Marine and Family Programs Division
Behavioral Health Branch
Marines Taking Care of
Marines
…With a Little Help From Our
Friends
AIRS Conference
22 May 2012
Purpose
• Current statistics, training programs, and
resources for Marines and families
• Opportunities for community-based
assistance
Background
• Headquarters Marine Corps
• Manpower & Reserve Affairs
• Marine and Family Programs Division
BH Branch
SAPR Branch
COSC
FAP
Sub Abuse
Suicide Prevent
• Doctrine, policy, training, oversight
Stress Continuum
READY
REACTING
INJURED
ILL
Good to go
Well trained
Prepared
Fit and
tough
• Cohesive
units, ready
families
• Distress or
impairment
• Mild, transient
• Anxious or
irritable
• Behavior
change
• More severe
or persistent
distress or
impairment
• Leaves
lasting
evidence
(personality
change)
• Stress
injuries that
don’t heal
without
intervention
• Diagnosable
•
•
•
•
Unit Leader
Responsibility
Individual Responsibility
PTSD
 Depression
 Anxiety
 Addictive
Disorder

Chaplain & Medical
Responsibility
Risk and Protective Factors
BH Risk Factors
• Multiple deployments
• Combat exposure
• Loss
• Concussive events
• Family issues
• Op tempo issues eg. sleep disruption
• Negative behaviors
• Substance using peers
• Decentralized support network
• Stigma
BH Protective Factors
• Ongoing unit cohesion
• Connectedness
• Morale
• Peer-to-peer support
• Resilience/strengthening factors
(mind, body, spirit, social)
• Calming techniques
• Healthy coping mechanisms
• Future orientation
• Achievement motivation
Understanding Operational Stress
Stressor
• High op tempo
• Unmet expectations
• Deployment
experiences
• Too much or too
little money
• Strained
relationships
• Repetitiveness/
Monotony
• Loss of identity
• Isolation
• Availability of
alcohol
• Legal troubles
STRENGTHEN
What we are doing
about it
Possible
manifestation
• Alcohol Prevention
Campaign Plan
• Integrating behavioral
health efforts including
universal training
• Enhancing COSC training
including OSCAR
• DSTRESS Line
• Never Leave a Marine
Behind
• Take a Stand
• Prime for life
• Trauma Informed Therapy
• Parent/Child Inter
Therapy
• Motivational Interview
• Cognitive Processing
Therapy
• Decreased job
performance
• Alcohol abuse
• Drug abuse
• Driving under the
influence
• Break down in
martial/child
relationships
• Domestic violence
• Physical Violence
• Sexual assault
• Suicidal ideations
MITIGATE
IDENTIFY
TREAT
REINTEGRATE
Locating USMC BH Resources
1. Google ‘MCCS’ (Marine Corps
Community Services) at the appropriate
installation
2. Marine and Family Programs/Services…
Combat Operational Stress
Control
Operational Stress Control and Resilience
“Have you talked to your OSCAR Mentor?”
• OSCAR Teams:
– At all battalions, squadrons (larger units)
– OSCAR Mentors (Selected Marines)
– OSCAR Extenders (Corpsmen, Medical Officers, Religious Ministry Team)
– Mental Health Professionals (Psychiatrists, Psychologists and Psych Nurses/Technicians)
embedded at Division and Regiment levels
• OSCAR Mentors:
– Identify small changes in behavior
– Quickly intervene when Marines show signs of negative stress reactions
– Refer for assistance when appropriate
– Reduce stigma concerning behavioral health
– Over 5000 Marines are OSCAR trained
Family Advocacy
Family Advocacy Overview
• Family Advocacy is a command program designed to prevent and
respond to incidents of child and spousal abuse. The program is staffed
with clinicians, victim advocates, home visitors and prevention
specialists who work as part of a coordinated response to meet the
needs of service members and their families on the installation.
•
General Counseling, Victim Advocacy, New Parent Support
• Emphasis on Evidence-based treatment and prevention programs
•Parent-Child Interaction Therapy (PCIT) and Child-Adult Relationship
Enhancement
• Trauma-Focused Cognitive Behavioral Therapy
• Cognitive Processing Therapy - a DoD recognized treatment for
PTSD
FAP Overview
• Evidence Based Training Programs
• Married and Loving It (MALI) – marital communication skills
• REAL COLORS/REAL STRESS – stress mgmt
• Crossroads Parenting – effective communication,
disciplining, nurturing skills
• STOP (Skills, Techniques, Options and Plans) –
anger/stress mgmt skills for offenders
• Century’s Anger Management
• New Parent Support Program – Home visits to improve
nurturing and parenting skills for parents in the military with
children ages birth to five years old.
Substance Abuse Prevention
Substance Abuse Prevention Overview
• Three Principal Tenets of the USMC Substance Abuse Program
• Alcohol & Drug Prevention Education
• Treatment
• Drug Demand Reduction
• Substance Abuse Counseling Centers (SACCs)
• Counselors and Prevention Specialists at major USMC installations
• Screenings and assessments; Early Intervention education, OutPatient treatment and Intensive Out-Patient treatment (depending on
treatment needs of the individual).
