An Cosantóir

An Cosantóir February 2020 www.dfmagazine.ie 20 | etc. The authors conclude that the positive findings were due to a combination of a preference for TMH being discovered by patients, coupled with shorter waiting times for follow-up appointments made possible over distance. Even when treating problems as severe as PTSD, research find- ings give cause for optimism. In a UK study of veterans affected by PTSD, the authors reviewed some 41 studies examining treatment outcomes of TMH compared with in-person formats. The findings suggest that outcomes of the TMH participants were comparable, sometimes even better, and that technical issues did not affect engagement in treatment or successful outcome. Some feedback suggested that TMH might make observations by therapists (eg of non-verbal behaviour of clients) more difficult to gauge, but the alliance between therapist and client did not seem worsened in any way that affected outcome. Other research suggests that treatment can even be delivered in-theatre for problems similar to PTSD. For example, Pelton and colleagues have reported using TMH effectively in the treatment of acute stress disorder (a condition similar to PTSD but where symp- toms have emerged quite early after a traumatic event). The patient in this case commenced therapy at a relatively secure forward op- erating base (FOB), with the second half of sessions being delivered by video conferencing at a remote combat outpost. Substantial improvement was achieved within just 10 sessions. The potential benefits of using TMH among military person- nel goes beyond clinical treatment also. It can be used to provide screening for difficulties, assist in administering questionnaires, and this data can even be used to generate personalised self-help infor- mation based on individuals' answers. As an example, female US Reserve and National Guard personnel were involved in a feasibility study of an online mental health screening and information process. High rates of both combat and military sexual trauma (95% and 50% respectively) were reported. Those who took part in feedback interviews suggested that they felt comfortable engaging online, that this reduced stigma, and that many were now considering accessing mental health services, sometimes in cases where they otherwise would not have. It's also worth mentioning that online support services and plat- forms have been developed elsewhere to provide assistance to the families of servicemen and women. These can be used to provide relevant information about supports available, arrange appoint- ments with those helping family members, and can sometimes pro- vide the same online direct supports (counselling sessions, etc.) available to a service member. Such platforms may further enhance, also, the sense of a shared 'military community' and available peer support. Chat function and online support groups may add to this. The above research, as articulated further in our Defence Forces Review 2019 article, would be of primary rel- evance to both the DF Medical Corps as well as the PSS. TMH is not suggested as a replace- ment of the already professional and skilled support provided through medical officers, chaplains, bar- racks personnel support services officers (BPSSOs), and social workers. Rather, TMH could instead be a means by which these efforts can be enhanced, made more readily available, prove more cost effective, and perhaps engage even more personnel concerned with either stigma or facing a lack of time to engage with existing supports or services. The use of the internet to enhance the support of currently serving personnel, veterans, and their families seems worthy of exploring further. Pte (AR) Eoin O'Shea is a senior counselling psy- chologist and serves in D Coy, 7 Inf Bn. He is cur- rently conducting research for the PSS concerning mental resilience train- ing. He also works in social care, for the Irish Red Cross, and in private practice. His focuses are occupational stress, psychological trauma, online mental health support, and care of military and humani- tarian personnel. Capt (AR) Mathew Mc- Cauley is a consultant military clinical psycholo- gist, based in the Office of DMB. His background includes 13 years within the US and UK military healthcare systems. He is an assistant professor at Trinity College Dublin, has served as both a researcher with NATO's Science & Technolo- gy Organisation and as a trainer with the US military's Uniformed Services University of the Health Sciences (USUHS), and is a mem- ber of the Reserve Defence Forces Represen- tative Association executive committee. Comdt Dorota O'Brien is chief military clinical psychologist and the first full-time clinical psy- chologist to serve with the Permanent Defence Force (PDF). As the current man- ager of the PDF's clinical psychology service, Comdt O'Brien is responsible for creating and delivering Defence Forces men- tal health policy, clinical governance over psychological services within the DF, and holds an advisory role to higher command. She also represents Ireland at the Military Mental Health Expert Panel for NATO/PfP.

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