Developing the skills of future allied health professionals to work effectively with veterans and first responders
DOI:
https://doi.org/10.11157/fohpe-vol26iss2id862Keywords:
mental health, emergency responders, post-traumatic stress disorder, education, healthcareAbstract
Introduction: Military personnel and first responders experience high rates of physical and psychological injury, reporting numerous barriers to accessing healthcare. These barriers are often related to the lack of population-specific knowledge and skills of health professionals, which may be alleviated by improved education and training. This study investigated education and training outcomes of students completing placement within a program—Invictus Pathways Program (IPP)—designed to promote the wellbeing of these populations.
Methods: Survey data were collected pre and post placement using the Health Professionals Attitudes Towards Veterans (HPATV) and Mental Illness Clinicians’ Attitudes (MICA-4) questionnaires for both IPP placement students (n = 41) and a control group (n = 29). Data were analysed using a mixed model analysis of variance. Focus groups were conducted following placement and data analysed using thematic analysis.
Results: Significant group by time interactions (p < 0.05) were identified for all HPATV subscales and the MICA-4 subscales of knowledge of mental illness and distinguishing physical and mental health. Three themes were identified, namely “value of the placement as a professional and personal experience”, “knowledge gaps and misconceptions” and “student support” from the focus group data.
Discussion: Results suggest students had an increased understanding of occupational culture, population specific concerns and mental ill health following completion of the IPP placement. Improved knowledge in these areas may address healthcare barriers experienced by veterans and first responders, which may subsequently facilitate greater access to services and improve clinical outcomes.
Conclusion: Findings demonstrate students have enhanced knowledge of occupational culture, attitudes towards working with veteran and first responder populations and capacity to work with individuals with mental ill health following completion of the IPP placement.
References
American Psychological Association (APA). (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. https://www.apa.org/ptsd-guideline/ptsd.pdf
Arjmand, H.-A., O'Donnell, M. L., Putica, A., Sadler, N., Peck, T., Nursey, J., & Varker, T. (2024). Mental health treatment for first responders: An assessment of mental health provider needs. Psychological Services, 21(3), 489–499. https://doi.org/10.1037/ser0000832
Australian Bureau of Statistics (ABS). (2022). Service with the Australian Defence Force: 2021 census. https://www.abs.gov.au/statistics/people/people-and-communities/service-australian-defence-force-census/latest-release#data-downloads
Australian Government Productivity Commission. (2019). Inquiry report: A better way to support veterans. https://www.pc.gov.au/inquiries/completed/veterans/report/veterans-overview.pdf
Berger, W., Coutinho, E. S. F., Figueira, I., Marques-Portella, C., Luz, M. P., Neylan, T. C., Marmar, C. R., & Mendlowicz, M. V. (2012). Rescuers at risk: A systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers. Social Psychiatry and Psychiatric Epidemiology, 47(6), 1001–1011. https://doi.org/10.1007/s00127-011-0408-2
Beyond Blue. (2018). Answering the call: National survey. https://apo.org.au/node/206886
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Butler, L. D., Linn, B. K., Ingraham, L. M., & McClain-Meeder, K. (2023). Teaching military/veteran cultural competence for working with veterans and military families: Effects on student knowledge, self-efficacy, comfort, and behavioral intentions. Journal of Military Social Work and Behavioral Health Services, 12(1), 86–95. https://doi.org/10.1080/21635781.2023.2293903
