CONTRIBUTIONS OF MILITARY PSYCHOLOGY  TO UN
PEACEKEEPING OPERATIONS

	Herman W. de Swart 1, Tessa G.E. Willigenburg 2, Natasja Alkemade 2

     The psychological effects of war and peacekeeping upon soldiers are, I think, very well known to this audience. They comprise all problems from maladaptation after return, up to and including fullblown post traumatic stress disorders.  
The Netherlands, although being a small country, has a large history of involvement in (UN) peacekeeping operations. It started with a peacekeeping operation in Albania in 1913, through Korea 1950, Lebanon 1979 - 1985. In this operation, UNIFIL, 8000 men and women from the RNLA served, of whom 9 were killed.

     Some recent figures: Recent operations started in Saudi Arabia and Iraq (with the Gulf war and later Provide Confort), then Cambodia, Haïti, Angola, operations in 15 countries in all). From the RNLA  2000 men and women now serve in the former Yugoslavia. All together about 10 000 men and women, regular as well as conscript soldiers, were and are involved, since Iraq until now. A unit for Burundi is on standby now.

     Neither the UN, NATO nor the WEU have a doctrine or clear policy on psychological support before, during and after operations. Each participating country has its own responsibility in this matter. 

     The Royal Netherlands Army (RNLA) developed a comprehensive policy to secure maximum deployability and minimize the (long)lasting effects of stressful encounters during operations. 

     In this conference much attention is paid to psychological support.
I will distance myself a little bit and focus upon policy concerning involvement of psychologists and other behavioural scientists in the RNLA, before, during and after missions of soldiers during UN operations, starting with initial psychological selection, up to and including veteran care, and thus set the stage in which psychological support fits very well.

     I will - with regard to the available time unfortunately very superficially - start with some remarks on the military psychological and sociological service of the Royal Netherlands Army and the guiding principles of our work in this field, and after that address the following topics of this policy, in which, in all its aspects, behavioural scientists can or should play an important role:  initial selection, psychological screening before deployment, education and training (e.g. on stress and psychological support), family support, field psychology, psychological debriefing, 'reintegration' meetings after return, veteran care, lessons learned and research.

    If the time allows me, I will focus more in detail upon the screening and some research data.  At the end of my presentation I will draw some conclusions about the effectiveness of the policy, and have a look at the future.

    Two final remarks to end this introduction. As I said, there is no UN policy, nor a policy in NATO or the WEU concerning psychological support. It is a national responsibility, and the remainder of my briefing is based on the policy of the RNLA.
Secondly: we not only have to do with NATO, the WEU, or the UN, but we also have to collaborate with the so called Non Governmental Organizations, like the Red Cross or Medicins sans Frontières.  Apart from these two important organizations, the World Health Organization knows over 300 non-governmental bodies that consider people in psychosocial need their responsibility. 

THE MILITARY PSYCHOLOGICAL AND SOCIOLOGICAL SERVICE
ROYAL NETHERLANDS ARMY

     To start with I will give you an overview of the specialists in my army in this field.  The RNLA comprises about 50.000 personnel; including civil servants, and - until 1997 - we employ conscripts as well. From that year on we will have an all volunteer force.  In that army over 50 officers serve as behavioural scientists, in all officers ranks - from lieutenant up to and including major-general. Over 20% of them are women - which in our army - and probably in most armies is an exceptionally high percentage. 
20 officers have a fixed term contract, and 30 have a permanent employment. They started, like I did, as an operational officer in for example infantry or armour, followed by a study (during one's captain time) in a civil university and graduation in psychology or sociology.  About 20 of my colleagues are clinical psychologists/psychotherapists, they also serve in the personnel branch, and not, as in most other NATO countries, in the medical branch.  The remaining 30 officers in our service are industrial psychologists, orginizational sociologists, educational psychologists, some experimental psychologists and methodologists.  We only have 2 psychiatrists in our army, (who belong to the medical branch), one in the department of psychiatry of the three Services' military hospital in Utrecht, and one in the Psychotherapy Department of the Army.  Over and above these military behavioural scientists several psychologists and sociologists are employed by our army as civil servants, predominantly in our research departments.

