Beyond first-line approaches: a scoping review of emerging operational stress interventions for military and public safety personnel

Abstract: Mental health issues such as posttraumatic stress disorder (PTSD) are increasingly common among military Veterans and public safety personnel. Typical or traditional treatments such as therapy and medication work for only about 50%?60% of individuals, showing a clear need for more options. A search of PTSD treatment programs in Canada between 2011 and 2022 to identify available programs was conducted. The authors screened hundreds of records and found 13 studies, plus an additional seven programs through a search of a public database. These programs use many methods, some of which include complementary and alternative medicine, such as yoga and mindfulness. This review found that Canada has many novel mental health programs; however, very few of these programs have been evaluated for their effectiveness, which may lead some health care providers to be resistant to recommending them. The authors suggest that much more research needs to be conducted to better understand and improve programs that are effective for military and public safety personnel. Introduction: Mental health conditions associated with military service, such as posttraumatic stress disorder (PTSD), can affect other high-risk public safety personnel (PSP) groups. Traditional psychotherapeutic and pharmaceutical approaches are effective for approximately 50% 60% of this population; thus, a broader range of treatment approaches needs to be identified. This scoping review aimed to identify and summarize programs available in Canada. Methods: Several databases were searched between 2011 and 2022, using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews to identify mental health programs for those at risk of developing occupation-based posttraumatic stress. Grey literature and a public web-based database were also searched. Results: After screening 599 records, 13 primary literature studies were identified. An additional seven programs were found by assessing 126 programs and services found in a public database search. Programs and services included a variety of prevention and intervention approaches, many of which used at least one complementary or alternative medicine modality. Discussion: Numerous therapeutic programs are available in Canada for military and PSP populations, many of which include a novel and holistic approach to treating mental health issues. However, there are few outcome studies, which may translate to the reluctance of some service providers to use or recommend these programs for mental health interventions or rehabilitation. More research is needed in these areas to better understand the utility of integrated approaches, which may help individualize and optimize mental health treatment in military and PSP populations.