Publication year
2017
Citation Title
Military Mental Health First Aid: Development and preliminary efficacy of a community training for improving knowledge, attitudes, and helping behaviors.
Journal Name
Military Medicine
Journal Volume
182
Issue Number
1
Page Numbers
1576-1583
DOI
10.7205/MILMED-D-16-00033
Summary
Barriers to behavioral health care for Service members include stigma, lack of knowledge, and negative attitudes towards treatment. Military Mental Health First Aid (MHFA), an evidence-based program that aims to reduce barriers to behavioral health care, was tested among military and community providers. Findings reveal that participation in Military MHFA may decrease barriers to care by increasing providers' ability to identify and refer Service members and veterans to the appropriate care providers.
Key Findings
Compared to the control group, providers who participated in Military MHFA were significantly more likely to use appropriate engagement strategies, support, and referral practices when identifying a Service member in need of behavioral health services.
There was a trend that providers who participated in Military MHFA showed increased confidence in their ability to help Service members in need of behavioral health services.
Improvements in confidence, knowledge, behaviors, and stigma following Military MHFA were sustained for eight months post-training.
Implications for Program Leaders
Provide information to military families on common barriers to behavioral health care and strategies to find supportive services both within the military and surrounding community
Tailor efforts to Service members and their families in order to reduce stigma associated with seeking mental health help
Disseminate information regarding possible symptoms of mental health problems Service members may encounter and where individuals and families can find help for those problems
Implications for Policy Makers
Encourage the training of military and civilian professionals to bolster providers' confidence in their ability to identify and refer Service members to the appropriate care
Recommend partnerships among military-based and community-based programs to help military families feel more comfortable seeking help from a variety of sources
Continue to support programs for identification and treatment of behavioral health concerns in Service members and their families
Methods
Participants in positions where they may come in contact with Service members during a mental health crisis, including family advocates, medics, and Army National Guard leaders, were recruited through outreach from four National Guard armories as well as surrounding civilian communities.
Two armories and the surrounding areas were randomly assigned to complete the intervention, while the other two served as comparison control groups.
The Military MHFA training consisted of an eight hour, in-person, group seminar, where participants completed surveys prior to the intervention, immediately following completion, and at four and eight month follow-up.
Those who completed the intervention were compared to the control group on a variety of measures, including confidence, attitudes, knowledge, and stigma.
Participants
A total of 176 providers participated in the study, with 69 assigned to the intervention group and 107 assigned to the control group.
Participants at rural armories comprised 51% of the intervention group and 39% of the control group.
Approximately 68% of the providers assigned to the intervention completed the four and eight month follow-up surveys, while only 17% of the control group completed both follow-up surveys.
Limitations
No data on gender, age, or race/ethnicity of providers were collected, which limits the ability to generalize findings.
There was no information provided about the participants who were assigned to attend the intervention but did not follow through. The participants (n = 69) who chose to attend could have been significantly different from those who did not, biasing the results.
The low proportion of participants that completed the follow-up surveys in the control group (17%) may be different than those that that withdrew from the study, biasing the results.
Avenues for Future Research
Collect full demographic data from participants in order to increase the likelihood that findings can be generalized
Report on the full sample assigned to participate in the intervention and conduct analyses including those who did not participate in order to ensure results that are not biased
Rigorously seek out follow-up data from all participants in order to ensure self-selection does not bias the results.
Focus
National Guard
Target Population
Population Focus
Military Branch
Military Component
Abstract
Persistent stigma, lack of knowledge about mental health, and negative attitudes toward treatment are among the most significant barriers to military service members and veterans seeking behavioral health care. With the high rates of untreated behavioral health needs among service members and veterans, identifying effective programs for reducing barriers to care is a national priority. This study adapted Mental Health First Aid (MHFA), an evidence-based program for increasing mental health knowledge, decreasing stigma, and increasing laypeople's confidence in helping and frequency of referring people in need, for military and veteran populations and pilot tested the adapted training program with 4 Army National Guard armories. A total of 176 community first responders (CFRs) participated in a comparative outcomes study, with 69 receiving the training and 107 participating in the control group. CFRs were individuals in natural positions within the Armory or home communities of Guard members to identify and help service members in mental health crisis. Surveys assessing confidence in helping, attitudes toward help seeking, knowledge of resources, use of MHFA practices, and stigma were completed before the training, immediately post-training, at 4 months post-training, and at 8 months post-training. Analyses included repeated measures analysis of variances on data from CFRs who received the training and mixed between-within subjects analysis of variances comparing the intervention and control group longitudinally at three time points. Institutional review board approval for this study was received from Montana State University and the U.S. Army Medical Department, Medical Research and Materiel Command, Human Research Protection Office. Significant and meaningful improvements in confidence (p < 0.05, η2 = 0.49), knowledge (p < 0.05, η2 = 0.39), behaviors (p < 0.05, η2 = 0.27), and stigma (p < 0.05, η2 = 0.16) were observed among trainees. When compared to a control group, statistically meaningful differences in change over time were observed for knowledge (η2 = 0.03), attitudes (η2 = 0.02), confidence (η2 = 0.06), and stigma (η2 = 0.02), with a significant and meaningful difference observed for practice behaviors (p < 0.05, η2 = 0.07). Results from the comparative outcomes pilot study of military and veterans MHFA indicate that the intervention is acceptable and feasible to implement in National Guard Armories and among non-Guard community–based first responders. There was a significant intervention effect detected for the likelihood that a CFR would use appropriate engagement, support, and referral practices when identifying someone in need of mental health support. In addition, there were positive growth trends in the data for improvements in confidence, knowledge of mental health resources, attitudes toward help seeking, and stigma, which indicate that with a larger number of participants and armories we would expect to see significant intervention effects. Study weaknesses included insufficient power and demographic data for more robust analyses of intervention effects. A larger randomized controlled trial is recommended for better establishing efficacy; however, these results indicate that Military and Veterans MHFA is a promising intervention for reducing critical barriers to care.
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