CONTRIBUTIONS OF MILITARY PSYCHOLOGY TO UN-OPERATIONS PRINCIPLES

     We learned a lot from literature and personal contacts with colleagues from other countries;  for example the experiences of our colleagues in Israel, the United States, especially after Vietnam, and Norway (the UNIFIL study).  But of course we also have our own experiences, with for example the veterans from the political conflicts in the former Dutch Indies, nearly 50 years ago but now a current topic again. Then Korea, and later the Lebanon (1979-1985) where we had, as I've said before, over 8000 men. After that operation we conducted three large studies into the problems of these UNIFIL-veterans (1980, 1987, 1989). To give only one of the research results: in 1987 about 10 procent of our Lebanon-veterans still suffered from problems related to their mission: from maladaptation to PTSD. In those days however, no support at all was given by behavioural scientists or psychotherapists, mainly because there were only a few of them at that moment, and psychological support was not so well accepted as it is nowadays.

     We profited a great deal from our participation in the so called NATO Research study groups, one on psychological fitness, and one on psychological support, from the 9 International stress workshops organized by the US Army Health Services Command (by David Mangelsdorff), and from collaboration with veteran organizations in Holland and specialized psychiatric hospitals (like the famous Centrum '45).

     Based upon our own experiences, and the knowledge we gained through literature, conferences and collaboration with colleagues in and outside NATO, we developed 'psychological' principles for missions abroad:

1. we need psychologically well balanced or stable individuals, to prevent the aggrevation of existing problems during their mission. In this way we try to prevent the deployment of so called 'escapists' as volunteers. This was - as we discovered afterwards - the main cause for psychological problems during the Lebanon-mission). Also candidates with a history of stressful life events are in our opinion not well suited for duties abroad. 

2. We attach great importance to the home front, family, partners. Not only for their sake, but for the well being of the deployed soldiers as well. For him or her a solid homefront is a problem less to worry about.

3. We consider stress a normal reaction to an abnormal situation, and propagate this as much as possible. Emotions are discussible, for soldiers too!

4. And then of course, but a little late, we apply the Salmon principes (from 1917) for the treatment of combat- or battle stress:

s simplicity
the treatment must be as simple and short as possible, so no psychodynamic therapy, to mention but one example;
p proximity
the treatment must be administered as near as possible to the spot where the stress was caused, so no transport of victims to the rear area;
i immediacy
the treatment must also be administered without delay;
e expectancy
the victim must expect to return to his normal military duty as soon as possible; this must also be the expectation of his buddies and his unit;
s standardization
the treatment must be standardized; that is not be dependent on personal preferences of the therapist and also independent of the unit the victim belongs to.

Summarizing: the stressed soldier is not a medical patient, but a soldier who is affected by an abnormal situation, and has some problems due to mental fatigue.

These four guidelines I mentioned (stable individuals, homefront care, stress as a normal reaction, and the Salmon principles) of course promptly follow 'normal' militairy principles: good leadership, group cohesion etc.

THE POLICY COMPRISES 10 'STEPS'

step 1: initial or intake selection for regular soldiers:
by means of among other things personality tests (NPV) and an interview, aimed at deployability abroad and psychological fitness, we assess psychological stability and try to filter out the high risk groups (among others the escapists and the personnel with a history of stressful life events).

step 2: for conscripts (only volunteers participate in UN operations) step 2 is is a psychological screening before they are deployed abroad, also aimed at psychological stability and assessing risk groups.
this screening consists of three elements:
a personality test (NVM or shortened version of the MMPI)
an interview by a psychologist
and a Peace Operations Deployment questionnaire, based upon DVL (defence questionnaire), that was put together after analysis of dossiers of 3000 conscripts who were dysfunctioning during duty in the the army, and after a comparison was made with conscripts without problems.

a remark: regular soldiers who served in the army before we started the UN peacekeeping operations are neither selected nor screened for deployment abroad; it is the responsibility of the soldier himself and his commander to assess his fitness for deployment, and to ask for a screening (medical or psychological) if a professional opinion is needed.
If a soldier is assessed unfit for missions abroad, and there is no foreseeable recovery, discharge from service will follow.

