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IntroductionFirst responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic. MethodsWe conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis. ResultsThe most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF’s 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences. ConclusionThe results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma.

IntroductionLes premiers répondants comme les autres membres du personnel de sécurité publique (travailleurs correctionnels, pompiers, ambulanciers paramédicaux, policiers, agents des communications en sécurité publique, etc.) sont souvent exposés à des événements potentiellement traumatisants sur le plan psychologique. Ces expositions sont susceptibles de contribuer à des problèmes de santé mentale et à un besoin accru en soins de santé mentale. Pourtant, aucune étude qualitative structurée et fondée théoriquement sur les obstacles aux comportements de recherche d’aide et sur les facteurs facilitant ces comportements n’a encore été entreprise auprès de cette population. Cette étude repose sur le cadre Theoretical Domains Framework (TDF) pour cerner et mieux comprendre les principaux obstacles et facteurs facilitants relatifs à la recherche d’aide et à l’accès aux soins de santé mentale dans le cadre d’une clinique de traitement des blessures de stress opérationnel pour premiers répondants. MéthodologieNous avons mené des entretiens semi-structurés en personne avec 24 premiers répondants (11 pompiers, 5 ambulanciers paramédicaux et 8 policiers), recrutés à l’aide d’un échantillonnage raisonné et par boule de neige. Les entretiens ont été analysés à l’aide d’une analyse de contenu déductive. Le cadre TDF a guidé la conception de l’étude, le contenu des entretiens, la collecte et l’analyse des données. RésultatsLes obstacles les plus signalés ont été des préoccupations concernant la confidentialité, le manque de confiance, le manque de connaissances des cliniciens sur la culture professionnelle, le manque de transparence quant à l’accès aux services et la stigmatisation au sein des organismes de premiers répondants. Les principaux thèmes influençant la recherche d’aide ont pu être classés au sein de 6 des 14 domaines du cadre TDF : le contexte environnemental et les ressources; les connaissances; les influences sociales; le rôle social/professionnel et l’identité; les émotions et enfin les croyances à l’égard des conséquences. ConclusionNous avons pu cerner les principales mesures utilisables pour adapter les interventions afin d’encourager la participation à une clinique de traitement des blessures de stress opérationnel pour les premiers répondants : la transparence en matière de confidentialité, la présence de politiques visant à accroître les connaissances sur la culture professionnelle par l’ensemble du personnel de la clinique, des descriptions claires des modalités d’accès aux soins, la participation systématique des familles et la lutte contre la stigmatisation.

Objectives The literature presents complex inter-relationships among individual-factors and organisational-factors and barriers to seeking mental health support after deployment. This study aims to quantify longitudinal associations between such factors and barriers to mental health support.Design A longitudinal online survey of Canadian Armed Forces (CAF) personnel collected data at 3 months post-deployment (T1), 6 months post-deployment (T2) and 1 year post-deployment (T3).Setting In 2020, as part of Canada’s response to the COVID-19 pandemic, 2595 CAF personnel deployed on Operation LASER to support civilian long-term care facilities in Québec and Ontario.Participants All Operation LASER personnel were invited to participate: 1088, 582 and 497 responded at T1, T2 and T3, respectively. Most respondents were young, male, non-commissioned members.Main outcome measures Barriers to mental health support were measured using 25 self-reported items and grouped into theory-based factors, including eight factors exploring care-seeking capabilities, opportunities and motivations; and two factors exploring moral issues. Logistic regressions estimated the crude and adjusted associations of individual and organisational characteristics (T1) with barriers (T2 and T3).Results When adjusting for sex, military rank and mental health status, increased meaningfulness of deployment was associated with lower probability of endorsing barriers related to conflicts with career goals and moral discomfort in accessing support at T2. Higher scores in trust in leadership were associated with lower probability of endorsing four barriers at T2, and five barriers at T3.Conclusions We identified several modifiable organisational-level characteristics that may help reduce perceived barriers to mental health support in military and other high-risk occupational populations. Results suggest that promoting individuals’ sense of purpose, instilling trust in leadership and promoting relatedness among team members may improve perceptions of access to mental health supports in the months following a domestic deployment or comparable occupational exposure.

BackgroundThe earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19–related deaths among residents of long-term care facilities (LTCFs). As part of Canada’s response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. ObjectiveThis study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. MethodsA multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. ResultsCAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. ConclusionsThe data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF–specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. International Registered Report Identifier (IRRID)DERR1-10.2196/44299

The Canadian Armed Forces (CAF) deployed 2595 regular and reserve force personnel on Operation (Op) LASER, the CAF’s mission to provide support to civilian staff at longterm care facilities in Ontario and in the Centres d’hébergement de soins de longue durée in Quebec. An online longitudinal survey and in-depth virtual discussions were conducted by a multidisciplinary team of researchers with complementary expertise. This paper highlights the challenges encountered in conducting this research and their impact on the design and implementation of the study, and provides lessons learned that may be useful to researchers responding to similar public health crises in the future.

