https://armypubs.army.mil/epubs/DR_pubs/DR_a/ARN45339-ALARACT_1102025-000-WEB-1.pdf
ALARACT 110/2025
DTG: R 122100Z DEC 25
UNCLAS
SUBJ/ALARACT 110/2025 – MEDICAL PLANNING AND EXECUTION
CONSIDERATIONS FOR COMBAT AND OPERATIONAL STRESS CONTROL
THIS MESSAGE HAS BEEN TRANSMITTED BY DISA/J6 ON BEHALF OF THE
OFFICE OF THE SURGEON GENERAL
1. (U) REFERENCES:
1.A. (U) DODI 6490.05, MAINTENANCE OF PSYCHOLOGICAL HEALTH IN MILITARY
OPERATIONS (AVAILABLE AT HTTPS://WWW.ESD.WHS.MIL/)
1.B. (U) AR 600–63, ARMY HEALTH PROMOTION
1.C. (U) DODI 6490.09, DOD DIRECTORS OF PSYCHOLOGICAL HEALTH
(AVAILABLE AT HTTPS://WWW.ESD.WHS.MIL/)
1.D. (U) FM 4–02, ARMY HEALTH SYSTEM
1.E. (U) ATP 4–02.5, CASUALTY CARE
1.F. (U) ATP 4–02.6, THE MEDICAL COMPANY
1.G. (U) ATP 4–02.8, FORCE HEALTH PROTECTION
1.H. (U) ATP 4–02.55, ARMY HEALTH SYSTEM SUPPORT PLANNING
1.I. (U) ATP 4–02.46, ARMY HEALTH SYSTEM SUPPORT TO DETAINEE
OPERATIONS (AVAILABLE AT
HTTPS://ARMYPUBS.ARMY.MIL/EPUBS/DR_PUBS/DR_D/ARN44573-ATP_4-02.46-
001-WEB-2.PDF)
2. (U) PURPOSE: TO CLARIFY THE COMBAT AND OPERATIONAL STRESS
CONTROL (COSC) FUNCTIONS (ROLES AND RESPONSIBILITIES) OF ARMY
MEDICAL DEPARTMENT (AMEDD) PERSONNEL AND PROVIDE ARMY MEDICAL
COMMANDERS AND PLANNERS WITH GUIDANCE FOR DEVELOPING THE
CONCEPT OF BEHAVIORAL HEALTH SUPPORT. AMEDD PERSONNEL
EXECUTING THE COSC FUNCTION SERVE IN A VARIETY OF DIFFERENT UNIT
SETTINGS ACROSS ALL COMPONENTS, INCLUDING OPERATIONAL UNITS,
MEDICAL FACILITIES, AND COSC DETACHMENTS.
2.A. (U) ALL BEHAVIORAL HEALTH, MEDICAL, LINE, AND UNIT MINISTRY
PERSONNEL HAVE ROLES IN MAINTAINING PSYCHOLOGICAL HEALTH DURING
ARMY OPERATIONS.
2.B. (U) COSC PERSONNEL INCLUDE MEDICAL SPECIALTIES THAT SPECIALIZE
IN COMBAT/OPERATIONAL STRESS REACTION (COSR) PREVENTION AND COSC
FUNCTIONS INCLUDE CLINICAL SOCIAL WORKERS, CLINICAL PSYCHOLOGISTS,
PSYCHIATRISTS, OCCUPATIONAL THERAPISTS, PSYCHIATRIC NURSE
PRACTITIONERS, PSYCHIATRIC NURSES, ENLISTED BEHAVIORAL HEALTH
SPECIALISTS, AND ENLISTED OCCUPATIONAL THERAPY SPECIALISTS.
BEHAVIORAL HEALTH OFFICERS (BHOS) SPECIFICALLY CONSIST OF CLINICAL
SOCIAL WORKERS, CLINICAL PSYCHOLOGISTS, PSYCHIATRISTS, PSYCHIATRIC
NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS WITH PSYCHIATRIC
TRAINING.
2.C. (U) LINE AND UNIT MINISTRY PERSONNEL SUPPORT PSYCHOLOGICAL
HEALTH DURING OPERATIONS AND DETAILED ENUMERATION OF THEIR ROLES
AND RESPONSIBILITIES IS OUTSIDE THE SCOPE OF THIS ALARACT.
3. (U) BACKGROUND: REFERENCE 1.A. REQUIRES THE SECRETARY OF THE
ARMY TO DEVELOP COMPREHENSIVE COSC POLICIES AND PROGRAMS FOR
ARMY-SPECIFIC OPERATIONS FROM GARRISON TO THE BATTLEFIELD. THIS
ALARACT COMMUNICATES INSTRUCTIONS AND INFORMATION TO HELP ARMY
COMMANDERS TASK-ORGANIZE THE BEHAVIORAL HEALTH FORCE, IN
COORDINATION WITH OTHER MEDICAL ASSETS, AND DIRECT, COORDINATE,
AND SYNCHRONIZE COSC ACTIONS IN GARRISON AND DURING OPERATIONS.
4. (U) SITUATION: MEDICAL COMMANDERS, MEDICAL PLANNERS, MEDICAL
LEADERS, AND COMMAND SURGEONS AT ALL LEVELS OF COMMAND IN
PLANNING AND EXECUTING ARMY HEALTH SYSTEM SUPPORT SHOULD
INCORPORATE THE GUIDANCE IN THIS ALARACT. THIS ALARACT COVERS
PLANNING AND EXECUTING THE COSC FUNCTION IN BOTH THE GARRISON
AND DEPLOYED ENVIRONMENT. ARMY AMEDD PERSONNEL EXECUTING THE
COSC FUNCTION SHOULD INCORPORATE THE INFORMATION IN THIS ALARACT
INTO PLANNING AND EXECUTING THEIR ACTIVITIES AS CAPABILITIES IN THE
ARMY’S COSC FUNCTION.
5. (U) IN ACCORDANCE WITH REFERENCE 1.A., COSC ACTIVITIES INCLUDE
PREVENTION AND TREATMENT OF STRESS REACTIONS AND MENTAL HEALTH
DISORDERS IN GARRISON.
5.A. (U) COSC PRINCIPLES ENHANCE ADAPTIVE STRESS REACTIONS, PREVENT
MALADAPTIVE STRESS REACTIONS, BUILD RESILIENCY SKILLS, AND ASSIST
SOLDIERS IN ADDRESSING COSRS AND BEHAVIORAL DISORDERS. COSC
MANAGEMENT PRINCIPLES ARE BREVITY, IMMEDIACY, CONTACT,
EXPECTANCY, PROXIMITY, AND SIMPLICITY (BICEPS).
5.B. (U) PLANNING COSC DELIVERY IN GARRISON. EFFECTIVE GARRISON COSC
REQUIRES UNDERSTANDING THE OPERATIONAL ENVIRONMENT AND BUILDING
COHESIVE TEAMS COMPOSED OF ARMY, JOINT, INTERAGENCY, AND CIVILIAN
PARTNERS. IT ENCOMPASSES THE PRE-DEPLOYMENT AND POST-
DEPLOYMENT TIMEFRAMES AND CONSIDERS REAR DETACHMENTS DURING
OPERATIONS.
5.C. (U) MOST TREATMENT IN GARRISON OCCURS THROUGH DEFENSE
HEALTH AGENCY ADMINISTERED MEDICAL FACILITIES. COSC PLANNING
NEEDS TO BALANCE READINESS AND HEALTH. BHOS MUST IMPROVE THEIR
MILITARY AND CLINICAL READINESS WHILE PREVENTING STRESS REACTIONS
AND TREATING MENTAL ILLNESS FOR THE SOLDIERS THEY SUPPORT. THEY
ARE ALSO INSTRUMENTAL IN TRAINING AND PLANNING FOR DELIVERING
CLINICAL SUPPORT DURING OPERATIONS. COSC OPERATING IN A GARRISON
ENVIRONMENT IMPACTS READINESS OF THE FORCE THROUGH INTEGRATION
AND COLLABORATION WITH THE SUPPORTING MILITARY TREATMENT FACILITY
BEHAVIORAL HEALTH (BH) CLINIC. INSTALLATION DIRECTORS OF
PSYCHOLOGICAL HEALTH ENSURE ORGANIZATIONAL PROCESSES ENABLE
ALL BHOS ON THE INSTALLATION TO PERFORM CLINICAL CARE.
