Presented by Mr J. Sousa Santos at the 10th International Lessons Learned Conference (10ILLC) dated Tue 17 May 17

The impact of combat stress – specifically Post-Traumatic Stress Disorder (PTSD) – on the operational effectiveness of a deployed force is a critical challenge to mission leadership that remains an under-explored issue. Academics and researchers focusing on the broader subject have already created a robust and in-depth body of work. This presentation does not seek to duplicate process but to build on the already established academic and practitioner research, data, and findings. More specifically it will focus on the under-researched area of the direct impact of combat stress disorders such as PTSD on a military force deployed to active duty, and the consequent challenges to leadership this presents.

As a whole, a small number of studies have focussed on the impact of PTSD on mission and unit effectiveness, unit cohesion and success, during the deployment itself. Combat related stress disorders as a force disruptor are left to be addressed by leadership such as officers and NCOs’ who have the responsibility to identify and mitigate combat stress issues during,  after deployment, and whilst preparing members for redeployment. It is widely acknowledged that unit cohesion, morale and good leadership are three critical factors in mitigating combat-related stress and mental health disorders. Again, the responsibility for identifying, addressing, as well as mitigating combat stress and PTSD on soldiers whilst on active duty lies with leadership. To address this challenge, a myriad of programs and studies have been commissioned and developed to capacity build current military leaderships’ response capability and skills.

Compounding the challenge to leadership, researchers working in this field, have not focused much attention on the effects of traumatic events or PTSD and their connection to individual behaviour during military deployment, specifically during active duty and other extreme situations. Data on the factors that compound this dynamic such as the impact interrelationships between leadership, and affected members have on unit effectiveness as well as the nature of environmental threats and hazards, faced by both the leader and their subordinates whilst on deployment, are not readily available. This huge gap in our knowledge impacts negatively on contingency factors designed for military units as well as members while on active duty, on return from deployment and during the redeployment phase. Indeed, Hannah, Campbell, and Matthews (2010) point out that “most of what has been captured or written about leadership in extreme situations is anecdotal, memoirs, historical reports, retrospective questionnaires or research conducted in simulated or near dangerous contexts.”

Not addressing this specific issue poses a risk to the individual soldier and a greater challenge to leadership by negatively impacting the deployed forces operational capability, cohesion, effectiveness, and mission success. It is, therefore, critical that leadership be consulted during the process of research, development as well as the implementation of mechanisms to identify, support and assist individuals and units at risk, thereby ensuring a holistic response to this critical yet largely unaddressed force disruptor.

This presentation has three main findings;

(1) To highlight the importance of the role of leadership and increasing its understanding of how the mental health of soldiers on deployment, on return from active duty, and during the preparation phase for redeployment can impact mission resilience and effectiveness;

(2) To demonstrate the effects of Combat Stress particularly PTSD on the overall capability, cohesion, and success of deployed units;

(3) To create a greater understanding of the concept of constructive and destructive leadership and its impact on this factor. This will increase an already existing capacity within leadership to identify and therefore develop and implement mechanisms to support vulnerable soldiers and address this force disruptor.

 

Combat stress disorders and their impact on operational effectiveness

Combat stress disorders such as PTSD are a critical challenge facing both active and returning members of the armed forces that negatively impacts both their behavioural and mental health. The trauma of active service continues to affect both behavioural and mental health of members of the armed forces during and post-combat deployment and subsequent return to civilian life. A conservative estimate of the incidence of PTSD in personnel whilst on deployments have ranged from 1-2 percent for New Zealand and Australian personnel through 2.5 percent to 10 percent for Dutch and United Kingdom personnel. However, in contrast more than 20 percent of Australian veterans which served on deployment in Somalia were identified as suffering from PTSD. A recent more large-scale Australian study has reported a 12-month prevalence rate of 8.3 percent, however a large percentage of personnel surveyed in that study (39 percent) had not been deployed. In a 2008 American study the rate was described as close to 12 percent for personnel deployed to Iraq and Afghanistan. Studies also suggest that the effect of unit cohesion and constructive or positive leadership are of great importance to members of military units on active duty, both during and post-combat deployment. The majority of studies though, tend to focus more broadly on issues affecting members of the armed forces upon their return and subsequent discharge from the military into civilian life. However, they do not distinguish between the different variations of PTSD and combat stress on deployed units. These are all aspects which severely impact the risk factor matrix affecting deployed units, and their interdependent relationship to mission objectives and success. Leadership scholars have only recently begun to explore the nature of the threats and hazards faced by the leader, subordinates, and the impact of combat stress disorders on individuals and their consequent effects on units deployed to active duty. Soldiers suffering from symptoms originating from combat stress disorders can and do have an impact on the units’ effectiveness, cohesion and success during the deployment itself. Interviews were conducted by researchers, from 2014 to 2016, with soldiers discharged from the Australian Defence Force and US military, who had been operationally deployed. These interviews demonstrated that units which had members suffering from Combat-related stress disorders, suffered from weak unit cohesion, issues of mistrust that negatively impacted on combat effectiveness. During the interviews soldiers stated that they believed this was due to the affected individuals exhibiting behaviours such as emotional withdrawal from the unit, reacting to stimuli with inappropriate levels of aggression and or emotion, hyper vigilance, and inappropriate and dangerous operational responses to risks or threats.  These behaviours are caused by PTSD and other combat induced major mood disorders such as major depressive disorder, bipolar disorder, panic attacks, obsessive compulsive disorder, social phobia and specific phobias.  Estimates of the percentage of personnel in Australian Defence Force affected by these disorders post deployment is 20.7 percent. No definitive data is available to date on personnel whilst on deployment.

