兰德-Out-of-the-Shadows_-The-Health-and-Well_143页_1mb

Summary of "The Health and Well-Being of Private Contractors Working in Conflict Environments"

Core Content

This report by the RAND Corporation examines the health and well-being of private contractors working in conflict environments, focusing on mental and physical health challenges and access to health care services. It is part of the RAND National Security Research Division's research on defense and national security issues, particularly in the context of private military and security contracting.

Main Points

1. Role of Private Contractors in Conflict Zones

• Private contractors have been deployed globally over the past decade, often supporting U.S. and allied forces in Iraq and Afghanistan.
• They provide a wide range of services, including base support, logistics, transportation, intelligence, and security.
• The number of U.S. Department of Defense (DoD)-funded contractors often exceeds the number of U.S. troops in these regions.

2. Health Risks for Contractors

• Contractors face similar physical and mental health stressors as military personnel, including exposure to combat, improvised explosive devices (IEDs), and psychological trauma.
• There is a lack of comprehensive research on their health outcomes, despite anecdotal evidence of mental health issues.

3. Survey Methodology

• A survey of 660 contractors who had deployed at least once in the 2011–2013 timeframe was conducted.
• Respondents were from the U.S., UK, Australia, South Africa, New Zealand, and other countries.
• The survey covered deployment experiences, mental and physical health, and access to health care services.

4. Key Findings

• Deployment Experiences:
  • Contractors' levels of preparedness and combat exposure are similar to military personnel, though some differences exist by nationality and job specialty.
  • UK contractors reported better preparation, lower combat exposure, and better living conditions compared to U.S. contractors.
  • Transportation contractors had the lowest levels of preparation and highest combat exposure.
  • Contractors with shorter, more frequent deployments reported better preparedness and lower combat exposure.
• Mental Health:
  • 25% of contractors met criteria for probable PTSD, 18% for depression, and 10% for high-risk alcohol use.
  • Transportation contractors had the highest PTSD rate at 50%.
  • U.S. contractors reported more mental health issues than UK contractors.
• Physical Health:
  • Most contractors reported being in "excellent" or "very good" health.
  • 10% had a history of traumatic brain injury (TBI), and 39% reported other physical health conditions (e.g., respiratory issues, back pain, hearing loss).
  • Physical health problems varied by country and job specialty, with transportation contractors most affected.
• Health Care Access:
  • 83% of contractors had health insurance, but many did not receive adequate care.
  • Only 28% of those with probable PTSD and 34% of those with probable depression received mental health treatment in the 12 months before the survey.
  • Stigma, cost, and concerns about being perceived as weak were major barriers to mental health care.
  • The Defense Base Act (DBA) claims were filed by 16% of contractors, with 57% of claims approved and 37% denied or pending.

Key Recommendations

• Increase Access to Stress Management and Mental Health Resources:

  • Contractors should have more consistent access to stress management and mental health resources, both before and during deployments.
  • Private companies and government agencies should consider including such resources as a contractual requirement.

• Reduce Stigma Around Mental Health Care:

  • Education and awareness programs should be implemented to reduce stigma and encourage contractors to seek mental health treatment.
  • Confidential counseling and team leader training on identifying and normalizing stress reactions can help improve mental health care utilization.

• Conduct Further Research:

  • Additional studies are needed to better understand the health needs of this population, including:
    • The impact of predeployment training on health outcomes.
    • The effects of different deployment experiences on health and well-being.
    • The causes of physical health issues among contractors.
    • Differences in health outcomes between contractors of different nationalities.
    • The long-term health effects of contractors deployed over the past decade.

Conclusion

The health and well-being of private contractors in conflict environments are significant concerns, with substantial mental and physical health challenges. Despite having health insurance, many contractors do not receive the care they need, highlighting the need for improved access to mental health resources and a reduction in the stigma associated with seeking such care. The findings suggest that the experiences and health outcomes of contractors vary by nationality, job specialty, and deployment characteristics, underscoring the importance of tailored support and further research in this area.

Key Tables and Data

• Table 1.1: Comparison of RAND Survey with DoD Data on Contractors.
• Table 2.1: Comparing beliefs of U.S. and UK service members with and without mental health diagnoses.
• Table 3.1: Overall deployment experiences of contractors.
• Table 4.1: Predictors of PTSD and depression among contractors.
• Table 5.1: Predictors of physical health problems among contractors.
• Table 6.1: Access to company-provided stress management resources.
• Table 6.2: Perceived barriers to mental health treatment.

Acknowledgments

The report acknowledges the contributions of various individuals, organizations, and companies that supported the survey development and dissemination. It also thanks the contractors who participated, as well as the RAND staff involved in the research and writing process.