Cheney, A. M., Koenig, C. J., Miller, C. J., Zamora, K., Wright, P., Stanley, R., Fortney, J., Burgess, J. F., & Pyne, J. M. (2018). Veteran-centered barriers to VA mental healthcare services use. BMC Health Services Research, 18, Article 591. https://doi.org/10.1186/s12913-018-3346-9
Ein, N., Gervasio, J., St. Cyr, K., Liu, J., Baker, C., Nazarov, A., & Richardson, J. D. (2024). A rapid review of the barriers and facilitators of mental health service access among veterans and their families. Frontiers in Health Services, 4, Article 1426202. https://doi.org/10.3389/frhs.2024.1426202
Fibbins, H., Lederman, O., Morell, R., Furzer, B., Wright, K., & Stanton, R. (2019). Incorporating exercise professionals in mental health settings: An Australian perspective. Journal of Clinical Exercise Physiology, 8(1), 21–25. https://doi.org/10.31189/2165-6193-8.1.21
Gabbidon, J., Clement, S., van Nieuwenhuizen, A., Kassam, A., Brohan, E., Norman, I., & Thornicroft, G. (2013). Mental illness: Clinicians' Attitudes (MICA) Scale: Psychometric properties of a version for healthcare students and professionals. Psychiatry Research, 206(1), 81–87. https://doi.org/10.1016/j.psychres.2012.09.028
Garcia, H. A., Finley, E. P., Ketchum, N., Jakupcak, M., Dassori, A., & Reyes, S. C. (2014). A survey of perceived barriers and attitudes toward mental health care among OEF/OIF veterans at VA outpatient mental health clinics. Military Medicine, 179(3), 273–278. https://doi.org/10.7205/MILMED-D-13-00076
Gibbs, C., Murphy, B., Hoppe, K., Clarke, P., Ratnaike, D., & Lovelock, H. (2020). Enhancing the capacity of the Australian health care workforce to support veterans’ mental health: A collaborative interdisciplinary approach. Military Medicine, 185(3–4), 499–505. https://doi.org/10.1093/milmed/usz188
Godier-McBard, L. R., Wood, A., Kohomange, M., Cable, G., & Fossey, M. (2023). Barriers and facilitators to mental healthcare for women veterans: A scoping review. Journal of Mental Health, 32(5), 951–961. https://doi.org/10.1080/09638237.2022.2118686
Gross, G. M., Spiller, T. R., Ben-Zion, Z., Rubenstein, A., Pietrzak, R. H., Duek, O., Hoff, R., & Harpaz-Rotem, I. (2024). Unraveling PTSD: Symptom cluster change during and 1 year after veterans’ residential PTSD treatment. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0001734
Gupta, M. A. (2013). Review of somatic symptoms in post-traumatic stress disorder. International Review of Psychiatry, 25(1), 86–99. https://doi.org/10.3109/09540261.2012.736367
Hitch, C., Toner, P., & Armour, C. (2023). Enablers and barriers to military veterans seeking help for mental health and alcohol difficulties: A systematic review of the quantitative evidence. Journal of Health Services Research & Policy, 28(3), 197–211. https://doi.org/10.1177/13558196221149930
Jones, R., Jackson, D., Ranse, J., Arena, A., Clegg, L., Sutton, C., Gayed, A., Rice, K., & Usher, K. (2024). A scoping review of trauma, mental health and first responders in Australia. International Journal of Mental Health Nursing, 33(6), 1817–1839. https://doi.org/10.1111/inm.13397
Jones, S., Agud, K., & McSweeney, J. (2020). Barriers and facilitators to seeking mental health care among first responders: “Removing the darkness”. Journal of the American Psychiatric Nurses Association, 26(1), 43–54. https://doi.org/10.1177/1078390319871997
Kerr, K., Romaniuk, M., McLeay, S., Khoo, A., Dent, M. T., & Boshen, M. (2018). Increased risk of attempted suicide in Australian veterans is associated with total and permanent incapacitation, unemployment and posttraumatic stress disorder severity. Australian & New Zealand Journal of Psychiatry, 52(6), 552–560. https://doi.org/10.1177/0004867417718945