These mentioned behaviours contributed to a lack of unit unity and cohesion; they also created an environment where fellow soldiers developed a lack of trust as well as uncertainty over the unit’s capacity to safely achieve operational directives to an acceptable standard. It was also stated that operational tempo was a key factor to affected members of the unit not being identified as exhibiting signs of combat-related stress disorders. Therefore, contingencies in place to address and mitigate this issue were never activated, and the member tended to slip through the cracks and be redeployed to active service with the unit. It is in these cases where negative factors affecting the unit become a force disruptor and negates force multipliers. This is the scenario where positive or supportive leadership becomes instrumental in identifying and addressing the issue caused by operational tempo and limited military resources to continue deployment directives or complete mission objectives. Supportive leadership ensures that mechanisms in place to address this factor are effective and that members identified as exhibiting symptom or behaviours related to combat stress disorders are given the support required including; delaying redeployment, ensuring adequate psychological screening and downtime to enable the necessary time to recover, when possible or appropriate.

These efforts also protect units or contingents from higher risk and mitigate the negative impact on unit operational effectiveness and cohesion. It must always be taken into account that combat deployments are precisely the kind of dangerous occupational environment where leaders, both officers and NCOs, play an important role in their soldiers’ mental health.

Deployed military personnel work in what Hannah and colleagues (2009) called a “critical action organisational context”—one in which members voluntarily place themselves at risk and where they may even be asked to sacrifice themselves in support of a unit mission. Combat deployment demands include long periods of isolation from family and friends, ambiguous mission demands, extreme physical danger, powerlessness, boredom, and extended work hours as stated by (Adler, Litz, & Bartone, 2003). Many deployment stressors are life-threatening or traumatic. This is precisely the context where positive or supportive senior leadership ensures compliance to good practices and guarantees the extent to which leaders provide appropriate emotional, informational, or institutional help to units and subordinates. This can be achieved through actions by officers and NCOs; such as demonstrating duty of care, showing concern and providing useful performance feedback, information, and advice as well as implementing measures which assist in mitigating the effects of combat stress on the individual or unit.

Destructive or Supportive Leadership

To quote Carl A. Castro; “few studies have investigated leadership in extremis: in dangerous contexts such as those encountered by deployed military personnel.”

It is also in this space that further research and attention must be given. The presentation will explain and contextualise Professor Castros’ concept of “Destructive and Supportive leadership in extremis.” It is a reality of combat that deployed members of the armed forces are placed in added danger, and it is leaderships’ responsibility or duty to protect them from unnecessarily harmful situations. Military deployments are a prototypical example of such situations.

Surprisingly few studies, however, have examined the relationship between military leaders’ behaviour and followers’ mental health, particularly with regard to destructive or supportive leadership. Although leadership is often assumed to be more important in extremis, this may be true only for supportive leadership; destructive leadership appears to be detrimental regardless of the context. Destructive leaders can also make decisions that place members of the deployed forces in situations of greater risk or danger. One of the important gaps regarding the destructive and supportive leadership literature concerns its relationship with the clinically significant impact of mental health on deployed members of the armed forces –specifically from conditions such as PTSD. This is particularly true in the military, where only limited evidence exists concerning the link between leader behaviour, subordinates’ mental health and its subsequent role on operational effectiveness and as force disruptor. One of the impacts of positive leadership lies in the buffering effect created when officers or NCOs, support and positive actions, mitigate the harmful effects of occupational stressors by providing subordinates with resources needed to cope with stressors or by facilitating recovery from the harmful effects caused by stressors. The literature on the buffering effects of supervisor support is extensive although with inconsistent findings from study to study – possibly due to differing methodologies employed. On the other hand, destructive leadership and its associated practices can and does negatively impact unit operational effectiveness by further exacerbating the effects on deployed personnel caused by traumatic factors, including the threat of snipers, mortar attacks, improvised explosive devices (IEDs), accidents, assaults, handling bodies, and seeing injured children.

