Mental Health and Help Seeking in the U.S.

Mental Health and Help Seeking in the U.S.

Mental Health and Help Seeking in the U.S. Military: Insights from Focus Groups with Gatekeepers Presented by Kristin G. Schneider, Ph.D. Behavioral Research Scientist Northrop Grumman Technology Services OPA/PERSEREC Any opinions, findings and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the Department of Defense, the Office of People Analytics, or the Defense Personnel and Security Research Center August 2, 2017 Authors Northrop Grumman Technology Services Schneider, Kristin G., Ph.D. Osborn, Marie, M.A. Ho, Tiffany E., MPH Hesse, Christina M., M.A. Smishney, Tegan M., Ph.D. Carlisle, Brandon L., Ph.D. Defense Personnel and

Security Research Center (PERSEREC) Shechter, Olga G., Ph.D. Defense Research, Surveys, and Statistics Center (RSSC) Kristin Williams, B.A. Schwerin, Michael J., Ph.D. 2 Presentation Roadmap Goals of current study Background Gatekeeper focus groups Recommendations 3 Goals of Current Study Identify barriers, policies, procedures, and cultural

factors that: a) undermine help seeking b) promote help seeking Method: Conduct and analyze data from focus groups with military suicide prevention gatekeepers. 4 Background DoD and Service-level policies support mental health awareness, stigma reduction, and suicide prevention efforts within the military. However, many Service members still do not seek help for mental health concerns Previously identified barriers to utilizing mental health services include: Barrier Example Stigma Fear of being perceived as weak by peers or chain

or command Career impact Loss of security clearance Practical concerns Time constraints associated with attending an appointment 5 Gatekeeper Focus Groups Goal: Examine factors that prevent and promote helpseeking in the military from the perspective of suicide prevention gatekeepers Gatekeepers were: 1. 2. 3. 4. Chaplains and religious programs personnel

Law enforcement and security managers Medical, mental, and behavioral health personnel Unit leadership 6 Focus Group Sites and Participants Focus groups conducted between November 2016 and January 2017 Chaplains and religious programs specialists Law enforcement and security personnel Medical, mental and behavioral health providers and counselors Unit leadership Multidisciplinary Total Naval Station Norfolk

Keesler Air Force Base Joint Base Pearl HarborHickam 13 10 8 18 8 57 4

7 8 16 7 42 8 7 16 13 8 52

1 8 11 11 22 16 17 22 8 10 59 67 34 46 70

86 41 277 Fort Bragg Fort Campbell Total 7 Focus Group Topic Areas 1. What mental and behavioral health issues are seen among Service members? 2. What strategies encourage help-seeking? 3. What are the barriers to help-seeking? 4. Are there policies, procedures, or guidelines that encourage

or discourage help seeking? 5. How do these issues differ for the Reserve and National Guard components? 8 Focus Group Coding and Analysis Round 1: Codes developed based on a priori codes from academic literature and first review of focus group transcripts Round 2: Seven coders applied the coding scheme from Round 1 to all focus groups transcripts Round 3: Higher order themes identified 9 Focus Group Findings Service members experience a wide-range of mental and behavioral health issues, such as:

- Depression Suicidal Ideation Anxiety - Alcohol abuse Substance abuse Relationship conflict Gatekeepers identify some of these problems as existing prior to service and others as developing over the course of service. 1 Observed Mental Health Issues Representative Quotes Finding Quote

Mental health issues General Ive seen people who have emotional issues that cant handle stress very well, and that kind of veers them off to that suicidal ideation. With that, Ive seen people who also have issues with drug and alcohol abuse. Pre-existing It does seem like we have a problem at the entry point. That there are a lot of things that are being missedthese key conditions that are disqualifying for retention, and are being allowed in. Developed during service Some people pick it up as they go along. You know, were not making cupcakes out here. Were in the business of killing people and breaking their stuff. So, yeah, people develop some problems along the way.

