DoD Instruction 6490.05, Maintenance of Psychological Health in Military Operations

Department of Defense

INSTRUCTION
NUMBER 6490.05
November 22, 2011
Incorporating Change 2, Effective May 29, 2020
USD(P&R)
SUBJECT:

Maintenance of Psychological Health in Military Operations

References: (a) DoD Directive 5124.02, “Under Secretary of Defense for Personnel and
Readiness (USD(P&R)),” June 23, 2008
(b) DoD Directive 6490.5, “Combat Stress Control (CSC) Programs,”
February 23, 1999 (hereby cancelled)
(c) DoD Instruction 6490.03, “Deployment Health,” June 19, 2019
(d) Chapter 47, sections 801-940 of title 10, United States Code (also known as
“The Uniform Code of Military Justice”)
(e) DoD Manual 8910.01, “DoD Information Collections Manual,” June 30,
2014, as amended

1. PURPOSE. In accordance with the authority in Reference (a), this Instruction:
a. Renames and reissues Reference (b) as a DoD Instruction.
b. Establishes policy and assigns responsibilities in accordance with References (c), (d), and
(e) for developing combat and operational stress control (COSC) programs within the Military
Departments, the Combatant Commands, and joint Service operations.
c. Establishes requirements for activities that support psychological health in military
operations and the early detection and management of combat and operational stress reactions
(COSR) in order to preserve mission effectiveness and warfighting capabilities and mitigate the
adverse physical and psychological consequences of exposure to severe stress.

2. APPLICABILITY. This Instruction applies to OSD, the Military Departments, the Office of
the Chairman of the Joint Chiefs of Staff (CJCS) and the Joint Staff, the Combatant Commands,
the Office of the Inspector General of the Department of Defense, the Defense Agencies, the
DoD Field Activities, and all other organizational entities within the DoD.

3. DEFINITIONS. See Glossary.

DoDI 6490.05, November 22, 2011

4. POLICY. It is DoD policy that:
a. The Military Departments shall implement COSC policies and programs to enhance
readiness, contribute to combat effectiveness, enhance the physical and mental health of military
personnel, and prevent or minimize adverse effects associated with combat and operational
stress.
b. The Military Departments’ leadership shall foster an environment and climate of
prevention and protection to enhance operational performance and mitigate the potential physical
and psychological consequences of combat exposure and other military operational stress and
shall require that:
(1) Combat stress prevention and protection principles be addressed in senior enlisted,
officer, and general/flag grade professional military education and training programs.
(2) COSC consultants and healthcare professionals are provided to support leadership.

5. RESPONSIBILITIES. See Enclosure 1.

6. PROCEDURES. See Enclosure 2.

7. RELEASABILITY. Cleared for public release. This Instruction is available on the
Directives Division Website at https://www.esd.whs.mil/DD/.

8. SUMMARY OF CHANGE 2. The change to this issuance updates references and
organizational titles and removes expiration language in accordance with current Chief
Management Officer of the Department of Defense direction.

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DoDI 6490.05, November 22, 2011
9. EFFECTIVE DATE. This Instruction is effective November 22, 2011.

Enclosures
1. Responsibilities
2. Procedures
Glossary

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DoDI 6490.05, November 22, 2011
TABLE OF CONTENTS

ENCLOSURE 1: RESPONSIBILITIES .........................................................................................5
ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS (ASD(HA))........5
DIRECTOR, DEFENSE HEALTH AGENCY (DHA) .......................................................5
ASSISTANT SECRETARY OF DEFENSE FOR MANPOWER AND RESERVE
AFFAIRS (ASD(M&RA)) ..................................................................................................5
SECRETARIES OF THE MILITARY DEPARTMENTS..................................................5
CJCS ....................................................................................................................................6
COMMANDERS OF THE COMBATANT COMMANDS ...............................................6
ENCLOSURE 2: PROCEDURES ..................................................................................................7
CORE PRINCIPLES OF COMBAT AND OPERATIONAL STRESS CONTROL .........7
COSC-SPECIFIC AND MILITARY EDUCATION PROGRAMS ...................................7
LEADERSHIP .....................................................................................................................8
COSC DELIVERY MODEL ...............................................................................................8
SURVEILLANCE AND MONITORING ...........................................................................9
GLOSSARY ..................................................................................................................................10
PART I: ABBREVIATIONS AND ACRONYMS ................................................................10
PART II: DEFINITIONS........................................................................................................10

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CONTENTS

DoDI 6490.05, November 22, 2011
ENCLOSURE 1
RESPONSIBILITIES
1. ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS (ASD(HA)). The
ASD(HA), under the authority, direction, and control of the Under Secretary of Defense for
Personnel and Readiness (USD(P&R)), shall ensure DoD compliance with this Instruction.

