An Cosantóir

www.military.ie THE DEFENCE FORCES MAGAZINE | 19 In what ways might these existing services and supports be improved upon, refined, and further enhanced, so as to reflect the on going interpersonal, behavioural, and technological changes in wider society? In an age of rapidly expanding professional and personal technological use, how might these technologies better meet the needs of DF personnel, their families, and our veterans? The authors of this article set out to explore such questions. Their efforts are included in an academic article published in the Defence Forces Review 2019. In preparing their article, a comprehensive review was carried out to explore other militaries' achievements in this field. Particular at- tention was paid to research studies reporting successful outcomes of such technology for both diverse and common mental health difficulties (e.g. depression and anxiety), post-traumatic stress disorder (PTSD), substance misuse, and problems that can arise for the families of those serving, as well as veterans. The particular technologies used were also quite varied, with examples including audio-visual formats (e.g. Skype), phone-based support, email, and online support groups. One term used to refer to all such 'distance' support is 'tele-mental health' (TMH). TMH has shown considerable promise in civilian use over recent years. It probably seems obvious to most that, as more and more of our communication, work, research, entertainment, and a whole host of other interactions have moved online, so too would the benefit of providing various levels of mental wellbeing sup- port from a distance. There are many benefits of expanding the traditional ways of support to tele-mental health. These include providing options and alternatives for those who might not live near relevant services, or for persons with transport or mobility issues. Other possible benefits include matters involving cost effec- tiveness, along with access to relatively sparse specialist services. On an individual level, some research has also suggested that a person may simply have a preference for interacting online; whilst others may find TMH to be 'disinhibiting', which addresses some of the challenges of potential stigma or shame that can surround help-seeking for mental health or wellbeing concerns. An example of such research is a large-scale study by Barak and colleagues who found that across a large number of studies that addressed varied problems, types of technology, and different outcomes, TMH was found to be broadly comparable to 'in-person' support in terms of effectiveness. TMH has its own challenges, however. One assumption that many might make is that the relationship between the Medi- cal Corps mental health clinician, or PSS staff member, and the service member might not be as strong within TMH. Indeed, some research studies have found this to be the case for some partici- pants. Nonetheless, not only do other studies find measures of the relationship to be comparable between the two formats (face-to- face versus TMH), some have found that those who have actually experienced TMH often go on to change their views in a positive direction; that is, those who try it often find it to be more effec- tive than they expected, including when asked specifically about the quality of the relationship and engagement with their doctor, therapist, helping volunteer, etc. While TMH will never be the pre- ferred option for some, such research highlights cause for optimism regarding its broader use. But what of these same technologies when used with military populations? After all, anyone who has served knows of the par- ticular culture, values, and outlook that military life can bring with it. Personnel are encouraged from the very start to get through things, to rely on each other, and to 'weather the storm' of hard- ships of various kinds. The barriers to help seeking in the military can include the stigma associated at times with both mental wellbeing concerns and clinically significant mental health difficul- ties. The military also commonly emphasises particular notions and concepts regarding strength, personal resilience, and perhaps the circumstantial focus on the group or mission over the individual. Such processes can thus present specific organisational, delivery, and acceptability challenges when providing emotional support or clinical mental health care to military personnel. One might therefore consider if there is potential utility and ef- ficacy in using TMH in the military context? Based on the research reviewed in our article, the answer to the above is cautiously optimistic. The authors reviewed evidence from English-speaking militaries and focused on studies, which yielded clear outcomes for consid- eration. Much of the research came from the US, though other examples were sourced from the UK, New Zealand, Australia, and Canada. As with the civilian findings, we included research across a range of presenting difficulties of personnel, varied formats of TMH, and with some surprising results. Samples of these are out- lined below. To begin with, the use of audio-visual TMH (think Skype or Facetime) can most fully capture some of the benefits of in-person support. The fact that helpers/clinicians and the service member can actually see each other may help to maintain those sometimes vital, visual cues. Being able to see a person's body language and facial expression, hear their tone of voice, or even observe their surroundings, can lessen the amount of information otherwise lost through other TMH formats. In a US study active duty personnel receiving mental healthcare at isolated bases reported greater sat- isfaction with TMH than the in-person equivalent. This finding held true despite no additional differences between the groups, such as number of medications prescribed, additional supports offered, Exercise Viking Medical Exercise held in the DFTC, April 2018. ESST conducting a route clearance operation in UNDOF.

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