If time allows, I will focus upon selection and screening in detail later on.

step 3: education and counselling on stress and social support, preferably by the psychologist who will accompany the unit as a field psychologist when the unit is sent abroad. I will discuss the field psychologist in a moment.

in this process of counselling we also incorporate the homefront.

in all initial training, lessons on stress are scheduled, and for that purpose in the Army's UN field manual a chapter on stress is included, and plastic pocket cards on stress are supplied

also during the training in the army's Centre for Peacekeeping operations (a specialised army training centre) much attention is given to stress - theoretically as well as in active training, by way of high risk-high stress training, and to buddy relations, group cohesion and so on.

Key personnel within each unit are specially trained in debriefing techniques (Mitchell Critical Incident Stress Debriefing), to apply after calamities have happened and the field psychologist is, for example because of the large distances and the lack of adequate transportation, not available. This field psychologist forms step 4 in the policy. 

step 4: support by a field psychologist in the area of operations

Each unit of battalion size has a so called social coordinating committee; already in the barracks in Holland. This committee comprises the unit medical doctor, the chaplain, the welfare officer,  the personnel officer (S1), and, when the unit is assigned for duty abroad, a field psychologist, that is a clinical psychologist with the rank of major or lieutenant colonel. If units of a size smaller then battalion are deployed, the estimated risks determine wether a psychologist is assigned to the unit.
The field psychologist has three tasks: he is an advisor to the commander, he supports the key personnel I spoke of, and he acts as a counsellor or therapist when necessary.

All activities concerning the field psychologist are described in a 'strategy of psychological support', approved by the chief of army staff.

step 5: family support or - as we call it - homefront care

The RNLA facilitates the establishment of and guides the so called 'home front committees'. They comprise partners or parents of soldiers deployed in UN operations, and help each other in difficult times, in meetings, and through so called telephone circles.
Of course a sitcen - a situation centre at the Army Headquarters - is available on a 24 hour basis for the family that needs information on the whereabouts of their relatives.

Although the RNLA takes initiatives and facilitates with financial help, personnel and so on, 	it is, and will stay, the responsabilitity of the partners and parents if they themselfes will join the committee of the unit the soldier belongs to. 
An evaluation study is being conducted now, with the purpose of providing guidelines on how to organize the family support in the best way.

step 6: Debriefing

Of course, after each serious incident, the psychologist or the key functionary in the unit will conduct a debriefing following the Mitchell principles of Critical Incident Stress Debriefing. 

Moreover, a psychological debriefing takes place before the personnel return home after their duty abroad. This is normally done in the area of operations and in the units, but if necessary, with personnel deployed inividually as UN monitors for example, debriefing can be done individually as well.

Eventually, when a psychotherapist is needed, but is not available in the area of operations (for example because the unit was to small to assign one to) a psychotherapist or a team will be flown into the area.

During these debriefing meetings written material is handed out on possible delayed effects and how to act if problems arise.

step 7: Concerns the so called reïntegration meetings.

8 weeks after returning to the Netherlands the soldiers are invited to take part in a reïntegration meeting guided by the social service of the army. This is done in units preferably, but here too individual personnel, again the UN monitors for example, can join these meetings as well. Participation is voluntary. During these meetings the soldiers discuss their adaptation to normal life, in work and family, the so called reintegration process, and the problems they are confronted with. Together they try to find solutions. The optimal way these meetings are organized is the subject of a current study by my department.

