How Did COVID-19 Change the Delivery of Embedded Mental Health Services for U.S. Air Force Airmen? A Qualitative Look.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic, in addition to increased mental health difficulties for society as a whole, brought unique challenges and opportunities to mental health professionals attempting to address the issues under public health limitations. Occupationally embedded mental health professionals were uniquely challenged in quickly and creatively adjusting to physical quarantining and working from home. The purpose of this study was to inquire about and categorize the experiences of embedded mental health professionals and their clients in U.S. Air Force (USAF) operational units. METHODS: We conducted a qualitative analysis of semi-structured interviews with 26 embedded mental health professionals across 24 USAF installations and 15 Airmen clients from 5 of those installations. Their experiences within the pandemic context were systemically categorized into actionable themes through thematic content analysis. RESULTS: U.S. Air Force embedded mental health professionals and Airmen primarily identified the challenges of staying engaged when not face-to-face, higher incidence of mental health problems, decreased availability of clinical care and other support resources, technology as a face-to-face substitute, managing safety measures, delayed initiatives, and clinical boundary setting. Alternatively, embedded mental health professionals and Airmen identified strategies to alleviate pandemic limitations, such as using technology to interact, COVID-19 mitigating actions, developing initiatives to target their population needs, and using opportunities to help reduce stigma associated with seeking help for mental health.

The Potential of an Embedded Mental Health Services Program Toward Increasing Health Care-Seeking Behaviors Among U.S. Air Force Aircrew: A Mixed-Methods Study.

INTRODUCTION: The U.S. Air Force implemented the Integrated Operational Support model, which involves embedding health care professionals within operational units to meet the health needs of the airmen. This study assessed the extent to which airmen sought out both traditional and embedded mental health services, as well as perceptions of factors that hinder or encourage health care-seeking behaviors. MATERIALS AND METHODS: A mixed-methods approach including a web-based occupational psychological health assessment and semi-structured interviews was used to assess airmen's experiences with seeking mental health care services. RESULTS: A total of 447 Remotely Piloted Aircraft operators participated in an occupational psychological health assessment (42% response rate) in 2018, and 15 airmen across five high operational tempo, restricted-access installations completed a semi-structured interview (60% participation rate) in 2021. From the occupational assessment, females (33%) sought care from the traditional mental health clinic significantly more than males (21%; χ2 = 5.10, P = .02). However, there were no significant gender differences in seeking embedded mental health services. Respondents who had not sought out help from either the traditional clinic or embedded services were significantly more likely to seek assistance from embedded mental health services (M = 4.29, SD = 2.09) over the traditional clinic (M = 3.92, SD = 1.90), t(205) = 4.94, P < .001. A resounding interview theme was the deep appreciation that airmen expressed for the availability of embedded mental health professionals. Airmen also discussed factors that hinder health care-seeking behaviors with the top-reported factor being the stigma associated with seeking mental health. The top three reported factors that encourage health care-seeking behaviors included leadership and mental health professionals normalizing care, trust in embedded mental health professionals, and ease of access to care. CONCLUSIONS: Findings suggest that having mental health professionals integrated within the unit brings the care straight to the airmen and may reduce the stigma associated with airmen asking for help.

Perspectives of mental health professionals on the delivery of embedded mental health services for U.S. Air Force airmen.

United States Air Force (USAF) leadership implemented the integrated operational support care model, which involves embedding mental health professionals directly within operational units to meet the mental health needs of airmen. The present study evaluated perspectives of embedded mental health professionals on the delivery of embedded care services for airmen assigned to various units and installations. We conducted semistructured interviews with 26 embedded mental health professionals. Interviews were audio-recorded and transcribed verbatim for qualitative analysis, involving thematic content analysis to identify and tabulate key themes emergent from the data. The most commonly reported barriers to delivering embedded mental health services were overcoming stigma associated with seeking mental health care, low staffing, insufficient training, and disconnected relationships between medical treatment facility and other support agencies. Interviewees described numerous strategies for effectively delivering embedded mental health services to include fully understanding and being able to communicate levels of mental health care services, reducing stigma, facilitating coordination of care/resources, and developing initiatives to target population needs. This is the first in-depth, systematic exploration of provider perspectives on embedded mental health services in the USAF. Future research should focus on how best to support embedded care programs to sustain this invaluable service for airmen and other military communities over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological and spiritual factors affecting well-being among military personnel engaged in remote combat.

INTRODUCTION: Remotely piloted aircraft (RPA) require multiple crewmembers to successfully operate the aircraft. RPAs shape modern warfare and pose challenges for the spiritual-emotional health of RPA personnel. This study explored whether (a) RPA crewmembers could be separated into groups based on their experiences, (b) the groups differed in psychological health outcomes, and (c) they differed in aspects of spiritual well-being. METHOD: Participants included 354 United States Air Force personnel involved in RPA duty. Participants provided demographic information and completed the Work Role Strain Scale as a predictor. Outcome measures included job satisfaction, the Maslach Burnout Inventory, Outcome Questionnaire-45.2, Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and medical complaints and psychosocial services indices. The Spiritual Well-Being Scale and Unit Cohesion Scale were assessed as moderating factors. RESULTS: Cluster analysis identified two groups of crewmembers. Psychologically healthy participants included 73.4% of crewmembers (n = 260); the remaining 26.6% (n = 94) were distressed. The distressed group included more imagery analysts, weapon-strike pilots, and females, and fewer sensor operators and males compared with the healthy group. Symptoms among the distressed group included more psychological difficulties and PTSD symptoms, more medical complaints, and greater use of psychosocial services. The distressed group reported greater work-role conflict, role ambiguity, work overload, relationship stress, emotional exhaustion, and cynicism as well as lower job satisfaction, unit cohesion, professional efficacy, and existential well-being. DISCUSSION: The strongest predictors of distress were lack of meaning and feeling overextended at work. Emotional exhaustion and low existential well-being identified distressed crewmembers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).