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Health Promotion International, 2019, 1–8
doi: 10.1093/heapro/day112
Article

Mental health first aid for the UK Armed Forces

Diane M. Crone 1,*, Mustafa Sarkar2, Thomas Curran3, Colin M. Baker1,
Denise Hill4, Elizabeth A. Loughren1, Tabitha Dickson5, and Andrew Parker6
1
School of Health and Social Care, University of Gloucestershire, Cheltenham, GL50 4AZ, UK, 2Department
of Sport Science, Nottingham Trent University, Nottingham, NG11 8NS, UK, 3Department for Health,
University of Bath, Bath, BA2 7AY, UK, 4College of Engineering, Swansea University, SA1 8EN, UK, 5School
of Health and Social Care, University of Gloucestershire, Gloucester, GL2 9HW, UK, and 6School of Sport
and Exercise, University of Gloucestershire, Gloucester, GL2 9HW, UK
*Corresponding author. E-mail: [email protected]

Summary
Education programmes in mental health literacy can address stigma and misunderstanding of mental
health. This study investigated self-rated differences in knowledge, attitudes and confidence around
mental health issues following participation in a bespoke Mental Health First Aid (MHFA) training
course for the Armed Forces. The mixed methods approach comprised quantitative surveys and quali-
tative interviews. A survey, administered immediately post-training (n ¼ 602) and again at 10-months
post-attendance (n ¼ 120), asked participants to rate their knowledge, attitudes and confidence around
mental health issues pre- and post-training. Quantitative findings revealed a significant increase in
knowledge, positive attitudes and confidence from the post-training survey which was sustained at
10-months follow-up.Semi-structured telephone interviews (n ¼ 13) were conducted at follow-up,
6-months post-attendance. Qualitative findings revealed that participation facilitated an ‘ambassador’
type role for participants. This study is the first to have investigated the effect of MHFA in an Armed
Forces community. Findings show participants perceived the training to increase knowledge regard-
ing mental health and to enhance confidence and aptitude for identifying and supporting people with
mental health problems. Results suggest that such an intervention can provide support for personnel,
veterans and their families, regarding mental health in Armed Forces communities.
Key words: Armed Forces, mental health literacy, mixed methods, community-based intervention

INTRODUCTION Armed Forces personnel undertaking major deploy-

ments (e.g. Iraq and Afghanistan), the need for support
People with mental health problems often avoid seeking on return, if mental health problems surface, is para-
professional help from GPs, psychologists or counselling mount. Estimates suggest that around 20% of service
services (Oliver et al., 2005). Armed Forces personnel men and women have mental health problems following
may be particularly vulnerable and choose not to utilize deployment (Sundin et al., 2011). Promisingly, in the
support services due to concerns over career develop- UK, the use of mental health services by Armed Forces
ment and mental health-related stigma, such as being personnel is increasing (MOD, 2015), and programmes
seen as weak or unable to cope (Hoge et al., 2004; have been implemented to improve mental health care
Iversen et al., 2011; Vogt, 2011). Given the number of provision for this particular community. These have

C The Author(s) 2019. Published by Oxford University Press. All rights reserved.
V
For permissions, please email: [email protected]
2 D. Crone et al.

