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Culture provides the unwritten rules that inform and shape expected behaviors. To date, little research has been conducted into the attitudes or opinions that service personnel hold toward mental health issues. This article examines current literature and research into the recognition of mental health problems in the military and potential organizational barriers to care including stigma and the specific characteristics of a military culture such as the significant reliance on buddy support. We conclude that the barriers to care which operate in both military and civilian populations are not insignificant. Western militaries in fact currently face an uphill struggle to combat the substantial barriers to care that exist. [ABSTRACT FROM AUTHOR]

Since the Persian Gulf War of 1990-1991, the operational tempo for soldiers has steadily increased, whereas the numbers of soldiers available to fulfill these missions has decreased. As a result, soldiers and their families are experiencing increased levels of stress that continue to manifest in ways that can often be destructive for the soldiers, their families, and the Army community. Current mitigation and identification support systems such as the Chain of Command, noncommissioned officer leadership, chaplains, and family support systems have all provided critical services, but may not be expected to optimally perform necessary early risk management assessment. Behavioral health care as a self-referral system is often still perceived as career ending, shameful, or even culturally unacceptable. Our allies have also experienced similar family, operational, and combat concerns. In 1996, at the direction of their Commandant General, the British Royal Marines developed and instituted a peer-driven risk management and support system that has experienced a high degree of success and acceptance among its forces-enough so that the Royal Navy is now in the process of implementing a similar program. The Soldier Peer Mentoring and Support program, as part of the proposed deployment Cycle Support Program, is a model for peer group assessment based on the British Royal Marines psychological risk management and support system. This article presents and describes this project, which has been considered for use within the U.S. Army, as a potential augmenter of existing behavioral health support assets as a culturally acceptable, company-level support program in deployment and home stations. [ABSTRACT FROM AUTHOR]

For many hundred of years, military forces have included chaplains of various faiths. Although these personnel mainly concentrate on providing for the religious and spiritual needs of the armed forces, they also contribute to the mental health of service personnel. This article provides a historical overview of military chaplains, examines their contributions to the psychological health of allied forces in World War I and World War II, and offers an overview of the scope of their present and future mental health related activities. The importance of the relationship between medical officers and chaplains in diagnosing and treating mental health problems is also discussed. We conclude that chaplains are capable of contributing significantly to the mental health of armed forces personnel if they are able to do so in informal and collaborative way. [ABSTRACT FROM AUTHOR]

This article reviews the use of psychological decompression as applied to troops returning from active service in operational theaters. Definitions of the term are considered and a brief history is given. Current policies and practices are described and the question of mandatory decompression is considered. Finally, the evidence base for the efficacy of decompression is examined and some conclusions are drawn. This article highlights variations in the definition and practice of decompression and its use. Although there is, as yet, no evidence that decompression works, there is also no evidence to the contrary. Given the lack of knowledge as to the balance of risks and benefits of decompression and the absence of any definitive evidence that decompression is associated with improved mental health outcomes or that lack of decompression is associated with the reverse, it is argued that the use of decompression should remain a matter for discretion. [ABSTRACT FROM AUTHOR]

Armed Forces personnel who deploy as individual augmentees (IAs), with a unit other than their formed unit, often fill shortages or provide specialized knowledge or skill sets. This article examined the effect of deploying as an IA on mental health outcomes and unit cohesion. A U.K. military cohort study was used to compare IAs (n = 1352) with personnel who had deployed with a formed unit (n = 2980). Differences between the groups in questionnaire assessed symptoms of post-traumatic stress disorder (PTSD Checklist-Civilian Version), common mental disorders (General Health Questionnaire-12) and alcohol misuse (Alcohol Use Disorders Identification Test) were examined with logistic and negative-binomial regression analyses. There was no difference between IAs and those who deployed with a formed unit in level of unit cohesion, symptoms of post-traumatic stress disorder or common mental disorder. Deployment as an IA was associated with less alcohol misuse (Odds Ratio 0.77, 95% Confidence Interval 0.63-0.94). IAs appeared able to integrate with the group they deployed with as levels of unit cohesion were similar to personnel who deployed with a formed unit. IAs were also at a lower risk of alcohol misuse compared to personnel who deployed with a formed unit. [ABSTRACT FROM AUTHOR]