• Prime For Life – an evidence-based motivational intervention
program to change perceptions and behavior regarding substance
abuse and risk.
• No in-patient treatment. (Send to other military, VA, or civilian
facilities.)
Magnitude of the Problem
Historic Trends in Binge Drinking
1998 2002 2005
Marine Corps
45.4
54.2
53.2
Army
37.5
41.4
52.8
Navy
32.0
44.2
41.7
Air Force
29.6
34.0
33.9
2008
57.6
48.2
47.8
39.0
Prevalence of Binge Drinking
Total
Males
Marine Corps
57.3
58.9
Army
48.3
51.0
Navy
44.5
46.8
Air Force
35.6
38.6
Civilian
40.6
42.9
Females
32.0
28.0
29.5
23.3
23.8
Data from the DoD Survey of Health Related Behaviors Among Military Personnel, 1998-2008. Table 3.2.3
Magnitude of the Problem
“For me, 18 beers
is ‘responsible’”
Prevalence of Heavy Alcohol Use
Total
Males
Marine Corps
29.0
30.1
Army
22.7
24.5
Navy
16.4
17.6
Civilian
13.6
14.7
Air Force
12.0
13.6
Females
11.1
9.6
8.7
5.5
5.4
Alcohol “Spokes of the Wheel”
18% had evidence of alcohol
use at the time of death
24% had evidence of past
alcohol abuse or dependence
diagnosis
80% of individuals with
TBI met criteria for
alcohol abuse and
dependence
40% of off duty
mishaps involved
alcohol
Alcohol
30% of spouse abuse
involved alcohol
Marine
Substance
Abuse
Data from internal Marine Corps Behavioral Health Program statistics: TBI data from RAND (2008)
Over 50% of victims
and offenders of
sexual assault were
associated with
alcohol
Alcohol Abuse Prevention Campaign
Pending EFPB Action (March 2012)
Increase Operational Readiness of the Marine Corps
by Reducing Alcohol Abuse and Misuse through
Revolutionary Changes to Prevention and Treatment
Three Foundational Efforts:
• “Levels of Risk” replace “Responsible Drinking”
• Change focus from the “Boom” being an alcohol-related
incident to the “Boom” being alcohol use
• SNCOs and Officers must support, enable and mentor
NCOs in their ownership of this effort
Levels of Risk
USMC Alcohol Consumption Continuum
No Risk
•
0 standard
drinks per day
(Abstinence)
“For me, 18
beers is
‘responsible’”
Low Risk
High Risk
•
No more than 4
standard drinks
a day / 14
standard drinks
a week- Men
•
Consumes
more than
EITHER the
single-day or
weekly limits
•
No more than 3
standard drinks
a day / 7
standard drinks
a week- Women
•
Consumes
more than
BOTH the
single-day or
weekly limits
•
No more than 1
standard drink
per hour
•
Drinking more
than 1
standard drink
per hour
Community & Medical Responsibility
Individual and Leadership Responsibility
http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/Rethinking_Drinking.pdf
Levels of Risk
USMC Alcohol Consumption Continuum - Science
Low Risk
No Risk
High Risk
No more than 4 standard drinks a day
/14 in a week (Men) and
3 standard drinks a day / 7 in a week
(women)
Only 2% of individuals who drink
within both the “single-day” and
weekly limits have alcoholism or
alcohol abuse diagnosis.
“For me, 18
beers is
‘responsible’”
Exceeds daily or weekly Low Risk Totals
Drinking more than the single-day or
weekly amounts is considered “highrisk”.
• About 1 in 4 people who drink this
much meet criteria for alcohol abuse,
the rest are at greater risk:
‘High Risk’ drinking chances of having
an alcohol use disorder:
• 1 time a month (20% chance)
• 1 time a week (33% chance)
• 2 times a week (50% chance)
http://pubs.niaaa.nih.gov/publications/RethinkingDrinking/Rethinking_Drinking.pdf
Sexual Assault Prevention and
Response
Sexual Assault Reports
USMC Total Reported Sexual Assaults
500
450
400
350
300
250
200
150
100
50
0
FY 07
FY 08
FY 09
FY 10
Total Reported Assaults
FY 11
FY 12
Myths
MYTH
Most offenders commit sexual assaults one time
FACT
Offenders commit on average 6 assaults, most of which go
unreported
MYTH
Most sexual assault reports are false
FACT
Rate of false reports is 2-7%
MYTH
Victims of sexual assault in the Marine Corps are only female
FACT
Anyone can be the victim of sexual assault. Males are less likely
to report than females because of stigma and culture
New Initiatives
•
•
•
•
•
•
Take A Stand for NCOs
Officer/SNCO training (in development)
Command Team Training
Annual SAPR Training
Chaplain training
24/7 Helplines (DOD and USMC installations)
CMC’s Comments
Suicide Prevention
USMC Suicides and Attempts
*Civilian Rate per 100,000
200
19.9
20.1
19.5
20.0
19.6
23.7
20.7
20.0
Through
April 2012
19.6
180
17.2
17.5
160
140
12.5
16.4
14.4
13.4
12.9
USMC Rate per 100,000
120
100
16 3
Suicides
14 6
60
112
20
03
28
25
33
42
20
08
26
34
73
20
07
23
20
02
80
20
06
82
10 3
99
85
20
05
40
20
172
16 4
80
52
37
32
Attempts
14
20
11
**
20
12
***
20
10
20
09
20
04
0
* Last available civilian suicide rate information from the Centers for Disease Control and Prevention. Rate adjusted for Marine demographics.
