Screening soldiers for mental health problems doesn't work

AL, which of my posts are you responding to? Because it looks like you responded to

And yet managed to do so 12 minutes before I (thought I'd) posted it. :omg:


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:omg::omg::omg:

And on that note, it's time for me leave the internet for a while.
 

MrBane

LE
Moderator
Kit Reviewer
Reviews Editor
The problem with the army is that we don't talk about these things unless something has happened. There's no regular screening / venting going on.

I'm a Trauma Risk Manager on the side for my lot, and when I get called in to deal with someone who's experienced a traumatic incident, it's usually not long before there's tears and snot, but about things in the past where the latest incident is just the catalyst for everything they've been burying for the last few months or years.

It's good to talk.
 
Total higgerance on my part, but how does "Critical Incident Stress Debriefing" as a technique differ from a listening ear? I know of at least one Fire and Rescue Service which has a number of mid-ranking officers trained in what I have gathered to be largely the latter. Incidentally they have to be pretty mentally robust themselves, as hearing five or six crews' worth of variations of the same major incident gets pretty harrowing.
The problem is that you’re supposed to feel crap after going through something like that, it’s a natural feeling, which for most people dissipates after a few days

CISD pathologises this feeling, ie makes it feel like it’s abnormal and that you are ‘ill’ and therefore need immediate counselling/medical input/and are bound to suffer PTSD. The introduction of TRiM was specifically to guard against this as it’s done by peers and not doctors/ MH professionals. What’s needed is to be vigilant for people who are struggling after the point that you might have expected them to be feeling better about it, rather than throwing everyone in with someone that you would normally see if you were unwell, if that makes sense.
 
The problem is that you’re supposed to feel crap after going through something like that, it’s a natural feeling, which for most people dissipates after a few days

CISD pathologises this feeling, ie makes it feel like it’s abnormal and that you are ‘ill’ and therefore need immediate counselling/medical input/and are bound to suffer PTSD. The introduction of TRiM was specifically to guard against this as it’s done by peers and not doctors/ MH professionals. What’s needed is to be vigilant for people who are struggling after the point that you might have expected them to be feeling better about it, rather than throwing everyone in with someone that you would normally see if you were unwell, if that makes sense.
Right. As I understand it that's exactly how it works. The listening ear in the same uniform with a bit of implied 'been there, seen that', being the major distinction. Thanks.

In a sense it harks back to "Old Soldiers Never Die", Frank Richards DCM MM in WWI where he tells of his one leave walking the hills to keep away from the general populace until he meets another soldier on leave, at which point being with someone else who understands - and a pint or two together - calms both of them down. .
 
To answer your question in total it is of no business of the Army to question your family's health. This is an absolute fact. The recruit's GP may send a letter of concern where warranted in relation to the individual but unless the applicant shows signifcant historical self harm or substance abuse then the physical factors are all that is taken into consideration.
 

ugly

LE
Moderator
Do we need to look back from the beginning, before someone joins, their early life, research more of that, family history?
Perhaps as part of the joining process?
 
Perhaps as part of the joining process?
No fecking way, half of us wouldn't get in and it could weed out those of us who do have the controlled , hateful, rage required to win the battles against strangers/ people who we need to be able to utterly detest for a limited time on occasions.

My early years were surrounded by a mad as feck, violent Paddy Dad in the mad as feck, violent streets of Bermondsey then later Lewisham - and also some Holocaust survivors on my Mum's side, who were either terrified of most things including loud voices and shouting, or were as angry as feck and had the scary laser like stares that told you that they were still seeing something that we never could.

The true heroes in my family were those who went through all of that and yet still managed to find a kind smile for us kids and they couldn't have been more gentler with us.

If that didn't turn me into a fecked up, spiteful, hateful cnut , only balanced out by my Mum's love, kindness and decency, then nothing did.

Not a chance of me being honest in any survey by a shrink.....too risky.
 