5.D. (U) MEDICAL LEADERS SHOULD OBTAIN THEIR COMMANDER’S INTENT ON
HOW AND WHERE BHOS SHOULD BE UTILIZED. BHOS AT ECHELONS BELOW
DIVISION SHOULD SPEND APPROXIMATELY 50 PERCENT OF THEIR TIME
PERFORMING CLINICAL CARE WHILE IN GARRISON AND NOT CONDUCTING
FIELD EXERCISES. MEDICAL LEADERS AND BHOS CAN FACILITATE THEIR
COMMANDER’S DECISION MAKING WITH A DESCRIPTION OF THE OPERATING
ENVIRONMENT THAT INCLUDES MEASURES OF THE HEALTH AND READINESS
OF THE FORCE. SEE ATTACHMENT 1 FOR EXAMPLES OF MEASURES THAT CAN
HELP SUPPORT DECISION MAKING.
5.E. (U) SPECIFIED COSC TASKS INCLUDE PREVENTION OF OPERATIONAL
STRESS REACTIONS (OSRS), IDENTIFICATION OF OSR, MANAGEMENT OF OSR
(INCLUDING AS CLOSE TO THE UNIT AS POSSIBLE), DELIVERY OF
PSYCHOLOGICAL FIRST AID, SURVEILLANCE OF MENTAL HEALTH PROBLEMS,
TRIAGE AND TREATMENT OF PSYCHIATRIC DISORDERS, AND REFERRAL FOR
SPECIALTY MENTAL HEALTH SERVICES AS INDICATED.
5.F. (U) REASONABLE PLANNING OBJECTIVES INCLUDE A BEHAVIORALLY
READY FORCE AND HAVING APPROPRIATE MEASURES IN PLACE TO ENSURE
OPERATIONAL BH NEEDS ARE MET. MEASURING EFFICACY OF COSC
ACTIVITIES ON HEALTH MAY BE CHALLENGING BECAUSE OF COMPLEXITY IN
THE OPERATIONAL ENVIRONMENT AND HUMAN BEHAVIOR IS INFLUENCED BY
COUNTLESS BIOLOGICAL, PSYCHOLOGICAL, AND SOCIAL FACTORS.
5.G. (U) COSC ACTIVITIES IN GARRISON SHOULD INFORM AND PREPARE UNITS
AND BHOS FOR OPERATIONS OTHER THAN WAR AND COMBAT OPERATIONS.
BHOS SHOULD TRAIN ON COSC TASKS REQUIRED BY REFERENCE 1.A. AND
UTILIZE TIME IN GARRISON TO DEVELOP WORKING RELATIONSHIPS WITH
ALLIED PROFESSIONALS.
5.G.1. (U) COORDINATION WITH OTHER INSTALLATION AND UNIT RESOURCES,
SUCH AS THE INSTALLATION DIRECTOR OF PSYCHOLOGICAL HEALTH,
HOLISTIC HEALTH AND FITNESS PERFORMANCE TEAM, SPECIFICALLY WITH
THE OCCUPATIONAL THERAPIST, SHOULD BE DONE TO MAXIMIZE THESE
EFFORTS AND MEASURES.
5.G.2. (U) BHOS SHOULD BE FAMILIAR WITH PRINCIPLES OF SPIRITUAL
FITNESS AND UNDERSTAND THE ROLE OF THE UNIT MINISTRY TEAM IN
EXECUTING COSC ACTIVITIES. BHOS SHOULD UNDERSTAND THE ROLE OF
SPIRITUAL READINESS AND RESILIENCE AND GAIN EXPERIENCE WITH
UTILIZING UNIT MINISTRY TEAMS TO IMPROVE THE EFFICACY OF OSR
PREVENTION EFFORTS.
5.H. (U) COSC ACTIVITIES IN ALL OPERATIONAL ENVIRONMENTS IS RELIANT ON
COSC PERSONNEL MAINTAINING CLINICAL SKILLS. BHOS MUST HAVE THE
OPPORTUNITY TO MAINTAIN CLINICAL SKILLS. BHOS SHOULD PROVIDE
DIRECT CARE WHILE IN GARRISON FOR A PORTION OF THEIR DUTY TIME AS
DETERMINED BY MISSION NEEDS, CREDENTIALING AND LICENSING
REQUIREMENTS, CLINICAL EXPERIENCE OF THE BHO (FOR EXAMPLE, EARLY
CAREER PROVIDERS GENERALLY WILL NEED MORE HOURS TO CONSOLIDATE
SKILLS), AND OTHER FACTORS. TO IMPROVE CLINICAL SKILLS AND PREPARE
FOR FORWARD DEPLOYMENT AND COMBAT OPERATIONS, BHOS SHOULD
SEEK OPPORTUNITIES TO ASSESS AND TREAT COMPLEX PATIENTS
SUFFERING FROM SEVERE MENTAL ILLNESS AND NEUROPSYCHIATRIC
EFFECTS OF COMBAT OPERATIONS.
5.I. (U) BHO NON-CLINICAL ACTIVITIES SHOULD BE CLOSELY ALIGNED TO
THEIR ROLES AND RESPONSIBILITIES IN PARAGRAPH 5.B. SURVEILLANCE OF
MENTAL HEALTH PROBLEMS, UNIT RISK FACTOR ASSESSMENT,
COORDINATION TO DELIVER PSYCHOLOGICAL FIRST AID PROGRAMS, AND
PREVENTION OF PSYCHIATRIC DISORDERS ARE CORE COSC TASKS THAT
BHOS CAN PERFORM IN GARRISON. COMMANDERS AND COMMAND
SURGEONS SHOULD ENSURE THAT BHO NON-CLINICAL ACTIVITIES SUPPORT
THE HEALTH OF THE FORCE AND DEPLOYMENT READINESS OF THE BHO.
BHOS MUST PERFORM NON-CLINICAL OPERATIONAL DUTIES TO MAINTAIN
THEIR READINESS AND COMMANDERS SHOULD BALANCE THIS WITH CLINICAL
CARE EXPECTATIONS.
5.J. (U) ROLES AND RESPONSIBILITIES OF AMEDD PERSONNEL SUPPORTING
THE COSC FUNCTION IN GARRISON. ROLES AND RESPONSIBILITIES OF ALL
AMEDD PERSONNEL, INCLUDING DIVISION PSYCHIATRISTS, BRIGADE
PSYCHOLOGISTS, BRIGADE SOCIAL WORKERS, INSTALLATION DIRECTORS OF
PSYCHOLOGICAL HEALTH, OCCUPATIONAL THERAPISTS, AND AMEDD
PERSONNEL IN COSC DETACHMENTS ARE OUTLINED IN ATTACHMENT 2.
6. (U) IN ACCORDANCE WITH REFERENCE 1.A., COSC ACTIVITIES INCLUDE
PREVENTION AND TREATMENT OF STRESS REACTIONS AND MENTAL HEALTH
DISORDERS DURING ARMY OPERATIONS OTHER THAN WAR.
6.A. (U) PLANNING COSC DELIVERY IN OPERATIONS OTHER THAN WAR
REQUIRES SURVEILLANCE OF MENTAL HEALTH PROBLEMS, PROJECTING
OPERATIONAL STRESS REACTION AND PSYCHIATRIC CASUALTY RATES, AND
IMPLEMENTING A STRUCTURE OF BEHAVIORAL HEALTH CARE IN
COORDINATION WITH THE MEDICAL ROLES OF CARE. DATA CAN BE USED TO
DEFINE MINIMAL BH FORCE REQUIREMENTS TO SUPPORT OPERATIONS OF
VARYING LENGTH. SEE ATTACHMENT 3 FOR LESSONS LEARNED FROM THE BH
UTILIZATION RATES IN GARRISON.
6.B. (U) THE CURRENT MODIFIED TABLE OF ORGANIZATION AND EQUIPMENT
FOR ARMORED AND INFANTRY BRIGADE COMBAT TEAMS REFLECTS A
REASONABLE ALLOCATION OF TWO BHOS AND TWO BEHAVIORAL HEALTH
TECHS PER APPROXIMATELY 4000 SOLDIERS AND ARE ROUGHLY CONSISTENT
WITH OPTIMAL MANNING LESSONS LEARNED FROM THE GLOBAL WAR ON
TERROR. THESE NUMBERS SHOULD ONLY BE USED IN THE ABSENCE OF
SURVEILLANCE AND WORKLOAD DATA AND PLANNERS SHOULD CONTINUALLY
ADJUST THEIR BH CONCEPT OF SUPPORT BASED ON THE OPERATING
ENVIRONMENT. COSC DETACHMENTS PROVIDE AREA COVERAGE TO UNITS
THAT LACK ORGANIC BEHAVIORAL HEALTH PERSONNEL AND MAY ALSO
SUPPORT ARMORED AND INFANTRY BRIGADE COMBAT TEAMS DEPENDING ON
OPERATIONAL CIRCUMSTANCES.