** Includes 1 suspected suicide that have yet to be confirmed by the Armed Forces Medical Examiner.
*** Includes 8 suspected suicides that have yet to be confirmed by the Armed Forces Medical Examiner.
Source: HQMC (MFC-5) 1 May 2012
Never Leave a Marine Behind
Annual Suicide Prevention Training
• Award-winning, evocative
• Developed and tested by Marines
• Separate modules for Jr. Marines, NCOs, SNCOs and officers
RACE Acronym
Recognize
• Note changes in personality, emotions, or behavior.
• Note withdrawal from co-workers, friends and family.
• Note changes in eating and sleeping patterns.
Ask
• Calmly question about the distress you observed.
• If necessary, ask the question directly: “Are you thinking
about killing yourself?”
Care
• Actively listen, don’t judge.
• Peacefully control the situation; do not use force; keep
everyone safe.
Escort
• Never leave your buddy alone.
• Escort to chain of command, chaplain, medical, or
behavioral health professional.
Never Leave a Marine Behind
Focus is on changing behavior
• Mind, body, spiritual, and social fitness
• Peer-to-peer support
• Frontline supervisor intervention
• Command climate management
The DSTRESS Line
DSTRESS Line
Video link: search “dstress line” on YouTube
DSTRESS Line
 Anonymous, 24/7 call center
 Marine-to-Marine counseling that
gives any Marine, attached Sailor,
or family member ‘one of their own’
to speak with about everyday stress
or their heaviest burdens in life.
1-877-476-7734
DSTRESS Line
 Staffed by veteran Marines
and “Fleet Marine Force”
corpsmen, Marine family
members, and civilian
counselors specifically trained in
Marine culture.
DSTRESS Line
 More than just combat stress…
 Enable the next step in helpseeking
 Referrals to Marine resources,
Navy Med, TRICARE, Military
One Source, VA …
www.dstressline.com
The “BHIN”
• Free educational tools and products for Marines and families
• Standardizes behavioral health messaging
• Conveys back to stakeholders what information is important
to whom
• Currently over 120K materials distributed
•Additional Behavioral Health materials forthcoming
• An evaluation of the BHIN found:
• 85% of the participants indicated that the BHIN website
was extremely useful in meeting their COSC needs
• 40% ordered materials for themselves
• 32% ordered information for their command/workplace
• 28% ordered for fellow Marines
http://bhin.usmc-mccs.org/
Wider DOD Resources
• Military One Source
• Military Homefront - information, policy and guidance designed to help
troops and their families, leaders, and service providers. Whether you
live the military lifestyle or support those who do, you'll find what you
need.
• Real Warriors - an initiative launched by the Defense Centers of
Excellence for Psychological Health and Traumatic Brain Injury (DCoE)
to promote the processes of building resilience, facilitating recovery and
supporting reintegration of returning service members, veterans and
their families.
• DOD Safe Helpline - live, one-on-one support and information to the
worldwide DoD community. The service is confidential, anonymous,
secure, and available worldwide, 24/7 by click, call, or text — providing
victims with the help they need, anytime, anywhere.
I&R Resources
USMC Demographics Update
• http://www.usmc-mccs.org/aboutmccs/
Behavioral Health Branch websites
• Leaders Guide to Managing Marines in Distress – a quick reference to help
leaders take care of Marines in distress because of their situation or behavior. It
covers approximately 40 different problems Marines may face. http://www.usmcmccs.org/leadersguide/
• Family Advocacy Program - http://www.usmc-mccs.org/famadv/
• Sexual Assault Prevention and Response - http://www.usmcmccs.org/sapro/index.cfm?sid=ml
• Substance Abuse Program - http://www.usmc-mccs.org/subabuse/
• Suicide Prevention - http://www.usmcmccs.org/suicideprevent/index.cfm?sid=ml
• DSTRESS Line - http://www.dstressline.com/, additional videos at
www.youtube.com/dstressline
•The Behavioral Health Information Network (BHIN). http://bhin.usmc-mccs.org/
Community-based Support Needed
• Community-based services can fill in gaps
• Pervasive social stigma against help-seeking
• The military culture is not for everybody
• Budget realities limit availability
• Most USMC resources are for active duty personnel and dependents.
• Reservists have limited access to benefits during drill periods and any
periods of active duty service. Their dependents have much less
access.
• Non-retired veterans have very little access to USMC resources.
Marine and Family Programs Division
Behavioral Health Branch
Questions?
Col Grant Olbrich
Program Manager
grant.olbrich@usmc.mil
703-432-9707