title: Long-term military work outcomes in soldiers who become mental health casualties when deployed on operations.
abstract: BACKGROUND
  little is known about longer term military work outcomes in UK military personnel who develop mental health problems when operationally deployed. Deployed Field Mental Health Teams (FMHTs) who support them follow the principles of "Forward Psychiatry," aiming to treat psychiatric casualties close to the front line to maximize operational effectiveness and occupational retention.
  
  
  OBJECTIVE
  to examine the short- and long-term military work outcomes in soldiers deployed to Iraq between 2003 and 2007 who were referred to the FMHT.
  
  
  METHODS
  FMHT clinical records were linked to occupational records with 825 resulting matches.
  
  
  RESULTS
  71.6% of the referred soldiers with a documented short-term military work outcome returned to their operational unit, and 73.5% of those who had a documented long-term military work outcome served on for a period in excess of two years. Adjusting for potential confounders, a shorter service length and removal from the operational theatre were both strongly associated with premature discharge; however, it was not possible to determine the severity of the presenting mental health problem and assess whether this impacted outcome.
  
  
  CONCLUSIONS
  the results of this study support the use of the Forward Psychiatry principles in achieving good short-term military work outcomes. Utilizing these principles, three-quarters of those referred to the FMHT were returned to their deployed unit and approximately three-quarters of those assessed by the FMHT remained in service two years after referral. We suggest that these are positive work outcomes; however, being evacuated out of the operational environment and having a short service length were both associated with premature discharge, though we were unable to examine the role of illness severity.
authors.affiliation: Academic Centre for Defence Mental Health, Department of Psychological Medicine, Institute of Psychiatry, King's College London. Norman.Jones@kcl.ac.uk
authors.forename: Norman
authors.initials: N
authors.lastname: Jones
authors.forename: Nicola T
authors.initials: NT
authors.lastname: Fear
authors.forename: Margaret
authors.initials: M
authors.lastname: Jones
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
authors.forename: Neil
authors.initials: N
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000523:psychology*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D013997:Time Factors