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demonstrated promising effects on stigma and attitudes signs, confidence building and enhancing of interper-
to mental health problems (Greenberg et al., 2010; sonal skills to guide people to further support. The mod-
Murrison, 2010; Mulligan et al., 2012; MOD, 2015). ifications to this course involved the inclusion of Armed
Despite the rise in the use of mental health services Forces specific content including cultural differences be-
by Armed Forces personnel significant barriers remain, tween the Armed Forces and civilian communities; spe-
including stigma towards seeking medical care for men- cific statistics, films/media clips and case studies;
tal health problems (Greenberg et al., 2003; Hoge et al., information on Adjustment Disorder and an expanded
2004; Fikretoglu et al., 2009; Zinzow et al., 2012; Post-Traumatic Stress Disorder section. Furthermore,
Schreiber and McEnany, 2015). Thus the number of per- following a pilot of the course, it was developed as a 2-
sonnel who experience problems, yet do not seek help is day, rather than the originally proposed 1-day course, to
unknown (Garvey Wilson et al., 2009). One approach enable depth of content and reflection. Currently only
through which barriers to care can be broken down is two mental health literacy programmes exist for Armed
via mental health literacy education, which encourages Forces; the UK MHFA programme under investigation
the active and open discussion of mental health issues in this study, and a US-based programme.
(Kitchener and Jorm, 2006; Warner et al., 2008; Dimoff This study evaluated the bespoke UK MHFA Armed
et al., 2016). Providing information on mental illness, its Forces programme that was delivered across the UK dur-
treatment and suitable pathways for support has been ing 2015 and 2016, and which targeted serving person-
shown to increase readiness to seek help in various set- nel, veterans and families. There is an increasing need to
tings including schools, the workplace and in the general develop and evaluate appropriate health literacy training
population (Esters et al., 1998; Jorm et al., 2010; among Armed Forces communities to identify whether it
O’Reilly et al., 2011; Morawska et al., 2013; Svensson is effective amongst this population. It is especially use-
et al., 2015; Aakre et al., 2016; Dimoff et al., 2016). ful to determine whether the effects endure over time
Some programmes have been introduced into military and to examine the potential for population level
environments which address mental health (Gould et al., impact. To address these issues, we conducted a mixed
2007; Mulligan et al., 2012), but recommendations sug- methods study evaluating change over time in: (i)
gest that whilst these are helpful, they should be intro- knowledge of mental health issues; (ii) attitudes toward
duced as a supplement rather than a replacement for mental health; and (iii) confidence to help, advise and
existing support (Greenberg et al., 2011). recommend support services to people who have mental
One of the best known mental health literacy educa- health problems. The overall objective was two fold,
tion programmes across the world is Mental Health firstly to examine change following participation in the
First Aid (MHFA) (Kitchener and Jorm, 2008). MHFA bespoke MHFA course and whether any changes were
seeks to improve mental health literacy, improve the sustained at follow-up, and second, to qualitatively ex-
identification of and access to mental health support, plore participants’ lived experiences of the MHFA
and reduce stigma associated with mental health issues course and perceptions in respect to sustainability of
(Kitchener and Jorm, 2006, 2008; Hadlaczky et al., mental health literacy, amongst members of Armed
2014). MHFA courses have been developed for the gen- Forces community.
eral population in addition to specific population groups
(Jorm et al., 2010, Morawska et al., 2013; Aakre et al.,
2014; Bond et al., 2015). They have been shown to be
effective in influencing changes in knowledge, attitudes METHODS
and behaviours and are recommended for general health The mixed method design is predominantly quantitative
education (Hadlaczky et al., 2014). However, relatively with a small, complementary qualitative component
little is known about the effect of these programmes which seeks to provide insight into the lived experience
when deployed specifically with Armed Forces commu- of participants (Tashakkori and Teddlie, 1998). The
nities. The bespoke MHFA course was developed fol- quantitative component included a survey, with both
lowing a request from UK-based military charities. open and closed questions, that was administered at two
Modifications were made by MHFA England (the orga- time points; after the course had been completed; and at
nisation that manages the programme in the UK) to tai- 10-months’ follow-up. The qualitative data for the study
lor the existing adult course to an Armed Forces included text responses from the open-ended questions
community. The existing adult course includes sessions in the two surveys, and follow-up telephone interviews
over 2 days on understanding mental health, factors that with attendees, 6 months after the course had been
affect wellbeing, practical skills to identify triggers and completed.
MHFA for the UK Armed Forces 3