6.C. (U) VIRTUAL BEHAVIORAL HEALTH ENHANCES BHOS’ ABILITY TO
CONDUCT PREVENTION AND TREATMENT ACTIVITIES IN GEOGRAPHICALLY
DISPERSED OPERATING ENVIRONMENTS. PLANNERS SHOULD OPTIMIZE THEIR
CONCEPT OF BEHAVIORAL HEALTH SUPPORT BY EMPLOYING VIRTUAL
BEHAVIORAL HEALTH TO THE MAXIMUM EXTENT POSSIBLE, IF OPERATIONAL
CIRCUMSTANCES PERMIT. LESSONS LEARNED FROM THE WAR ON TERROR,
THE CORONAVIRUS PANDEMIC AND EXPANSION OF TELEHEALTH SUGGEST
THAT VIRTUAL BEHAVIORAL HEALTH, BOTH AUDIO/VISUAL AND AUDIO ONLY, IS
EQUIVALENT TO FACE TO FACE BEHAVIORAL HEALTH CARE IN
EFFECTIVENESS AND OVERALL SATISFACTION.
6.D. (U) NON-BH MEDICAL PERSONNEL AND UNIT MINISTRY TEAMS SHOULD BE
INCLUDED IN THE CONCEPT OF BH SUPPORT. PHYSICIANS, PHYSICIAN
ASSISTANTS, NURSES, OCCUPATIONAL THERAPISTS, AND MEDICS ARE
IMPORTANT BH CARE EXTENDERS AND OFTEN PROVIDE BH SUPPORT IN THE
FORM OF MEDICATION MANAGEMENT, MEDICAL COUNSELING, AND MENTAL
HEALTH TRIAGE. BHOS PROVIDE LEADERSHIP AND EDUCATION TO SUPPORT
NON-BH MEDICAL PROVIDERS’ KNOWLEDGE, CONFIDENCE, AND SKILLS IN
MANAGING ROUTINE BH PROBLEMS. BHOS SHOULD TRAIN NON-MENTAL
HEALTH MEDICAL PERSONNEL ON THE IDENTIFICATION OF STRESS-RELATED
CONDITIONS, PSYCHOLOGICAL FIRST AID, RESILIENCE-BUILDING, AND
MANAGEMENT OF OPERATIONAL STRESS REACTIONS. SPIRITUAL RESILIENCE
IS A CRITICAL ELEMENT OF PSYCHOLOGICAL RESILIENCE, AND PASTORAL
COUNSELING MAY HELP PREVENT AND TREAT OSR. PSYCHIATRISTS PROVIDE
CONSULTATION AND TRAINING TO NON-BH MEDICAL PROVIDERS ON THE
MEDICAL MANAGEMENT OF MENTAL ILLNESS.
6.E. (U) THE STRUCTURE OF BH CARE SHOULD BE ALIGNED WITH AND
COORDINATED WITH OTHER MEDICAL SERVICES TO ENSURE INTEGRATED
DELIVERY OF TRIAGE, ASSESSMENT, DIAGNOSTIC, AND TREATMENT
CAPABILITIES. THIS SHOULD INCLUDE THE ABILITY TO DELIVER
PSYCHOLOGICAL CARE ACCORDING TO BICEPS PRINCIPLES AS CLOSE TO
THE UNIT AS POSSIBLE. SINCE TREATMENT OF COSRS AND ACUTE MILD
TRAUMATIC BRAIN INJURIES INVOLVE SIMILAR APPROACHES (FOR EXAMPLE,
REST, EDUCATION, MONITORING, AND EXPECTATION OF RETURN TO DUTY),
RESTORATION CAPABILITIES FOR COSRS AND MILD TRAUMATIC BRAIN
INJURIES (MTBIS) MAY BE COMBINED AND COORDINATED.
6.F. (U) ROLES AND RESPONSIBILITIES OF AMEDD PERSONNEL EXECUTING
THE COSC FUNCTION IN MILITARY OPERATIONS OTHER THAN WAR: THE
ROLES AND RESPONSIBILITIES OF BHOS REMAIN THE SAME AS THOSE IN
GARRISON, WITH THE ADDITION OF CLINICAL DUTIES TYPICALLY PERFORMED
BY MEDICAL STAFF IN GARRISON, OPERATIONAL MISSION READINESS, AND
ADDITIONAL ROLES AND RESPONSIBILITIES ENUMERATED IN ATTACHMENT 4.
7. (U) IN ACCORDANCE WITH REFERENCE 1.A., COSC ACTIVITIES INCLUDE
PREVENTION AND TREATMENT OF STRESS REACTIONS AND MENTAL HEALTH
DISORDERS ON THE BATTLEFIELD.
7.A. (U) PLANNING COSC DELIVERY IN LARGE SCALE COMBAT OPERATIONS
(LSCO). EFFECTIVE COSC SUPPORT IN LSCO INVOLVES ALL OF THE SAME
COSC ACTIVITIES OUTLINED FOR OPERATIONS OTHER THAN WAR. PLANNING
WILL REQUIRE ADAPTING IN CONTACT TO PREVENT PSYCHIATRIC
CASUALTIES, CONDUCTING INITIAL DIAGNOSIS OF PSYCHIATRIC CONDITIONS,
TREATING COSRS AND PSYCHIATRIC BATTLEFIELD CASUALTIES, AND
PERFORMING PREVENTION IN A BATTLESPACE WHERE COSC CAPABILITIES
WILL BE UNDER CONSTANT SURVEILLANCE AND SUBJECT TO ENEMY FIRES,
AND WHERE EVACUATION FOR SERIOUS PSYCHIATRIC CASUALTIES MIGHT BE
SIGNIFICANTLY DELAYED.
7.B. (U) THE ROLES AND RESPONSIBILITIES OF BHOS REMAIN SIMILAR TO
OTHER ENVIRONMENTS WITH THE ADDITION OF INCREASED DEMAND FOR
INTERVENTIONS TO MANAGE COMBAT STRESS REACTIONS AND IMPROVE
RESILIENCE AT THE POPULATION AND INDIVIDUAL LEVEL. BHOS SHOULD
EXPECT TO SUPPORT UNITS AND SOLDIERS THAT HAVE EXPERIENCED
INTENSE, PROLONGED COMBAT AND SUFFER FROM A HIGH PREVALENCE OF
COMBAT STRESS, ACUTE STRESS DISORDER, AND SUB-ACUTE/CHRONIC MILD
TBI FROM MULTIPLE CONCUSSIVE IMPACTS/BLAST OVERPRESSURE.
ADDITIONAL SPECIFIC INFORMATION ON BHO ROLES AND RESPONSIBILITIES
IS INCLUDED IN ATTACHMENT 5.
7.C. (U) THERE IS INADEQUATE DATA TO PROJECT BHO REQUIREMENTS IN
LSCO ENVIRONMENTS, OR WHETHER THE CURRENT ALLOCATION OF 2 BHOS
AND 2 TECHS PER BCT WILL BE ADEQUATE. HOWEVER, BASED ON LESSONS
LEARNED FROM RECENT CONFLICTS, THERE WILL LIKELY NEED TO BE
GREATER RELIANCE ON BUDDY AID STRATEGIES, MEDICS AND PRIMARY CARE
PROVIDERS, HOLISTIC HEALTH AND FITNESS, AS WELL AS ON VIRTUAL BH
OPTIONS. ALL MEDICS, PRIMARY CARE PROVIDERS, AND HOLISTIC HEALTH
AND FITNESS PERSONNEL SHOULD HAVE FOUNDATIONAL KNOWLEDGE IN
BUDDY AID TOOLS SUCH AS ICOVER FOR ACUTE STRESS REACTIONS,
UNDERSTANDING THE STRESS CONTINUUM, AND MANAGING OSRS AS CLOSE
TO THE UNIT AS POSSIBLE FOLLOWING, MTBI SCREENING (FOR EXAMPLE,
MACE), WITH CONSULTATION AND MORE DEFINITIVE CARE OF SERIOUS
PSYCHIATRIC CASUALTIES AVAILABLE FROM BHOS. BHOS NEED TO HAVE
PROFICIENCY IN IDENTIFYING SERIOUS MENTAL HEALTH CONDITIONS IN
FORWARD ENVIRONMENTS, SUCH AS PSYCHOSIS AND BIPOLAR DISORDER,
AND IN MANAGING THOSE CONDITIONS IN COLLABORATION WITH A
PSYCHIATRIST AND/OR UNIT SURGEON.