1 Findings Factors that undermine help-seeking among Service members: 1) Stigma 2) Career impact concerns 3) Practical barriers generated by available services (e.g., taking time off work) 1 Factors that Undermine Help-Seeking Representative Quotes Finding Quote Factors that Undermine Help-Seeking: Stigma So when I was up at Fort Drum, the behavioral health center

up there was not on base. It was off post. You went in with a suicide ideation, the first thing they were going to do was strap you to a bed and put you in a special room. There were not very many false suicide ideations at Fort Drum. And we made sure that if you did have a suicide ideation, you were going through the whole process, and you were going to spend three days strapped to a bed, even if halfway through you recognize, oh, this aint going the way I thought it was going to go. 1 Factors that Undermine Help-Seeking Representative Quotes Finding Quote Factors that Undermine Help-Seeking: Career impact concerns A new directive that came out this week, actually, for the Air

Force, was that any time someone has started or has any dosage change of a psychotropic med, they instantly get a 90 day profile, which means they can't deploy, they can't PCS, they can't go TDY for 90 days. Practical barriers The system is broken at a number of levels. And some of it is not the systems fault. They just dont have the bodies. The funding is not there. The bodies are not there. 1 Findings Factors that promote help-seeking and mental health care utilization: 1) Policies that support self-referrals, reduction of stigma, and training programs 2) Informal and formal command-directed evaluations 3) Integrated and embedded mental health 4) Supportive, trusting environment, with options for confidential help, and escalation to more intensive services if needed

1 Factors that Promote Help-Seeking Representative Quotes Finding Quote Policies It seems like most of the policies talk about self-referral as a good thing, and that encourages people to step forward, rather than waiting until it becomes a disciplinary issue or performance issue, so that type of language, in all of our policies, is really helpful. Command- directed It's commander driven, really. So it's those leaders standing up, saying, you need to go. Integrated and embedded mental

health Having embedded psychologists can be very helpful; other embedded resources is helpful in general. Visiting people weekly if you can or just be around where they are, so that they're familiar with you. Trust and support We've all been in this business long enough to know that the functionality of any unit always comes from the top. Confidentiality The very first thing that comes out of my mouth is the MFLC [Military Family Life Consultant]. Because of that confidentiality, the lack of tracking the information and from there at least I have them with someone that can push them into another direction if 1 Recommendation # 1 Conduct effective suicide prevention training and mental health awareness campaigns, and evaluate their implementation

a) ACTION: Ensure that the right person leads the trainings b) ACTION: Stress the importance of trainings to commanders and leaders in addressing the health and functioning of units c) ACTION: Make suicide prevention information available to a wider community of individuals who support Service members (e.g., spouses, friends outside the military) 1 Recommendation # 2 Establish programs designed to encourage Officers to seek help for mental health concerns a) ACTION: Develop training programs for senior leaders, separate from programs for junior-enlisted personnel b) ACTION: Provide opportunities to engage in peer-support systems 1

Recommendation # 3 Address Service members concerns that seeking help will have an adverse impact on their careers a) ACTION: Provide accurate information regarding impact on career, clearance, deployability, etc. b) ACTION: Highlight stories from Service members about how help seeking did not end their military career c) ACTION: Raise awareness of transition planning programs for a soft landing if headed down a path to separation d) ACTION: Explore adapting the SAPR restricted and unrestricted reporting paradigm for suicide help-seeking

1 Reserve and Guard Recommendations 1. Increase awareness of Guard and Reserve issues among active duty gatekeepers 2. Conduct further research on access to and utilization of mental health care by Guard and Reserve personnel 3. Increase mental health support service offerings a) ACTION: Offer mental health appointments and support services during training weekends, including evening weekend appointments b) ACTION: Increase remote services (e.g., via telephone or internet) Future Research Directions 1.

Develop support programs and resources designed to encourage officers to seek help, separate from programs for junior-enlisted personnel 2. Examine specific needs and barriers of high-risk subpopulations in the military (e.g., Navys nuclear energy and submarine community, personnel in Special Access Programs) 3. Conduct further research on mental health care access, utilization, and perceived barriers by Guard and Reserve personnel 2 Contact Information Kristin G. Schneider, Ph.D. Behavioral Research Scientist Northrop Grumman Technology Services PERSEREC/OPA [email protected]

Olga G. Schechter, Ph.D. Project Director Office of People Analytics (OPA) Defense Personnel and Security Research Center (PERSEREC) [email protected] 2

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