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Sample course. Participants were asked if they would be willing
Participants (n ¼ 602) were members of Armed Forces to take part in a telephone interview to discuss the train-
communities and included veterans, serving personnel ing, and related topics. Of those who agreed to take part
and their families, and civilian and medical staff work- (n ¼ 61), a sample of (n ¼ 16) participants were con-
ing with Armed Forces personnel. Participants enrolled tacted directly (by e-mail) and invited for interview. The
on an MHFA accredited training course and were pro- invited sample was chosen, using stratified random sam-
vided with a multi-section survey at the end of their pling (Coyne, 1997), based on having attended different
MHFA training, in a classroom setting. Participants for courses to ensure a range of views were captured in the
the qualitative component were recruited from the sur- interviews. Participants were sent follow-up emails (n ¼ 2)
vey sample. if no response had been received within 7 days of re-
ceipt. Those who responded positively (n ¼ 13) were
contacted and a date and time for interview arranged.
Data collection Individual telephone interviews were conducted with
The bespoke survey, with both open and closed ques- n ¼ 13 trainees (female n ¼ 7) at 6-months post-follow-
tions, was designed to capture the specific outcomes of up. Branches of the armed forces were represented in-
the study, including participants’ perspectives of their cluding: the Ministry of Defence, the British Army, the
knowledge, attitudes and confidence in mental health lit- Royal Air Force, the Royal Navy, The Royal British
eracy. The survey, administered at the end of the course, Legion, in addition to private healthcare.
asked participants to rate their knowledge (viz. ‘How
would you rate your knowledge of mental health Data analysis
issues’), attitudes (viz. ‘How would you rate your atti- Survey
tudes toward mental health?’) and confidence (viz. To test for differences in self-rated knowledge, attitudes
‘How would you rate your confidence to help, advise and confidence around mental health issues, from pre-
and recommend support services to people who have to post-training, and from post-training to 10 months
mental health problems’) around mental health issues. follow-up, a repeated measures ANOVA with
As the survey was administered at the end of the course, Bonferroni pairwise comparisons was performed. SPSS
participants were asked to rate their pre-training level at (Version Statistics 22) (IBM) was used for statistical
the same time as their post-training score. Responses to analyses. A p-value of 0.05 and 95% CIs that do not
the knowledge, attitudes and confidence items were cross 0 were considered as statistically significant.
recorded on a 5-point Likert scale (1 ¼ very low/not at
all useful; 5 ¼ very high/very useful). The closed (Likert-
based) questions were analysed statistically, and open Qualitative interviews and open-ended survey
responses
questions were analysed qualitatively. Demographic in-
Interviews lasted between 20 and 60 min and were digi-
formation (e.g. age, gender) was also collected.
tally recorded, transcribed verbatim and anonymized.
For follow-up, the same survey was distributed elec-
Textual responses from the surveys and the interview
tronically to individuals 10-months after the course had
transcripts were analysed using inductive thematic
been completed, in order to establish post-training
analysis techniques (Braun and Clarke, 2006; Braun
changes (if any) were sustained. In total, 120 partici-
et al., 2014; Clarke et al., 2015) and managed using
pants completed the follow-up survey and were matched
qualitative software (NVivo 8). Quotations are selected
using a unique identifier (date of birth and initials) that
for illustration of key themes and divergent findings.
had been allocated at baseline. The qualitative aspect of
These are identified with the participant’s pseudonym
the evaluation comprised of textual analysis of open-
ended responses from the follow-up survey and semi- and line number from the relevant transcript, or identi-
structured telephone interviews with trainees. In respect fied as ‘open-ended survey response’. Ethical approval
to the open-ended survey, questions included their opin- for the study was obtained from the first author’s
ions and perceived learning from the programme. For University Research Ethics committee.
the telephone interviews, a semi-structured interview
guide was developed designed to explore the perceived
RESULTS
effect of the course on mental health literacy, knowledge
and confidence, and their application. Recruitment for Quantitative findings
the telephone interviews was via the initial pre- and In terms of self-rated knowledge the repeated measure
post-quantitative survey distributed at the end of the ANOVA yielded a significant Mauchly’s test, indicating
4 D. Crone et al.

