by Makayla House, University of Kentucky BSW Practicum Student
Military culture can affect the way military members and their families perceive mental health. This also influences how they go about getting mental health care. In this blog, we will cover what the basics of military culture are, some of the barriers to military members receiving mental health care, and how we can help.

What is Military Culture?

Defining a culture, let alone military culture, can be complicated. There is a broad range of cultures and ideas inside the military, its different branches, and its people (Abraham et al., 2015 & Westphal & Convoy, 2015). The military is also a diverse population, bringing in multiple ethnicities, languages, religions, and more (Abraham et al, 2015 & Westphal & Convoy, 2015). Military culture can affect how service members and their families use healthcare services and utilize mental healthcare practices (Abraham et al., 2015 & Westphal & Convoy, 2015).
One key piece of military culture that can affect military mental health is the military code of ethics (Westphal & Convoy, 2015). While there are different codes of ethics for each military branch, the United States Army code combines the ideas of them all into one: loyalty, duty, respect, selfless service, honor, integrity,  and personal courage (The U.S. Army, n.d.). These codes can make it seem like military service members need to be heroic, so when interacting with civilians, military members can feel like they are not living up to the expectations of the civilians they serve (Westphal & Convoy, 2015). This idea of military members being heroic can cause others to miss the aspects of what military culture truly is and how it affects those involved (Westphal & Convoy, 2015).
Barriers to Receiving Care
Since healthcare professionals work with the general population as a whole, they can be one of the biggest barriers to military members receiving care (Westphal & Convoy, 2015). One barrier that military members have when it comes to healthcare professionals is that, when explaining their concerns, the military member may not realize all of the stressors that are building up on top of each other causing their health concerns (Westphal & Convoy, 2015). The healthcare professional may not realize the patient does not know this because they are not personally involved in military culture (Westphal & Convoy, 2015). There is both a knowledge and confidence gap when it comes to healthcare professionals assessing and treating military members (Westphal & Convoy, 2015). This gap has been explained by military members who have received quality care, but stated that the care they received was not relevant to their experience or that the provider did not understand the stressors of the military experience (Westphal & Convoy, 2015). This can create more barriers to getting care and help-seeking (Westphal & Convoy, 2015).
There have also been studies that show that military members may not receive care due to the mental health stigma in the military (cheney et al, 2018). Some worry about being judged by their fellow military members (Cheney et al, 2018). They also do not receive care due to the difficulty of receiving mental health care from the Veterans Administration, including but not limited to (Cheney et al, 2018):

• Slow clinic responses
  
• Scheduling problems
• Inconsistency in providers
• Large amounts of paperwork
• Lack of knowledge of where to go for mental health services
• Problems getting service-connected disability resources

How We Can Help
One way we can help is by increasing healthcare professionals’ cultural knowledge when it comes to the aspects of military culture and how it affects patients’ illnesses and reaction to treatments (Westphal & Convoy, 2015). This involves increasing awareness of exposure injury, defined as the distressing aftermath of exposure to an event, which can help healthcare professionals explain to patients why they are experiencing a disorder from the same experience that someone else came out fine from (Norman & Maguen, 2018 & Westphal & Convoy, 2015). Healthcare professionals need to understand the close-knit bond of combat service members and the impact that the loss of a military comrade can have on a military service member (Westphal & Convoy, 2015). Military members also need to work on the de-stigmatisation of mental health among themselves, which is critical in whether help for a mental illness is sought after (Abraham et al, 2015).

Conclusion

Military mental health is complicated, considering all the aspects going into it through both the civilian and military world. With the work of healthcare professionals and military members across the country, we can work towards making mental health resources more available for our country’s military members on all levels. One step is de-stigmatizing mental health in military culture, which will take the work of everyone involved and how it can impact help-seeking behaviors of patients coming from the military.

Resources
Abraham, T., Cheney, A.M., & Curran, G.M. ( 2015, July 29). A bourdieusian analysis of U.S. Military culture ground in the mental help-seeking literature. American Journal of Men’s     
Health. https://doi.org/10.1177/1557988315596037
Cheney, A.M., et al. (2018). Veteran-centered barrier to VA mental healthcare services use. BMC Health Services Research, 18(591). https://doi.org/10.1186/s12913-018-3346-9
Norman, S.B. & Maguen, S. (2020, May 19). Moral injury. National Center for PTSD. Retrieved March 8, 2021, from https://ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp
The U.S. Army (n.d.). The army values. Retrieved February 15, 2021, from https://www.army.mil/values/index.html
Westphal, R. & Convoy, S. (2015). Military culture implications for mental health and nursing care. OJIN: The Online Journal of Issues in Nursing, 20(1), M. 4. https://doi.org/10.3912/ 
OJIN.Vol20No01Man04

This film follows a U.S. Marine Corps veteran, his experience with PTSD, and his bond with an injured, stray dog. This film does have depictions of suicide and combat-related hallucinations, so a trigger warning is needed.

