Asking for help can be challenging for anyone, but
there are particular concerns that may prevent service
members and veterans from seeking support or care
for invisible wounds. Surveys have consistently shown
that some service members believe that seeking
care for psychological health concerns will negatively
impact their career and may cause their command
and/or unit to lose conﬁdence in them.
The Mental Health Advisory Team (MHAT), established
by the Ofﬁce of the Army Surgeon General, assesses
deployment-related psychological health concerns of
service members and provides recommendations on
their psychological health care and support. In 2010,
the assessment expanded to become a joint effort
across the Ofﬁces of the Air Force, Army and Navy
Surgeons General as well as the Ofﬁce of the Marine
Corps Medical Ofﬁcer to create the Joint Mental
Health Advisory Team (JMHAT). According to MHAT
and JMHAT assessments, factors that discourage
members of the military from seeking psychological
health services include:
It would be seen as weak.
My unit membership might
treat me differently.
Members of my unit might
have less conﬁdence in me.
My leaders would blame
me for the problem.
It would harm my career.
It would be too
These concerns may be particularly relevant for those
individuals most in need of psychological health care
or support. According to a study by the American
Psychological Association, the proportion of service
members who expressed anxiety about reaching out
for care was approximately two times higher among
service members who met screening criteria for a
psychological health concern in comparison with
those who did not.3
It has also been proven that there is an increased risk of
experiencing psychological health concerns with each
additional deployment. The MHAT VII survey showed that:3
• 14.3 percent of service members experience
psychological health concerns during their ﬁrst
• 21.8 percent of service members experience
psychological health concerns during their second
• 32.5 percent of service members experience
psychological health concerns during their third or
Since September 11, 2001, approximately 2.4
million military personnel have deployed to Iraq and
Afghanistan, according to the U.S. Department of
Veterans Affairs.4 Of these, more than 40 percent of
service members have deployed more than once.5
Deployments have a signiﬁcant impact on military families.
While many military families successfully adapt to
the challenges of the military lifestyle, the cumulative
impact of deployments can lead to increased
emotional and psychological health concerns among
military children and spouses. Within the U.S. military,
55 percent of service members are married and
40 percent have two children.6 More than 700,000
children have experienced one or more parental
The 2010 Report to Congress, The Impact of
Deployment of Members of the Armed Forces on
Their Dependent Children, noted that young children
(ages 0–5) are likely to exhibit anger and attention
difﬁculties, while school-age children (ages 6–12)
demonstrate increased “anxiety and fear, sensitivity
to media coverage and reduced school performance.”
Among adolescents (ages 13–18), the report cited
an increase in “declining academic performance,
depressive symptoms and behavioral problems in
response to emotional stress.”
The effects of deployment on children are among
the primary concerns reported by military families in
the Blue Star Families’ 2012 Military Family Lifestyle
Survey. Other top concerns include pay and beneﬁts,
military spouse employment and issues surrounding
posttraumatic stress disorder (PTSD) and combat stress.
www.realwarriors.net ★ 866-966-1020
The post-deployment experience of National Guard
and reserve members can be especially isolating.
The National Guard and reserve have been called on
to serve at an unprecedented level in support of the
most recent conﬂicts in Iraq and Afghanistan. In a
2010 survey conducted by the Department of Veterans
Affairs, 94 percent of National Guard respondents
have served since September 11, 2001, compared to
only 27 percent in the preceding ten years.
Several factors contribute to the unique challenges
faced by the National Guard and reserve following
• Experiencing less social and community support
when they are no longer surrounded by the unit
withwhich they served;8
• Resuming their civilian careers immediately upon
their return, leaving little time to readjust and
decompress from the stressors of deployment;9
• Dealing with the perception by employers and coworkers that their service was “time off” from their
“real” lives and civilian jobs; and10
• Living further away from military installations and
treatment facilities, which can create barriers
to receiving care and increase susceptibility to
adjustment issues and psychological health
Transitioning to civilian life can be challenging for
Veterans who experienced emotional or physical
trauma while serving are at the greatest risk of having
difﬁculties readjusting to civilian life. According to the
Pew Research Center survey, Difﬁcult Transition from
Military to Civilian Life, “the probabilities of an easy
re-entry drop from 82 percent for those who did not
experience a traumatic event to 56 percent for those
Another Pew report, War and Sacriﬁce in the Post-9/11
Era: The Military-Civilian Gap, found that nearly half
of all post-9/11 veterans say they have experienced
“strains in family relations” since separating from the
military, and nearly four-in-ten believe they have experienced symptoms of PTSD, whether or not they were
formally diagnosed. Sources of stress for veterans
after returning may include understanding their beneﬁts and accessing care, as well as ﬁnding post-military
Reaching out is a sign of strength.
