Buddies Promote Access and Adherence to Mental Health Treatment Among Citizen Soldiers
Sayaka Hino, MPH Candidate
Citizen soldiers face a variety of well-documented challenges when they reenter life on American soil post-deployment. One recent and particularly salient topic has been the high prevalence of mental health issues, such as PTSD, clinical depression, sleep dysregulation, and suicidal thoughts. Proper diagnosis and treatment of these needs is complicated by several factors, the most pressing of which is the stigma associated with seeking mental health care. A peer support intervention at the University of Michigan, called Buddy-to-Buddy, has found a unique way to address this stigma through an approach that uses the military culture to change the culture of treatment avoidance (Greden et al., 2010).
Using Culture to Change Culture
The Buddy-to-Buddy intervention utilized peer influence, through the provision of peer supporters, to change the cultural barriers surrounding treatment entry and adherence. In the formative phase of the intervention, the authors had found that many citizen soldiers were reluctant to seek mental health treatment but felt that they could connect with people with shared experience. Common attitudes expressed were: “if you haven’t been there, you don’t get it,” “other veterans can be trusted,” and “another veteran who has been there may make it easier to get help” (Greden et al., 2010, p. 93). Peer supporters were thus a natural choice for intervention, as their shared experiences enabled them to earn the trust of citizen soldiers and establish rapport.
Of particular importance to this intervention is the belief discussed by citizen soldiers that “we believe in taking care of our own” (Greden et al., 2010, p.93). Buddy-to-Buddy was able to draw on this natural tendency to look after the health and safety of fellow soldiers and apply it to mental health. Expanding the culture of care through peers provides an alternative entry point to mental health care that is more acceptable than professionals. The use of culture to change culture is one that could prove very valuable for other peer support interventions throughout the world, particularly in environments where there is a strong cohesive culture that presents barriers to treatment.
Peer Supporters as a Screening Tool
The Buddy-to-Buddy program incorporated a two-tiered soldier peer support program to improve mental health treatment entry and adherence. Buddy Ones were responsible for checking in with their assigned soldiers, identifying behavior that may be indicative of a need for treatment, linking the soldier with treatment, and helping maintain adherence to treatment. The Buddy Twos were created to serve as a back up to the Buddy Ones, to connect soldiers with resources, and to help them navigate the health system. While these functions align well with the four key functions outlined by Peers for Progress, an interesting addition is one assigned to the Buddy Ones – helping to identify those with clinical needs.
The use of peer supporters as a screening tool for mental health is one that could be particularly useful in situations where a strong stigma towards seeking mental health treatment exists. Peer supporters in this intervention contacted all soldiers returning from deployment, not just those who exhibited worrisome symptoms. This is especially valuable when one considers the fact that mental health symptoms may not appear immediately – having an established relationship with a peer supporter prior to experiencing symptoms provides soldiers with a readily available and familiar resource to turn to. Reducing the period between the appearance of symptoms and treatment through early detection by peer supporters could also potentially result in fewer suicides due to improved management of symptoms.
Preliminary Results and Implications
The Buddy-to-Buddy study only has preliminary results at this time, but they hold much promise for mitigating the challenges experienced by citizen soldiers post-deployment. As the authors state that previously only half of soldiers who are in need of treatment will enter treatment, it was of particular importance that the Buddy peer soldiers referred more than 20% of the participants to formal treatment. Greden and colleagues argue that this reflects unmet clinical needs that the peer supporters are able to facilitate. Another core principle of this peer support intervention was tailoring to the military culture, accurately captured in its use of “military culture to change the culture of treatment avoidance” (Greden et al., 2010, p. 93). The fact that around two-thirds of the participants felt comfortable talking with their Buddy and more than half reported that they had used the suggested resources or services reflects the acceptability of the intervention by its target population.
While a full evaluation must be undertaken before the true efficacy of the Buddy-to-Buddy program is established, its results thus far indicate a viable and acceptable intervention for mental health treatment entry and adherence for citizen soldiers post-deployment. Further data that would be useful to glean from this intervention concerns the effectiveness of utilizing peer supporters as a screening mechanism. If this catchment system proves to be efficient and appropriate, it could be beneficial for future mental health interventions as well, particularly in situations with high levels of stigma. Buddy-to-Buddy’s use of culture to change culture operationalizes the notion of tailoring peer support intervention, and is a promising approach in improving mental health outcomes like PTSD and depression in the military setting.
Greden, J.F., Valenstein, M., Spinner, J., Blow, A., Gorman, L.A., Dalack, G.W., Marcus, S., Kees, M. (2010). Buddy-to-Buddy, a citizen soldier peer support program to counteract stigma, PTSD, depression, and suicide. Annals of the New York Academy of Sciences, 1208: 90-97.