Kleim, B., & Westphal, M. (2011). Mental health in first responders: A review and recommendation for prevention and intervention strategies. Traumatology, 17(4), 17–24. https://doi.org/10.1177/1534765611429079
Knopf-Amelung, S., Brommelsiek, M., Peterson, J. A., Roman, Z., & Graybill, T. L. (2018). Developing a measure for health professionals' attitudes toward veterans. The Journal of Nursing Education and Practice, 8(7), 60–67. https://doi.org/10.5430/jnep.v8n7p60
Lane, J., & Wallace, D. (2020). Australian military and veteran’s mental health care Part 1: An introduction to cultural essentials for clinicians. Australasian Psychiatry, 28(3), 267–269. https://doi.org/10.1177/1039856220901470
Lederman, O., Grainger, K., Stanton, R., Douglas, A., Gould, K., Perram, A., Baldeo, R., Fokas, T., Nauman, F., & Semaan, A. (2016). Consensus statement on the role of accredited exercise physiologists within the treatment of mental disorders: A guide for mental health professionals. Australasian Psychiatry, 24(4), 347–351. https://doi.org/10.1177/1039856216632400
Lee, J., Sanders, K. M., & Cox, M. (2014). Honoring those who have served: How can health professionals provide optimal care for members of the military, veterans, and their families? Academic Medicine, 89(9), 1198–1200. https://doi.org/10.1097/ACM.0000000000000367
Linn, B., Butler, L., Bruce, S., McClain-Meeder, K., & Meeker, M. (2015). On working with veterans: What social work and nursing students need to know. Journal of Military and Veterans Health, 23(3), 5–11. https://pure.psu.edu/en/publications/on-working-with-veterans-what-social-work-and-nursing-students-ne
McFarlane, A. C. (2010). The long-term costs of traumatic stress: Intertwined physical and psychological consequences. World Psychiatry, 9(1), 3–10. https://doi.org/10.1002/j.2051-5545.2010.tb00254.x
McGuire, A., Dobson, A., Mewton, L., Varker, T., Forbes, D., & Wade, D. (2015). Mental health service use: Comparing people who served in the military or received Veterans' Affairs benefits and the general population. Australian and New Zealand Journal of Public Health, 39(6), 524–529. https://doi.org/10.1111/1753-6405.12431
Mensink, B., van Schagen, A., van der Aa, N., & Ter Heide, F. J. J. (2022). Moral injury in trauma-exposed, treatment-seeking police officers and military veterans: Latent class analysis. Frontiers in Psychiatry, 13, Article 904659. https://doi.org/10.3389/fpsyt.2022.904659
Naturale, A., & Pulido, M. (2012). Helping the helpers: Ameliorating secondary traumatic stress in disaster workers. In J. Framingham & M. Teasley (Eds.), Behavioral health response to disasters (pp. 51–69). CRC Press. https://cectresourcelibrary.info/wp-content/uploads/2021/07/Helping-the-Helpers-Final-2-3-10.pdf
O'Toole, B. I., Marshall, R. P., Grayson, D. A., Schureck, R. J., Dobson, M., Ffrench, M., Pulvertaft, B., Meldrum, L., Bolton, J., & Vennard, J. (1996). The Australian Vietnam veterans health study: II. Self-reported health of veterans compared with the Australian population. International Journal of Epidemiology, 25(2), 319–330. https://doi.org/10.1093/ije/25.2.319
Parliament of Australia. (2018). The role of Commonwealth, state and territory governments in addressing the high rates of mental health conditions experienced by first responders, emergency service workers and volunteers. Retrieved June 20, 2024, from https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Education_and_Employment/Mentalhealth
Petrie, K., Milligan-Saville, J., Gayed, A., Deady, M., Phelps, A., Dell, L., Forbes, D., Bryant, R. A., Calvo, R. A., & Glozier, N. (2018). Prevalence of PTSD and common mental disorders amongst ambulance personnel: A systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology, 53(9), 897–909. https://doi.org/10.1007/s00127-018-1539-5
