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The Mental Health of UK Military Personnel, Reservists and Veterans: A
programme of research
Dr Lisa WebsterPost-doctoral Research AssociateMental Health Research Group
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What does the research tell us?• Harmful drinking
• Armed forces 13%; general population 5.4% (Knight et al., 2011)• More common among deployed than non-deployed personnel
• Post-Traumatic Stress Disorder (PTSD) (Iraq/Afghanistan) • Armed forces 3.2%; general population 2.7% (McManus et al., 2009)• Non deployed 2.8%
• Common mental health disorders• Armed forces 19.7%; general population 15% (Fear et al., 2010)
• Intentional self-harm/attempted suicide• Armed forces 4.2%; general population 8% (Pinder et al., 2012)
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Help-seeking, barriers to care and stigma• Half of those returning from combat with MH problems do not seek help
(Hoge et al 2004; Iversen et al., 2005)
• 80% of military personnel who perceive they have a MH problem sought some type of help (Iversen et al., 2005)
• Preference for informal support (72.6-84.6%)
• Only one quarter of those with a diagnosed MH problem accessed medical help
• 23% with alcohol problems
• 50% with depression and anxiety
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Help-seeking, barriers to care and stigma• Stigma and lack of trust or confidence in providers of MH services
(Greene-Shortridge et al., 2007)
• Strong masculine norms/fear of being labelled
• Internal (self) stigma significant barrier to care and prevalent among all ranks of personnel (Langston et al, 2010)
• Not knowing where to seek help, fear of employer blaming them
• Persists even after leaving the Armed Forces (Iversen et al., 2011)
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Serving personnel – what can we do to help?
• Is Behavioural Activation (BA) therapy clinically effective for depressed military personnel when delivered by military mental health nurses by remote means?
• BA is a form of Cognitive Behavioural Therapy
• BA is shown to be clinically effective for depression
• BA can be delivered by mental health nurses following a brief training package (Ekers et al., 2011)
• The last decade has seen emerging evidence demonstrating that computer and internet based interventions can be effective (Kenter et al., 2013)
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How?
• To develop a BA training package for military clinicians • 10 military mental health nurses will be provided with a five day training
package, using a short BA training package based upon an existing 12-session treatment protocol
• To assess whether BA can be effectively delivered by remote means• Pilot study = feedback and refinement
• To examine the mental health impact of receiving remotely delivered BA• Pre- post- mental health outcomes (including 3/6/12 month follow-up)
• To evaluate the patient and clinician experience of remotely delivered BA
• Via semi-structured interviews (responders and non-responders)
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Impact
• BA: • Simple, brief, effective therapy targeting 20% of military psychiatric referrals
• Patients: • Improved access to evidence based therapies by reducing barriers to care
i.e. geography and time away from work• Opportunity to promote resilience and recovery within the service person’s
normal occupational role
• Nursing: • Legacy training package for military mental health nurses
• Operational: • Remote therapy is not constrained by geography
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Reservists: What does the research tell us?
• Post-deployed Reservists are at a greater risk of suffering from PTSD and psychological distress than regular personnel (Fear et al., 2010)
• 26.3% of Reservists (6%); 19.4% Regulars
• Not purely as a consequence of traumatic experiences during deployment, rather a culmination of deployment and post-deployment events (Dandeker et al., 2011)
• Study of the MH of UK military personnel while on deployment in Iraq (Mulligan et al., 2010)
• Readjustment and reintegration process
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Reservists – what can we do to help?
• Provide insights into the relative contributions potential risk factors which span:
• pre-deployment (e.g., exposure to traumatic events or other highly stressful life events before deployment; perceived preparedness for deployment)
• peri-deployment (e.g., combat experiences; living and working environment during deployment; sense of closeness/ camaraderie with peers in the unit)
• post-deployment (e.g., social support from family and friends, career concerns).
• If we can determine the risk factors that contribute to ill-health, we will be able to inform how such illnesses can be prevented, or the effects, minimised.
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Impact
• As the reliance on Reservists increases, so then does the risk of personnel experiencing mental health problems
• Indirect negative effects on families of personnel, employers, and health and support organisations can be reduced
• Increase their support and aid in the sustainability of our Reserve Forces.
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Future Prospects
• Main gaps in research (Forces in Mind, 2014)• Why particular military personnel e.g. deployed Reservists appear more
susceptible to MH problems and how these can be prevented
• The prevalence of diagnosed mental health problems in UK serving personnel
• What would improve help-seeking rates to primary care services for ex-service personnel with mental health problems
• The impact of deployment on families of UK personnel and what can be done to support families with mental health problems