7.D. (U) BATTLEFIELD CIRCULATION OF BHOS MAY HAVE TO BE CURTAILED OR
MODIFIED TO ENSURE THAT BH SERVICES ARE RETAINED AND AVAILABLE
FOR THE LARGEST PROPORTION OF FORCES. MOST BHO ACTIVITIES WILL BE
CONDUCTED IN THE SUPPORT AREA FOR UNITS RETURNING FROM OR
MOVING TO THE CLOSE AREA AND FORWARD LINE OF TROOPS. THIS IS
DIFFERENT FROM THE GLOBAL WAR ON TERROR PRACTICE OF BHOS
REGULARLY LEAVING THE SUPPORT AREA TO TRAVEL TO FORWARD
POSITIONED UNITS.
7.E. (U) THE STRUCTURE OF BH CARE SHOULD BE ALIGNED WITH AND
COORDINATED WITH OTHER MEDICAL SERVICES TO ENSURE INTEGRATED
DELIVERY OF TRIAGE, ASSESSMENT, DIAGNOSTIC, AND TREATMENT
CAPABILITIES. THIS SHOULD INCLUDE THE ABILITY TO DELIVER
PSYCHOLOGICAL CARE ACCORDING TO BICEPS PRINCIPLES AS CLOSE TO
THE UNIT AS POSSIBLE. SINCE TREATMENT OF COSRS AND ACUTE MILD
TRAUMATIC BRAIN INJURIES INVOLVE SIMILAR APPROACHES (FOR EXAMPLE,
REST, EDUCATION, MONITORING, AND EXPECTATION OF RETURN TO DUTY),
RESTORATION CAPABILITIES FOR COSRS AND MTBIS MAY BE COMBINED AND
COORDINATED.
7.F. (U) ADDITIONAL ROLES AND RESPONSIBILITIES:
7.F.1. (U) DIVISION PSYCHIATRIST: THE DIVISION PSYCHIATRIST WILL HAVE
PRIMARY RESPONSIBILITY FOR ESTABLISHING THE STRUCTURE OF CARE AND
DISTRIBUTION OF BH RESOURCES WITHIN THE DIVISION IN THE COMBAT
ENVIRONMENT IN COORDINATION WITH THE THEATER BEHAVIORAL HEALTH
CONSULTANT, DIVISION SURGEON, MEDICAL PLANNERS, AND BHOS. THE
CAPABILITY OF DELIVERING FORWARD BH CARE NEEDS TO BE BALANCED
WITH THE LIMITATIONS IN RESOURCES, LIMITATIONS IN EVACUATION
CAPABILITIES, AND OTHER OPERATIONAL CONSIDERATIONS. DIVISION
PSYCHIATRISTS WILL ALSO BE RESPONSIBLE FOR SELECTING THE MOST
APPROPRIATE PSYCHIATRIC MEDICATION FORMULARY FOR THE GIVEN
OPERATIONAL ENVIRONMENT FOR BRIGADE AND BATTALION LEVEL MEDICAL
SUPPORT. IF DIVISION PSYCHIATRIST IS NOT LOCATED IN THE AREA OF
OPERATIONS, DIVISION PSYCHIATRIST SHOULD PROVIDE OVER THE HORIZON
MEDICATION FORMULARY RECOMMENDATIONS TO SENIOR BHO IN THE AREA
OF OPERATIONS. THE DIVISION PSYCHIATRIST INTEGRATES WITH AND
INCLUDES DIVISION UNIT MINISTRY TEAM AND HOLISTIC HEALTH AND FITNESS
OFFICER IN ESTABLISHING STRUCTURE OF CARE.
7.F.2. (U) FIRST RESPONDERS INCLUDING PHYSICIAN ASSISTANTS, BATTALION
SURGEONS, NURSES, AND MEDICS: BHOS MAY NOT BE CONSISTENTLY
AVAILABLE TO FIRST RESPONDERS DUE TO ADVERSARY DEEP FIRES LIMITING
MOBILITY, MULTI-DOMAIN OPERATIONS DISRUPTING COMMUNICATIONS, AND
CONSTANT OBSERVATION OF MEDICAL OPERATIONS. BHOS SHOULD PROVIDE
FIRST RESPONDERS WITH EDUCATION AND TRAINING PRIOR TO DEPLOYMENT
AND DURING ROTATIONS TO THE REAR. FIRST RESPONDERS EXPECT TO
PERFORM PSYCHOLOGICAL FIRST AID AND TRIAGE PSYCHIATRIC CASUALTIES
WITHOUT CONSULTATION WITH A BHO.
8. (U) POINT OF CONTACT: LTC(P) PETER ARMANAS, MC, CHIEF, BEHAVIORAL
HEALTH DIVISION, READINESS AND HEALTH INTEGRATION, HEADQUARTERS,
U.S. ARMY MEDICAL COMMAND, COMMERCIAL, (703) 681–4598, EMAIL:
PETER.S.ARMANAS.MIL@ARMY.MIL.
9. (U) THIS ALARACT MESSAGE EXPIRES ON 2 DECEMBER 2026.
ATTACHMENTS:
1. (U) MEASURES AND TOOLS TO SUPPORT COMMANDERS’ DECISION MAKING
WITH REGARD TO UTILIZATION OF BHOS
2. (U) ROLES AND RESPONSIBILITIES OF AMEDD PERSONNEL IN GARRISON
3. (U) BH PATIENT UTILIZATION DATA
4. (U) COSC ROLES AND RESPONSIBILITIES OF MEDICAL PERSONNEL IN
MILITARY OPERATIONS OTHER THAN WAR
5. (U) ROLES AND RESPONSIBILITIES OF BHOS DURING COMBAT OPERATIONS
ATTACHMENT 1. MEASURES AND TOOLS TO SUPPORT COMMANDERS’
DECISION MAKING WITH REGARD TO UTILIZATION OF BHOS
1. (U) MEASURES. THE FOLLOWING LIST OF MEASURES IS NOT ALL INCLUSIVE
AND MAY NOT BE APPLICABLE IN ALL ENVIRONMENTS. MEDICAL PLANNERS
SHOULD ADVISE LEADERS WHICH MEASURES BEST INFORM SPECIFIC UNIT
DECISION MAKING: ACCESS TO CARE FOR BEHAVIORAL HEALTH CLINICS,
SHORT-TERM/LONG-RANGE TRAINING SCHEDULE FOR UNITS, UTILIZATION
RATES OF BEHAVIORAL HEALTHCARE AT THE MILITARY TREATMENT FACILITY,
SOLDIER REFERRALS TO PRIVATE SECTOR BEHAVIORAL HEALTHCARE, RATES
OF DUTY LIMITING BEHAVIORAL HEALTH PROFILES IN THE UNIT, PROJECTED
RATE AND QUANTITY OF SOLDIER WHO WILL REQUIRE BEHAVIORAL HEALTH
(BH) RELATED THEATER MEDICAL WAIVERS FOR DEPLOYMENTS, RATES OF
PSYCHIATRIC HOSPITALIZATIONS, PREVALENCE OF ALCOHOL RELATED
INCIDENTS IN THE UNIT, CHAPLAIN ANALYSIS OF FREQUENTLY REPORTED
STRESSORS, AND RESULTS OF MORALE AND WELLBEING SURVEYS AS
INDICATED. LEADERS SHOULD ALSO ASSESS BEHAVIORAL HEALTH OFFICER
(BHO) TRAINING COMPLETION OF COMBAT AND OPERATIONAL STRESS
CONTROL AND TRAUMATIC EVENT MANAGEMENT COURSE, BHO CLINICAL
EXPERIENCE, BHO MILITARY EXPERIENCE, UNIT SUICIDE PREVENTION
TRAINING, PARTICIPATION IN BHO-LED BH TRAINING BY NON-BH MEDICAL
PERSONNEL, AND CURRENT BHO UTILIZATION TO INCLUDE CLINICAL,
PREVENTIVE, AND STAFF OFFICER DUTIES.