Phelps, A. J., Varker, T., Metcalf, O., & Dell, L. (2017). What are effective psychological interventions for veterans with sleep disturbances? A rapid evidence assessment. Military Medicine, 182(1–2), e1541–e1550. https://doi.org/10.7205/MILMED-D-16-00010
Pietrzak, R. H., Goldstein, M. B., Malley, J. C., Johnson, D. C., & Southwick, S. M. (2009). Subsyndromal posttraumatic stress disorder is associated with health and psychosocial difficulties in veterans of Operations Enduring Freedom and Iraqi Freedom. Depression and Anxiety, 26(8), 739–744. https://doi.org/10.1002/da.20574
Possemato, K., Wray, L. O., Johnson, E., Webster, B., & Beehler, G. P. (2018). Facilitators and barriers to seeking mental health care among primary care veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 31(5), 742–752. https://doi.org/10.1002/jts.22327
Post, D., Baker, A., Milanese, S., Freegard, S., & Parfitt, G. (2023a). The physical, psychological, and social impacts of participation in the Invictus Pathways Program: A qualitative analysis of veterans’ perceptions and experiences. PloS One, 18(10), Article e0287228. https://doi.org/10.1371/journal.pone.0287228
Post, D., Baker, A., Milanese, S., Freegard, S., & Parfitt, G. (2023b). Process evaluation of the Invictus Pathways Program. PloS One, 18(11), Article e0293756. https://doi.org/10.1371/journal.pone.0293756
Rikkers, W., & Lawrence, D. (2021). Mental health help-seeking experiences and service use among Australian first responders. Australian Journal of Psychology, 73(2), 125–133. https://doi.org/10.1080/00049530.2021.1882271
Ross, M. H., Prguda, E., & Setchell, J. (2023). Exploring the experiences of Australian veterans with accessing healthcare: A qualitative study. Journal of Veterans Studies, 9(1), 61–72. https://doi.org/10.21061/jvs.v9i1.399
Shi, S., Almklov, E., Afari, N., & Pittman, J. O. (2023). Symptoms of major depressive disorder and post-traumatic stress disorder in veterans with mild traumatic brain injury: A network analysis. PloS One, 18(5), Article e0283101. https://doi.org/10.1371/journal.pone.0283101
Syed, S., Ashwick, R., Schlosser, M., Jones, R., Rowe, S., & Billings, J. (2020). Global prevalence and risk factors for mental health problems in police personnel: A systematic review and meta-analysis. Occupational and Environmental Medicine, 77(11), 737–747. https://doi.org/10.1136/oemed-2020-106498
Tsai, J., Sippel, L. M., Mota, N., Southwick, S. M., & Pietrzak, R. H. (2016). Longitudinal course of posttraumatic growth among US military veterans: Results from the National Health and Resilience in Veterans Study. Depression and Anxiety, 33(1), 9–18. https://doi.org/10.1002/da.22371
Varker, T., Metcalf, O., Forbes, D., Chisolm, K., Harvey, S., Van Hooff, M., McFarlane, A., Bryant, R., & Phelps, A. (2018). Research into Australian emergency services personnel mental health and wellbeing: An evidence map. Australian & New Zealand Journal of Psychiatry, 52(2), 129–148. https://doi.org/10.1177/0004867417738054
Vest, B. M., Kulak, J. A., & Homish, G. G. (2019). Caring for veterans in US civilian primary care: Qualitative interviews with primary care providers. Family Practice, 36(3), 343–350. https://doi.org/10.1093/fampra/cmy078
Waller, M., Treloar, S. A., Sim, M. R., McFarlane, A. C., McGuire, A. C., Bleier, J., & Dobson, A. J. (2012). Traumatic events, other operational stressors and physical and mental health reported by Australian Defence Force personnel following peacekeeping and war-like deployments. BMC Psychiatry, 12, Article 88. https://doi.org/10.1186/1471-244X-12-88
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Focus on Health Professional Education: A Multi-Professional Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
On acceptance for publication in FoHPE the copyright of the manuscript is signed over to ANZAHPE, the publisher of FoHPE.
How to Cite