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Perhaps as part of the joining process?
Not sure how we could other than setting some form of psychometric test which could potentially flush out an issue. And thats the problem its 'potentially/could be an issue' this then can't be raised in a formal interview process where certain questions and discussions are totally off limits. Its a bit like asking a secretary at interview if she is planning a family!!
 

ugly

LE
Moderator
There’s no evidence anywhere that it would make the slightest bit of difference.
Has it been attempted here?
I've no dog in the fight, I'm not a head case or intending to become one but the majority of troops in my intake were from what were broken homes by the standard of the day and possibly psychotic families by todays standards. If the wierdos were weeded out there would be no Trg NCO's for a start. Also the Army needs nutters, they win wars it just needs them to stay normal until then!
 
The background of many of our young recruits, particularly those heading to infantry as not always the best, as we all know. If you looked into the backgrounds of a lot of them (not all or even most) you could find issues or life events that a screening programme would either bar or lead to a career full of unwanted and unwarranted checks and follow up. The large majority of these people will have no significant consequences after a traumatic event.

The reality is that traumatic events on operations (or elsewhere) affect everyone differently, and previous family history isn’t a reliable guide to reactions to future events.

So a screening programme may make the Army as an institution think that it’s ‘done something’ but that has no real value in terms of prediction/output and costs a whole heap of money and human resource. Proper in depth psychological assessments don’t come cheap as they need to be done by Consultant level psychiatrists or psychologists. Once all the admin time is taken into account it would add at least £1k to every applicant for something that isn’t an accurate predictor of anything.
 

jarrod248

LE
Gallery Guru
The background of many of our young recruits, particularly those heading to infantry as not always the best, as we all know. If you looked into the backgrounds of a lot of them (not all or even most) you could find issues or life events that a screening programme would either bar or lead to a career full of unwanted and unwarranted checks and follow up. The large majority of these people will have no significant consequences after a traumatic event.

The reality is that traumatic events on operations (or elsewhere) affect everyone differently, and previous history isn’t a reliable guide to reactions to future events.

So a screening programme may make the Army as an institution think that it’s ‘done something’ but that has no real value in terms of prediction/output and costs a whole heap of money and human resource. Proper in depth psychological assessments don’t come cheap as they need to be done by Consultant level psychiatrists or psychologists. Once all the admin time is taken into account it would add at least £1k to every applicant for something that isn’t an accurate predictor of anything.
Then when you look at some of those psychiatrists and think they aren’t fit to decide which shirt to wear.
 
The background of many of our young recruits, particularly those heading to infantry as not always the best, as we all know. If you looked into the backgrounds of a lot of them (not all or even most) you could find issues or life events that a screening programme would either bar or lead to a career full of unwanted and unwarranted checks and follow up. The large majority of these people will have no significant consequences after a traumatic event.

The reality is that traumatic events on operations (or elsewhere) affect everyone differently, and previous family history isn’t a reliable guide to reactions to future events.
I had a phone call one day, shortly after taking up the reins in my first post. The RBS manager on the other end of the line didn't want to get the young man in trouble, but neither did he wish to let him go on accruing further debt on his rather large (several thousand early 80s' pounds) loan. I dragged in said young man, who had just returned to the unit after spending time in Colchester for going AWOL. I then got his story; it involved protecting a family member from 'abuse' in one of the more infamous parts of Glasgow. Naturally, being a gullible young officer, I checked it out with the SNCOs and read his file; he was genuine. I was frankly appalled that he'd got a custodial sentence and a fine, both of which could only have made his situation worse (I don't mind hanging people from the rafters if there is good cause, but I didn't see how his punishment benefitted the individual or the Service). So, I made a fuss in admin to get a few things sorted out to help him. I then rang the bank manager back to see what we could do, and got a very good deal that payed the bank back and left matey with a reasonable income.

I have little doubt that this young man would not have got in at all, should there have been a background "screening programme".

The last time I saw was about 8 years afterwards, by which time he was a SNCO, married with 2 kids, and doing well.

--------------------------

OTOH, I'd have been screened out, so maybe there is merit in the idea. :-D
 
Then when you look at some of those psychiatrists and think they aren’t fit to decide which shirt to wear.
Quite..

