Joshua C. Morganstein

Leaders play a critical role in protecting the mental health and readiness of military personnel and communities during war and disasters. This chapter explores how leadership actions at various levels—first-line supervisors, community leaders, and elected officials—sustain operational readiness and guide recovery, preventing long-term psychological harm. War, as a type of disaster, generates profound psychological and behavioral consequences, including acute stress, risky behaviors, and disorders like PTSD and prolonged grief. Leaders must address these through fostering cohesion, normalizing help-seeking, and promoting resilience. Key frameworks include Psychological First Aid (PFA) with its five elements (safety, calming, efficacy, connectedness, hope) and peer-based interventions like the YaHaLoM protocol. The chapter also discusses managing suicide risk, grief leadership, and the impact of climate-related disasters intersecting with conflict. Practica and actionable resources, such as fact sheets, pocket cards and interactive online training, empower leaders to support mental health effectively. By integrating evidence-based strategies, leaders can enhance unit and community resilience, ensuring readiness and long-term psychological health in complex, high-stress environments.

Aside from personal impacts, costs to employers and national economies of mental health can be measured in trillions of dollars. With volatility, uncertainty, complexity and ambiguity increasingly describing the new normal workplace, the need for evidence-based interventions for sustained mental health at work to be developed, evaluated and implemented by specialists in psychiatry and occupational health could not be greater, nor an updated position statement on work and mental health from the World Psychiatric Association.

What is the public significance of this article?—This paper describes a novel approach to speaking with Military personnel about safe storage of firearms. Approximately 70% of Military suicides inv...

The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) worked together to revise the 2017 VA/DoD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder. This article summarizes the 2023 clinical practice guideline (CPG) and its development process, focusing on assessments and treatments for which evidence was sufficient to support a recommendation for or against. Subject experts from both departments developed 12 key questions and reviewed the published literature after a systematic search using the PICOTS (population, intervention, comparator, outcomes, timing of outcomes measurement, and setting) method. The evidence was then evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method. Recommendations were made after consensus was reached; they were based on quality and strength of evidence and informed by other factors, including feasibility and patient perspectives. Once the draft was peer reviewed by an external group of experts and their inputs were incorporated, the final document was completed. The revised CPG includes 34 recommendations in the following 5 topic areas: assessment and diagnosis, prevention, treatment, treatment of nightmares, and treatment of posttraumatic stress disorder (PTSD) with co-occurring conditions. Six recommendations on PTSD treatment were rated as strong. The CPG recommends use of specific manualized psychotherapies over pharmacotherapy; prolonged exposure, cognitive processing therapy, or eye movement desensitization and reprocessing psychotherapy; paroxetine, sertraline, or venlafaxine; and secure video teleconferencing to deliver recommended psychotherapy when that therapy has been validated for use with video teleconferencing or when other options are unavailable. The CPG also recommends against use of benzodiazepines, cannabis, or cannabis-derived products. Providers are encouraged to use this guideline to support evidence-based, patient-centered care and shared decision making to optimize individuals' health outcomes and quality of life.