The mental health needs of our military and the invisible wounds of war

Military tradition emphasises competence, discipline, courage and combat readiness. These laudable attributes are ingrained through rigorous training, exercise routine and drills that transform ‘bloody civilians’ into a well-drilled and competent fighting machine. Ability to withstand adversity, resilience and not cracking under pressure are rewarded and promoted within the rank and file.

However, as with the normal distribution of any attribute in any given population, not everyone will be cut from the same cloth. A combination of inherited traits as well as individual attributes ensure that people have different abilities to cope with stress, and harsh discipline over sustained periods of time.

Some people naturally excel and cope better than some others – without necessarily implying that those struggling to cope are weaker. And a good commanding officer is the one who is able to recognise the different strengths of the rank and file under his command, and deploy same as the situation demands.

Thus, it is a naturally occurring phenomenon that some members of the military may suffer from mental health challenges, while some may resort to substance taking behaviour to relieve stress and help them cope. Others may take solace in their religious faith. These different coping abilities are further exposed, during periods of combat engagements such as the on-going war against the Boko Haram insurgency in the North East; securing peace in the middle belt; as well as the operations to protect and safeguard the oil installations in the Niger Delta region.

The focus of intervention efforts towards rebuilding and rehabilitating the North-East have been directed at the displaced civilians – women, children and other citizens. The aim is to gradually return the ravaged region, from the scars of war, back to normalcy. However, in pushing ahead with these efforts, the invisible wounds and emotional scars of the gallant officers of the Nigerian Armed Forces should not be overlooked.

While I am not sure if the Armed Forces have more than five psychiatrists in the three arms combined (Army, Navy, and Airforce), interventions can be provided and organised, for example, in collaboration with nearby mental health facilities such as the Neuropsychiatric Hospitals.

Figures from the US Military and Veteran mental health office indicates that nearly one out of every five American combatants, returning from active tours of duty suffer from a mental health disorder – commonly severe depression and post-traumatic stress disorder (PTSD).

We do not have(at least in the public domain), similar figures and data for our service men. We can only hope and advocate that those who put their life on the line for the peace and security of this nation, are guaranteed the best health care service that they need, as may be indicated – including for mental health problems.

Indeed, we have seen a few returning officers seeking care at the behest of their family members, for symptoms in keeping with depression in some cases, and post-traumatic stress disorder in other cases. The common thread in these instances, is their reluctance to disclose to the military that they were suffering from these conditions. Such secrecy should not be allowed to fester or exist in the first place.

Even without adequate numbers of mental health professionals within the military, recognition and awareness of these invisible wounds of war by the top echelons of the military, can prompt changes in policy. For example, reducing the number of tours per combatant, the duration of tours, positive motivation and psychosocial interventions and support e.t.c. are low hanging fruits at minimal expense, that can help to promote mental wellbeing of our gallant officers and men; and reduce the risk of emotional break down.

The professional associations such as the Association of Psychiatrists in Nigeria (APN) may also be invited to organise and provide psychosocial support as well as screening, treatment and intervention programmes, in conjunction with the military hospitals and health personnel.

Other allied mental health professionals such as the Psychological Association of Nigeria, and the Association of Psychiatric Nurses may also play an active role, with support from the established tertiary mental health facilities across the country.

A huge potential barrier to mental health services which must be overcome, is the associated stigma and embarrassment of being labeled as having a mental health challenge and subsequently seen as a weakling, within the driven and ‘macho’ environment of the military establishment.

However, if these efforts are initiated by the top military brass, it should become acceptable and less stigmatised within the rank and file. It is a duty we owe our military servicemen: to ensure that we not only tend to their physical wounds, but that we also look out for, and provide adequate support and treatment for the often-invisible wounds, in the form of mental health challenges that they may be suffering from.