2. DIRECTOR, DEFENSE HEALTH AGENCY (DHA). The Director, DHA, under the
authority, direction, and control of the Under Secretary of Defense for Personnel and Readiness,
through the ASD(HA), shall:
a. Annually monitor the quality and effectiveness of Military Service COSC programs, in
coordination with Military Service quality assurance monitors, in an effort to identify evidencebased COSC programs for dissemination and use by the Military Services as applicable.
b. Develop and standardize required COSC data collection metrics.
c. Promote COSC initiatives that prepare Service members for military operations, support
them during periods of transition, enhance psychological resilience, and reduce stigma associated
with seeking mental health assistance.
d. Ensure that Military Service psychological health consultants meet as needed to develop,
coordinate, and oversee implementation of COSC programs.

3. ASSISTANT SECRETARY OF DEFENSE FOR MANPOWER AND RESERVE AFFAIRS
(ASD(M&RA)). The ASD(M&RA), under the authority, direction, and control of the
USD(P&R), shall ensure that policies for the Reserve Components (including the National
Guard) and Joint COSC Program are consistent with the policies established for Active
Components.

4. SECRETARIES OF THE MILITARY DEPARTMENTS. The Secretaries of the Military
Departments shall:
a. Ensure that their senior Military Service commanders comply with this Instruction.
b. Develop comprehensive COSC policies and programs for Military Service-specific
operations from garrison to the battlefield that:
(1) Establish standardized COSC policies.

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ENCLOSURE 1

DoDI 6490.05, November 22, 2011
(2) Enhance psychological health, to include strength building strategies and application
of psychological principles in mission performance, and address prevention and management of
stress before deployment and stress reactions during and after deployment.
c. Coordinate COSC policies and programs with the CJCS, the other Military Department
Secretaries, the ASD(M&RA), the Director, DHA, and the ASD(HA).
d. Ensure assignment of appropriately trained personnel to provide COSC services.
e. Annually monitor, review, and evaluate COSC policy and training curricula using
appropriate program evaluation procedures. Make recommendations for policy and program
improvements to the ASD(HA) and Director, DHA, when appropriate.
f. In coordination with the CJCS, oversee Combatant Command and Military Service COSC
Program implementation both during combat operations and during military operations other
than war.
g. Assign mental health professionals to serve as consultants to the Combatant Commanders
as needed, based on contemporary or anticipated operational tempo and demands.

5. CJCS. The CJCS shall monitor the execution of the policies in this Instruction during all
operations.

6. COMMANDERS OF THE COMBATANT COMMANDS. The Commanders of the
Combatant Commands shall:
a. Ensure that the policies of this Instruction are executed during all operations.
b. Designate a mental health professional with training and demonstrated expertise in COSC
principles and management to serve as the COSC consultant to each Command Surgeon and
Combatant Commander, as needed.
c. Apprise the Joint Staff Surgeon regarding the availability of COSC resources.