2. (U) TOOLS. TOOLS MAY INCLUDE THOSE FOUND IN A VARIETY OF CURRENT
AND FUTURE INFORMATION SYSTEMS. CURRENT TOOLS THAT CAN INFORM
BHO UTILIZATION INCLUDE INFORMATION FOUND ON DEFENSE HEALTH
AGENCY DASHBOARDS, BH PULSE RESULTS, URI/DEOCS RESULTS, ARMY
MEDICAL OPERATIONAL DATA SYSTEM (MODS), THE COMMANDER’S RISK
REDUCTION TOOLKIT (CRRT), AND INTEGRATED PERSONNEL AND PAY
SYSTEM-ARMY (IPPS–A).
ATTACHMENT 2. ROLES AND RESPONSIBILITIES OF AMEDD PERSONNEL IN
GARRISON
1. (U) ROLES AND RESPONSIBILITIES OF ARMY MEDICAL DEPARTMENT
(AMEDD) PERSONNEL INCLUDING DIVISION PSYCHIATRISTS, ORGANIC
PSYCHOLOGISTS, ORGANIC SOCIAL WORKERS, HOLISTIC HEALTH AND
FITNESS, AND AMEDD PERSONNEL IN COSC DETACHMENTS ARE SPECIFIED IN
THIS ATTACHMENT.
1.A. (U) ALL COSC PERSONNEL WILL BE FULLY TRAINED IN PREVENTIVE
STRESS MANAGEMENT TECHNIQUES, UNIT RISK FACTOR ASSESSMENT,
OPERATIONAL RISK MANAGEMENT, COMMAND CONSULTATION, AND
APPLICATION OF PRINCIPLES TO ENHANCE COMBAT EFFECTIVENESS. THE
PREVENTION, IDENTIFICATION, AND MANAGEMENT OF COMBAT AND
OPERATIONAL STRESS REACTIONS AND OTHER MENTAL HEALTH
CONDITIONS, INCLUDING SEVERE PSYCHIATRIC DISORDERS, AS APPLICABLE.
2. (U) BEHAVIORAL HEALTH OFFICERS (BHOS) MAXIMIZE SERVICEMEMBER
AND UNIT PSYCHOLOGICAL READINESS THROUGH COMMAND CONSULTATION
OF COSC/BH PREVENTION, ASSESSMENT, AND TREATMENT STRATEGIES.
2.A. (U) MEDICAL TREATMENT FACILITY CLINICAL RESPONSIBILITIES. BHOS
ARE RESPONSIBLE FOR MAINTAINING CREDENTIALING, BECOMING
PROFICIENT IN ELECTRONIC HEALTH RECORD (EHR), ESTABLISHING
PERCENTAGE FULL TIME EQUIVALENT (FTE) IN THE FORM OF TEMPLATED
APPOINTMENTS, PERFORMING PROVIDER OF THE DAY (POD), PERFORMING
TARGETED CARE PROVIDER DUTIES, CONDUCTING GROUP THERAPY,
CONDUCT COMMAND DIRECTED BEHAVIORAL HEALTH EVALUATIONS
(EMERGENCY AND ROUTINE), CONDUCT ADMINISTRATIVE SEPARATION
EVALUATIONS, CONDUCT SPECIALTY SCHOOL AND SPECIAL DUTY
EVALUATIONS. BHOS SHOULD ESTABLISH APPROXIMATELY 50 PERCENT FTE
FOR TEMPLATED APPOINTMENTS, DEPENDENT ON MISSION CONSTRAINTS.
2.B. (U) ORGANIC BHO RESPONSIBILITIES. CONDUCT UNIT CIRCULATION AS A
FORCE HEALTH PROTECTION ACTIVITY, DECREASE BEHAVIORAL HEALTH
STIGMA AND INCREASE BHO CREDIBILITY, CONDUCT INFORMAL (FOR
EXAMPLE, WALKABOUTS) AND FORMAL (FOR EXAMPLE, BEHAVIORAL HEALTH
(BH) PULSE) ASSESSMENTS OF UNIT FUNCTIONING, COHESION, MORALE,
SAFETY, ETC., INTEGRATING WITH SUPPORTING BH CLINIC TO PROVIDE
DIRECT CLINICAL CARE, EXECUTE TRAUMATIC EVENT MANAGEMENT AS
APPLICABLE, SUPPORT OF HIGH/AT-RISK SERVICEMEMBERS IN THE UNIT
FOOTPRINT, FACILITATE COORDINATION OF CARE FOR SERVICEMEMBERS
INVOLVED IN VARIOUS LEVELS OF TREATMENT, PARTICIPATE IN
OPERATIONAL FIELD TRAINING ACTIVITIES, COORDINATE WITH INSTALLATION
RESOURCES TO ENHANCE READINESS AND RESILIENCY INCLUDING BUT NOT
LIMITED TO UNIT AND GARRISON CHAPLAINS, MILITARY FAMILY LIFE
CONSULTANTS (MFLC), INTEGRATED PREVENTION ADVISORY GROUPS (IPAG),
COMMUNITY READY AND RESILIENT INTEGRATORS (CR2I), SUICIDE
PREVENTION PROGRAM MANAGERS (SPPM), HOLISTIC HEALTH AND FITNESS
(H2F) COORDINATORS, INSTALLATION DIRECTORS OF PSYCHOLOGICAL
HEALTH (IDPH), ARMY SUBSTANCE ABUSE PROGRAM MANAGERS (ASAP),
ARMY COMMUNITY SERVICES (ACS), AND SOLDIER FAMILY READINESS GROUP
(SFRG) COORDINATORS.
2.B.1. (U) READINESS ACTIVITIES. PARTICIPATE IN PRE AND POST-
DEPLOYMENT SUPPORT ACTIVITIES AND ADVISE THE COMMANDER ON
MEDICAL READINESS TRACKING (FOR EXAMPLE, MEDBOARD STATUS, BH E-
PROFILE STATUS). WRITING WAIVERS IN AND OF ITSELF IS NOT A COSC
FUNCTION, BUT ORGANIC BHOS SHOULD ADVISE COMMANDS WHEN WAIVERS
MAY BE APPROPRIATE PRIOR TO A DEPLOYMENT. PROVIDE COMMAND
CONSULTATION INCLUDING PARTICIPATING IN FORMAL AND INFORMAL
MEETINGS WITH COMMANDERS AND/OR COMMAND TEAMS TO SUPPORT
COSC/BH MEDICAL PLANNING, CONSULTATION DURING THE COMMANDER’S
READY AND RESILIENT COUNCIL (CR2C), CONDUCT LEADER AND UNIT
TRAININGS ON STRATEGIES TO SUSTAIN AND ENHANCE READINESS AND
RESILIENCY (FOR EXAMPLE, SLEEP MANAGEMENT, PERFORMANCE
ENHANCEMENT).
2.C. (U) TRAINING AND SUPERVISION. THIS OCCURS IN ANY GARRISON
SETTING AND INCLUDES SUPERVISING BH TECHNICIANS AND/OR INTERNS IN
CLINICAL CARE AND DIDACTICS, TRAIN BEHAVIORAL HEALTH TECHNICIANS
AND NON-BEHAVIORAL HEALTH MEDICAL PERSONNEL ON PSYCHOLOGICAL
FIRST AID AND RELEVANT BH PREVENTION, ASSESSMENT, AND TREATMENT
PRACTICES, MONITOR ENLISTED SPECIALISTS COMPLETION OF INDIVIDUAL
CRITICAL TASKS AND PROVIDE SUPERVISION, AS APPROPRIATE, WHILE
TRAINING ON INDIVIDUAL CRITICAL TASKS, PARTICIPATING IN BEHAVIORAL
HEALTH CONTINUING EDUCATION TRAINING ACTIVITIES.