Les Forces armées canadiennes (FAC) ont déployé 2 595 membres de la Force régulière et de la Force de réserve dans le cadre de l’Opération LASER (Op LASER), la mission des FAC destinée à soutenir le personnel civil des établissements de soins de longue durée en Ontario et des centres d’hébergement et de soins de longue durée au Québec. Les membres d’une équipe multidisciplinaire de chercheurs possédant une expertise complémentaire ont dirigé une enquête longitudinale en ligne et des discussions virtuelles approfondies. Cet article met en lumière les défis que les chercheurs ont dû relever dans le cadre de l’étude et l’incidence de ces obstacles sur la conception et la mise en oeuvre de celle-ci. Il présente également les constats qui en ont été dégagés et qui sont susceptibles d’être utiles aux chercheurs qui auront à intervenir au cours d’autres crises de santé publique similaires.

Abstract Background Despite increased interest in workplace mental health interventions, the evidence for beneficial effects is mixed. Furthermore, many existing studies lack methodological rigor. We report results from a group randomized control trial to test the efficacy of a vastly popular intervention in Canada, the Road to Mental Readiness (R2MR) program, which has been widely disseminated in military, first responder, and civilian settings. Methods The trial took place among Canadian Armed Forces military recruits completing their basic military qualification (BMQ) training, and randomized 65 platoons (N = 2831) into either (a) an Intervention (R2MR at week 2 of BMQ), or (b) a delayed Intervention Control (R2MR at week 9 of BMQ) condition. The principal investigator, participants, and data collection staff were blinded to platoon condition. Individual-level psychological functioning, resilience, mental health service use attitudes, intentions, and behaviours, and additional covariates were assessed with questionnaires around week 2 (a day or two before Intervention platoons received R2MR), at week 5, and at week 9 (a day or two before the Control platoons received R2MR). Military performance outcomes were obtained from administrative databases. Results The full trial results were mixed; for some outcomes (psychological functioning, resilience, and military performance), we saw no evidence of beneficial effects; where we did see benefits (mental health service use attitudes, intentions, behaviours), the effects were very small, or disappeared over time. Analyses among two subsamples (Group 1: Intervention platoons with a Fidelity Check and their Controls, and Group 2: Intervention platoons without Fidelity Check and their Controls) indicated that for some outcomes (attitudes and help-seeking), under high fidelity conditions, the beneficial effects of R2MR were increased and better sustained; Conversely, under poor fidelity conditions, decreased beneficial effects or even iatrogenic effects were observed. Analyses across three training divisions indicated the larger organizational climate further influences efficacy. Conclusions Our findings paint a very complex picture in which it is made evident that sensible, evidence-informed workplace mental health interventions such as R2MR may work under high fidelity conditions, but may yield no discernable benefit or even inadvertent iatrogenic effects if implemented poorly or without sufficient consideration to the larger organizational context. Trial registration ISRCTN 52557050 Registered 13 October 2016.

Objective: Potentially morally injurious experiences (PMIE) (events that transgress an individual’s subjective moral standards) have been associated with psychologically distressing moral emotions such as shame and guilt. Military leaders and clinicians have feared that those with PMIEs may be less likely to seek help due to the withdrawing nature of shame/guilt; however, to date, help-seeking patterns of military personnel with PMIEs has not been explored. Our objective is to address this research gap. Method: Data from a nationally-representative mental health survey of active Canadian military personnel were analysed. To assess the association between exposure to three PMIEs and past-year help-seeking across different provider categories (i.e. professionals, para-professionals (those delegated with mental health advisory tasks but are not licenced to practice as medical professionals), non-professionals), a series of logistic regressions were conducted, controlling for exposure to other deployment and non-deployment-related psychological trauma, psychiatric variables, military factors, and sociodemographic variables. Analytical data frame included only personnel with a history of Afghanistan deployment (N = 4854). Results: Deployed members exposed to PMIEs were more likely to seek help from their family doctor/general practitioner (OR = 1.72; 95%CI = 1.25–2.36), paraprofessionals (OR = 1.72; 95%CI = 1.25–2.36), and non-professionals (OR = 1.44; 95%CI = 1.06–1.95) in comparison to members not exposed to PMIEs. Those exposed to PMIEs were also more likely to seek professional care from the civilian health care system (OR = 1.94; 95%CI = 1.27–2.96). Conclusion: Contrary to long-held, but untested, assumptions regarding the impact of PMIEs on help-seeking, we found those with PMIEs are more likely to seek help from gatekeeper professionals (i.e. general practitioners), para-professionals, and non-professionals rather than specialized mental health professionals (e.g. psychologists). Increased utilization of civilian professionals raises concerns that active military members may be avoiding military health services. Clinically, this highlights the need to increase awareness of moral injury to ensure that actively serving military members are provided with appropriate advice and treatment.