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The Army needs to more than double the number of mental health providers in Afghanistan where troops are widely dispersed and reporting falling morale and increasing difficulty getting the care the need, the Army said Friday.

The ratio of one mental health professional for about every 1,120 soldiers isn’t enough to help, particularly with fighting intensifying and forces spread out among the local population to carry out the counterinsurgency strategy, according to a mental health assessment conducted there between April and June.

By December, the Army will reduce that ratio to one provider for every 700 soldiers — the ratio prescribed by Army doctrine — by sending an additional 60 to 65 psychologists, psychiatrists, nurses and others to the country, said Lt. Col. Paul Bliese, a leader on the Mental Health Assessment Team. Two reserve units were recently activated to help boost the number of mental health providers available for deployment.

Previous mental health assessments in 2005 and 2007 found that Iraq lacked enough mental health providers. It was unclear why those lessons weren’t applied already to Afghanistan.

To give better access to care, the report recommends a two mental health professionals for each brigade combat team, rather than just one. That way one of the providers could be traveling among the far-flung troops while the other can be at the base providing treatment.

However, even with the optimal number of providers, “the tyranny of terrain and weather” makes it difficult for soldiers to get to the providers at the larger bases or for providers to get to them, Lt. Gen. Eric Schoomaker, Army surgeon general, said at a press conference releasing the findings. That might contribute to stigma regarding mental heath services, since seeking care is rather conspicuous under those circumstances, the report found.

The Army’s massive campaign to reduce the stigma surrounding mental health services doesn’t seem to be having an effect on soldiers deployed to Afghanistan, who have reported the same level of stigma since the 2005 survey, according to the report.

President Barack Obama is debating whether to increase troop levels in the country at the same time soldiers are reporting a dramatically decreased unit morale compared with previous years. Those difficulties are also manifesting themselves at home, with an ever-increasing number of soldiers reporting they are getting or considering divorce.

The report found that about 14 percent of all soldiers in Afghanistan have some sort of psychological problem — acute stress or depression, for example. That number jumps significantly when looking at males in the ranks of private through specialist. Of that group more than 21 percent have a mental health issue. That’s down 2 percent from 2007, but still more than double the rate in 2005.

Those numbers have been steadily dropping in Iraq, where the mental health picture is improving overall. Morale is up and suicides didn’t increase there for the first since 2004, the report said. Stigma, as in Afghanistan, isn’t showing improvement, however. Units who spend most of their time outside the wire are reporting the presence of stigma at a higher level than the last assessment, though that may be attributed somewhat to an increase in the number of such soldiers participating in the survey.

Soldiers in support units, who have better access to care because they are typically on larger bases, experience much lower levels of stigma, the report found.

The assessment also reinforced the importance of dwell time. Soldiers deployed to both countries had better mental health if they had more time at home between deployments. In fact, the cumulative time deployed is less a factor in mental health than amount of dwell time between those deployments.

Other survey findingsJunior enlisted soldiers reported significantly more marital problems than noncommissioned officers, stating they intended to get a divorce.

Exposure to combat, a strong factor in mental health problems, was significantly higher this year than rates in 2005 and similar to rates in 2007 for the combat units.

Combat units reported significantly lower unit morale in the last six months of their tours of duty, more evidence of the wearing effect of long deployments.

— The Associated Press

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