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ENCLOSURE 1

DoDI 6490.05, November 22, 2011
ENCLOSURE 2
PROCEDURES
1. CORE PRINCIPLES OF COMBAT AND OPERATIONAL STRESS CONTROL
a. To support the development and maintenance of an environment and climate of
prevention and protection, psychological interventions for combat and operational stress
reactions shall be implemented by first-responders on the same parity with physical injuries in
order to mitigate the risk of potential longer-term physical and psychological consequences of
combat and other military operations.
b. Policies developed for the implementation of psychological first-response intervention
for combat-related reactions shall identify the required services and programs as “psychological
first aid,” or an equivalent stigma reducing term, to mitigate risk that this assistance be viewed as
either clinical treatment or traditional mental health care and follow up.
c. Military Service COSC policy shall emphasize the importance of psychological first aid as
the first step in preventing complications arising from combat and operational stress.
2. COSC-SPECIFIC AND MILITARY EDUCATION PROGRAMS
a. The required Military Departments’ leadership education or training program curricula as
appropriate shall incorporate the DoD principles of risk mitigation for combat stress prevention
and protection.
b. All mental health, medical, and line personnel and the Chaplain Corps shall be trained in
role-appropriate COSC principles. The amount, content, and type of training shall be appropriate
to the rank and responsibility of the Service member or associated civilian personnel.
c. Training of COSC personnel shall include the ability to consult with units/individuals on
psychological principles that enhance combat effectiveness and to evaluate, identify, and
differentiate combat stress reactions from diagnosable mental health conditions and concerns.
Interventions shall be appropriate to the qualifications and credentials of the COSC team
member and tailored to the organizational and individual context. Only licensed, privileged
providers will be trained to diagnose and treat mental health conditions.
d. In addition to assessment and intervention with individuals, training of Military
Departments’ leadership and COSC personnel shall include a focus on organizational assessment
and intervention regarding the effects of traumatic events on the unit as a whole.
e. Senior enlisted Service members shall be trained in COSC principles including
identification of COSRs, resilience, and psychological first aid.

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ENCLOSURE 2

DoDI 6490.05, November 22, 2011
f. Leaders shall be trained to recognize the indicators of COSR in themselves and their
unit(s) that may require consultation with COSC personnel.
g. Training standards for mental healthcare personnel providing COSC services shall include
experiential learning of universal, selective and indicated prevention, and COSR intervention
approaches. At a minimum, mental healthcare providers shall also be trained in command
consultation, psychological first aid, management of COSRs, and all related regulations pertinent
to the COSC mission. In addition, COSC functions should be consistent and interoperable across
the Military Services. Cross-Service differences in COSC practice shall be included in training
for sister Service personnel performing COSC functions for other Military Services.
h. All other non-mental health medical personnel shall be familiar with the general
principles of COSC management. Non-mental health medical personnel shall also be trained in
identification of stress-related conditions, psychological first aid, resilience-building, and
management of COSR.
3. LEADERSHIP. Leaders (officer and non-commissioned officer) at all levels shall:
a. Understand COSC policy and management strategies and integrate COSC plans in
strategic and operational planning, both in wargaming and on the battlefield.
b. Develop strategies related to leadership, communication, unit cohesion, resilience, and
morale to mitigate impact of COSR.
c. Take action to ensure personnel seeking or requiring mental health services are afforded
access without stigma or other barriers to seeking such care.
4. COSC DELIVERY MODEL
a. Military Departments’ COSC programs shall consist of curricula, training, and exercise
requirements for joint and Military Services-specific operations that focus on using
psychological principles that enhance combat effectiveness and prevention and management of
COSR in settings from garrison to the battlefield. This shall include a variety of command
consultation activities. In addition to psychological first aid, the training shall address leadership
training, communication with Service members, peer support activities, unit morale and
cohesion, operational risk management, unit assessment of functioning, health risk
communication, individual psychosocial stressors, preventive stress management, trauma
management, referral resources, and psychological first aid, before, during, and after
deployment.
b. As unit enlisted personnel are most likely to seek out COSC team members who are
themselves among the enlisted grades, Service members experiencing a combat stress reaction
shall be managed within the unit or as close to the Service member’s unit as possible.
c. COSC personnel shall be fully trained in:
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ENCLOSURE 2

DoDI 6490.05, November 22, 2011

(1) Preventive stress management techniques, unit risk factor assessment, operational
risk management, command consultation, and application of principles to enhance combat
effectiveness.
(2) The prevention, identification, and management of combat and operational stress
reactions and other mental health conditions, including severe psychiatric disorders, as
applicable. Enlisted specialists and administrative support COSC team members will be trained
on mental health conditions, but they are not qualified to diagnose or treat those conditions.
d. COSC personnel shall coordinate delivery of psychological first aid programs with
available mental health clinical assets assigned to military units or with deployed medical assets.
e. When possible, COSC team members shall forward deploy to conduct COSC operations
in coordination with deployed mental health clinical assets.
f. When possible, only evidence-based universal, selective, and indicated prevention, and
management approaches shall be applied to prevent and treat COSRs and other mental health
conditions in garrison and theater. If evidence is unavailable, the Military Services shall conduct
program evaluations to ensure the effectiveness of the ongoing programs or undertake efforts to
transition to evidence-based programs.
g. The use of algorithms for assessing and managing behavioral health problems following a
traumatic event in the deployed setting shall be incorporated into the Military Departments’
COSC delivery system and continuously revised based on the best available clinical practice
guidelines or recommendations of Blue Ribbon panels of cross-Service experts.

