Frontline Psych with Doc Bender: How Mental Health Concerns are Treated In-theater

By Dr. James Bender, DCoE psychologist

Dr. James Bender is a former Army psychologist who deployed to Iraq as the brigade psychologist for the 1st Cavalry Division’s 4th Brigade Combat Team out of Fort Hood, Texas. During his deployment, he traveled through Southern Iraq, from Basra to Baghdad. He writes a monthly post for the DCoE Blog on psychological health concerns related to deployment and being in the military.

I talk to many civilian doctors and they sometimes ask me about treating psychological health concerns in-theater. Many are surprised to learn the extent of our mental health resources: we have psychologists and psychiatrists, provide medications and therapy, and even have programs to help service members quit smoking available. As combat theaters mature, more assets are available to help service members and their mental health. However, there are differences in how we manage mental health treatment in-theater compared to how we manage them at home. While managing care in-theater, because of limited time, importance of the mission and unit cohesion, we use the “BICEPS” model to guide mental health treatment instead of methods civilian providers may be more familiar with.

The “BICEPS” approach uses six components to help guide providers while they manage treatment of service members during intense situations, like being in a war zone:

■Brevity: Treatment is brief, usually a few sessions occurring over days. It's solution-based and future-focused.

■Immediacy: Treatment is provided immediately to keep problems from getting worse. This is when service members can’t wait weeks for a referral from a primary care doctor.

■Centrality: Treatment occurs where the service member is stationed and close to their unit’s medical clinic. Combat stress control clinics are set up to resemble a common doctor or dentist office.

■Expectancy: Service members who experience a psychological health concern are expected to get better with treatment. After reactions pass, the assumption is that the warrior will return to the fight.

■Proximity: Treatment happens on base. Service members aren’t sent miles away to see a psychologist. We don’t want to pull individuals away from their unit, reinforcing the idea that they’re sick or that something is permanently wrong with them. Also, this provides the people in their unit a chance to offer support.

■Simplicity: Treatment should be simple. We look for practical, real-world solutions to address individuals’ war-related psychological and emotional symptoms.

This model ensures deployed providers are able to deliver quality health care, including mental health care, to service members during military deployments.

For more on in-theater care, read the DCoE newsletter article, “BICEPS Model, Leader Support Mitigates Combat Stress.” Also, join us for the May webinar, Operational Stress and In-theater Care Thursday.

Thanks for reading and thank you for your service. Please post a question or comment if you have one.