2.D. (U) RESERVE COMPONENTS. RESERVE COMPONENT BEHAVIORAL
HEALTH PERSONNEL MAY HAVE DIFFERENT GARRISON ROLES AND
RESPONSIBILITIES DURING ANNUAL TRAINING AND INACTIVE DUTY FOR
TRAINING PERIODS. BHOS SHOULD BE FAMILIAR WITH ROLES AND
RESPONSIBILITIES IN THIS ALARACT AND UTILIZE WHAT IS MOST
APPROPRIATE BASED ON LOCAL ORGANIZATIONAL PROCEDURES AND
RESOURCES.
3. (U) BHOS SHOULD ASSIST LEADERS AT ALL LEVELS TO DEVELOP
STRATEGIES TO MITIGATE THE IMPACT OF OPERATIONAL STRESS. LEADER
ACTIONS INCLUDE INTEGRATING PSYCHOLOGICAL READINESS INTO
COMMAND ETHOS AND TRAINING, BUILDING CULTURE OF TRUST, PREPARING
FOR EXPOSURE TO EXTREME STRESSORS OR POTENTIALLY TRAUMATIC
EVENTS, REGULAR CHECK INS AND MORALE ASSESSMENTS, EARLY
IDENTIFICATION OF PROBLEMS, IMPLEMENTATION OF EFFECTIVE SLEEP
LEADERSHIP, SUPPORTING UNIT LEVEL INTERVENTIONS (FOR EXAMPLE, SELF-
AID, BUDDY AID), SUPPORTING COSC FUNCTIONS, AND COORDINATING WITH
MEDICAL, CHAPLAINS, AND BHOS. THE MENTAL HEALTH CONTINUUM MODEL
(FIGURE 1) PROVIDES A FRAMEWORK FOR ASSESSING AND ADDRESSING
PSYCHOLOGICAL HEALTH AND EARLY IDENTIFICATION OF PROBLEMS. AS ONE
MOVES FROM GREEN TO RED ZONES THE LEVEL OF NEEDED PROFESSIONAL
BHO SUPPORT INCREASES (FIGURE 2). BHOS SHOULD USE THESE MODELS TO
ADVISE COMMANDERS IN SUPPORT OF COSC FUNCTIONS.
4. (U) ADDITIONAL ROLES AND RESPONSIBILITIES:
4.A. (U) DIVISION PSYCHIATRIST. DIVISION PSYCHIATRISTS SHOULD OVERSEE
BH OPERATIONS FOR THE DIVISION, PROVIDING GUIDANCE, LEADERSHIP,
COORDINATION, AND TRAINING FOR ORGANIC BHOS. COMMANDERS SHOULD
CONSIDER INCLUDING DIVISION PSYCHIATRISTS IN THE RATING CHAIN OF
ORGANIC BHOS AS AN INTERMEDIATE RATER. DIVISION PSYCHIATRISTS
COORDINATE WITH THE DIVISION SURGEON ON MEDICAL SUPPORT OF THE
DIVISION, INCLUDING READINESS, TRAINING, AND OPERATIONAL PLANNING.
DIVISION PSYCHIATRISTS ESTABLISH THE OPERATIONAL BEHAVIORAL HEALTH
STRUCTURE OF CARE ACROSS THE DIVISION, AND PROVIDE CLINICAL
SUPPORT AND ADVICE ON PRESCRIBING PRACTICES, COORDINATION OF
CARE, AND RELEVANT TRAINING OF OTHER BHOS AND MEDICAL STAFF.
DIVISION PSYCHIATRISTS MAY ALSO BE SIGNATURE AUTHORITY ON
PERMANENT BEHAVIORAL HEALTH PROFILES AND MAY BE ASKED TO
PERFORM RULE OF COURTS MARTIAL EVALUATIONS.
4.B. (U) BDE PSYCHOLOGISTS AND SOCIAL WORKERS. BDE BHOS SHOULD BE
UTILIZED AS BDE STAFF TO PLAN PSYCHOLOGICAL HEALTH SUPPORT TO THE
BDE. AS INTEGRATED MEMBERS OF THE BDE STAFF, THE BDE BHOS SHOULD
BE RATED BY THE BDE SURGEON, INTERMEDIATE RATED BY THE DIVISION
PSYCHIATRIST, AND SENIOR RATED BY BDE COMMANDER. AT INSTALLATIONS
WITHOUT A DIVISION PSYCHIATRIST, CONSIDER INCLUDING INSTALLATION
DIRECTOR OF PSYCHOLOGICAL HEALTH AS INTERMEDIATE RATER.
4.C. (U) PSYCHOLOGISTS. PSYCHOLOGISTS MAY ALSO PERFORM
PSYCHOLOGICAL ASSESSMENTS AND PERFORM RULE OF THE COURTS
MARTIAL EVALUATIONS.
4.D. (U) 68X BEHAVIORAL HEALTH SPECIALIST. BEHAVIORAL HEALTH
SPECIALIST ACTIVITIES, WHEN CONDUCTED IAW THEIR INDIVIDUAL CRITICAL
TASKS LIST, IMPROVE THE PSYCHOLOGICAL HEALTH OF THE FORCE IN
GARRISON. COMMANDERS SHOULD UTILIZE 68X BEHAVIORAL HEALTH
SPECIALISTS AT THEIR HIGHEST CREDENTIALS TO PERFORM MOS-SPECIFIC
ACTIVITIES BECAUSE THEY EXTEND AND AMPLIFY THE EFFICACY OF BHOS IN
THE GARRISON COSC FUNCTION AND INCREASE ACCESS TO BEHAVIORAL
HEALTHCARE AND READINESS OF THE UNIT. ENLISTED BEHAVIORAL HEALTH
SPECIALISTS ARE TRAINED ON MENTAL HEALTH CONDITIONS, BUT THEY ARE
NOT QUALIFIED TO DIAGNOSE OR TREAT THOSE CONDITIONS.
4.E. (U) COSC AND BDE OCCUPATIONAL THERAPISTS. COSC DETACHMENT
OCCUPATIONAL THERAPISTS AND BDE OCCUPATIONAL THERAPISTS PERFORM
OCCUPATIONAL THERAPY ASSESSMENTS AND EXECUTE SERVICE DELIVERY
IAW THE BH CONCEPT OF SUPPORT ESTABLISHED BY THE AREA SUPPORTED
OR ASSIGNED. OCCUPATIONAL THERAPISTS WILL SUPPORT BHOS WITH EARLY
IDENTIFICATION OF PROBLEMS, TRIAGE, IMPLEMENTATION OF EFFECTIVE
SLEEP LEADERSHIP, SUPPORTING UNIT LEVEL INTERVENTIONS (FOR
EXAMPLE, SELF-AID, BUDDY AID), SUPPORTING COSC FUNCTIONS, AND
COORDINATING WITH MEDICAL, CHAPLAINS, AND BHOS. OCCUPATIONAL
THERAPISTS WILL PROVIDE SERVICES APPLYING COSC PRINCIPLES,
ENHANCING ADAPTIVE STRESS REACTIONS, PREVENTING MALADAPTIVE
STRESS REACTIONS, BUILDING RESILIENCY SKILLS, AND ASSISTING SOLDIERS
IN ADDRESSING COMBAT / OPERATIONAL STRESS REACTIONS (COSRS) AND
BEHAVIORAL DISORDERS. OCCUPATIONAL THERAPISTS WILL ALSO APPLY
COSC MANAGEMENT PRINCIPLES.
4.F. (U) 68L OCCUPATIONAL THERAPY TECHNICIANS. OCCUPATIONAL THERAPY
TECHNICIAN ACTIVITIES, WHEN CONDUCTED IAW THEIR INDIVIDUAL CRITICAL
TASKS LIST, IMPROVE THE PSYCHOLOGICAL HEALTH AND HUMAN
PERFORMANCE OF THE FORCE IN GARRISON. COMMANDERS SHOULD UTILIZE
68L OCCUPATIONAL THERAPY TECHNICIANS TO PERFORM MOS-SPECIFIC
ACTIVITIES BECAUSE THEY EXTEND AND AMPLIFY THE EFFICACY OF BHOS IN
THE GARRISON COSC FUNCTION.
4.G. (U) PSYCHIATRIC/BEHAVIORAL HEALTH NURSES. PSYCHIATRIC/
BEHAVIORAL HEALTH NURSES PERFORM ESSENTIAL COSC TASKS INCLUDING
PERFORMING COSC STABILIZATION, CONDUCTING UNIT NEEDS
ASSESSMENTS, PERFORMING PSYCHOLOGICAL FIRST AID, PERFORMING
PSYCHOLOGICAL DEBRIEFINGS, AND FACILITATING PSYCHOEDUCATION
GROUPS. PSYCHIATRIC/BEHAVIORAL HEALTH NURSES CONDUCT CLINICAL
ASSESSMENTS AND INTERVENTIONS TO SUPPORT RESILIENCY AND
PSYCHOLOGICAL HEALTH.
