Improving Mental Health Care in the Military
“Resiliency” teams embedded among Air Force non-combat squadrons help address trauma, moral injury, and more. The other services should take note.
“WILL, YOU GOT A MINUTE?” It was mid-September 2022, and my group commander had called on a Saturday afternoon—never a good sign.
“Yes, sir.”
“I’ve got bad news,” he said.
I knew immediately what he was going to say. It was the phone call all commanders dread. One of my airmen had died.
We spent about five minutes exchanging information, ensuring I had a good understanding of what had occurred. He knew this would be a body blow for the tight-knit unit my team had been building, so before we ended our conversation so I could start calling my squadron’s enlisted leadership, he left me with one piece of advice.
“Don’t forget to lean on the ART,” he said, referring to the Airman Resiliency Team, a combination of medical, psychological, and spiritual personnel. Our ART consisted of a psychologist, a physician, a physician assistant and the physician assistant’s two senior noncommissioned officers, a medical technician, a chaplain, and a chaplain’s assistant. Rather than being a standalone medical unit, this team was embedded among us. While most also do rotations at medical facilities, their place of duty is inside the unit, shoulder-to-shoulder with our airmen.
The ART would play a crucial part in what my squadron went through in the weeks that followed. It provided the kind of mental and spiritual support that is so often lacking in the military and the intelligence community. The image of a combat veteran suffering from PTSD is common—perhaps too common. Less familiar is the mental toll on servicemembers who conduct intelligence, surveillance, and reconnaissance missions, like the 240-man Air Force squadron I led, or on other kinds of personnel, including diplomats and intelligence civilians, who play an integral role in executing missions a world away, even if they’re not on the front lines.
After I got off the phone with my group commander, I recalled my entire squadron to work to relay the news. The ART was there. “We are available to all of you for whatever reason,” they promised the squadron.
When we held the squadron’s memorial service, which the airman’s family attended, the ART showed up, too. They ensured that my squadron survived the blow and grew stronger and closer because of it. The ART did this by meeting with airmen one-on-one, sharing meals with those grieving, and checking up on them at their work centers. They were—are—all-stars working behind the scenes, ensuring the Air Force’s intelligence professionals are ready—emotionally, psychologically, spiritually—to accomplish their mission.
AN ART HAS A SPECIAL UNDERSTANDING of their patients because they are also their teammates. They appreciate the airmen’s operational tempo and the high-pressure environment they work in because, unlike most military health practitioners, they have the requisite security clearances to meet their patients where they work. The ART routinely walks through their airmen’s work centers to check in on them, get to know them, and build trust. They provide meals every quarter and during the holidays for those airmen working the dreaded graveyard shift.
These constant touchpoints help foster trust. My airmen did not see them as the infamous “they”—the officers and commanders who can get them in trouble—and instead viewed them as confidants.
Getting these airmen to open up can be difficult. While the stigma associated with mental health is receding, many servicemembers still fear losing their security clearance if they admit to needing psychological help. This misplaced worry is a constant problem for unit leaders. Out of more than 2.3 million clearance adjudications made by the Department of Defense’s Consolidated Adjudication Facility from 2012 to 2018, just twelve were denied for psychological reasons alone, and of those, none were for seeking care. Servicemembers do not have to report standard counseling for marriage problems, post-traumatic stress disorder, or other mundane preventative problems. But they still worry.
The ART is an invaluable tool for any commander. Commanders are responsible for essentially everything those in their command do, including their preparedness, their level of training, their safety, and their morale. To be effective, they must build a healthy rapport with their troops but cannot be their confidants. Command teams can’t ensure good order and discipline and focus on executing the mission if they’re buddies with their troops. They need to create a healthy unit culture that is lethal, agile, and ready to fight. That means ensuring their troops are prepared at all times. The ART helps commanders achieve those goals.
While having embedded health practitioners and chaplains is familiar to most of the military’s combat units, the practice has taken hold inside the Air Force’s intelligence, surveillance, and reconnaissance wings only fairly recently. One of the many common misconceptions about mental health issues is that they only affect frontline combat arms units. Before my command tour, I assumed in-garrison units faced a completely different set of problems from those in the field. I was wrong. Those who work in the intelligence community—even in the United States, far from physical harm—routinely encounter traumatic events.
Support personnel can experience battlefield trauma usually associated with combat. And with the proliferation of overhead imagery, the battlefield and all its horrors can be witnessed a world away. Remote drone pilots are not the only ones who are a part of the remote kill chain. Intelligence support personnel assist pilots in targeting and battle damage assessments, and analysts are sometimes required to sift through gruesome terrorist beheading videos or hard drives full of pornography.