I always understood that whilst the psy profession can cope (just!) with those who have suffered a mental episode, their ability to predict future behaviour is still in the crystal ball domain. At the end of the day where do you draw the lines between behaviour that needs medical intervention, that which can be dealt with by Legal/managerial/social/peer influence and that which society has to tolerate as "personality"?

The military is perfectly capable of dealing with a much wider spectrum of character and behaviour types than modern society seems to be able to cope with. They should be allowed to continue to deal with it as they always have. If the flakeys can't cope with it. then they should stop looking!
 

Sarastro

LE
Kit Reviewer
Book Reviewer
Fascinating discussion in the first few pages, and really interesting to see so many people on ARRSE who have taken a professional / education interest in this.

From a totally amateur perspective, but having lightly read some of the more serious literature, unlike @jarrod248 I'd be totally unsurprised that screening wasn't shown to work. HOWEVER, I'd point out this doesn't mean that screening cannot work, it may simply mean that we don't know what or how to screen for.

One of the criticisms of more recent, serious scientific psychologists is that what is broadly thought of as psychology has been, for a long time, incredibly unscientific. There have been some good reasons for this (complex interacting data sets, lack of equipment to accurately measure results, lack of statistical training, etc). But it would mean that a lot of the accepted truths and textbooks of the profession are unreliable. It's unfortunate that some conspiracy theorists (Scientologists) have picked up on this and run with it, but serious professionals like Kahneman increasingly note the same thing.

Looking at diagnoses in particular, and the systems that select and feed patients towards a diagnosis, it seems that a glaringly obvious problem is selection bias. People often get fed towards a particular diagnosis not so much by the symptoms they display, because symptoms tend to be quite general across a number of diagnoses, but because of the context of the diagnosis, patient, and system that has fed them in. So soldiers are much more likely to be diagnosed with PTSD. Selection bias doesn't mean that a higher than average number of soldiers don't get PTSD. It means that if you had a perfectly normal population of people, and put them through that selection system, statistically you would expect them to have a higher than average rate of diagnoses of PTSD. Any screening process emphasises that - you are screening for something. So you will tend find it.

What is not at all clear is that the process really understands what it is screening for. Someone posted a Aspergers / autism spectrum questionnaire earlier. The main problem with anything like that is: it's an Aspergers / autism spectrum questionnaire. The psychologist, or worse, sometimes the patient too, knows what is being tested for. But a lot of the questions on there are interchangeable with, say, questions on a antisocial personality disorder test. Replace or add some of the questions with ones about violence, and it becomes a different test set. Now apply that to a niche population like soldiers: how does that question set work? Particularly the violence questions? I understand those online tests aren't valid, but the point stands: the symptoms and methods of diagnosis are often very similar between radically different diagnoses. In any case like that where symptom sets may be representative of multiple causes, you need strong differential diagnosis, a high level of granularity and data, and eventually, you need some unique identifiers.

The problem is, there are very few such treatments or indicators available. Equipment which gives the required level of data isn't widely available, and therefore there usually isn't sufficient data to establish firm results. In other words: the science of psychology just isn't very advanced yet. Arguably, a lot of the results from many psychological tests should say: not enough data. Instead, some talk about the strongest correlation, even when it is too weak to be statistically significant.

My hunch would be that in a hundred years, people will understand psychology not as a set of distinct, diagnosable disorders, but a complex network of interacting symptoms, which produce highly individual results in each patient, much like where gene therapy is going. It will be less likely to diagnose people as "having" PTSD, Aspergers, autism, APD, and more likely that they will be marked as diverging from a middle range in some aspects: they are particularly good at this thing; particularly bad at that thing; pretty much normal elsewhere. I think that will look very, very different to how we expect people with any of those diagnoses to be and behave today. I also suspect our blanket treatments (particularly the US instant-chemicals approach) will be seen as medieval.

Curious to see what everyone else on here thinks, having collectively spent a lot more professional time on this.

TL : DR Screening tends to find what it is looking for, and requires that you know what to look for and how. It's not at all clear that we know either of those things.
 
Quite..

