Forward psychiatry - early intervention for mental health problems among UK armed forces in Afghanistan.
This observational study examined return to duty (RTD) rates following receipt of early mental health interventions delivered by deployed mental health practitioners.



In-depth clinical interviews were conducted among 975 UK military personnel referred for mental health assessment whilst deployed in Afghanistan. Socio-demographic, military, operational, clinical and therapy outcomes were recorded in an electronic health record database. Rates and predictors of EVAC were the main outcomes examined using adjusted binary logistic regression analyses.



Overall 74.8% (n=729) of personnel RTD on completion of care. Of those that underwent evacuation home (n=246), 69.1% (n=170) returned by aeromedical evacuation; the remainder returned home using routine air transport. Predictors of evacuation included; inability to adjust to the operational environment, family psychiatric history, previously experiencing trauma and thinking about or carrying out acts of deliberate self-harm.



Deployed mental health practitioners helped to facilitate RTD for three quarters of mental health casualties who consulted with them during deployment; psychological rather than combat-related factors predicted evacuation home.
Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom. Electronic address: norman.jones@kcl.ac.uk.
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Jones
Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
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Fear
King's Centre for Military Health Research, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
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Wessely
Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
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Thandi
Academic Department of Military Mental Health, Academic Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Cutcombe Road, London SE5 9RJ, United Kingdom.
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Greenberg
D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D003130:Combat Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D016728:Self-Injurious Behavior / Q000517:prevention & control* / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D006113:United Kingdom; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult
Deployment; Forward psychiatry; Military; Occupational; United Kingdom