Awhile back I was contacted by RAND to help promote this survey. I agreed because there was not enough information out there on the subject of contractor physical and mental health in these wars. So it is cool to see a final product and available for folks to check out.
The information provided is pretty revealing and I highly suggest reviewing the document if you are interested in either getting into this industry, or just learning about the actual health of this industry.
Now for some of the interesting tidbits that I found in the survey.
Only 16 percent of contractors sampled had ever made a DBA claim. Among those whose most recent contract had been funded by the U.S. government, 22 percent reported that they had made a DBA claim. The DBA mandates that all civilian employees working outside the United States on U.S. military bases or under a contract with the U.S. government for public works or national defense have access to workers’ compensation for injuries or deaths sustained as a result of such employment. We found that, among respondents who applied for benefits, 57 percent of claims were approved and 37 percent were either denied or still being processed at the time of the survey. (Six percent of respondents reported that they did not know the outcome of their DBA claim.) Contractors from the United States were more likely to file DBA claims than those from other countries. -page 20
Only 57 percent approved? This is a horrible statistic, but not new. The survey mentioned the findings of T. Christian Miller’s report as well, which I posted several years back.
In a series of articles for ProPublica, T. Christian Miller reported on the types of physical and mental health problems affecting contractors, including loss of limbs,burns, loss of hearing or eyesight, various wounds (such as from shrapnel, gunshots, mortar attacks, or IEDs), PTSD, TBI, depression, suicidal ideation, and suicide. Despite the reported frequency and severity of these problems, Miller (2009a) found that between 2002 and 2007, “insurers had denied 44 percent of all serious injury claims” under the DBA and that they “also turned down 60 percent of contractors who claimed to suffer psychological damage, such as post-traumatic stress disorder.” He highlights systemic flaws in the DBA—along with a lack of regulation and enforcement by the U.S. Department of Labor and the monopoly of insurance company AIG—as contributors to the high rate of DBA claim denial.
It just blows me away that ’60 percent of contractors’ with PTSD or some mental health issue, were turned down! And according to this recent survey, only 57 of these folks surveyed had that had DBA claims, had them approved. That has to change and contractors have sacrificed in this war. They deserve better than that, and it is shameful contractors are treated like this.
They also mentioned a company that specializes in providing mental health services. Back in 2008, I wrote a brief deal about Mission Critical Psychological Services and it is good to see they are still doing their thing.
Individual private companies have also developed programs to address the psychological challenges facing contractors, though there is limited publicly available information on how these programs are structured or the types of support they offer. For example, Mission Critical Psychological Services is a U.S.-based firm that provides psychological support services to firms in the contracting industry. Asked to estimate the number of contractors suffering from mental health issues, its CEO stated, “I think the numbers are in the thousands, maybe tens of thousands. Many are going undiagnosed. These guys are fighting demons, and they don’t know how to cope” (Risen, 2007). -page 45
I hope to see more companies pop up to meet the demand of contractor mental health, and especially after reports like this bringing attention to the matter. Or maybe, PMSC’s will be more focused on paying attention to this. Especially when they get their various certifications that show how compliant they are or when they are signatories to things like the ICoC. Check this quote out.
The extent to which the diverse array of contracting companies rely on private providers of psychological services tailored to the industry is unclear. However, recent U.S. and international codes and standards aimed at regulating the private security industry, in particular, clearly mandate that these firms establish policies that promote a safe and healthy working environment, including policies that address the psychological health of employees. One such requirement is embedded in the American National Standards Institute/ASIS International document Management System for Quality of Private Security Company Operations (known as the PSC.1 standard), which states, “The organization shall establish, implement, and maintain procedures to promote a safe and healthy working environment including reasonable precautions to protect people working on its behalf in high-risk or life threatening operations consistent with legal, regulatory, and contractual obligations.” One of the procedures specified is “medical and psychological health awareness training, care, and support” (American National Standards Institute and ASIS International, 2012,p. 24). The inclusion of such a requirement in the PSC.1 standard is significant, because compliance with the standard is now mandated in all DoD- and UK government-funded contracts. Moreover, the International Code of Conduct, a multi-stakeholder initiative aimed at industry self-regulation to which more than 600 private security companies are now signatories, includes a similar provision requiring that signatory companies adopt policies that support a safe and healthy working environment. This requirement specifically mentions a requirement for policies that address psychological health (“International Code of Conduct for Private Security Service Providers,” 2010,section 64d, p. 14). -page 45
Why is this important? Well for one, if you look at past incidents of contractors ‘snapping’ like with the Fitzsimmons case in Iraq, you can see why it is so important for companies to care about this stuff. Unfortunately, they do not care.