step 8: Veteran care.
Four basic principles guide our, that is the RNLA's, policy concerning veterans from UN operations:
1. veteran care is the responsibility of the army, even if the veterans are no longer part of that army.
2. there should be an active approach, an outreach to the veterans, to survey possible problems and to offer help
3. the help offered by the army is as accessible as possible, that is, there are no barriers.
A veteran in need of support can approach his own psychotherapist, the officer-psychologist who he served with during his duty, even if the veteran has left the army already.
4. there is good collaboration between the military mental health services, the veterans organizations, and the specialized civilian mental health centres. The foundation for veteran care has a central coordinating role in these activities.

step 9: All lessons learned are collected by a special office of the chief of army staff. This relates not only to the experiences in our branch, but also in operations, logistics and so on. Behavioural scientists help to structure the way the information is compiled, and to analyse the data and draw conclusions.

step 10:  Last, but not at least, there is the systematic evaluation of all the steps I mentioned before. An example of such a study is the one the army conducts among UN veterans. 
I will present an overview of that study in a few moments, with some preliminary results.

SCREENING

As I promissed, I will go into the screening in some detail now.

With effect from February 1993 conscripts willing to be deployed (in UN operations) in the former Yugoslavia are screened before they are called up for training at the Training Centre for UN Peace (Keeping) Operations (known as the CVV in Dutch). 

The screening procedure consists of a psychological test and a medical checkup. The screening test is conducted by psychologists and doctors from the Directorate of Conscript Personnel's conscription boards. The psychological test only is to be discussed in these notes. 

The objectives of the screening test are:
.	to prevent adjustment problems;
.	to limit the number of combat stress victims, the development of Post-Traumatic Stress Disorder (PTSD) or other problems regarding stress management. 
Screening tests can only constitute a decision on someone's unsuitability for a particular post, in this case for deployment abroad.

In the screening test, conscript personnel are assessed with regard to personal factors which might influence the manifestation of adjustment problems, combat stress, PTSD or stress management problems.

The different factors have been categorised into the following five groups:

1.	Styles of coping, locus of control and motivation for deployment (flight). Coping mechanisms are characteristic ways of handling a particular or changed situation. Coping is often regarded as a stabilising factor which ensures that individuals can face stressful occurrences confronting them. There are more adequate and less adequate styles of coping. More adequate styles of coping with traumatic events are acting in a planned and rational way, expressing emotions, seeking social support and using humour as a toning down tool. 

The style of coping is also closely related to an individual's 'Locus of Control'.The Locus of Control is the idea that someone has of his/her capacity to give direction to his/her life. 

In order to adapt to a new (and stressful) situation, a certain amount of flexibility is required. People confronted with a new situation need to (be willing to) feel that it is a challenge to solve problems occurring in the new situation with new solving methods. 

Experiences with former UNIFIL personnel who required psychological counselling upon their return to the Netherlands have shown that this need for 'aftercare' is closely related to the 'flight' motivation. The motivation to go to the Lebanon as a volunteer stemmed from the need to leave the Netherlands, having grown bored with the Netherlands, thus trying to avoid or solve the problems at home. Fleeing the problem might be a way of dealing with problems in general. 

2.	Social skills, assertiveness and expressing emotions. In order to function well in a new and stressful situation, it is important for each individual to be included in and supported by the group. The ability to get on well with others is of vital importance in order to function within a group and for the creation of a group spirit. Moreover, this requires flexibility, the ability to adapt to others, and a cooperative disposition. This is closely related to being aware of others and to easily making contact with others. 

In order to process traumatic experiences, the ability to express emotions and the social support of others play a central part. In order to function in stressful situations, the individual must have social skills, must dare to express emotions and must be able to cope with others expressing their emotions. It is likely that people who cannot express their emotions were also unable to do so in any traumatic experiences they might have had in the past. It could be the case that these emotions have not yet been processed, and that an 'affect bridge' is created from the present to the past by the confrontation with violence and suffering. The experiences from the past are recalled and relived.

3.	Psychosocial problems. Problems of this kind (death of a close relative, termination of a relationship, problems in a relationship, etc.) can lead to (temporary) emotional instability.

