Children surround an airman on convoy duty in Afghanistan. They smile and shout, tugging on his clothes, asking for treats. He immediately goes on high alert: Training and experience have taught him these kids may well be a deliberate distraction while an enemy is placing a bomb on the other side of his vehicle. He braces for combat.
A few days later, the airman returns home from the long deployment. Reunited with his family at the airport, his children swarm around him, tugging on his clothes, demanding his attention. Involuntarily, he tenses up, adrenaline flowing, ready for battle. Instead of a joyous reunion, the scene becomes one of tension and frustration, and he doesn’t immediately know why.Such scenarios have become common during the past decade of war in Afghanistan and Iraq. The speedy return of troops—from perpetual danger to the family dinner table in a matter of days or even hours—has been hard on airmen and their families. Behaviors and habits born out of hard-earned combat experience are difficult to simply shed. Given the stigma that persists in seeking therapy, or indeed any kind of counseling, most airmen have tried to tough it out, sometimes unsuccessfully. The Air Force has seen the results in the form of domestic troubles and suicides.
As part of its overall efforts toward resiliency of both airmen and their families, the Air Force has been running a program intended to help those returning from deployment with the challenges of re-entering their home lives.
Called Combat Bridge, the 17-month-old program focuses on airmen who have served “outside the wire” in Afghanistan, in particularly stressful jobs, or in missions where they have had traumatic experiences. It aims to do four things: Provide an opportunity for airmen to decompress; let them rest and readjust to home-like surroundings; give them time to reflect on their experiences; and give them the mental tools to cope with the extra stresses of returning to their families and home units.
A combat controller hands out bottles of water to Afghan children in Khanda village in Laghman province, Afghanistan.(USAF photo)
The program takes place at Ramstein AB, Germany, and has been in operation since summer 2010. Since that time, roughly 2,200 airmen have gone through Combat Bridge. Among the specialties targeted for the program are security forces, explosive ordnance disposal, tactical air control party personnel, convoy operators, RED HORSE personnel, field medics, and members of provincial reconstruction teams.
As much as possible, the program is worked into the routine of a deployment. Participants are identified before they even go overseas, and on their orders, the program is listed as “post-deployment training.” Tremendous effort is exerted to avoid any implication that participants are involved in a mental health program. It is, rather, an investment in avoiding such problems.
“This is ‘sneaky therapy,’ ” said SMSgt. Mark A. DeCorte, superintendent of the Deployment Transition Center at Ramstein. It is meant specifically for airmen who are not symptomatic with conditions such as post-traumatic stress disorder or brain injury—those cases are treated medically—but who could benefit from an opportunity to talk about their experiences and learn some techniques for coping with the return to family life.
Anonymity Is Key
Program staff, who facilitate group discussions and lead activities, all have combat experience and have been through the process of adjusting to a normal life afterward. Participants get to talk with veterans from their own career fields who have recently had the same kinds of exposure to traumatic situations and can offer good advice on making the transition back to normal life.
“They have the ‘been there, done that’ credibility” necessary to get the attention of battle-hardened airmen, DeCorte said. “Trainers” are assigned to the DTC on short, six-month tours.
The program lasts four days and begins as soon as the returnees reach Ramstein. “As soon as possible, we get them in civilian clothes,” the uniform of the day for the program’s duration, said Maj. Derek C. Jenkins, commander of the Deployment Transition Center. The returnee has someone else handling the checking-in process and taking care of moving luggage to the Combat Bridge residence area, on the edge of family housing at Ramstein.
The relaxation process begins at once, with low-key activities. The schedule builds in extra sleep periods. It also involves group activities such as visiting the Ramstein Air Base mall, a local sports bar, outings to tourist attractions, and dining out “on the local economy,” Jenkins said. Whenever feasible, rules and regulations are put aside in favor of a civilian atmosphere. Even the transportation is by commercial buses, not Air Force vehicles. As much as possible, the participants are exposed to civilian surroundings and activities. However, during the program, they may not drive—a stressor in itself—even if Ramstein is their home base.
The program allows time for participants to talk to each other about what they’ve seen and done, DeCorte said. Group discussions are kept casual, but are guided by staff to touch on subjects needing to be aired out.
Finally, the program helps returnees develop strategies for recognizing and defusing the habits they’ve developed that are inappropriate for home life, and helps them anticipate and cope with the special stresses they’ll encounter when they reunite with their families.
“When you get home, sooner or later, someone is going to ask you—probably one of your kids—‘Did you kill anybody?’ And if you haven’t really given much thought to how you’re going to answer that, it can be pretty hard,” said DeCorte.
The program facilitators scrupulously avoid any record keeping about what participants say; anonymity is the rule of the day. They will only report someone for mental health treatment if they perceive that he poses a danger to himself or others or has broken the Uniform Code of Military Justice. Talks with mental health counselors or chaplains are completely confidential. When they have finished the program, most participants go home on commercial airliners, not military transports.