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that the assumption of sphericity had been violated, endured to 10-months follow-up [Mdifference pre.follow ¼
v2(2) ¼ .842, p < 0.001. This is the assumption that the 1.26, 95% CI ¼ (1.00, 1.51)]. A small but significant de-
variances for the repeated measures (i.e. knowledge, crease in reported confidence occurred from post-
attitudes and confidence) are the same and that the training to 10-months follow-up [Mdifference post.follow ¼
covariances between the pairs of repeated measures are 0.26, 95% CI ¼ (0.43, 0.09)]. These findings are
the same. It is a commonly violated assumption in longi- displayed in Table 1.
tudinal research, especially as the period between mea- Furthermore, to examine those who were in follow-
surement occasions widens (Heck et al., 2010). To up and those that did not, an independent t-test was
adjust for unequal variances, the degrees of freedom in undertaken examining difference on pre-knowledge, atti-
the ANOVA model were corrected using Greenhouse- tude and confidence for those who completed follow-up
Geisser estimates of sphericity (e ¼ 0.86). Results (n ¼ 120) vs those that did not (n ¼ 489). There were no
showed that there was a significant main effect of the significant differences between the groups for
training on self-rated knowledge of mental health issues knowledge [mean difference ¼ 0.08759, t (607) ¼
[F (1.73, .51) ¼ 247.17, p < 0.001]. Bonferroni pairwise 0.821, p ¼ 0.412], attitudes [mean difference ¼
comparisons revealed that immediately following train- 0.18855, t (607) ¼ 1.599, p ¼ 0.110] and confidence
ing, from (retrospective) pre- to post-intervention, par- [mean difference ¼ 0.10762, t (607) ¼ 0.915, p ¼
ticipants showed a significant increase in their self-rated 0.361]. There were therefore no differences in the key
knowledge of mental health issues [Mdifference pre.post ¼ outcomes at baseline between those who followed up
1.68, 95% CI ¼ (1.48, 1.87)], which endured to 10- and those that were not.
months follow-up [Mdifference pre.follow ¼ 1.62, 95% CI ¼
(1.37, 1.86)]. A small but significant decrease in Qualitative findings
reported self-rated knowledge occurred from post-train- Interviewees came from the three Armed Forces with ex-
ing to 10-months follow-up [Mdifference post.follow ¼ pertise in education, recruitment/selection, training, pol-
0.55, 95% CI ¼ (0.71, 0.39)]. icy development and veteran’s welfare. Degrees of
For attitudes, a similar pattern of findings emerged. seniority included departmental head, Petty Officer and
Here, Mauchly’s test was also violated [v2(2) ¼ 0.685, p ¼ Flight Lieutenant.
0.00] and so the Greenhouse-Geisser correction (e ¼ 0.76) Thematic analysis revealed perceived changes in
was applied to the degrees of freedom. Results showed that awareness, knowledge, attitudes and confidence and
there was a significant main effect of the training on reported their application to day-to-day life. Two closely con-
positive attitudes toward mental health issues [F (1.52, 0.66) nected themes emerged; (i) the impact on participants’
¼ 60.93, p ¼ 0.00]. Bonferroni pairwise comparisons awareness, skills and confidence in dealing with mental
revealed that immediately following training, from (retro- health issues and, (ii) through undertaking the course,
spective) pre- to post-intervention, participants showed a sig- participants’ perceived role as ambassadors for mental
nificant increase in reported positive attitudes toward mental health within their working contexts.
health issues [Mdifference pre.post ¼ 0.98, 95% CI ¼ (0.75, Impact on awareness, skills and confidence in dealing
1.21)], which endured to 10-months follow-up [Mdifference with mental health issues
pre.follow
¼ 0.68, 95% CI ¼ (0.42, 0.95)]. A small but signifi- A number of participants described the effect of the
cant decrease in reported positive attitudes toward mental programme in terms of how it helped them to develop
health occurred from post-training to 10-months follow-up an awareness of the importance of mental health literacy
[Mdifference post.follow ¼ 0.30, 95% CI ¼ (0.45, 0.15)].
Finally, for confidence Mauchly’s test was also vio- Table 1: Results of the repeated measures ANOVA
lated [v2(2) ¼ 0.82, p ¼ 0.00] and so the Greenhouse-
Geisser correction (e ¼ 0.85) was applied to the degrees Pre Post Follow-up
of freedom. Results showed that there was a significant
M SE M SE M SE
main effect of the training on self-rated confidence in
b,c a,c a,b
supporting those displaying mental health issues Knowledge 2.87 0.08 4.54 0.05 3.99 0.06
(F [1.69, 0.59] ¼ 159.38, p ¼ 0.00). Bonferroni pairwise Attitudes 3.80b,c 0.10 4.78a,c 0.04 4.48a,b 0.06
comparisons revealed that, immediately following training, Confidence 2.96b,c 0.10 4.48a,c 0.05 4.22a,b 0.06
from (retrospective) pre- to post-intervention, participants
All mean differences were significant at the p < 0.01 level.
showed a significant increase in their self-rated confidence a
Significant difference versus pre.
in supporting those displaying mental health issues b
Significant difference versus post.
[Mdifference pre.post ¼ 1.52, 95% CI ¼ (1.29, 1.75)], which
c
Significant difference versus follow-up.
MHFA for the UK Armed Forces 5

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education, its role in reducing stigma and its potential had supported friends and family, whereas others
for sustainable change if more people were to be trained: reporting supporting work colleagues.