Background: United Kingdom Armed Forces personnel currently undertake arduous operational tours that can make homecoming psychologically challenging. To assist them in this transition, they undergo a process of "decompression" before returning to their base unit. This article reports their subjective impression of the process.Methods: Personnel completed a brief survey at the end of the decompression process conducted in Cyprus in 2008 and this study reports the analysis of the free text element of the questionnaire.Results: 6,734 comments were available for analysis from a total of 11,304 questionnaires. Although responses were largely positive, significant numbers indicated that decompression could be improved by allowing personnel more choice, improving air transport out of theatre, and greater flexibility in harmonizing decompression activities with the operational role and military characteristics of decompressing units.Conclusion: Although decompression is generally viewed positively by participants, elements of the process could be further developed to improve acceptability. [ABSTRACT FROM AUTHOR]

Culture plays a crucial role in the military, helping the armed forces achieve their goals. However, cultural issues can negatively affect personnel's well-being and effectiveness, especially when there is a "clash" between military and other cultures. The literature suggests there should be more training and education on individual service cultures, as well as other countries' military cultures to improve cooperation and coordination during joint operations and working in multinational forces. A greater knowledge of local cultures may help avoid offending noncombatants. When deployment ends, service personnel need more support when they transition back to civilian culture. [ABSTRACT FROM AUTHOR]

Like the United States, the United Kingdom (U.K.) population expresses ongoing interest in the mental health of their nation's armed forces and veterans. Current U.K. military mental health research efforts center on the work of military and civilian academics based at King's College London. These academics work closely with NATO partners, in particular the United States, in planning for future research. Conscious of the cultural dimensions to mental health among military personnel, considerable efforts have been made to strengthen informal support mechanisms including the training of lay Trauma Risk Management (TRiM) practitioners and other welfare services. Formal healthcare support provision comes from primary care providers and Departments of Community Mental Health, which provide local case management and appropriate escalation to in-patient services where required. Although veteran's healthcare is provided by the National Health Service, considerable efforts have been made to ensure their services best meet the needs of veterans and their families. [ABSTRACT FROM AUTHOR]

Communication with home can be beneficial to deployed service members' mental health, morale, and occupational effectiveness. Conversely a lack of communication with home increases the risk of developing mental health problems. Therefore it is important to ensure that communications media is both affordable and accessible while on deployment. However, contact with families can sometimes have negative effects, particularly when problems arise at either end. It can also be difficult for military personnel and their families if the level of contact is lower than they expected. Conversely, too much contact with home may have a negative impact on occupational effectiveness. More research is required to determine the optimal level of communication with home. Additional research is required to determine which types of communications media are most beneficial and whether the benefits of communication with home differ depending on the context of the deployment and the family status of the service member. [ABSTRACT FROM AUTHOR]

Background: Little is known about the patterns of alcohol use in the U.K. Armed Forces or the factors associated with heavy drinking.Methods: Analysis of existing data from the King's Military Cohort was conducted of a large, randomly selected cohort of service personnel. The original sample consisted of 8,195 service personnel who served in the U.K. Armed Forces in 1991: a third deployed to the Gulf (1990-1991), a third deployed to Bosnia (1992-1997), and the final third, an "Era" comparison group, in the Armed Forces in 1991 but not deployed. For the purposes of this study, female serving personnel were excluded. The study used a "case-control" study design nested within the above cohort; "heavy drinkers" (those who drank >30 units/week) were compared with "light drinkers" (those who drank <21 units a week).Results: Heavy drinking was associated with current military service and being unmarried or separated/divorced. Heavy drinking was more common in younger personnel who had deployed to Bosnia. Those who drank heavily were also more likely to smoke; heavy drinking was associated with poorer subjective physical and mental health.Conclusions: Certain subgroups of the Armed Forces appear to be more at risk and it may be possible to target resources to such individuals to improve detection and allow prompt treatment. [ABSTRACT FROM AUTHOR]

Peacekeeping operations form an increasing part of the role of the U.K. Armed Forces. This study identified perceived needs for training before such operations, experiences of stress during deployments, beliefs and attitudes regarding psychological support and debriefing on return, general attitudes toward peacekeeping duties, and positive aspects of the peacekeeping role. Although nearly all peacekeepers were exposed to a variety of experiences, most perceived stress came from professional difficulties and frustrations with the occupational role of being a peacekeeper, rather than from dangerous situations. The exception was a significant fear of land mines. For many, peacekeeping had a positive impact on soldiers' lives, most commonly an appreciation of "things back home." Respondents' opinions about the peacekeeping experience vary greatly. Additional training addressing and exploring potential conflicts between the traditional role of the soldier and the role of the peacekeeper may be useful. [ABSTRACT FROM AUTHOR]

