GREAT LAKES - Navy's Recruit Training Command creates an Embedded Mental Health program (EMHP) to provide mental health care to staff.
For most enlisted Sailors, they will never forget their Recruit Division Commanders (RDC). What they may not have realized while they were trying to make it through boot camp is that being a staff member at Recruit Training Command (RTC) is even more stressful than being a recruit!
In October 2017, Lt. Cmdr. Kathleen Saul, clinical psychologist, conducted a Quality of Life survey, which showed that despite low levels of self-destructive behaviors, there were high levels of stress underneath and many were suffering in silence.
“Results of the survey showed that our staff was experiencing stress levels much higher than what we would expect given the extra screening and seniority in rank and time in service,” said Saul. “The majority of the staff was coping well, but a good number of people were experiencing clinically significant levels of stress.”
Survey results showed the need for a change to support the hard-working staff who train over 35,000 recruits annually.
RTC responded with several initiatives to address what has become known as the Health of the Force.
First, leadership stood up an Embedded Mental Health program (EMHP) to provide mental health care to staff. At RTC, the EMHP is called Third Fleet since many departments are referred to as fleets (e.g. Sixth Fleet, Pacific Fleet, etc.). Third Fleet consists of three psychologists, a corpsman leading chief petty officer (LCPO), and two behavioral health technicians.
EMHPs are a growing care delivery model across the fleet starting with aircraft carriers, then expanding to amphibious strike groups, submarine squadrons, and most recently high surface concentration areas, such as Destroyer Squadron Sixty (DESRON 6) in Rota (link to article). The EMHP at RTC is the first program to be embedded within a training command.
“RTC takes a stance that to be successful it’s the intersection of the mind, body, and soul,” said RTC Commanding Officer Capt. Erik Thors. “Having an [EMHP] is a force multiplier by ensuring that we care for the whole person and provide the assets to be holistically ready to execute our mission.”
The goal of the EMHP is to increase the likelihood that a Sailor will seek out mental health care, especially before their stress escalates.
“In the past if you showed any problems with mental health you likely would lose your rope. Because of that, RDCs would never ask for help,” said RTC Command Master Chief David Twiford, referring to the red rope worn on an RDC’s uniform. “RTC has absolutely removed that stigma and now that we have a team whose job it is to help you do the job and keep you in the fight. We have seen an increase in Sailors seeking help and remaining on the job. Going to mental health and continuing to perform can go hand in hand and that has not always been the case here.”
EMHP is delivered in close proximity to the Sailor; Third Fleet is physically located in one of the training ships on base.
“Staff members at RTC have an incredible amount of responsibility at all levels; their workload is both sizable and tightly scheduled,” said Hospital Corpsman 2nd Class Jonathan Pittman, behavioral health technician. “Increasing access to care by being both proximal, the likelihood that someone will not see their time constraints as an impassible barrier to care.”
EMHPs not only improves access to care, but also increases quality of care.
“As a provider, the value this adds is immeasurable. I get to see firsthand the staff at work and know the nuances of the various positions staff members may have here,” said Dr. Jenny Siddiqi, RTC clinical psychologist. “I think this has made me a better clinician – it has helped me appreciate the hard work that is done by all and the value that everyone adds to this place.”
Even though the EMHP staff is organic to the command, services are still confidential. At RTC, staff is required to go to Third Fleet offices for many other reasons (e.g. training certification), so mere presence in the offices does not identify someone as a mental health patient. The goal for the EMHP is that staff members will seek help earlier and therefore be able to stay in the fight.
“Ninety percent of the staff that have come to Third Fleet has been psychologically fit for full duty. We’re trying to promote the idea of getting ‘left of bang’ and talking to us before they are in a full blown crisis,” said Saul.
There are unique challenges to RDC duty and instructor duty at boot camp as can be seen in the “Behind the Scenes” documentary.
“Recruit Training Command is a one of a kind command; there is no duty or command to compare it to,” said Twiford. “Having embedded mental health as members of the command team make it much easier for RDCs and instructors to go to someone they trust and who truly understands their dynamic is beyond important.”
RDCs frequently have seven-day work weeks and 15-hour work days with frequently changing schedules. Instructors have to get creative to prevent monotony due to teaching the same lesson plan daily for their tour. EMHP is not mandatory and only one of the options for staff, who can still seek mental health care at the Captain James A. Lovell Federal Health Care Center, Fleet and Family Service Center, and MilitaryOneSource.
“It is vital for any EMHP to work closely with their [Military Treatment Facility] and community partners to ensure the best care to our staff,” said Saul.
Other initiatives to support the staff include mandating a post-graduation week to allow RDCs to catch up on training, take leave, and reconnect with family with waiver authority resting with the commanding officer.
The Blue H Health Promotion program was established to address the overall health of the staff, including mental health.
“We know that when people exercise, get good sleep, and eat right, that they tend to feel psychologically healthier,” said Lt. Cmdr. Brain Lees, clinical psychologist and Health Promotion Program coordinator. “We hosted a sleep expert from Naval Postgraduate School to talk about sleep and the ramifications of not getting enough of it at our last command safety stand-down.”
The Blue H Health Promotion program has been very successful; RTC was awarded the Silver Award in its first year. Human Factors Boards were implemented to engage leadership with their Sailors in identifying potential issues early.
RTC is also fortunate to have the largest concentration of chaplains outside of the Naval Chaplaincy School and Center. Chaplains are available to provide spiritual counseling to staff and began offering marriage retreats for couples.
“These retreats are a great resource for staff to enhance their marriage,” said Lt. Jamil Khan, RTC chaplain. “They even provide daycare and lodging to be able to attend.”
To protect the supply chain and keep sending Sailors to an undermanned fleet, RTC has gone to extraordinary measures to meet mission since the start of the COVID-19 pandemic. This has included a majority of staff being placed on a rotation schedule between restriction on base (ROB) and restriction of movement (ROM) at home.
“I’ve been so impressed with everyone’s ability to shift and mobilize to a completely different way of doing business,” said Siddiqi.
Third Fleet was able to quickly pivot to a telebehavioral health model so staff may still receive treatment whether at work or at home, on duty, or an isolation status.
“We try to match the flexibility and motivation of the staff, getting creative in how we help them just as they are innovating the way we train recruits,” said Saul.