I found the training informative and helpful. . . ..I think

many more people should be trained, particularly in the Ambassadors for mental health within the
Armed Forces, to raise awareness and remove the stigma working context
attached to mental health issues. (Open-ended survey data) Participants had developed a better understanding of
their role in supporting other people in relation to the
Participants developed a number of relevant skills, prin- wider range of services available and in signposting peo-
cipally the ability to recognize and deal with situations ple to access support services for such problems:
in which mental health issues were important. A number
reported that the programme helped them to assess and You can begin to recognise the symptoms in there,
understand the requirements of the situation, and to re- which groups of people were at higher risk . . . of devel-
oping those problems and issues. And then what you
spond appropriately:
might be able to do to help them, put that signpost into
I have learnt to step back from the first response from place, so they can seek better help to deal with those
the individual and listen to what is going on and evalu- issues. (Alan, 58-61)
ate the whole situation before advancing with their care.
(Simon, 455-457)
Interaction with other participants appeared to help par-
ticipants develop confidence to talk about mental health
Another participant alluded to the fact that the pro- issues and to address some of the social norms and
gramme focussed on providing skills to deal with issues stigma regarding talking about such issues:
in the first instance, rather than being concerned with
One of the most useful things was talking to other peo-
solving these in the long term:
ple in the room and hearing kind of, experiences that
We’re not trying to diagnose what the mental health is- people have had or shared or heard of the more you talk
sue might be, we’re just trying to stop them from doing about it the more common it becomes and the more nor-
anything catastrophic and then signpost them and de- mal it becomes (Claire 81-84).
liver them to the next point in the process. So, I was
completely reassured by that and felt well enough
This sense of awareness and increased confidence was
equipped to go on and deal better than I had before tak- expressed broadly, however participants also displayed
ing up the training. (Adam, 98-102) an ability to reflect on the benefits more specifically, for
themselves and others:
The skills obtained were not only important in enabling
trainees to meet individual needs, but also in providing I think I am more aware of my own mental health and
confidence to address the broader subject of mental health: that of others. I am more prepared to talk about mental
health issues and dispel stigma surrounding it (sic). For
I actually felt more confident to address, and more con- those who have suffered mental health issues, or are still
fident to speak openly about it [mental health] and actu- recovering, I have been able to talk about how it affected
ally it’s not going to offend people if you speak about it. their lives and how they overcame, in particular what
Sometimes, actually you might ease the situation for was helpful to them. (Open-ended survey data)
that person just to know that, yeah, you are aware of it,
and that it’s not kind of a taboo. (Grace, 345-348) As a consequence of increased awareness, participants
perceived that they were more able to play a role in sup-
This sense of confidence enabled participants to talk porting mental health issues in, e.g. signposting them to
about, understand, appreciate, and respond to people support services in the future. In this sense, they could
with mental health issues: be described as mental health representatives or advo-
cates, both at home and at work:
I have met one or two people since [the course] that I
have been able to, sort of, say things [that] I wouldn’t I am now more confident in looking out for people. Due
have dreamed of saying to them otherwise. So it’s im- to my role I am frequently approached outside of my
proved my confidence, and I’ve perhaps realised that we working role for advice and guidance. I am better pre-
can all be in a bad place at a certain time, . . ..but if it’s pared to give proper guidance and signpost individuals,
not addressed, discussed and sign-posted, then it can or give advice to relatives. (Open-ended survey data)
turn into something worse. (Jocelyn, 152-158)
Additionally, for some, they also wanted to promote the
Participants highlighted that this enhanced sense of con- course, to make more people aware of it and to encour-
fidence impacted upon them in a number of ways; some age attendance:
6 D. Crone et al.