The U.S. Defense Department partnered with the International Initiative for Mental Health Leadership on effective leadership and operational practices for delivery of mental health (MH) as well as addiction services throughout the world for Service Members (SM) and beneficiaries. A Military Issues Work Group (MIWG) was established in 2011 to focus on challenges experienced by military SM and beneficiaries among countries. The MIWG found common concerns related to MH care delivery to rural and remote beneficiaries. Gaps in access to care were identified and prioritized to explore. This led to better collaboration and understanding of telemental health (TMH) practices and technology applications (apps) which increase access to care for rural and remote SMs and beneficiaries. An assessment of the number of SMs and dependents distant from MH care services in the USA was conducted, as well as an environmental scan for psychological health-focused mobile apps and TMH services geared toward SM, veterans, and beneficiaries. The MIWG is developing a compendium of existing military TMH programs and apps that address MH concerns and extant literature on use of technology to extend global access to care for military members and their families across the world., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.)

Background: Several studies have reported significant airborne lead exposures during training at indoor firing ranges. Scarce attention has been given to airborne lead exposures in outdoor shooting ranges with automatic weapons., Objective: To assess the prevalence and magnitude of airborne and blood lead levels (BLL) among firing instructors and shooters in military outdoor ranges., Methods: Exposure assessment, for both trainees and instructors, included airborne and BLL during basic and advanced training at outdoor firing ranges. Personal airborne samples were collected in both day and night shooting during both training periods., Results: During basic training, there is 95% likelihood that up to 25% of instructors and 99% likelihood that up to 5% of trainees might be exposed above the action level (AL) (25 μg/m(3)). During advanced training, there is 90% likelihood that 10% of instructors and 99% likelihood that up to 10% of trainees might be exposed above the AL., Conclusions: Military personnel participating in automatic weapon marksmanship training can be exposed to considerable levels of airborne lead during outdoor firing range training. As a result, the Israel Defense Force Medical Corp has classified firing range instructors as workers that require periodic medical examinations., (Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.)

Objective: To evaluate the possible mental health impact of resistance training on UK Armed Forces personnel undergoing training and the psychological effects of delivering such training., Method: British Military personnel (n = 42) completed a battery of self-report measures on anxiety, general mental health, post-traumatic stress disorder, resiliency and training outcomes 1 month before, on the first and last day of the course and at 1-month follow-up. Resistance Instructors (RIs) (n = 40) completed a battery of self-report measures on anxiety, depression, post-traumatic stress disorder, alcohol use, sleep, burnout, leadership, and morale., Results: Although student self-ratings of resiliency did not change, they reported significant improvements in their ability to use strategies to cope with captivity. There was no significant increase in anxiety between precourse and follow-up. Post-traumatic stress intrusive symptoms were elevated at 1-month postcourse but remained low. Prevalence rates of psychological distress among RIs were elevated compared to U.K. military personnel but views of professional efficacy, unit leadership and morale were broadly positive., Conclusion: Resistance training demonstrates some benefit to students but was associated with increase in traumatic stress symptoms at follow-up, whereas the mental health of RI appears modestly worse than the rest of the Armed Forces population., (Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.)

Objectives: To compare attitudes to mental illness in the U.K. military and in the general population in England., Methods: Using data from a cross-sectional survey of 821 U.K. military personnel and a separate cross-sectional survey of 1,729 members of the general population in England, levels of agreement with five statements about mental illness were compared in the military and the general population., Results: The majority of respondents from both populations showed positive attitudes toward mental illness. The general population showed slightly more positive attitudes toward integrating people with mental illness into the community (68.0% [65.7%-70.1%] agreed that "People with mental illness have the same rights to a job as everyone else," vs. 56.7% [51.5%-61.7%] of the military). However, the general population showed more negative attitudes about the causes of mental illness (62.4% [60.1%-64.6%] disagreed that "One of the main causes of mental illness is a lack of self-discipline and willpower," vs. 81.3% [77.0%-84.9%] of the military)., Conclusions: Overall, attitudes toward mental illness are comparable in the general population in England and the U.K. military. Differences included the military holding more positive attitudes about the causes of mental illness, but more negatives attitudes about job rights of those with mental illness. Strategies aiming to improve attitudes toward mental illness could focus particularly on personnel's concerns around mental illness impacting on their career., (Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.)