Motivation for deployment abroad could be the desire to escape from problems, either in the social environment or in the relationship with the partner and/or family. The 'flight' motivation seems to be closely related to the need for psychological counselling after the period of deployment.

If a soldier is worried about things at home, his emotional stability will be influenced. These worries are often about the family and/or partner having to carry on alone. 

The attitude of those around the soldier during his period of deployment is an influential factor on his motivation. There can be a conflict of loyalties between family/social environment and the army. The environment can either be a source of social support, or indeed an additional burden.

All of the above situations (therefore) influence emotional stability. Emotional instability increases the likelihood of adjustment problems, combat stress and the occurrence of PTSD.

4.	Neuroticism, personality and development disorders and homesickness. Research has shown that in particular psychiatric disorders, neuroticism, personality and development disorders serve to promote the manifestation of combat stress. Obviously, they also influence the adjustment to the new situation. One example of the consequences of such disorders is homesickness. 

5.	Miscellaneous: preparation, addictions, criminal tendencies, philosophy of life, forming an identity and discrimination.

Inadequate mental preparation (non-realistic expectations) make it more difficult to adapt to the new situation. 

The mental health and the pressure-resistance of an individual is influenced by gambling, alcohol and the use of drugs. Stressful circumstances will result in a stronger need for these substances, which impedes functioning. 

Individuals who have committed (minor) criminal offences constitute an additional risk in the event of deployment. They tend to continue such activities, even in the war zone. If criminal tendencies go hand-in-hand with violence, this can indicate an aggression regulation disorder or a lack of social skills. 

The race, sex or sexual orientation of service personnel can cause them to become the victim of harassment and/or discrimination. Assertiveness and the ability to deal with aggression directed towards them are important qualities in this respect. 

The philosophy of life of individual service personnel influences their attitude towards other norms and values.  How tolerant is he of others? Is he capable of cooperating with service personnel from other cultures and with other norms and values? 

The period of identity formation between 18 and 22 years of age can constitute a risk. During this period it is possible that the individual has little self-respect and is very unsure. This can be a negative influence in social contacts and coping with a situation. 

A model has been created for the screening test, based on the personal factors distinguished above. The screening test consists of an interview and questionnaires. 

Interview
All of the above factors are assessed in the interview based on past behaviour, responses to proposed situations and questions on the experience of events in the candidate's past. 
The interview is structured. To assist the psychologists in making their assessment, the theoretical foundation of the screening tests indicates for each factor the types of behaviour and experiences considered positive and those seen as negative in respect of the prediction of adjustment problems, combat stress and the occurrence of PTSD.

Reports are drawn up and, on the basis of the interview, a risk estimation is made with respect to all of the aforementioned factors (low, average, high risk). The estimations lead to a risk verdict taking all factors into account. Risk detection with regard to the factors of addictions, criminal tendencies and motivation (flight) result directly in a rejection (high risk).

Questionnaires
Questionnaires are used in addition to the interview. An abridged Dutch version of the MMPI is used, focusing on the following aspects:

Extraversion:			The items from this scale cover all manner of social contacts and an energetic and active attitude towards them. 

Psychopathology:		This scale contains items with respect to delusory feelings, paranoid thoughts and bizarre experiences.

Shyness:				The items in this scale chiefly reflect a feeling of shyness and difficulty in contacts with others.

Occurrence of psycho-	This scale contains mainly items
somatic symptoms as a 	involving all kinds of vague physical
result of stress:		complaints. 

Negativism:			This scale contains items involving passive avoidance behaviour, feelings of dissatisfaction and resentment towards various aspects of everyday life, and aggressive behaviour. 

The 'Peace Operations Deployment' (POD) questionnaire is also used (abridged Defence questionnaire), which includes two (abridged) scales for measuring depression and neuroticism. 

The scale for neuroticism is a composition of the Buss and Plomin temperament scales ('75). The scale measures emotionality, depressiveness and feelings of self-respect. 