Afterward, they fill out a survey, evaluating the program and offering their observations for how beneficial it was, whether it was the right length, whether it addressed their needs, and so on. It also asks about their state of mind—whether they are anxious or relaxed, getting quality sleep, their confidence level, and whether they are thinking about separating from the Air Force. The survey is entirely voluntary and anonymous, and there is no tracking of participants to see if, later, they encounter marital problems or mental health issues.
As a result, few empirical metrics exist to judge the program’s usefulness.
“Candidly, we are not connecting the dots there—at least not yet,” said Gen. Norton A. Schwartz, Chief of Staff. “If we want to avoid stigmatizing this experience, we need to be careful about data collection. This is the tension,” he said, between offering airmen a program in which they can be completely frank and one that some might fear will somehow affect their careers.
“We’re looking for objective measures,” Schwartz said, but he’s directed that everything must be done to avoid participants questioning “whether they are under scrutiny, and whether this is a continuing process.” The surveys, though hardly comprehensive, “give us a sense of whether we’re on the right track, without being too intrusive.” So far, the anecdotal evidence from surveys is positive.
Schwartz said the main objection from airmen at first was the requirement to lay over at Ramstein at the end of deployment. Obviously, he said, “people want to get home.” However, now that there is some word of mouth about the program, and it is generally positive, those objections have begun to disappear.
Combat Bridge’s genesis came in early 2009. Reacting to a rising number of suicides and family problems causing people to separate from the service, top USAF leaders decided to confront, at a minimum, the stress of people with the roughest duty overseas.
No one’s “individual genius” got the program going, Schwartz said, though he credited former vice chiefs of staff Gen. Carrol H. Chandler and Gen. William M. Fraser III with pursuing it once the idea was deemed to have merit.
Airmen are greeted by base leadership as they deplane at Davis-Monthan AFB, Ariz., after serving a seven-month tour in Afghanistan.(USAF photo by SrA. Christina D. Kinsey)
A task force got under way, and leaders decided at the February 2010 Corona meeting to launch the program. By June, it was up and running.
Some precedents existed, Schwartz said. The Army had experimented with something like Combat Bridge, and the Air Force Office of Special Investigations “had its own process for their outside-the-wire people. They would spend some time before they got home.”
Ramstein was chosen for a number of reasons, Schwartz said.
“There was debate, whether it should be in-theater, adjacent to theater, … in the US, or en route—i.e., a third location,” he explained.
“The consensus was, it was not a good idea to do it in CONUS,” given participants’ anxiousness to get home. Also, “we really didn’t have a good place in-theater to do it, and it probably wasn’t far enough away.” The US Air Forces in Europe commander, Gen. Roger A. Brady (now retired), suggested Ramstein.
Ramstein was “pretty near perfect,” Schwartz said. It had an underused housing facility easily adapted for Combat Bridge; it had a new American mall-like base exchange with American brand-name restaurants; and off-base opportunities offered a taste of home as well. Plus, about 85 percent of airmen returning from Afghanistan transit Ramstein anyway.
Schwartz said Combat Bridge had at least one unexpected outcome.
“Not only is this an opportunity to relax, download, to interact with professionals or contemporaries, but some of the units have also used this as an opportunity to debrief,” Schwartz said.
“The units sit around in a relaxed setting, and they actually think through their whole deployment, from beginning to end: what we did well, what didn’t we do well, and part of that process actually seemed to be very effective in allowing people to release that experience, and the challenges associated with it.”
The program seems to be an effective way to put “a bookend on the deployment.”
Marine Corps Interest
Schwartz said he’s not sure how Marine Corps Commandant Gen. James F. Amos heard about Combat Bridge—Schwartz thinks he himself may have “mentioned it in the ‘Tank,’ ” or perhaps Marine Corps EOD specialists heard about it from their Air Force brethren—but Amos asked to put some marines through Combat Bridge. About 100 EOD specialists went through and had complimentary comments about it. That experiment is over; the Marine Corps may set up a similar program.
There is a team looking at ways to have a corresponding program on the family side, but it has not been developed yet.
Combat Bridge has a capacity to handle about 2,000 people a year. Operation and maintenance funds provide the money for it, but Schwartz does not think it will be expanded.
“The idea is to focus on those folks who have … perhaps the most demanding experience, which is close combat or similar outside-the-wire experience where the stress is likely to be highest.” He added that the Air Force doesn’t have the capacity to expand it for all deploying troops. He also thinks the program will see its sunset circa 2014, when US troops are expected to be fully out of Iraq and Afghanistan. By then, the program will have run its course.
Schwartz does not pretend that Combat Bridge will cure all the problems faced by airmen returning from stressful deployments, but he feels it is at least a good start.
“You need to decompress those hard-learned habit patterns,” he noted. “And this is one mechanism. … I’m not saying it’s the only one or it’s the solution, but it clearly has had good reception with our outside-the-wire operators, and I think that’s the plus.” He added, “The original anxiety about, ‘I don’t want to take a three-day delay at Ramstein,’ I think, has subsided almost completely as the scuttlebutt has spread.”
Despite the lack of metrics to prove that Combat Bridge is an effective tool, Schwartz said the anecdotal evidence is enough to convince him of its benefits. “This is an investment,” he said. “If we help even a handful out of the 2,000 people, I would argue it’s worth it.”