02 March 2009

Pinoy Soldiers Gone Wild?

Photo courtesy of alvinchan-photos
First, there was a report about an alleged Master Sergeant who shot dead two cops and wounded a passing jeepney driver last 24 February 2009 in Caloocan City. The suspect was Aristoter Calagui, 44, who was mauled by bystanders after fleeing the crime scene. He was later turned over to pursuing the cops.

About 24 hours later, an army soldier who apparently went berserk due to personal problems shot dead three of his comrades and wounded another officer at their barracks in Fort Bonifacio in Taguig City. Sgt. Elias Tial, who was performing night duties when the incident occurred, went into a shooting rampage after he was reportedly affected by the loss of his father. Tial was able to escape after the incident, but his firearm was wrestled away from him by the other soldiers who witnessed the shooting.

These two cases are just some of the incidents that contribute to the increasing trend of soldiers committing suicide, going on a shooting rampage at the slightest provocation and even taking hostages over seemingly flimsy reasons. The numbers might not be staggering, but what is troubling is that they have become regular fare in the news lately.

It is disturbing, at the least. But to say that the military organization is not doing anything to address the problem has no basis at all, Army psychiatrist Dr. Joel Enrico Anastacio said in an interview with Inquirer.Net last year.

“There is an Armed Forces of the Philippines Mental Health Program. There are ongoing efforts to ensure that soldiers get the proper attention after going through a highly stressful experience, such as an encounter or ambuscades,” Anastacio explained.

“Weapons and tactics have been modernized, but one thing has not changed, and that's the soldier as a human being,” he added.

Shell-shocked and battle-fatigued are two of the most popular terms used to describe a soldier who has survived harrowing experiences that civilians may never be able to imagine. Prolonged separation from family, loneliness and financial problems are also known to trigger anxiety among soldiers, Anastacio explained.

A prime component of the AFP Mental Health Program is the Critical Incident Stress Debriefing (CISD) given to soldiers after an ambush or an encounter. This consists of the soldier talking about what he just went through. Anastacio said reliving the experience provides catharsis for the soldier. It also gives the psychiatrist the data needed to evaluate the soldier's reaction and coping mechanisms.

Unfortunately, the AFP still has to come up with hard statistics on military suicides and other negative behavior. Anastacio said that as of now, the only data the AFP has available are the number of admissions to the AFP Medical Center’s Ward 23, 24 and 25, the neuropsychiatric section. The admissions are classified under the general category of “anxiety disorders.”

Because it is a highly stressful profession, the AFP also imposes strict neuro-psychiatric tests for its applicants. Anastacio said military recruits have to undergo both IQ (intelligence quotient) and EQ (emotional quotient) screening. An average IQ is a preferred, of course. But it has to be balanced with a healthy, favorable EQ. Many pass the IQ screening but fail in EQ, he noted.

“A lot of the soldiers’ morale really depends on the state of mind of their commander. It’s the result of effective leadership,” he said.

Commanders, he said, should be able to spot signs of anxiety disorder among his troops. A module on this has been incorporated into the Command and General Staff College (CGSC), a special course for officers prior to their deployment as battalion commanders, Anastacio added.

To guide commanders and the troops on mental health, the AFP in 2002 began distributing a pocket-size handbook on mental health to units across the islands. It explains battle fatigue or combat stress can be temporary, but if allowed untreated could lead to a mental breakdown.

The book also reports that battle fatigue can be mild, moderate or severe, depending on the symptoms. Units with battle fatigue usually show a high incidence of AWOL, bickerings, fisticuffs, verbal abuse and misconduct. A soldier who has battle fatigue will display symptoms ranging from trembling to insomnia to the more serious reaction of ducking and trembling at the sound of an explosion.

Because of lack of information and the military’s tough image, soldiers initially resisted the program. Anastacio recalled that when they first went to Jolo in 2001, the troops asked them if they were offering loans. “They asked if we were from AFPSLAI (the AFP Savings and Loans Association),” he said.

These days, he said the program has become well-appreciated. Even “macho” commanders, the kind who see psychiatric evaluation as stuff for sissies, attend the sessions.

However, there are still a lot of areas that needs to be improved. Many military service personnel and their family members are going without mental health care because of the limited availability of such care and the barriers to accessing care. While service delivery efforts by individual military mental health providers are laudable, the military system falls short in its ability to meet the psychological health needs of deployed personnel and their families.

Reduced access to care due to long waiting lists, limited clinic hours, breakdowns in the referral process and hard-to-reach locations also make it difficult for returning military personnel and their family members to get help. The problems range from maintaining mental health care for service members who are transitioning from active duty to veteran status, to finding health services for reserve personnel who live far from military bases.

Further, stigma and negative attitudes within the military about obtaining mental health treatment often prevent those in need of care from seeking it.

A report from the American Psychological Association (APA) recommends the following for any mental health program for military personnel:
  • Establish centralized leadership of military mental health services to better coordinate the services on military bases and surrounding communities.
  • Educate military leadership about the importance of mental health care among service members and their families and about reducing stigma associated with seeking mental health services.
  • Undertake more research on mental health issues related to deployment to guide policies, program development and treatment plans for service members and their families.
  • Ensure that treatment is available to service members and their families throughout the deployment cycle with special focus on post-traumatic stress disorder (PTSD) and traumatic brain injuries (TBI).
  • Increase recruitment efforts to hire more psychologists and to retain well-trained and experienced psychologists.
  • Provide special ongoing training in deployment stress for all psychologists in the military system – both military and civilian providers.
  • Allocate additional funding to ensure access to high quality mental health care for service members and their families.