4.H. (U) INSTALLATION DIRECTOR OF PSYCHOLOGICAL HEALTH.
INSTALLATION’S PRINCIPAL SERVES AS THE CONSULTANT AND ADVOCATE FOR
PSYCHOLOGICAL HEALTH, CONVENES MEETINGS OF ALL INSTALLATION OR
LOCAL ARMY RESOURCES THAT SUPPORT PSYCHOLOGICAL HEALTH, APPRISE
INSTALLATION COMMANDER OR SENIOR COMMANDER OF THE STATUS OF THE
PSYCHOLOGICAL HEALTH IN THE LOCAL BENEFICIARY POPULATION, AND THE
DEGREE TO WHICH NEEDS FOR PREVENTION, EARLY INTERVENTION, AND
TREATMENT ARE BEING MET, REPORT TO INSTALLATION COMMANDER OR
SENIOR COMMANDER AND THE MILITARY TREATMENT FACILITY COMMANDER
ABOUT THE ADEQUACY OF STAFFING, RESOURCES, AND PROCESSES TO MEET
THE PSYCHOLOGICAL HEALTH OF THE INSTALLATION, ENSURE COORDINATION
OF MILITARY AND NON-MILITARY SERVICES BETWEEN THE VARIOUS
PROGRAMS FOR SOLDIERS AND THEIR FAMILIES PROVIDING SUPPORT FOR
PSYCHOLOGICAL HEALTH.
5. (U) ALLIED PROFESSIONS. VARIOUS ALLIED MEDICAL PROFESSIONALS
SUPPORT COSC PRINCIPLES. MEDICAL LEADERS AND BHOS SHOULD INCLUDE
THESE ADJACENT ROLES IN COSC PLANNING.
5.A. (U) FIRST RESPONDERS, INCLUDING BATTALION SURGEONS, PHYSICIAN
ASSISTANTS, NURSES, AND MEDICS. FIRST RESPONDERS SHOULD ENSURE
THEY RECEIVE TRAINING ON OSR, TRIAGING PSYCHIATRIC CASUALTIES, AND
MANAGING MENTAL ILLNESS. ROLE 1 PROVIDERS AND MEDICS SHOULD BE
FAMILIAR WITH MENTAL HEALTH SCREENING AND DEVELOP RELATIONSHIPS
WITH FELLOW SOLDIERS TO INFORM BHOS AND UNIT LEADERSHIP INSIGHT
INTO RESILIENCE OF THE FORCE.
5.B. (U) REGISTERED DIETITIANS (RDS/RDNS). IN RESPONSE TO STRESS,
SOLDIERS MAY INCREASE OR DECREASE FOOD AND BEVERAGE INTAKE.
INADEQUATE NUTRITION CAN CONTRIBUTE TO PHYSICAL AND MENTAL
FATIGURE, DECREASING PERFORMANCE. REGISTERED DIETITIANS CONDUCT
NUTRITION ASSESSMENTS AND PROVIDE INDIVIDUALIZED PLANS TO ASSIST
SOLDIERS IN MEETING GOALS RELATED TO BODY COMPOSITION,
PERFORMANCE, AND MISSION COMPLETION. RDS/RDNS PLAN, IMPLEMENT,
AND SUPERVISE NUTRITION RELATED PERFORMANCE AND READINESS
SERVICES FOR INDIVIDUAL SOLDIERS AND UNITS. AS SUCH, RDS/RDNS WORK
AS A MEMBER OF THE COLLABORATIVE HEALTH CARE TEAM IN PROVIDING
NUTRITION SERVICES.
5.C. (U) 68M NUTRITION CARE SPECIALISTS. NUTRITION CARE SPECIALIST
ACTIVITIES, WHEN CONDUCTED IAW THEIR INDIVIDUAL CRITICAL TASK LIST,
IMPROVE THE NUTRITION ENVIRONMENT AND STATUS OF SOLDIERS AND
UNITS. COMMANDERS SHOULD UTILIZE 68M NUTRITION CARE SPECIALISTS TO
PERFORM MOS SPECIFIC ACTIVITIES BECAUSE THE EXTEND AND AMPLIFY THE
WORK OF RDS/RDNS.
5.D. (U) CLINICAL PHARMACIST. CLINICAL PHARMACISTS PROVIDE
CONSULTATIONS TO REVIEW PATIENT POLYPHARMACY RISKS, IDENTIFY
POTENTIAL DRUG-DRUG INTERACTIONS, DEVELOP IMPROVED MEDICATION
COMPLIANCE STRATEGIES, IDENTIFY POTENTIAL THERAPEUTIC
ALTERNATIONS, REVIEW THEATER ENTRY REQUIREMENTS, AND ASSIST IN
CARE PLAN DEVELOPMENT TO PREVENT UNNECSSARY DISRUPTIONS IN
MEDICATION TREATMENT WHILE DEPLOYED.
FIGURE 1. MENTAL HEALTH CONTINUUM MODEL
FIGURE 2. BALANCE OF CHAIN OF COMMAND AND MENTAL HEALTH PROFESSIONAL SERVICES RESPONSIBILITY
ATTACHMENT 3. BH PATIENT UTILIZATION DATA
1. (U) THIS ATTACHMENT OUTLINES A PLANNING FORMAT TO DETERMINE
APPROPRIATE BEHAVIORAL HEALTH OFFICER (BHO)SUPPORT REQUIRED FOR
MILITARY OPERATIONS OTHER THAN WAR AND COMBAT OPERATIONS. METT-
TC NEEDS MAY DETERMINE A DIFFERENT PLANNING FORMAT AND VARIED
ESTIMATES OTHER THAN PROVIDED.
2. (U) LESSONS LEARNED FROM BEHAVIORAL HEALTH (BH)UTILIZATION RATES
IN GARRISON (2023 DATA) SHOW THAT APPROXIMATELY 15 PERCENT OF
ACTIVE COMPONENT SOLDIERS ACROSS THE ARMY ACCESS OUTPATIENT BH
SPECIALTY CARE PER YEAR AND AVERAGE 4 VISITS FOR CARE. ANOTHER 7-8
PERCENT RECEIVE TREATMENT FOR A BH DIAGNOSIS ONLY THROUGH
PRIMARY CARE. APPROXIMATELY 1 PERCENT OF SOLDIERS HAVE
PSYCHIATRIC HOSPITALIZATION PER YEAR.
3. (U) TO PREDICT A WORKLOAD FOR BEHAVIORAL HEALTH UTILIZATION IN A
DEPLOYED SETTING, PLAN FOR 15 PERCENT OF THE UNIT TO UTILIZE
BEHAVIORAL HEALTH CARE. FIGURE 4 VISITS PER SOLDIER UTILIZING
BEHVIORAL HEALTH. AN APPROXIMATE PLANNING FACTOR OF 1 HOUR PER
VISIT WILL PROVIDE AN ESTIMATE FOR THE NUMBER OF HOURS A BHO MAY
SPEND IN CLINIC. (UNIT STRENGTH * .15 * 4= NUMBER OF HOURS A BHO
SHOULD PLAN TO SPEND DOING TREATMENT ACTIVITIES.)
4. (U) MEDICAL PLANNERS NEED THE COMMANDER’S INTENT TO DETERMINE
HOW MUCH TIME BHOS SHOULD PLAN FOR PREVENTION ACTIVITIES AND
DETERMINE IF ORGANIC BH ASSETS ARE SUFFICIENT FOR THE MISSION.
ATTACHMENT 4: COSC ROLES AND RESPONSIBILITIES OF MEDICAL
PERSONNEL IN MILITARY OPERATIONS OTHER THAN WAR
1. (U) PSYCHIATRIST. DIVISION PSYCHIATRISTS PROVIDE LEADERSHIP,
OVERSIGHT, AND DIRECTION ON THE STRUCTURE OF BH CARE, DISTRIBUTION
OF BEHAVIORAL HEALTH (BH) RESOURCES, AND INTEGRATION WITH OTHER
MEDICAL SERVICES, IN COORDINATION WITH THE DIVISION SURGEON,
BRIGADE BEHAVIORAL HEALTH OFFICERS (BHOS), OTHER COMBAT AND
OPERATIONAL STRESS CONTROL (COSC) UNITS, AND MEDICAL PLANNERS.