It is my experience as a contractor that none of the companies I have worked for, presented any kind of program that focused on the mental health of it’s contractors. I was never informed of any services and was just expected to deal with issues on my own.
Nor have I have ever worked with anyone in the past that has filed a DBA as a contractor for mental health issues–even though I know there are guys who should. Hell, this year alone, I am aware of two contractors that I worked with in the past that committed suicide recently–one of which was a friend. So I know there are mental issues out there, and yet the companies are not really getting involved with this stuff.
The report also mentioned the fact that many contractors are prior veterans and may have gotten their PTSD from service in the military, which I concur. So with that said, the VA should be highly responsive to the needs of these veterans. Should, is the key word, because you get an earful from guys on contract on how crappy the VA is when dealing with this stuff. Several issues I have seen with contractors whom are veterans, are sleeping issues and TBI or traumatic brain injury. Or the use of pain killers to deal with past injuries. As for mental stuff, it is there, but guys usually don’t like going there.
On the positive side, contracts are a great way for veterans to come together again and share experiences. This is called armed group therapy. lol. Many contractors are attracted to this type of work, because it gets them back in the game of war, and gets them amongst a group that understands war. It is hard for guys to relate to others whom have not experienced that stuff, so that is what makes contracting a plus for veterans.
It is also interesting to note that if you watch AFN (Armed Forces Network) commercials overseas on TV, you are constantly bombarded by deals about suicide in the military or PTSD in the military. The services are constantly trying to reach out to Joes, and work the problem of suicide and PTSD. There are no commercials reaching out to contractors with similar health issues–even though there are more contractors in the war zones than there are military folks. There are no commercials at all geared towards contractors, which is interesting. With such health issues identified by RAND and others, some kind of effort to reach out to contractors could save lives.
Some other factoids that were of interest to me were the combat experiences and living conditions of contractors overseas. The one group of contractors that saw the most combat in this survey were the transportation security contractors or PSD/Convoy guys. The folks that go outside the wire and are exposed to the same dangers as the military, who all have to travel the same roads.
Training and advising contractors were the second most dangerous, which makes sense with all of the green on blue incidents involving contractors happening in places like Afghanistan. Also, by nationality in this survey, the US contractors saw more combat than any other nationality surveyed. Although I doubt this would be the case if Afghan or Iraqi contractors were more involved in this survey. lol
The living conditions of contractors were interesting as well. The worst living conditions experienced were the transportation guys. Living in transient tents all the time or sleeping in your truck can get old. You also work really long hours and the whole 12 hour shift concept seems to be used more and more by companies. Which really sucks, because this hinders sleep, thus making it difficult to keep sharp on the job. More companies neglect giving time off out in the field as well, and there is not enough emphasis on giving folks a break out there so they can recharge. Getting good sleep and not being overworked is crucial to security operations, and this is neglected all the time by the companies.
The best living conditions were experienced by the maritime security folks and logistics/maintenance folks.
Interesting report and check it out for yourself. Companies should take the time to read this and get a better feel for what is going on out there with their people, or try to work harder to meet the needs of their people. Thanks to RAND and authors, and to all of the contractors that participated in this survey. Hopefully this will get the conversation going on the true health of this industry, and how to meet the needs of contractors. –Matt
Read the report here.
Read the summary here.
This is a quick report done on AIG and the way they have treated DBA claims of contractors. Horrible treatment is all I have to say, and the statistics support that.
Contractors Who Worked in Conflict Zones Suffer High Rates of PTSD, Depression and Get Little Help
December 10, 2013
Private contractors who worked in Iraq, Afghanistan or other conflict environments over the past two years report suffering from post-traumatic stress disorder and depression more often than military personnel who served in recent conflicts, according to a new RAND Corporation study.
Researchers found that among the contractors studied, 25 percent met criteria for PTSD, 18 percent screened positive for depression and half reported alcohol misuse. Despite their troubles, relatively few get help either before or after deployment.
“Given the extensive use of contractors in conflict areas in recent years, these findings highlight a significant but often overlooked group of people struggling with the after-effects of working in a war zone,” said Molly Dunigan, co-author of the study and a political scientist with RAND, a nonprofit research organization.
