation facilities and good food all contributed to morale, Bliese added.

While the study looked at both officer and NCO leadership, Bliese said good officer leadership was found to be a significant factor in platoons that were deemed "resilient." These were platoons with a high rate of combat exposure, without a corresponding high rate of combat stress or anxiety, Bliese said.

The study recommended that new resiliency training be developed and validated. The report went on to state that several groups are now working to test such training.