Stigmatizing beliefs about seeking help for mental health conditions and perceived barriers to care (BTC) may influence the decision to seek support and treatment in U.K. military personnel. Many coalition partners, including the U.K. Armed Forces (UKAF), have made considerable efforts to reduce stigma/BTC although the impact of these efforts over time has not been assessed. We surveyed a total of 23,101 UKAF personnel who deployed to Afghanistan and Iraq between 2008 and 2011 and examined whether stigma/BTC levels changed during this time. The results suggested that stigma, including the fear of being treated differently by commanders and loss of trust among peers, was greater than perceived BTC. The likelihood of reporting stigma/BTC, although significantly greater during deployment than postdeployment, reduced significantly over the survey period. A similar reduction was less apparent during postdeployment phase. These findings support the notion that UKAF's anti-stigma campaigns may have had some positive effects, particularly among deployed personnel. However, we suggest that stigma still plays a part in inhibiting help-seeking, particularly during deployment when stigma rates are higher, and that a careful balance must be struck between encouraging help-seeking and maintaining the operational effectiveness of deployed personnel., (Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.)

Objectives: British forces have a comprehensive system for managing acute psychological distress in a combat zone. This includes peer support via Trauma Risk Management (TRiM), access to deployed medical personnel, and a Field Mental Health Team (FMHT). TRiM and medical personnel need to be aware of the FMHT's presence in the combat zone and capability to provide specialist mental health care., Methods: TRiM and medical personnel completed a survey based on 6 audit standards. Differences between TRiM and medical personnel and the effects of rank, role, and location in theater were assessed using the Pearson χ(2) statistical test. Statistical significance was defined as p ≤ 0.05., Results: Most TRiM and medical personnel knew that an FMHT was embedded within the deployed force. Significantly less TRiM than medical personnel knew that the FMHT would carry out clinical assessments at forward locations. There was a high degree of satisfaction with the service provided by the FMHT., Conclusion: Corporate knowledge of the FMHT by both Medical and TRiM personnel was generally good. TRiM training should increase its emphasis on the FMHT's ability to undertake assessments at forward locations. Efforts by the FMHT to ensure corporate knowledge among TRiM personnel should focus on more forward locations., (Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.)

Culture provides the unwritten rules that inform and shape expected behaviors. To date, little research has been conducted into the attitudes or opinions that service personnel hold toward mental health issues. This article examines current literature and research into the recognition of mental health problems in the military and potential organizational barriers to care including stigma and the specific characteristics of a military culture such as the significant reliance on buddy support. We conclude that the barriers to care which operate in both military and civilian populations are not insignificant. Western militaries in fact currently face an uphill struggle to combat the substantial barriers to care that exist.

Background: Little is known about the patterns of alcohol use in the U.K. Armed Forces or the factors associated with heavy drinking., Methods: Analysis of existing data from the King's Military Cohort was conducted of a large, randomly selected cohort of service personnel. The original sample consisted of 8,195 service personnel who served in the U.K. Armed Forces in 1991: a third deployed to the Gulf (1990-1991), a third deployed to Bosnia (1992-1997), and the final third, an "Era" comparison group, in the Armed Forces in 1991 but not deployed. For the purposes of this study, female serving personnel were excluded. The study used a "case-control" study design nested within the above cohort; "heavy drinkers" (those who drank >30 units/week) were compared with "light drinkers" (those who drank <21 units a week)., Results: Heavy drinking was associated with current military service and being unmarried or separated/divorced. Heavy drinking was more common in younger personnel who had deployed to Bosnia. Those who drank heavily were also more likely to smoke; heavy drinking was associated with poorer subjective physical and mental health., Conclusions: Certain subgroups of the Armed Forces appear to be more at risk and it may be possible to target resources to such individuals to improve detection and allow prompt treatment.

Peacekeeping operations form an increasing part of the role of the U.K. Armed Forces. This study identified perceived needs for training before such operations, experiences of stress during deployments, beliefs and attitudes regarding psychological support and debriefing on return, general attitudes toward peacekeeping duties, and positive aspects of the peacekeeping role. Although nearly all peacekeepers were exposed to a variety of experiences, most perceived stress came from professional difficulties and frustrations with the occupational role of being a peacekeeper, rather than from dangerous situations. The exception was a significant fear of land mines. For many, peacekeeping had a positive impact on soldiers' lives, most commonly an appreciation of "things back home." Respondents' opinions about the peacekeeping experience vary greatly. Additional training addressing and exploring potential conflicts between the traditional role of the soldier and the role of the peacekeeper may be useful.