The results are from an anonymous online survey of 660 people who had deployed on contract to a theater of conflict at least once between early 2011 and early 2013. The study attracted participants through several methods, including contacting individual companies and trade associations and posting links to the survey on websites and blogs. It is the first survey to examine a broad range of deployed contractors, not just those who provide security services.
While the contractors surveyed suffered problems at higher rates than military members, researchers caution that such rates cannot easily be compared because of variations in measures and methodology. Among U.S. troops deployed to Iraq or Afghanistan, PTSD rates are estimated at 4 percent to 20 percent, depression rates are estimated at 5 percent to 37 percent and alcohol misuse is estimated at 5 percent to 39 percent.
“Because many of the contractors participating in the study — 84 percent — had previously served in the armed forces, it is difficult to gauge whether their work on contract is the source of these problems, or whether they stem from prior military experiences,” Dunigan said. “However, the critical thing to take away from this study is that a significant number of people working on the ground in conflict environments are suffering from these problems, and many of their deployment-related health needs are not being addressed.”
Researchers say more resources are needed to help contractors at all stages of their deployments.
“The military has programs before, during and after deployment to help service members address deployment-related mental health problems,” said Carrie Farmer, co-author of the study and a RAND health policy researcher. “The majority of contractors we surveyed reported that they did not have access to similar resources.”
Companies also may want to put more stringent pre-employment screening methods in place, but this might also inadvertently eliminate some potential hires with highly specialized skill sets.
“The critical thing to keep in mind is that mental health problems can be addressed. There are evidence-based treatments for these conditions,” Farmer said.
Sixty-one percent of those responding to the RAND survey were U.S. citizens, 24 percent were from the United Kingdom and the rest were citizens of Australia, South Africa, New Zealand and other nations.
Contractors have deployed extensively around the world in the past decade, supporting U.S. and allied forces in Iraq and Afghanistan, as well as assisting foreign governments, nongovernmental organizations and private businesses. Duties of contractors have included base support and maintenance, logistical supports, transportation, intelligence, communications, construction and security services.
During the height of the conflicts in Iraq and Afghanistan, the number of private military and security contractors employed by the U.S. Department of Defense outnumbered U.S. troops in both theaters. There were 155,826 contractors alongside 152,275 U.S. troops in Iraq in 2008, and 94,413 contractors alongside 91,600 U.S. troops in Afghanistan in 2010.
Although contractors are not supposed to engage in offensive combat, researchers say they may be exposed to such stressors as gunfire, improvised explosive devices, serious injury, kidnapping, the deaths of fellow personnel and the psychological aftermath of killing.
The RAND study found differences between the U.S. and U.K. contractors surveyed, with the former reporting nearly twice the rate of PTSD and depression as U.K. contractors. Contractors from the U.K. also reported better preparation, lower levels of combat exposure and better living conditions than U.S. citizens, on average. However, respondents who were citizens of countries other than the U.S. and U.K. reported even better experiences in these categories.
“While we tried to control for combat experience, there may be unmeasured differences in what the two groups were exposed to, or there may be social or cultural differences in how they respond to combat,” Farmer said.
Transportation contractors in particular reported the lowest levels of preparation, the highest combat exposure and the worst living conditions of all the job specialties surveyed. Logistics and maintenance contractors fared best in all three categories, while maritime security contractors fared well in terms of combat exposure and living conditions. Contractors who carried a weapon felt better prepared for deployment than those who did not.
A number of contractors also reported physical health problems as a result of deployment, including traumatic brain injuries, respiratory issues, back pain and hearing problems. Although most had health insurance, only 28 percent of those with probable PTSD and 34 percent of those screening positive for depression reported receiving mental health treatment in the previous 12 months.
The study, “Out of the Shadows: The Health and Well-Being of Private Contractors Working in Conflict Environments,” can be found at www.rand.org. Other authors of the study include Rachel M. Burns, Alison Hawks and Claude Messan Setodji.
The study is a product of the RAND Corporation’s continuing program of self-initiated independent research. Support for such research is provided, in part, by donors and by the independent research and development provisions of RAND contracts for the operation of its U.S. Department of Defense federally funded research and development centers.
The research was conducted within the RAND National Security Research Division, which conducts research and analysis on defense and national security topics for the U.S. and allied defense, foreign policy, homeland security and intelligence communities and foundations and other nongovernmental organizations that support defense and national security analysis.