ANDERSEN AIR FORCE BASE, Guam --
Life can be stressful.
In addition to everyday life, dealing with frequent temporary duty trips, ever-lurking deployments and permanent reassignments from one end of the globe to the next can be both physically and mentally taxing for service members.
Often separated from family and social support systems, Airmen encounter various stressors throughout their career.
"Stress exists in life," said Capt. Julianna Petrone, 36th Medical Operations Squadron mental health element chief and one of two suicide prevention managers with the 36th Wing. "There is good stress and then there is bad stress, but what matters is how we manage stressful situations."
To help Airmen combat stress and cope with setbacks, a specialized team of Airmen with the 36th Medical Group mental health clinic seeks to support Airmen at Andersen Air Force Base.
Maintaining trust, breaking down stigma
While Airmen have a variety of options to seek assistance, the most difficult part for Airmen may be the initial step to seek help. Misconceptions about what mental health treatment involves, the effectiveness of mental health services, and the concerns about potential impact on their military career and relationships can make them reluctant to seek help.
"The Air Force realizes that Airmen need this type of proven medical help and that's why we're here," Petrone said. "Our job is not to get you out of your job or take your clearance away; our job is to help so you can continue to be successful personally and professionally."
The Air Force's commitment to fostering a culture of support is rooted in Department of Defense Instruction 6490.08, which limits command notifications and encourages military leaders to dispel the stigma in providing mental health care to service members.
Notification to Airmen's commanders, for example, only occurs if a patient is hospitalized with a mental health condition, is having active suicidal or homicidal thoughts, domestic violence is reported, or the service member is unable to perform his or her job safely, Petrone said.
"We have a duty and responsibility to protect," Petrone said. "At a point where service members would endanger themselves or others, we'd have to inform the command and elevate the level of care the person receives so we can monitor their progress and ensure their safety."
Even when mental health staff is required to inform command about a risk concern, notifications are similar to other medical notifications and do not disclose details of the mental health visit, just the nature of the risk concern and what the commander or unit can do to support the individual.
"If we need to call their command, we are the first to let them know," said Master Sgt. Heather Gulsby, 36th MDOS Mental Health Flight chief, certified drug and alcohol counselor and suicide prevention manager. "Airmen are never blindsided and we do everything we can to build and maintain trust. Our patients know that unless we tell them, command is not going to be informed on their treatment at all."
If Airmen seek help before problems are noticed by commanders or affect duty performance most do not experience any negative career impact at all -- if not the opposite.
"Most of our patients experience no negative career impact," said Staff Sgt. Carlo Santiago, 36th MDOS mental health NCO in charge and Alcohol and Drug Abuse Prevention and Treatment program technician. "In fact, many Airmen come back and report they are lauded by their leadership because they are doing better and their performance starts to improve."
Airmen who decide that mental health counseling is not for them are free to terminate treatment at any point, Gulsby added. Mental health treatment is conducted on a strictly voluntary basis.
Despite lingering stigmas and misinformation, the mental health clinic is not much different from other medical offices to which patients may have grown accustomed. However, instead of bones or teeth, the treatment team focuses solely on Airmen's mental and social well-being throughout their career.
Before deployments, Airmen administer automated neurological assessment metrics tests, or ANAM, to deployers. These computer-based assessments test a subject's ability to concentrate, their reaction time, memory and decision-making and provides the clinicians valuable indicators of an individual's cognitive status and changes that may have occurred as the result of a traumatic brain injury.
The counselors also see Airmen for a large variety of reasons, from depression or post-traumatic stress disorder to alcohol and substance abuse problems. They also help with issues that are not significantly impairing, such as mild stress, a sleep problem, or anxiety.
No matter their reasons to visit, the first step in treating each person is triage. Much like taking blood pressure and medical history, specially trained enlisted Airmen collect a nuts-and-bolts baseline assessment on their patient's current state. The specialists then brief the medical provider, who continues the session with an in-depth discussion of the patient's needs and options.
Since the team assists others during difficult times in their life, the mental health technicians have to build rapport with each individual quickly and confidently.
"You have to have empathy; it is the biggest thing," Santiago said. "We are all people, we are human and we all are affected by things differently. Everybody gets stressed out and has that 'down' point, and that is why we are here. We are here for the people who need help at this particular moment in their life."
From vague feelings of "being down" to PTSD, the team follows evidence-based treatments, which aim to equip Airmen with the tools and skills that will allow them to adjust to their environment by maintaining a healthy balance of emotional stamina and well-being.
Treatment, however, is much more than standard procedure. While many Airmen undergo significant stress, each individual may have different life situations and the team tailors treatment according to each patient's need.
"Our ultimate goal is to help Airmen carry out their job -- to take care of their mission and be healthy within their family unit, whatever that my look like," Petrone said. "Increasing coping skills is a big part of what we do."
From behavioral health optimization, which works to aid Airmen in adopting better work and life habits, to one-on-one counseling sessions with skilled psychiatrists or psychologists, the team always puts patients' needs first.
"From the minute a patient comes in, we try to determine what their goals are," Petrone said. "We ask what they are looking for, what's going on and what they need from us. And that can be a number of things."
Seeking help early
But when is the right time to seek care? It may be difficult for some Airmen to decide how long they should deal with stress alone and when it's time to seek help.
"They could have anger at work, they could be having mood swings, not sleep well, or maybe somebody else noticed that they just seem 'off,'" Gulsby said. "There are various reasons why people come in and sometimes they come in simply because they don't know where to begin, and that's totally ok. Even if they can't pinpoint what is wrong, we have the right questions to figure out what is wrong."
Rather than dealing with stress or difficult life circumstances alone you can seek some assistance. Gulsby warns that leaving mental anguish untreated can 'snowball,' causing manageable problems to grow worse with time, Gulsby said.
"People often think they can handle it on their own," she said. "But if somebody fractured an ankle, they would not continue to walk on it. It would clearly make it worse. The same goes with mental health; Problems can escalate and people can develop some unhealthy habits if problems go untreated. Drinking and self-medicating can become an issue, sleep patterns may suffer and suicidal thoughts may build. Without even noticing, people can get to a bad place."
Data shows mental health issues are best treated early so the team encourages Airmen to contact their office as soon as concerns develop.
"It's ok to ask for help. You don't have to do it alone," Petrone said. "Early intervention is the key. If Airmen are having symptoms of anxiety, or feel troubled related to something at work or home, we encourage them to come in so we can help them with healthy coping skills and guide them in a direction to not go down a wrong path."
When Airmen follow the tips learned during sessions, Gulsby said they will gain an improved toolkit to meet challenges head-on. Helping Airmen succeed is what the team's mission is all about after all.
"Mental health is like any other thing that can be injured," Gulsby said. "We need to make sure that Airmen and their family are healthy. We need you all in, so you can fight the fight. Seeking help is a good thing. It's not a sign of weakness, but a sign of strength. And leaders should encourage themselves and their Airmen to go get help and get better."
The mental health team is available every day from 8 a.m. to 5 p.m. and located in the 36th Medical Group Clinic in Building 10088. They can be reached at 366-9355 (WELL). For more information on early intervention, visit http://www.airforcemedicine.af.mil/mentalhealth/earlyaction/index.asp.