A cluster randomized controlled trial to determine the efficacy of Trauma Risk Management (TRiM) in a military population

Abstract

Trauma Risk Management is a peer-support program that aims to promote help-seeking in the aftermath of traumatic events. Prior to its implementation, the British military conducted a randomized controlled trial of Trauma Risk Management against standard care in 12 warships; 6 were randomized to use Trauma Risk Management after collecting baseline measurements. Follow up after 12-18 months found no significant change in psychological health or stigma scores in either group; however, the studied vessels only encountered low numbers of critical incidents. Additionally, measurements of organizational functioning were modestly better in the Trauma Risk Management ships. The authors conclude that within organizations using Trauma Risk Management may be beneficial and may, in time, lead to a valuable cultural shift.

Mental Health, Stigmatising Beliefs, Barriers to Care and Help-Seeking in a Non-Deployed Sample of UK Army Personnel

“…Only a quarter of those deemed to be cases had sought help. This figure is commensurate with the rate of help-seeking for alcohol problems reported by Iversen et al [23,25] which was based upon data obtained during 2006-2007. Similar low rates of help-seeking amongst young people have been reported in international studies [37,38].…”

“…They were asked to consider nine potential help sources, which represented military medical assistance (mental health professional, regimental medical officer or doctor and other medical staff) and non-medical help (friend or family, unit chain of command, colleague, Trauma Risk Management (TRiM) practitioner, chaplain and Big White Wall therapist support). TRiM practitioners are military peers serving in the same unit trained to provide support following exposure to traumatic events [23]; the Big White Wall is an online early intervention service for people experiencing psychological distress which has been further developed for use by those with a history of military service [24]. Participants were further asked whether they would be willing to use these help sources in the future.…”

Military and Disaster Psychiatry

“…In general the mental health of trauma-exposed personnel is more a function of good organizational preparation and camaraderie/leadership than the availability, or not, of mental health professionals. Organizational preparedness can include training for employees and managers to foster group cohesion (e.g., peer support training such as Trauma Risk Management (TRiM) developed in the UK (Greenberg et al, 2010)) or a variety of resilience training packages some of which (e.g., mindfulness-based approaches) have shown promise although well-conducted randomized controlled trials of these training packages is lacking. There have been various efforts to routinely screen troops after deployment in order to advise those with possible mental health disorders to seek help, but to date there is no evidence that these, costly processes, have been effective in spite of their widespread use (Milliken et al, 2007).…”

The injured mind in the UK Armed Forces

“…The aims of TRiM are to provide personnel, who ordinarily carry out a wide variety of nonmedical roles, with the skills to enable them to monitor how colleagues are coping with the psychological effects of being exposed to potentially traumatic events. Some previous attempts to do this, such as single-session psychological debriefing, turned out to probably do more harm than good, but there is now good evidence that this is not the case with TRiM [40]. Research confirms that the TRiM process is also highly acceptable to military personnel and those units that use TRiM function better than units that do not.…”