Two questions on the Locus of Control are included in the questions on the feelings of self-respect. The scale measures elements of frustration, ways of experiencing mental pressure, getting upset and agitation. The scale is composed on the basis of research which compared functioning and dysfunctioning conscripts (van Eck, '91).

The aforementioned research also produced the scale for depression. This scale measures the extent to which someone is susceptible to moods characterised by despondency, dejection, helplessness and pessimism. The scale contains a number of questions from the Zung Self-rating Depression Inventory (Van Son, '78). 

Biographical information is also looked at in the POD.

The questionnaires are studied in combination with the information gathered during the interview, and lead, in combination with the interview's risk verdict, to the final advice: low, average or high risk, the last group counting about 50% (of the volunteers!). 

RESEARCH

The second subject to present in more detail now is the so called veteran care study. This is a research project conducted by my department in cooperation with the psychotherapy department of the RNLA, of which ltcol Martens is present here in this workshop.

As mentioned before, since 1990 almost 10.000 military personnel from the Royal Netherlands Army (RNLA) have participated in one or several UN missions. I think all of you will be aware of the psychological consequences of war and peacekeeping upon soldiers.

The project I will expound here involves actually contacting military personnel about nine months after their return from a mission, to ascertain how they are getting on, what consequences of their deployment they still experience.

Research and experiences of our social workers show that soldiers who have problems coping with their experiences resulting from a mission, frequently withdraw from social contacts, feel themselves misunderstood and often deny that they have any psychological problems. These symptoms mean that military personnel with psychological problems will not, by their own initiative, get in touch with a social worker or therapist. This is why we think it is necessary for each individual serviceman or woman to be contacted to see whether they are encountering problems as a result of their assignment and to offer them help if they need it. This active, personal approach is also called outreach. (Outreach can prevent military personnel having to battle along with problems for years before they end up seeking help. The chance of successful treatment is enhanced if the symptoms are spotted in time)

Moreover, by contacting military personnel and finding out how they are getting on, we can obtain insight into the long lasting effects of missions. Since more and more military personnel are likely to be sent abroad in the future, we need insight into these long-term effects. Psychological and/or psychosocial problems resulting from a posting may place constraints on the deployability and effectiveness of military personnel in a subsequent mission. 

So this study was a combination of veteran care and research.

In the study we obtained an image of the long-term effects of missions on a small group of personnel. I shall give you an impression of what this involves. I will also evaluate the outreach project. How well does the outreach work and what is the RNLA going to do with it in the future?

Method

We decided to use a questionnaire for the active approach. This was sent to military personnel who had been back from their mission for longer than six months. Overall the questionnaire asked: what was the mission like, how are you getting on now and do you need any help?

The questionnaire sought to discover, by means of an exposure scale and additional questions, what stressors military personnel had experienced during the mission. The questionnaire also included Dr J.E. Hovens' Post Traumatic Stress Disorder (PTSD) self-inventory list. This list includes feelings, thoughts, behaviour and complaints which are characteristic of PTSD. It contains items on intrusion, avoidance and hyperarousal experiences.

We also asked questions about physical and/or mental changes since the mission and adjustments to life at work and at home in the Netherlands. Lastly, military personnel were asked whether they felt the need to talk to a therapist to recapitulate on what happened during the mission and discuss the process of adjusting in the Netherlands.

Besides these questions on the welfare of military personnel, a number of questions were also included to find out what military personnel thought in general of the psychological support in relation to the mission, and what they thought about receiving the questionnaire as part of the veteran care.

Since missions are not only stressful for the soldiers but as well for their partner or family, a separate part of the questionnaire was reserved for questions to partners, parents or friends. Military personnel were asked to fill in this part together with someone important to them.

As part of the study the questionnaire was sent to 226 servicemen and women who had taken part in a UN mission in the former Yugoslavia, Angola or Iraq. 139 of them returned the questionnaire (60% response).

The Norwegian army carried out a comparable survey into the psychological effects of Unifil missions in 1993. The Norwegian survey revealed that a high proportion of the high risk group of personnel who had been contacted by means of a questionnaire did not return it. Personal contact with these non-respondents made it clear that this group, comparatively speaking, had more problems than those who had returned the questionnaire.