The Real Warriors Campaign seeks to connect
service members, military families, members of
the National Guard and reserve and veterans to
resources that help address the unique challenges
of military life and promote psychological health and
resilience. The campaign is an integral part of the
Defense Department’s overall efforts to encourage
help-seeking behavior for invisible wounds and raise
awareness of the available resources. Additional
efforts by the Defense Department and Department
of Veterans Affairs to encourage the use of available
psychological health care resources include:
• Adjusting the National Security background
questionnaire (SF-86), which asked security
clearance applicants to indicate whether they had
ever received psychological health care, to exclude
counseling related to service in combat.
• The National Guard has implemented state
directors of psychological health (DPH) and aligned
one with each of the 54 Joint Force Headquarters.
Each DPH is the focal point for coordinating
psychological support for National Guard members
and their families.
• The Military Crisis Line, a toll-free, conﬁdential
resource that connects service members in
crisis and their families and friends with qualiﬁed,
caring responders. For conﬁdential assistance,
call 1-800-273-8255 and press 1, chat online at
www.MilitaryCrisisLine.net or send a text message
to 838255 to receive free, conﬁdential support 24
hours a day, 7 days a week, 365 days a year.
• Make the Connection is a public awareness
campaign sponsored by the Department of
Veterans Affairs that connects veterans and
their families with information and resources to
help them cope with transitions, physical and
psychological health concerns and challenging life
events. Visit www.MaketheConnection.net for more
1 Hoge, C. and others. “Combat Duty in Iraq and Afghanistan, Mental Health Problems and Barriers
to Care,” New England Journal of Medicine, Vol. 351, pages 13-22. Published July 2004.
2 “Mental Health Advisory Team (MHAT) V Operation Enduring Freedom 8 Afghanistan,” Ofﬁce of
the Command Surgeon and Ofﬁce of the Surgeon General U.S. Army Medical Command, page 173.
Published Feb. 14, 2008.
3 “Joint Mental Health Advisory Team 7 (MHAT IIV) Operation Enduring Freedom 2010 Afghanistan,”
Ofﬁce of the Surgeon General U.S. Army Medical Command, Ofﬁce of the Command Surgeon HQ
CENTCOM, and the Ofﬁce of the Command Surgeon US Forces Afghanistan. Published Feb. 22, 2011.
4 “VA Medical Article Discusses Specialized Iraq and Afghanistan Veteran Health Care Needs,”
Department of Veterans Affairs. Published June 12, 2012.
5 “Number of Deployments for Those Ever Deployed for Operation Iraqi Freedom and Operation
Enduring Freedom,” Defense Department Contingency Tracking System. Information as of Dec. 31,
6 Flake EM and others. “The Psychosocial Effects of Deployment on Military Children,” Journal of
Developmental and Behavioral Pediatrics, Vol. 30 No. 4, pages 271-278. Published August 2009.
7 “Strengthening Our Military Families,” Department of Defense. Published January 2011.
8 Brim, William. “Who is watching a Guard member’s mental health?” Defense Centers of
Excellence for Psychological Health and Traumatic Brain Injury. Published July 28, 2010.
9 “Adjusting to Civilian Life after Combat Duty with the Guard or Reserve” Military One Source. Last
accessed Nov. 21, 2012.
10 “Returning to Work,” Employer Support of the Guard and Reserve. Last accessed Nov. 19, 2012.
11 “An Achievable Vision: Report of the Department of Defense Task Force on Mental Health,”
Defense Department. Published June 2007.
www.realwarriors.net ★ 866-966-1020