Wednesday, October 7, 2009

America launched Operation Enduring Freedom on Oct. 7, 2001, to clean out the viper’s nest in Afghanistan from which al Qaeda had plotted the brutal Sept. 11 attack on the United States. “Clear, hold and build” was the goal.

Now, the counterinsurgency campaign - “the thinking man’s war,” Gen. David H. Petraeus calls it - beyond bricks and mortar, aims to “build trust,” essential to building stable Afghan communities impervious to terrorists’ siren call. The urgent work proceeds apace to prevent extremists from converting Afghanistan into a base for destabilizing nuclear Pakistan and plotting future attacks on the American homeland.

Simultaneously, another counterinsurgency, if you will, is under way stateside to deal with the Army’s skyrocketing suicides the past five years - 2009 is expected to exceed last year’s record 141.

The point person in this effort is Gen. Peter W. Chiarelli, vice chief of staff of the U.S. Army, who commanded the Multinational Corps Iraq under Gen. George W. Casey Jr. in 2006. He was, according to a key source, Gen. Petraeus’ “golden boy” in successfully laying the groundwork for and adapting to counterinsurgency operations, starting as commander of the 1st Cavalry Division in Iraq in 2004.

“I like to caution people from thinking there is any one cause to suicide,” he said in a recent interview. The causes are as varied as the individual soldiers, albeit the stresses of continuing combat since Sept. 11 are a factor, he has noted many times.

The challenge, Gen. Chiarelli said, is “to train soldiers to be more resilient” so that rather than being beaten down, they not only endure and excel through the rigors of war but are stronger for the experience. This, he said, is “the big idea in the United States Army.”

Ted Kennedy Jr. in his eulogy for his father beautifully encapsulated this concept, reflecting on how the late senator had helped him overcome the loss of his leg at age 12.

“You see, my father taught me,” he said, “that even our most profound losses are survivable, and … it is what we do with that loss, our ability to transform it into a positive event, that is one of my father’s greatest lessons.”

“Comprehensive soldier fitness” is how Gen. Chiarelli brands the transformation of the Army’s loss into a positive event.

It has three elements.

c First is the Army’s program of emotional resiliency training, being introduced at two bases this month and to be phased in gradually throughout the service - eventually to be available to families.

Gen. Chiarelli characterized this first-of-its-kind initiative as “huge” because it preventively tackles mental health issues affecting about 1 in 5 soldiers returning from war.

With comprehensive soldier fitness, “we’re shifting to the left,” on the “assess, educate, intervene, treat” continuum, he said - assessing “every single soldier that comes in [to] help us understand what training that individual soldier needs” to build career-long resiliency.

The Army has enlisted the University of Pennsylvania to prepare Master Resiliency Trainers - 1,500 by next summer - who will train all 1.1 million soldiers, including active-duty, Reserve and National Guard members.

c Second, the Army is “attacking the issue of stigma hard,” Gen. Chiarelli said, so that every soldier knows “it’s OK to seek assistance.”

A big step was removing Question 21 from the security clearance questionnaire so a soldier is no longer required to reveal that he or she sought assistance, “provided they weren’t intending to harm someone else.”

Furthermore, Gen. Chiarelli outlined efforts to make mental health services available to every soldier, including a pilot program launched Aug. 1 through Tricare, making telemedicine online available for short-term problem-solving from the privacy of one’s home, enabling hands-on care if needed, and Telemental Health Care at 251 locations where soldiers talk securely online with a doctor and receive the full range of behavioral health services. The goal, Gen. Chiarelli said, is to expand it to the home once efficacy of care and licensing issues are addressed.

“This program,” Gen. Chiarelli said, “has real benefit for a place like Fort Campbell, which is remote and dealing with a shortage of providers.

“My vision,” Gen. Chiarelli continued, is “to make the best use of our limited resources” by “leveraging this network to set up a gym with 200 computers when a unit redeploys,” enabling “evaluation starting with the brigade commander” down to everyone in the unit. This way, “there’s no stigma because everyone does it.”

c Finally, Gen. Chiarelli highlighted the Army’s groundbreaking five-year, $50-million study of suicide and behavioral health among 500,000 military personnel, launched last October in partnership with the National Institute on Mental Health.

Just as the 1948 Framingham Study identified risk factors for heart disease, this study, Gen. Chiarelli said, “will identify risk factors for mental illness” and interventions. “We asked for the study for the Army,” Gen. Chiarelli said, “but we think it could have real value for larger society.”

Indeed, everything Gen. Chiarelli is envisioning seems to have real value for the larger society.

Mary Claire Kendall was special assistant to the assistant secretary for health in the U.S. Department of Health and Human Services in 1989-93.

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