In our study, therefore, the non-respondents were contacted by telephone. The aim of these telephone calls was:
-	to find out whether these non-respondents were encountering problems as a result of the mission and if so to offer them immediate help.
-	to find out what they thought of the active approach, the questionnaire and the telephone call.

The questionnaires that were returned to us were assessed by psychotherapists. The therapists determined, by looking at the replies, whether help should be offered and invited these respondents for an interview.

Aim of the study

The RNLA considers it necessary to actively contact military personnel to find out whether they are having problems as a result of the mission. This study was set up as a try-out to see how the outreach worked.

We try, through this study, to answer the following questions:

1.	Which soldiers encounter psychological problems as a result of the mission and who needs help? The question to be answered is whether the questionnaire can be used to find out who needs help.

2.	What are the pros and cons of outreach? We wondered what military personnel thought of the questionnaire and whether they wanted to answer the personal questions about feelings, thoughts and problems. Is there a need for outreach? This was why the outeach was evaluated.

3.	How many soldiers in the target group have problems as a result of the mission and what kind of problems are they? The RNLA wants to find out more about the effects of missions for military personnel and their families.

If it is ascertained, by means of the questionnaire, that the veterans are still encountering problems as a result of their posting, there has to be sufficient staff in the organisation who can assess the questionnaires, offer help and further therapy to respondents who do have psychological problems.

Long-term effects

At this moment the study is nearing completion. I will tell you something about the long-term effects in so far as these have become clear up to now.

I will examine two questions. Does the questionnaire work, and what are the long-lasting effects of the mission?

As regards the longlasting effects, it emerges from the questionnaires returned that the majority of military personnel look back on the mission as a positive experience. At the same time 40% of the respondents, however, admit that the mission was very demanding for their family.

Partners or sometimes parents indicated in the questionnaire that they were less negative about the mission in retrospect than they had anticipated beforehand. It turned out better than they had expected. Nevertheless, one third of the partners referred to the mission as a very stressful period and hoped that they would not have to go through it again.

The majority of the military personnel said that after the mission they had no serious difficulties in getting used to the situation at home. One third of the respondents, however, did say they had difficulty in getting on with people who were important to them in their close surroundings and in getting used to the way of life in the Netherlands.

Therapists assessed the questionnaires. They observed that 45 respondents (20%) were suffering from psychological and/or psycho-social problems to some degree and thought it desirable to offer them the opportunity of coming to talk. It cannot be said with any certainty on the basis of the questionnaire whether their problems had arisen as a result of the mission. But, irrespective of the cause of the problem, help, naturally, was offered.

The group of 45 persons comprised 13 who reported PTSD symptoms (10%); four of them could almost certainly be diagnosed as having PTSD (3%). Other reasons for inviting someone for counselling were: 

.	reported stressfull encounters during operations
.	reported fysical or mental changes
.	welfare or complaints of the partner
.	or if the respondent asked for an interview with a therapist

So 45 people were invited and offered help. 10 persons responded positively. 7 of them are in therapy now. For 3 of them further counselling proved unnecessary. All respondents diagnosed as having PTSD are in therapy now.

These were the long term effects of the respondents. I now come to the non-respondents.
Forty % of the addressed soldiers did not return the questionnaire. It was ascertained by telephone among these non-respondents whether they had problems. Up to now 42 people have been reached and they cooperated in an interview by telephone (48% of the non-respondents). Minor psycho-social problems were noted among four of them, but they did not respond to the therapist's offer of help. Given the fact that the problems were not very serious, the therapist did not press the matter. Up to now there would not appear to be more psychological problems in this group of non-respondents than in the group of respondents. About 4% of the subjects could, unfortunately, not been traced and it could very well be that the small group of those who have not been reached are having more problems.