I always understood that whilst the psy profession can cope (just!) with those who have suffered a mental episode, their ability to predict future behaviour is still in the crystal ball domain.
That's a key and well acknowledged problem.

Although past behavior is seen as the best predictor of future behavior, you or I can't even predict what we're going to have for dinner on a given day with 100 percent certainty, until we actually sit down to eat it.

Human behaviour is complex and is contingent on all manner of internal and external factors. We're usually pretty good at predicting overall group behaviour, but we can't predict who will be the outliers on the edge of the bell curve.

We might be able to improve the hit rate in the future with the rich data from social media (e.g. I read a while ago, apparently facebook can predict how long a relationship will last/when it's going to break-up), but I doubt never approaching anything close to 100 percent accuracy.
 
That's a key and well acknowledged problem.

Although past behavior is seen as the best predictor of future behavior, you or I can't even predict what we're going to have for dinner on a given day with 100 percent certainty, until we actually sit down to eat it.

Human behaviour is complex and is contingent on all manner of internal and external factors. We're usually pretty good at predicting overall group behaviour, but we can't predict who will be the outliers on the edge of the bell curve.

We might be able to improve the hit rate in the future with the rich data from social media (e.g. I read a while ago, apparently facebook can predict how long a relationship will last/when it's going to break-up), but I doubt never approaching anything close to 100 percent accuracy.
There you go, problem mostly solved. Write an AI program to monitor FB, etc and apply subtle pressure via friending, messages, tweets, etc to get 'suitable' candidates to say "Gosh, you know, joining the Army sounds like a really great thing to do!". I will, of course, refrain from suggesting that an ability to keep your cocaine habit and sex life under the media radar guarantees a place on the Perisher Course.
 
There you go, problem mostly solved. Write an AI program to monitor FB, etc and apply subtle pressure via friending, messages, tweets, etc to get 'suitable' candidates to say "Gosh, you know, joining the Army sounds like a really great thing to do!". I will, of course, refrain from suggesting that an ability to keep your cocaine habit and sex life under the media radar guarantees a place on the Perisher Course.
I was chatting to a colleague earlier about something like this - in a similar vain, there's a biotech company that has supposedly developed an AI algorithm that can measure how much pain one is experiencing using technology like Siri, Amazon echo. Seems very invasive. A bit like a company I interviewed with a couple of years back, and decided not to pursue their job offer - they created products which use video-games to assess potential job candidates.

The main theme was they took standardised computer tasks used to assess personality, made a video-game based on the task and sold them as recruitment tools. Invariably, because most mental health conditions are just extremes of healthy behaviour, companies administering these tasks would also get a wealth of data on far beyond what most people would reveal in any kind of work assessment - on things like impulsivity, neuroticism etc.

Technology is great, but there's definitely a darker, creepy side to it. Imagine a future, where you get facebook/amazon ads for painkillers because it's detected through your voice you suffer chronic pain, or you lose out on a job because you're overly impulsive compared the rest of the population, despite you use an extreme sport etc, as an outlet for it.
 
or you lose out on a job because you're overly impulsive compared the rest of the population, despite you use an extreme sport etc, as an outlet for it.
If you are overly impulsive but use eg extreme sports as an outlet, you wouldn't demonstrate the need to act impulsively in the videogame personality test, unless your outlets didn't sufficiently satisfy your impulsiveness. In which case, it would be a valid result. I also think it would be preferable to a face-to-face interview where someone who isn't overly impulsive is considered to be too much of a risk because they mentioned taking part in extreme sports when what they actually mean is they once did a bungee jump, on holiday.
 
If you are overly impulsive but use eg extreme sports as an outlet, you wouldn't demonstrate the need to act impulsively in the videogame personality test, unless your outlets didn't sufficiently satisfy your impulsiveness.
That's not true. The video-games were testing low-level/systems level behaviour, very basic low level behaviours of impulsivity etc. The most basic example of behaviour, one would say.

And just because you show dysfunction/atypical performance on a low-level system behaviour, doesn't mean the same will apply to higher level behaviours.
 
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