DIVISION PSYCHIATRISTS ALSO ESTABLISH THE BH MEDICATION FORMULARY
MOST APPROPRIATE TO THE GIVEN OPERATIONAL ENVIRONMENT FOR
BATTALION AND BRIGADE LEVEL MEDICAL SUPPORT.
2. (U) PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONERS. PSYCHIATRIC
MENTAL HEALTH NURSE PRACTITIONERS SERVE AS PSYCHIATRIC
PRESCRIBERS AND PROVIDE CONSULTATION AND EDUCATION ON
PRESCRIBING IN SUPPORT OF PRIMARY CARE AND OTHER HEALTH
PROFESSIONALS. IN THE ABSENCE OF A PSYCHIATRIST, THE PSYCHIATRIC
MENTAL HEALTH NURSE PRACTITIONER ESTABLISHES THE MEDICATION
FORMULARY.
3. (U) BHO. PRIOR TO DEPLOYMENT, AND PERIODICALLY DURING
DEPLOYMENT, BHOS SHOULD TRAIN FIRST RESPONDERS ON ROLE
APPROPRIATE MENTAL HEALTH COMPETENCIES TO INCLUDE IDENTIFICATION
OF OPERATIONAL STRESS REACTIONS, PSYCHOLOGICAL FIRST AID, AND
PSYCHIATRIC TRIAGE. BHOS SHOULD REVIEW DEPLOYMENT ROSTERS AND,
IN COORDINATION WITH DOWNTRACE MEDICAL PERSONNEL, DEVELOP PLANS
TO MANAGE SOLDIERS WITH EXISTING MENTAL ILLNESS DURING
DEPLOYMENT. FIRST RESPONDERS AND BHOS SHOULD ESTABLISH
COMMUNICATION PLAN FOR CONSULTATION DURING DEPLOYMENT.
4. (U) 68X BEHAVIORAL HEALTH SPECIALIST. OPERATIONAL ENVIRONMENTS
REQUIRE PSYCHIATRIC TECHNICIANS TO PERFORM THEIR DUTIES IN
GEOGRAPHICALLY DISPERSED LOCATIONS. AS SUCH, THEY RECEIVE LESS
BHO OVERSIGHT THAN IN GARRISON ENVIRONMENTS. TRAINING ON
INDIVIDUAL CRITICAL TASKS PRIOR TO DEPLOYMENT PREPARES 68XS TO
SUPPORT THE COSC FUNCTION IN DIVERSE OPERATIONAL ENVIRONMENTS.
5. (U) OCCUPATIONAL THERAPISTS. OCCUPATIONAL THERAPISTS SUPPORT
THE COSC AND BH CONCEPT OF SUPPORT IN OPERATIONS OTHER THAN WAR
WITH EARLY IDENTIFICATION OF PROBLEMS, TRIAGE, AND PERFORMING
INTERVENTIONS TO IMPROVE SOLDIER AND UNIT PERFORMANCE.
OCCUPATIONAL THERAPISTS PROVIDE SERVICES THAT SUPPORT COSC
FUNCTIONS IN COSC DETACHMENTS AND BDE HPTS.
6. (U) FIRST RESPONDERS, INCLUDING BATTALION SURGEONS, PHYSICIAN
ASSISTANTS, NURSES, AND MEDICS. TRAVEL AND COMMUNICATION MAY BE
CHALLENGING IN OPERATIONAL ENVIRONMENTS AND BHO CONSULTATION
MAY NOT BE READILY AVAILABLE. AS SUCH, FIRST RESPONDERS SHOULD BE
PREPARED TO ASSUME A MORE SIGNIFICANT ROLE IN MANAGING
OPERATIONAL STRESS REACTIONS, TRIAGING PSYCHIATRIC CASUALTIES,
AND MANAGING MENTAL ILLNESS.
6.A. (U) ROLE 1 PROVIDERS SHOULD CONTINUE SCREENING FOR MENTAL
ILLNESS AT CLINICAL ENCOUNTERS.
6.B. (U) 68W COMBAT MEDICS SHOULD DEVELOP SUPPORTIVE RELATIONSHIPS
WITH FELLOW SOLDIERS AND PROVIDE BHOS, COMMAND SURGEONS, AND
UNIT LEADERSHIP WITH INSIGHT INTO THE RESILIENCE AND MENTAL HEALTH
OF THE FORCE.
ATTACHMENT 5. ROLES AND RESPONSIBILITIES OF BHOS DURING COMBAT
OPERATIONS
1. (U) ALL BEHAVIORAL HEALTH OFFICERS (BHOS) CONDUCT COMMAND
CONSULTATION OF COMBAT AND OPERATIONAL STRESS CONTROL
(COSC)/BEHAVIORAL HEALTH (BH) PREVENTION, ASSESSMENT, AND
TREATMENT STRATEGIES; SUPPORT COMMAND SURGEONS IN ASSESSING
UNIT AND SOLDIER PSYCHOLOGICAL HEALTH READINESS, THREATS, AND
NEEDS; CONDUCT INFORMAL (WALKABOUTS) AND FORMAL (FOR EXAMPLE, BH
PULSE) ASSESSMENTS OF UNIT FUNCTIONING, COHESION, MORALE, SAFETY,
AND SO ON; PROVIDE PSYCHOLOGICAL FIRST AID AND SHORT-TERM
SOLUTION-FOCUSED CLINICAL CARE IOT MAXIMIZE RTD AND MINIMIZE
PSYCHIATRIC EVACUATIONS; FACILITATE COORDINATION OF CARE FOR
SERVICEMEMBERS REQUIRING HIGHER LEVELS OF TREATMENT INCLUDING
BUT NOT LIMITED TO EMERGENCY PSYCHOLOGICAL STABILIZATION AND
THEATER EVACUATION; COORDINATE WITH AVAILABLE SUPPORT
RESOURCES; CONDUCT COMMAND DIRECTED BEHAVIORAL HEALTH
EVALUATIONS (EMERGENCY AND ROUTINE); CONDUCT ADMINISTRATIVE
SEPARATION EVALUATIONS; TRAIN BEHAVIORAL HEALTH TECHNICIANS AND
NON-BEHAVIORAL HEALTH MEDICAL PERSONNEL ON RELEVANT BEHAVIORAL
HEALTH PREVENTION, ASSESSMENT, AND TREATMENT PRACTICES; PROVIDE
CONSULTATION AND SUPPORT TO NON-BEHAVIORAL HEALTH MEDICAL
PERSONNEL PROVIDING LOWER-LEVEL BEHAVIORAL HEALTH TREATMENT TO
SERVICE MEMBERS IN ISOLATED OR REMOTE AREAS; EXECUTE TRAUMATIC
EVENT MANAGEMENT AS APPLICABLE; SUPPORT RESTORATION,
RECONDITIONING, AND RECONSTITUTION ACTIVITIES AS APPLICABLE.
2. (U) BHOS SHOULD CONDUCT BATTLEFIELD CIRCULATION TO DECREASE
BEHAVIORAL HEALTH STIGMA, INCREASE BHO CREDIBILITY AND
ENGAGEMENT IF OPERATIONAL ENVIRONMENT ALLOWS. MEDICAL PLANNERS
SHOULD MAXIMIZE FORWARD POSITIONING FOR COSC ASSETS TO FACILITATE
RAPID RESPONSE AND BICEPS PRINCIPLES.
3. (U) LARGE NUMBERS OF CASUALTIES MAY REQUIRE BHOS TO SUPPORT
THE ARMY HEALTH SYSTEM BY PROVIDING CARE OUTSIDE OF THEIR
GARRISON SCOPE OF CARE. BHOS WILL NEED TO ASSESS FOR
NEUROCOGNITIVE DISORDERS AND BE PREPARED TO ASSESS AND TREAT
NEUROPSYCHIATRIC SEQUELAE OF LARGE-SCALE COMBAT OPERATIONS.
NON-PHYSICIAN BHOS WHO ARE NOT TRAINED TO ASSESS AND TREAT THE
NEUROPSYCHIATRIC EFFECTS OF LARGE SCALE COMBAT SHOULD EMPLOY
MULTIDISCPLINARY CONSULTATION.