These were the main long-term effects of the survey group. Twenty % of the response group is experiencing problems. Three % of the respondents have developed PTSD.  5% of the respondents have been traced by the questionnaire and receive therapy now. 

This study has made it clear that psychological problems can be spotted by means of the questionnaire. Soldiers dare report their problems in the questionnaire.

Evaluation of outreach

Another aim of the study was to ascertain the pros and cons of outreach by means of a questionnaire. 

More than two thirds of the respondents were positive about receiving the questionnaire as part of the veteran care programme. This emerged, too, from the fact that a great many respondents gave lots of information on the open questions and enclosed letters when returning the questionnaire explaining their specific experiences and feelings.
The respondents were enthusiastic about the questionnaire because they appreciated the care that the RNLA is devoting to personnel and because the questionnaire offered them the opportunity of talking about the things that were preoccupying them and of relating their experiences. The questionnaire was found to work as a kind of self-debriefing.

The respondents who were not very enthusiastic about receiving the questionnaire, indicated that the questionnaire arrived much too late for them (for example two years after they had returned from a mission) and that they felt that the questionnaire should have been sent to them much sooner.
Only four respondents explicitly said that they did not wish to take part in a survey of this kind.

Partners and parents of military personnel also responded positively. They said that this was because they now had the chance to tell their own story and because it was apparent from the questions that the RNLA realised what the mission had meant for family and friends.

It emerged from the telephone calls with non-respondents that, generally speaking, they had not returned the questionnaire because they thought it was too much work to reply to the fairly detailed questions. Only a few refused to cooperate in the telephone interview and refused to have anything to do with the survey. On the whole people responded positively to the telephone call. People generally reacted in the vein of: I forgot to return the questionnaire and now somebody is taking the trouble to call me. They appreciated the concern demonstrated. Up to now only half of the non-respondents have been reached, so we cannot say that this finding is generally applicable to non-respondents.

What can we conclude from this study?

It has emerged from the study that military personnel who are experiencing psychological problems as a result of a mission can be traced by means of the questionnaire.

It turned out that 20% of the respondents had problems and that 3% of the respondents would appear to be suffering from PTSD. 5% of the respondents are in therapy now as a result of the questionnaire.

So far it seems as if the group of non-respondents has no more psychological problems than the group of respondents.

It was clear that the majority of the respondents and non-respondents thought well of the active approach by means of a questionnaire and by means of a telephone call. 

On the strength of this study the RNLA intends to continue with the active approach by means of a questionnaire. In the next few years, all military personnel who have taken part in a UN mission since 1990 will be sent the questionnaire and, if necessary, help will be offered to them. In the future it will become a standard procedure as part of the veterancare for all military personnel to be sent the questionnaire about nine months after returning from a mission.

I will conclude with two final remarks:

I have presented an overview of a policy including ten separate steps in which behavioural scientists can contribute to peace keeping operations.
This policy, adopted by the RNLA, seems to be effective. 
We see a decrease in problems, and these psychosocial problems we do meet can be treated at an earlier stage and thus be resolved easier, quicker and more thoroughly. 
Above that we notice a great acceptance of the contribution of psychologists in the army, and more and more operational commanders ask for behavioural scientists in their units. 
The fact that soldiers too have emotions and can have emotional problems that can be discussed and treated is now a fact of life in the army. 

In the near future I foresee that NATO will develop a policy on these matters, and cooperation with partnership for peace countries will strongly increase. RNLA for example has some kind of collaboration on a binational level with the Ukraïne, Poland, Bellarussia, and Slovakia.  And this workshop on psychological support is the best proof of the increasing collaboration between NATO countries and our PFP-partners.

I thank you very much for your kind attention.

1 Colonel Herman W. de Swart, experimental psychologist
Head of the Behavioural Sciences Department, Directorate of Personnel, 
and Head of the Military Psychological and Sociological Service
Royal Netherlands Army

2 Tessa G.E. Willigenburg, Natasja Alkemade, psychologists
Behavioural Sciences Department, Directorate of Personnel,
Royal Netherlands Army

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