Destructive leadership removes endemic unit coping mechanisms and negates the systems already in place to reduce the harm and risks posed by combat-related stress disorders. Kelloway and colleagues (2005) described two of the general effects of poor leadership on followers: (1) that poor leadership is stressful for followers, to the extent that leaders are abusive or incompetent, and (2) that poor leaders typically create work environments that are “rife with other work stressors such as lack of control and heavy workloads”

Example of positive research

The 2010 Australian Defence Force mental health prevalence and Wellbeing Study is a case study conducted of an entire Defence Force, designed to use a two-phase approach with an initial screening questionnaire and subsequently followed by interviews of selected individuals. Priority was given to members who were identified as having a higher probability of suffering from a combat-related stress disorder. The study found that although mental health disorder prevalence amongst ADF personnel was the same as that of the community – or general population – ADF personnel experienced a different type of mental disorder consistent with the occupational stressors to which personnel are exposed, notably deployment experiences and absence from family and support networks. The study informed the subsequent 2011 ADF Mental Health and Wellbeing Strategy and the 2012-2015 ADF Mental Health and Wellbeing Action Plan.

Importantly, the study provided Leadership with the required data on the incidence of mental health disorders linked to deployment in comparison to data regarding civilians and also to understand the effects of deployments on the mental health of ADF personnel. This however did not create a clearer picture of the resulting impact of combat-related stress disorders on the operational effectiveness and of its impact as a force minimizer on the military resources of the ADF in possible future deployments or actions.

Conclusion

This presentation has highlighted the challenges faced by leadership due to the impact of combat-related stress disorders on the operational effectiveness of units and forces on deployment or active service. It has looked at the concept of destructive and supportive leadership in mitigating or exacerbating the effects of combat-related stress disorders and how this impacts on members and units’ ability to operate at full effectiveness. It has also identified failures in current mechanisms employed by leadership to support soldiers on the deployment, and a means to highlight weaknesses and risks to their successful implementation. It is hoped that this paper further increases the already present capacity of leadership to facilitate and participate in further studies and research into this area. Leaderships critical input will ensure that any additional mechanisms developed and implemented compliment already existing platforms and reduce the risk posed by Combat-related stress disorders on military personnel on deployment and in particular its effect as a force disruptor to units on deployment to active duty.

To quote retired Major General John Cantwell:

“I have learnt that the mind, like the human body, is a wonderful but vulnerable thing, and that its invisible wounds can be painful, lifelong and even fatal.

I have learnt there is a way back from confusion, anger and distress of profound mental trauma and that the first step is to admit you are suffering – and that doing so can take a great deal of courage.” ‘

With your permission, ladies and gentlemen I would like to finish this presentation with an ode to both serving and returned military personnel. The human factor to this subject matter, and those who battle with the effects of having served their nations, and must now live with those scars:

It is for them we undertake this work.

“They walk among us.”

They walk among us and yet we do not see them.

They are the ones with a distant stare in their eyes as their minds race back to memories of loss and violence in days gone by.

They are the quiet ones standing next to you in a queue in a shopping centre.

They are the aloof parent picking up a child from school, difficult to engage in conversation.

They are the ones that seem detached, sad and alone.

They are the ones who seem to stand back from the world.

They are the walking wounded hiding their scars bravely from the world at large.

We look at them yet cannot see them; at a glance, they appear no different.

They are the sombre ones who stand each April, at dawn wearing a suit and medals, amongst the jeans and t-shirts.

They are the ones with a tear in the corner of an eye as they remember fallen mates when the ‘Last Post’ plays.

They are the ones that quietly retire from the world to seek peace.

They are the rough men who have done violence on our behalf so that we sleep peacefully each night.

They are the ones who lay awake when darkness falls, fearful of the dreams that come.

Their fight rages on, though the battlefield is now very different.

They are the walking wounded, and they walk among us.

Lest we forget them.