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Military Mental Health First Aid: Development and Preliminary Efficacy of a Community Training for Improving Knowledge, Attitudes, and Helping Behaviors.

INTRODUCTION
Persistent stigma, lack of knowledge about mental health, and negative attitudes toward treatment are among the most significant barriers to military service members and veterans seeking behavioral health care. With the high rates of untreated behavioral health needs among service members and veterans, identifying effective programs for reducing barriers to care is a national priority. This study adapted Mental Health First Aid (MHFA), an evidence-based program for increasing mental health knowledge, decreasing stigma, and increasing laypeople's confidence in helping and frequency of referring people in need, for military and veteran populations and pilot tested the adapted training program with 4 Army National Guard armories.


MATERIALS AND METHODS
A total of 176 community first responders (CFRs) participated in a comparative outcomes study, with 69 receiving the training and 107 participating in the control group. CFRs were individuals in natural positions within the Armory or home communities of Guard members to identify and help service members in mental health crisis. Surveys assessing confidence in helping, attitudes toward help seeking, knowledge of resources, use of MHFA practices, and stigma were completed before the training, immediately post-training, at 4 months post-training, and at 8 months post-training. Analyses included repeated measures analysis of variances on data from CFRs who received the training and mixed between-within subjects analysis of variances comparing the intervention and control group longitudinally at three time points. Institutional review board approval for this study was received from Montana State University and the U.S. Army Medical Department, Medical Research and Materiel Command, Human Research Protection Office.


RESULTS
Significant and meaningful improvements in confidence (p < 0.05, η2 = 0.49), knowledge (p < 0.05, η2 = 0.39), behaviors (p < 0.05, η2 = 0.27), and stigma (p < 0.05, η2 = 0.16) were observed among trainees. When compared to a control group, statistically meaningful differences in change over time were observed for knowledge (η2 = 0.03), attitudes (η2 = 0.02), confidence (η2 = 0.06), and stigma (η2 = 0.02), with a significant and meaningful difference observed for practice behaviors (p < 0.05, η2 = 0.07).


CONCLUSIONS
Results from the comparative outcomes pilot study of military and veterans MHFA indicate that the intervention is acceptable and feasible to implement in National Guard Armories and among non-Guard community-based first responders. There was a significant intervention effect detected for the likelihood that a CFR would use appropriate engagement, support, and referral practices when identifying someone in need of mental health support. In addition, there were positive growth trends in the data for improvements in confidence, knowledge of mental health resources, attitudes toward help seeking, and stigma, which indicate that with a larger number of participants and armories we would expect to see significant intervention effects. Study weaknesses included insufficient power and demographic data for more robust analyses of intervention effects. A larger randomized controlled trial is recommended for better establishing efficacy; however, these results indicate that Military and Veterans MHFA is a promising intervention for reducing critical barriers to care.