Nasa’s behavioural health and performance services for long duration space missions
Authors: Dukes Charles 
Published: November 2023

Dr. Charles Dukes is an Aerospace psychiatrist working with NASA’s behavioral health and performance operations group under the human health and performance contract at Johnson Space Center in Houston Texas. At NASA, Dr. Dukes provides operational behavioral health support to astronauts on the International Space Station. His other duties include, astronaut selection and he provides psychiatric support for NASA mission controllers, divers and other NASA personnel. Other NASA duties include working with the clinical and science team of Exploration Medical Capability.

Dr. Dukes has a long history in the US Army where he serves as a flight surgeon and as the Army Reserve psychiatric consultant to the Surgeon General of the Army. His currently holds the rank of Colonel. Additionally, Dr. Dukes has had four combat deployments where he deployed as both a psychiatrist and flight surgeon. He also has worked with the Federal Aviation Administration for many years as an Aviation Medical Examiner and psychiatric consultant to the Federal Air Surgeon.

Additionally, Dr. Dukes has many years working in medical education. He came to NASA from the University of Oklahoma where he served as psychiatry residency training director and Director of Consultation psychiatry services. He currently holds faculty appointments at the University of Oklahoma, University of Texas Medical Branch and the Uniformed Services University of the Health Sciences.

Dr. Dukes is a Fellow in the American Psychiatric Association and holds memberships in the Aerospace Medical Association, Space Medical Association, and the Society of US Army Flight Surgeons. His current projects include publishing a paper on the efficacy and safety of SSRIs for long duration space missions. He is a co-author for the behavioral health chapter of the newest edition of Dr. Mike Barratt’s Principles of Clinical Medicine for Space Flight and he recently wrote the foreword for the latest edition of Dr. Nick Kanas’ book, Behavioral Health and Human Interactions in Space.

We live in the age of long duration space missions. With the advent of missions lasting greater than 30 days on the International Space Station, to the commercial crew program and private astronaut missions, NASA’s Behavioral Health and Performance Operations Group remains an integral part of crew health and safety at NASA’s Johnson Space Center.

The BHP group consists of a team of psychologists, psychiatrists, and psychological support personnel. The approach is a multifaceted career spanning behavioral health program which is involved in astronaut selection, astronaut candidate training, annual behavioral health evaluations, preflight training and exams, inflight support, inflight neurocognitive exams, postflight reintegration exams and elective behavioral health services.

NASA’s behavioral health teams work very closely with our international partners from the European Space agency, Japanese Space agency, Russian Space Program, and the Canadian Space agency to provide cooperative behavioral health support to all astronauts who serve on the International Space Station. Every year there is a meeting of the International human health and behavior working group for spaceflight to ensure our efforts are coordinated and relevant to optimize crew health and safety.

With long duration missions, there are unique stressors that crewmembers face in space and isolated and confined environments. Stressors include., physiologic adaptation to microgravity, circadian disruption, radiation exposure, environmental changes and psychological stressors related to separation from family and friends.

As the missions change in duration and distance the risks increase in severity and new threats emerge related to changes in the environment (lunar gravity) and other unique stressors which will test the boundaries and limits of human performance. Additionally, when planning for long duration missions and the delivery of medical and behavioral health services there are certain unique limits such as communication delays as well as mass and volume constraints.

To provide care for flight personnel through all phases of their career and training, NASA’s BHP team employs countermeasures which are focused on prevention, and mitigation of the risks of behavioral health problems in the unique environment of space.

In this talk I will discuss the background and composition of NASA’s Behavioral Health and Performance Operations group. The elements of astronaut selection from the earliest classes to present will be discussed along with the composition of the selection team to include the psychological support service personnel which help connect astronauts to their families and friends. Additionally, the history of long duration missions with resultant physiologic and psychological stressors will be examined.