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I mean to be quite honest, if the course was on the open or by comparing it to another existing intervention
market I would have a word with various people within aimed at this particular target group, would highlight
my life to actually get their backsides on it; my GP first. further efficacy. There was a potential for bias within
(Clive, 107-108)
the study in a number of areas. First, to acknowledge
the subjective nature of participants’ own rating of
how their knowledge, attitude and confidence had
DISCUSSION changed, is open to respondent bias. Second, because
the pre-measure was retrospective, there is a risk of
Participants who attended the MHFA training course
bias if participants’ enjoyed the course and thirdly,
showed a significant increase in self-rated knowledge, at-
with regard to the limited follow-up, both in terms of
titude and confidence in relation to mental health issues,
time and number of participants lost to follow-up. The
pre- to post-intervention (i.e. the training course). At
loss-to-follow-up may also have created potential bias
10-months follow-up, this effect was found to be slightly
in the sample of participants that provided post-
decreased, but still statistically significant. Qualitative
intervention data, potentially limiting the demographic
findings supported these findings of improved confi-
to groups that are more engaged or otherwise more
dence, knowledge and understanding. It also showed
likely to adhere or respond. Furthermore, with respect
that participants felt it had a role in addressing stigma in
to the follow-up interviews, there is a possibility some
the Armed Forces community, and provided them with a
of the participants may have been interviewed before
responsibility to be mental health advocates in both their
the follow-up survey was completed. Therefore, there
role, and their immediate communities.
is a possibility that the telephone interviews may have
People with mental health problems often avoid
biased the responses of a handful of participants to the
seeking professional help (Oliver et al., 2005) and
knowledge and attitudes questionnaire items at follow-
Armed Forces personnel may choose not to utilize sup-
up. On this point, however, we note that any bias is un-
port services due to stigma associated with mental
likely to be consequential to the overall results, given
health problems (Hoge et al., 2004; Iversen et al., 2011;
the small sub-sample interviewed (n ¼ 13), and our fo-
Vogt, 2011). MHFA education programmes have been
cus on personal experiences of the intervention (i.e.
found to improve mental health literacy, identification
how they interpreted the content) in our interview
of mental health support and to reduce stigma associ-
discussions.
ated with mental health issues in community groups
The study did not include a pre-existing mental
(Kitchener and Jorm, 2006, 2008; Hadlaczky et al.,
health literacy questionnaire, and instead employed an
2014). However, relatively little is known about its in-
adapted assessment of this concept. Although there is
fluence across Armed Forces communities.
still uncertainty over both the measurement of mental
This mixed method study supports previous pub-
health literacy and suitable tools (O’Connor et al.,
lished research which has investigated the impact of
2014) it may have been more beneficial, and recom-
MHFA in specific communities (Kitchener and Jorm,
mended for future research, to use an existing inven-
2006, 2008; Hadlaczky et al., 2014). However, it is the
tory, such as the Mental Health Literacy Scale
first evaluation that has investigated the impact of
(O’Connor et al., 2014), pre- and post-intervention.
MHFA on Armed Forces communities. These findings
Further, this study was only able to assess trainee per-
provide evidence that the MHFA Armed Forces pro-
spectives on outcomes whereas the ultimate goal of
gramme has helped to improve mental health literacy in
such an intervention is also to learn how best to imple-
the UK Armed Forces. In the longer term, such an inter-
ment the programme, how the knowledge is used in
vention could provide sustained support for personnel,
practice over time, and its impact on access to support
veterans and their families’ in identifying mental health
services. Further in-depth qualitative research may be
problems and encouraging access to support services for
best placed to provide this in future programme evalua-
those people.
tions. Furthermore, we were also unable to investigate
any changes within Armed Forces type, or level of posi-
Limitations of this study tion from participants, due to that specific data not be-
Due to the nature of this project (an exploratory evalu- ing available at an individual level. This information
ation of an intervention in practice), the study was un- would be invaluable to both developing an understand-
able to employ a control group for comparative ing about the future implementation of such pro-
purposes. Adopting a randomized-control trial design grammes in Armed Forces communities and their long-
with this specific paradigm, either with a control group term implications.
MHFA for the UK Armed Forces 7

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ACKNOWLEDGEMENTS prior to the wars in Iraq and Afghanistan. Social Psychiatry
and Psychiatric Epidemiology, 44, 473–481.
Our thanks go to the study participants and to the
Gould, M., Greenberg, N. and Hetherton, J. (2007) Stigma and
MHFA Armed Forces Project Steering Group including repre-
the military: evaluation of a PTSD psychoeducational pro-
sentatives from Soldiers, Sailors, Airmen and Families
gram. Journal of Traumatic Stress, 20, 505–515.
Association (SSAFA), Mental Health First Aid (MHFA)
Greenberg, N., Langston, V., Everitt, B., Iversen, A., Fear, N. T.,
England, Combat Stress, Royal British Legion and the
Jones, N. et al. (2010) A cluster randomized controlled trial
Department of Health.
to determine the efficacy of Trauma Risk Management
(TRiM) in a military population. Journal of Traumatic
Stress, 23, 430.
FUNDING Greenberg, N., Langston, V., Iversen, A. C. and Wessely, S. (2011)
The work was supported by Libor Funding administered by the The acceptability of ‘Trauma Risk Management’ within the
Soldiers, Sailors, Airmen and Families Association (SSAFA). UK Armed Forces. Occupational Medicine, 61, 184–189.
Greenberg, N., Thomas, S. L., Iversen, A., Unwin, C., Hull, L.
and Wessely, S. (2003) Do military peacekeepers want to
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