Many intelligence professionals also encounter moral injury, the psychological trauma from witnessing or participating in an event that violates your most deeply held principles—an old concept that found new life after the fall of Kabul.
I’m familiar with moral injury. I figured I’d seen every horror war had to offer in Iraq and Afghanistan. Then, my entire life’s work disintegrated in August 2021. The combat trauma I experienced in the slums of Baghdad and rural Afghanistan paled in comparison to the moral trauma I endured as the Taliban hunted, tortured, and killed my Afghan brothers. This complex multilayered moral injury nearly destroyed me.
While trauma and moral injury are separate mental health issues, they are often intertwined.
In August 2021, America’s military evacuated 120,000 people from Kabul amid a deteriorating security environment. Many of them bear the scars of those two fateful weeks. And they weren’t all on the front lines. My former airmen, who provided intelligence support to the withdrawal, watched everything unfold in live high definition. Many witnessed the suicide bomber that killed thirteen of their comrades and gasped in horror as Afghans fell from the sky.
When their shifts were up, they had to go home to care for their kids and support their spouses. “I would go to work, watch us kill a bunch of terrorists from a drone strike,” an airman said to me, “then I’d go home and make my husband and children’s dinner.”
The ART’s psychologist, chaplain, and chaplain’s assistant play a lead role in mental health support, especially in helping airmen work through complex emotions. The psychologist helps triage acute issues and crises before helping to arrange long-term mental health care. The chaplain, who also has extensive mental health training, provides counseling for all airmen, regardless of their religious preference. However, unlike the psychologist, the chaplain has no mandatory reporting rules. Airmen can tell them literally anything and they are forbidden from reporting it.
AN ART DOESN’T JUST RESPOND TO PROBLEMS; it also focuses on prevention and performance enhancement. This focus is relevant to mental health. But it is also about fielding resilient airmen who are mentally, physically, and spiritually fit. It’s both negative, in terms of averting and ameliorating problems, and positive, in terms of helping airmen succeed.
With this vision in mind, our squadron’s ART helped create a two-day “Warrior Mindset” course—the brainchild of a grizzled prior enlisted commander with nearly thirty years of experience, Jerry “Marvin” Gray. He wanted to build resilient airmen who could thrive in, for example, a possible war with China, where the death count could exceed the total of all American wars since Vietnam. His airmen and the ART worked together to create a course today that could start preparing young airmen for such a horrific event.
The Warrior Mindset course occurs far from the airmen’s high-paced, classified work centers. Over nearly sixteen hours of group assignments, physical activities, and conversations, the ART and other leaders discuss topics ranging from nutrition to physical fitness to moral injury.
In 2023, at the end of the latest iteration, the airmen heard from multiple speakers, including a panel I sat on with two other commanders. The three of us had nearly seventy years of combined military and intelligence experience, with about ten combined years of deployments.
There were no company lines. It was real talk. We talked about the horrors of war. A few of us, including me, wept. You could have heard a pin drop.
I wish I had had this type of training before I deployed in 2006. By the time I got in, the only guys who had seen similar fighting to what we would experience, the Gulf War vets, were few and far between. There was some talk of post-traumatic stress disorder. Nobody had even heard of moral injury. The military trained us to conduct the mission, but didn’t do enough to prepare us for what we would see or how to deal with it. That is, mercifully, changing.
Much of this work is happening at the unit level, where frontline commanders are becoming more proactive amid a recruiting and retention crisis. Intelligence professionals, whether civilians or military, are costly to train. And since many intelligence civilians are veterans, the military’s ability to train resilient intelligence personnel has an outsized effect on the intelligence community as a whole.
The innovative work of the ARTs offers a blueprint for other services to follow. Most of it grew organically, arising as they saw problems needing solutions. And no two ARTs are the same; they differ by geographic location and based on whom they’re embedded in. If the other services were to follow the Air Force’s model—and they should—they would find the concept malleable to their needs. Regardless of the differences, an embedded, multifunctional team focusing on holistic medical support would pay dividends across the armed forces—and for the country.
And the model could be applied beyond the military. Civilian intelligence professionals, too, play a critical role in protecting Americans, supporting our allies, and advancing America’s foreign policy. If they were to receive world-class support comparable to what my airmen received, the result would be a workforce better able to meet the intelligence demands of the world’s remaining superpower.
More importantly, our dedicated intelligence professionals have earned this support after executing worldwide operations for decades. It’s the least we could do.
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