Mental Health Problems

Overview | What to Look For | What to Do | What to Avoid
What to Expect | Troubleshooting

Overview

Marines that seem depressed, anxious, or isolated may be having an adjustment problem. The Marine may be dissatisfied with a work situation or frustrated with peers. He may feel that he just doesn't fit in. Or, he may be upset about something outside of work entirely. There may be a relationship problem, or a financial problem. In some cases it may be a more serious problem, such as clinical depression or anxiety, which would require mental health treatment. In any case, when a Marine appears depressed, anxious or isolated, it is a red flag that something needs to be done. Getting help before the problem becomes too big can get a depressed or anxious Marine back on track and help unit readiness at the same time

What to Look For

• Sadness or depression
• Isolation or withdrawal
• Irritability or short temper
• Excessive nervousness or worrying
• Unreasonable fears
• Marked changes in behavior
• Change in productivity or attitude
• Change in hygiene

What to Do

The first line of action should be at the lowest and simplest level possible to get your Marine back on track, and then take further actions as needed. Unless you feel the Marine is at risk for hurting himself or other, first see if he has a problem you can solve through leadership and listening. Here are some things that you can do if one of your Marines seems to be having trouble:

• Observe the Marine and see what you think may be the problem.
• Privately and directly ask how the Marine is doing at a time that maximizes the Marines likelihood to talk.
• Use active listening skills so that the Marine will open up.
• If reluctant to talk, help the Marine understand that you are concerned about what you see and you want to help.
• Listen closely for what may be the underlying problems.
• Suggest some possibilities (sounds like you are having trouble with… ).
• If you think the Marine might be suicidal, take appropriate action.
• If a problem is identified, ask if the Marine would like some help with it and what type of help would be useful.
• Ask the Marine if you can set up a meeting for them with someone who can help, then set up the meeting before they leave your office.
• In order to reduce the stigma of asking for help, it is recommended that you initially refer your Marine to someone other than mental health, unless you feel they are at risk of harming themselves or others.
• In the field you will probably refer to the Chaplain.
• In garrison, your first referral might be to Marine and Family Services, or there are several other resources available to you.

What to Avoid

The idea is for leaders to let their Marines know they are safe and in good hands if they ask for help. If you can communicate your genuine concern for your Marines they will tell their fellow Marines that seeing you was the right thing to do and that you had their best interests in mind. Here are some things to avoid that might destroy their trust, close the lines of communication, or deter other Marines from asking for help in the future:

• Not taking the problem seriously – saying “is that all?”
• Overreacting – remain calm and in control
• Giving simplistic advice by telling them “all you have to do is…” - Telling them to “suck it up,” “get over it.”
• Telling them about your own or others' problems.
• Keeping the problem to yourself rather than getting appropriate chain of command involved.
• Telling personnel who don't have a need to know, making the problem a source of unit gossip.
• Ignoring the problem and hoping it will go away.
• Delaying a necessary referral for more specialized help.

What to Expect after Taking Action

• Most Marines will respond positively to unit leaders taking an interest in their problems if it is done with their best interests in mind.
• The Marine will get assistance from the agency to which they were referred, and that agency will send them to the next higher level of intervention if needed, such as a mental health clinic.
• Agencies above the level of a rest and recuperation unit may not give feedback to the command on the Marine's progress unless the Marine specifically gives them permission to do so.
• The Marine should be willing to keep leaders apprised of general progress with the problem so far as it affects unit readiness, but is not obligated to divulge every detail.

Troubleshooting

• Marine does not endorse a problem: In order to help a Marine who is reluctant to disclose a problem you may want to reassure the Marine, convincingly and genuinely, that you have the best of intentions and only want to help. You want to see the Marine get better not only because you are concerned about what you have seen and heard, but also because you want the Marine to take care of the problem before the problem gets out of hand and starts affecting performance as well as the readiness of the unit. Emphasize to the Marine that you are all in this together. When one Marine hurts the whole unit hurts. Therefore, it is important for you to make sure that the Marine is doing well and not just having to suck it up. You may also want to emphasize that getting help is a sign of strength and loyalty to the unit because they are making sure that they are ready to be there for fellow Marines and would want fellow Marines to do the same. If the Marine continues to be reluctant in disclosing the problem reinforce that you are always available to talk if they should change their mind.
• Marine gets angry when asked about problem: If the Marine gets angry when asked about the problem it may be due to several factors. For example, the Marine may be ashamed of having the problem noticed, resentful due to feelings that the unit is the problem, or may feel that nobody can understand or help with the problem. The Marine may also place blame on themselves for the problem or perhaps feel guilty for not getting a grip on life. Take this opportunity to turn the emotion toward getting help. The trick is to get the Marine to endorse frustration and sadness and realize that problem solving is not a solo operation. Keep the focus on what your Marine is feeling. Do not accuse the Marine of not giving 100 % this will increase anger. Say, “you seem really angry about…” to show your understanding and promote discussion. If you can get the Marine to endorse the anger, you can probably get acknowledgement that help would be welcomed. In order to get the Marine to accept help from the command the Marine will need to trust that the command is truly interested in helping. Good listening will go a long way toward building this trust.
• Marine does not want help: In this case the Marine has endorsed that there is a problem and does not want help. The Marine may or may not say why, but it is probably because of the belief that it is no one else's business or concern of negative career implications. Reassure the Marine, convincingly and genuinely, that you have the best of intentions and only want to help. You want to see the Marine get better not only because you are concerned about what you have seen and heard, but also because you want the Marine to take care of the problem before the problem gets out of hand and starts affecting performance as well as the readiness of the unit. Emphasize to the Marine that you are all in this together. When one Marine hurts the whole unit hurts. Therefore, it is important for you to make sure that the Marine is doing well and not just having to suck it up. You may also want to emphasize that getting help is a sign of strength and loyalty to the unit because they are making sure that they are ready to be there for fellow Marines and would want fellow Marines to do the same. If you are in the field, you can order the Marine to your forward rest and recuperation unit for “three hot and a cot” and further observation. They, in turn, will either observe that the Marine is recuperated and send them back to duty, or will refer them to a higher level of care.
• Marine agrees to get help but does not follow through: Sometimes a Marine will agree to get help, but for any number of reasons may not follow through. The Marine may decide the problem is not bad enough and can fix it alone. The Marine may have agreed to get help just to get out of your office, or may have genuinely forgotten the time of the appointment. In any case the solution is to put the responsibility onto the Marine to get the needed help. Emphasize that you genuinely want to see your Marine get better, and listen to any concerns shared. Offer again to help. If there is resistance to your help, emphasize that the bottom line is performance, and that it is ultimately the Marine's responsibility to take advantage of all the help that is offered so that the problem does not start to affect performance. Be sure the Marine understands that letting the problem fester and get worse is what will negatively affect their progression.
• Marine does not get better after getting help: In some cases a Marine may get help but still not improve. This may be because the Marine's needs are different and a more intensive intervention is needed, either because the Marine is not motivated to improve, or because there is a more serious problem such as a personality disorder or mental illness. If you are not having any success at the small unit level, and you feel like you have given it a good effort, you should refer your Marine to a professional with more specialized expertise. In cases of adjustment problems, the chaplains or Marine and Family Services have counselors who can usually get to the root of the problem. If not, they will recognize that the problem is more serious, such as clinical depression or anxiety and will refer the Marine for a mental health evaluation and treatment. If after mental health intervention the Marine is still not getting better, and the Marine is still a problem for the unit, mental health may contact the command with a recommendation for administrative action.
• Marine seems mentally ill or suicidal but refuses evaluation: See Command Directed Evaluation.