5. SURVEILLANCE AND MONITORING
a. Surveillance of mental health problems and workload measures shall be conducted for
ongoing monitoring and future planning. As combat stress reactions are not clinical disorders
but instead are consequences associated with either prolonged exposure to high-demand
environments or exposure to single or repeated intense or traumatic events, rates of COSR shall
be monitored by COSC personnel as a discrete, separate category from neuropsychiatric and
disease and non-battle injury rates.
b. COSC unit personnel shall engage in first-hand surveillance activities through:
consultation with commanders about surveillance and prevention; identification, and
management of COSR in units or individuals; identification of at-risk populations by assessing
unit morale, cohesion, and stress levels; evaluation of combat units on a periodic basis or after
exceptionally stressful events; and, by the provision of consultation to commanders about endof-tour and transition training and briefings. Wherever possible, COSC personnel shall use
standardized measures to assess the status of units and individuals.

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ENCLOSURE 2

DoDI 6490.05, November 22, 2011
GLOSSARY
PART I. ABBREVIATIONS AND ACRONYMS

ASD(HA)
Assistant Secretary of Defense for Health Affairs
ASD(M&RA) Assistant Secretary of Defense for Manpower and Reserve Affairs
CJCS
COSC
COSR

Chairman of the Joint Chiefs of Staff
combat and operational stress control
combat and operational stress reactions

DHA

Defense Health Agency

USD(P&R)

Under Secretary of Defense for Personnel and Readiness
PART II. DEFINITIONS

Unless otherwise noted, these terms and their definitions are for the purposes of this Instruction.
COSC. Programs developed and actions taken by military leadership to prevent, identify, and
manage adverse COSRs in units; enhance mission performance; increase individual and unit
resilience; conserve fighting strength; prevent or minimize adverse effects of combat stress on
members’ physical, psychological, behavioral, and social health; and to return the unit or Service
member to duty. In accordance with Reference (c), COSC activities include continual
assessment and consultation to line, medical, and other personnel from garrison to the battlefield
regarding physiologic, psychological, and organizational stressors; personnel training about
combat stress; traumatic event management; and individual and unit management of COSRs.
COSC consultant. A mental health professional with training and expertise in COSC
management who consults with the Combatant Command Surgeon and the Combatant
Commander about matters related to combat stress such as unit cohesion, unit morale, resilience,
leadership, effective communication, and perceived mission importance. Completion of gradeappropriate professional Military Service or Joint Staff education is recommended prior to
appointment as COSC consultant.
COSC personnel. Active and Reserve Component mental health professionals or other personnel
including enlisted specialists and administrative support personnel who are trained in COSC
principles, including combat and operational stress first aid and application of principles to
enhance combat effectiveness. Senior experienced COSC personnel serve as advisors to line
commanders on leadership, communication, unit cohesion, morale, and training factors that
prevent or minimize COSRs.
COSR. The physical, emotional, cognitive, or behavioral reactions, adverse consequences, or
psychological injuries of Service members who have been exposed to stressful or traumatic
events in combat or military operations. COSRs vary in severity as a function of operational

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GLOSSARY

DoDI 6490.05, November 22, 2011
conditions, such as intensity, duration, frequency of combat exposure, rules of engagement,
leadership, effective communication, unit morale, unit cohesion, and perceived importance of the
mission, etc. COSRs do not represent mental health disorders or medically diagnosable
conditions and concerns. Post-traumatic stress disorder is not equivalent to or another name for
COSR.
Prevention of COSRs
indicated prevention. Interventions targeted to Service members with COSR or indications
of a potential mental health disorder, and to units that show signs that their mission effectiveness
is being affected by combat or operational stressors.
selective prevention. Interventions targeted to a unit or Service member whose risk is higher
than average.
universal prevention. Interventions targeted to the general population or area of
responsibility.
treatment. Interventions targeted to treat and follow up Service members with mental health
disorders to prevent their loss from duty.

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GLOSSARY