Top military doctors say six- to nine-month combat tours would reduce stress

The surgeon generals of the Army, Navy and Air Force told senators on Wednesday that the optimal tour in Afghanistan and Iraq to reduce combat stress should be six to nine months with 18 months at home, far shorter than the cut in tours from 15 to 12 months ordered by President Bush last week.

Army Surgeon General Lt. Gen. Eric Schoomaker emphasized that his was a medical assessment of the optimal length for combat tours and that "operational imperatives dictate [length of] deployments."

Vice Adm. Adam Robinson, the Navy's surgeon general, said less time at home between deployments has had a "devastating" effect on troops and their families since the United States commenced operations in Iraq five years ago.

While Air Force personnel in general average much shorter deployments -- about three months -- Lt. Gen. James Roudebush, the service's chief doctor, told the hearing that "my leadership pays close attention to rotation and dwell times…I agree that six months, plus or minus" is an optimal deployment length.

The views of the top military doctors on deployment periods and increased time at home dovetail with the opinions of senior military leaders and studies that have shown stress increases with the length of time in combat.

The Army's chief of staff, Gen. George W. Casey, told the Senate Armed Services Committee in February that "The cumulative effects of the last six-plus years of war have left our Army out of balance, consumed by the current fight, and unable to do the things that we know we need to do to properly sustain our all-volunteer force and restore our flexibility for an uncertain future." Casey added that "frequent deployments are taking their toll on our soldiers and their equipment."

Also in February, the Army reported that a mental health assessment team sent to evaluate troops deployed overseas determined that "reports of work-related problems due to stress, mental health problems and marital separations generally increased with each subsequent month of deployment." Also, the team's report said, "Soldiers on their third or fourth deployment were at significantly higher risk than soldiers on their first or second deployment for mental health problems and work-related problems." The team conducted its field studies between October and November 2007.

The military services have boosted the number of mental health professionals in war zones, including psychologists and social workers, the three surgeon generals told the panel. But the same stresses that troops experience from frequent and long deployments have a deleterious effect on recruitment and retention of mental health professionals, Schoomaker told the hearing. Behavioral health personnel, he said "are among the most frequently deployed."

Schoomaker said the Army tries to meet its target of one behavioral health professional per 1,000 soldiers, but the mental heath assessment team said deployed soldiers reported in 2007 that they had "more difficulty accessing behavioral health services…." Behavioral health specialists also told the assessment team that they saw a significant increase in the advice they gave commanders about mental health issues and at the same time experienced higher burnout themselves.

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