Veteran and First Responder Mental Ill Health and Suicide Prevention

Dr. Donald McCreary, with the support of Movember, undertook a scoping review to examine the effectiveness of current programs for first responders and military veterans for mental health and suicide prevention that take a prevention or early intervention approach in Canada, Australia, New Zealand, Ireland, and the UK. The review has 5 main goals:

1. Identify general types of mental health prevention, early intervention, and suicide prevention programs used by first responders and military veterans.
2. Identify similar programs offered to the families of first responders and veterans.
3. Review the evidence for the effectiveness of the programs offered.
4. Summarize the evidence and identify promising programs for both employees and families.
5. Identify potential gaps with the existing programs.

The review was done in 3 steps

1. Identifying existing research to support prevention and early intervention programs.
2. Interviewing Subject Matter Experts (SME) in each country about available programs, their validity, and gaps in current knowledge.
3. Exploring Google and social media sites (LinkedIn, Twitter, and Facebook) to find additional program information. 

What was found?

In reviewing the existing literature the following was found:

• The review of the scientific literature revealed that there is little evidence of overall effectiveness when it comes to psychoeducation and skills based programming.
• Any effects on participants’ mental health tends to be small and diminishes over time (> 1 month).
• Early intervention programs had little effect on reducing mental ill health in first responders.
• Most workplace suicide prevention programs have no evidence of effectiveness, mostly because these types of programs are generally not evaluated for effectiveness.

In speaking with SMEs, these themes were identified:

• There are no validated mental health prevention programs available.
• Everyone appears to be working on their own.
• Organizations are attempting to find a balance between doing the work and protecting their people.
• No one seems to be aware of the limited evidence for the programs.
• Gender differences need to be considered when developing programs.
• There may be group differences in prevention expectations.

A review of the research literature and interviews with SMEs also identified a range of knowledge gaps in our understanding about existing prevention and early intervention programs for mental health in first responders, veterans, and their families. These gaps include a: lack of high quality prevalence data, restrictive focus on PTSD, lack of evidence for existing programs, lack of focus on families, and a lack of understanding of organizational barriers.

Where do we go from here?

The review showed that many organizations recognize the importance of the mental health burden faced by these groups and they are trying to address the problem. However, prevention and early intervention programs appear to be used without making sure they do what they say they do. The programs also tend to focus on the employee, placing a burden on individuals to maintain their own psychological health. The report makes eight recommendations for next steps.

1. Better quality data is needed to monitor mental health
2. Prioritize the evaluation of programs and the development of evaluation standards
3. Move beyond the focus on traumatic events
4. Move beyond the focus on PTSD
5. Establish separate programs focused on suicide prevention
6. Organizations need better targeted programs for veterans
7. Families need more than just Employee Assistance Program (EAP) access
8. Gender differences need to be considered when developing programs.

 The original wording of the executive summary was changed and condensed for the current lay summary.

To view the executive summary please click here

For information on the full report or a copy of the report please contact: andrea.tuch@movember.com

To learn more about Movember and their mental health initiatives visit: www.ca.movember.com

The Original Report: McCreary, D.R. (2019, August). Veteran and first responder mental ill health and suicide prevention: A scoping review of prevention and early intervention programs used in Canada, Australia, New Zealand, Ireland, and the United Kingdom. British Columbia, Canada: Donald McCreary Scientific Consulting.

Summary Prepared by: Kossick, E., Martin, R., and McCreary, D. October 2019

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