I believe that this film not only highlights how important animals can be when it comes to healing, but also family. Although he and his wife are separated, his wife and child still are there to support him through this troubling time. During his hallucinations, he seems to be seeing his commander who was killed in action in front of him. It is very common for those who see a comrade die to feel like they could have done something to save them, therefore blaming themselves for their death. 

This TED Talk, by dr. Richard Doss, does a great job of highlighting how military culture affects those in the military and how they handle their mental health. Richard Doss, at the time this video was published, worked for the Veterans Administration as a  Licensed Clinical Psychologist, was a former Department of Defense Suicide Prevention Program Manager for the United States Army Reserve, and is certified in Applied Suicide Intervention Skills Training (ASIST).

Dr. Ross talks about a man who went from being a talented musician in high school, to becoming a soldier in the United States Marine Corps. During a tour in Afghanistan, the soldier is asked to shoot a kid. When he explains that he cannot do it, he is told to "do what you're trained to do." Dr. Ross goes on to indicate that the soldier ends up suffering from PTSD from this encounter.

Further into the video, Dr. Ross explains that there is no correlation between combat experience and military suicide rates. As a matter of fact, military suicide rates are the same among combat-related military occupations and non-combat-related military occupations. This is explained in that, the basic training that all military personnel go through, trains them that showing emotion is a sign of weakness. He explains that there are three primary stressors when it comes to military mental health:

• Relationship Problems
• Financial Problems
• Legal Problems

Dr. Ross explains how the military has adopted the ideology that has led to toxic masculinity. He explains that the training military personnel receive trains them to not ask for help, so they do not do so in the categories previously stated. Dr. Ross explains that it is partially society's fault for portraying soldiers as invincible. Dr. Ross explains that there are a couple things that every military training takes out of their recruits, while training them to kill:

• Empathy
• Comfort in Being Able to Ask for Help

Dr. Ross explains that, as civilians, we should help military personnel learn how to feel again and to ask, "How did you heal?" Instead of, "Who did you kill?"

If you would like to watch this video for yourself, check it out here:

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• Support S.B. 45 is in Senate Banking & Insurance TODAY at noon EST. SB 45 would end a practice in which insurance companies refuse to count funds received as grants and coupons from pharmaceutical companies toward a patient's deductible. It's a complicated situation, as most things with insurance are, but here is a Newsweek article that helps explain it the clearest. Please call the LRC Message Line at 1-800-372-7181 and ask all of the Senate Banking & Insurance Committee to vote YES on S.B. 45.
• Support H.B. 148 which ends the death penalty for individuals with severe mental illness is in House Judiciary Committee this Wednesday, 2/24, at 12pm EST. Please call the LRC Message Line at 1-800-372-7181 and tell the House Judiciary Committee to vote YES on H. B. 148 to protect individuals with serious mental illness from the death penalty!
• SUPPORT HCR 7 which would establish a Severe Mental Illness Task Force to study issues impacting adults with severe mental illness, is in House Health & Family Services Committee Wednesday, 2/24, at 9am EST. Please call the LRC message line at 1-800-372-7181 and ask the House Health & Family Services Committee to vote YES on HCR 7!
• SUPPORT H.B. 50: Mental Health Parity Bill has been assigned to the Senate Health & Welfare Committee! This bill requires insurers to demonstrate compliance with federal law in how they design and apply managed care techniques for mental health and addiction treatment to ensure coverage is no more restrictive than for any other medical condition. Stay tuned for action!
  • History of Mental Health Parity, in case you want to know more
• SUPPORT H.B. 38: Psychological Intrajurisdictional Compact: will allow psychologists to working 13 states who have already agreed to the compact, without requiring additional licensing fees. It has also been assigned to the Senate! Stay tuned for action!
  • More from KPA.org on this bill  
• SUPPORT H.B. 126 Increases the amount of damage or property loss that constitutes a felony from the very old standard of $100 to $500-$1,000.00. Felony status affects many parts of mental wellness - employment, housing, even relationships. It should not be applied inappropriately. Increasing the damage from a very old standard of $100 to $500 - still less than the cost of the average cell phone - is an important step to bring the law up to date and more closely reflect its original intent.  This bill has also been assigned to the Senate. Stay tuned for action!
• SUPPORT H.B. 19 and S.B. 30: Youth Mental Health Protection Act
  • These bills have not yet been assigned to committee. Please use this link to contact legislators and ask them to send H.B. 19 and S.B. 30 to the Licensing & Occupations Committee. 
  • Want to know more? Check out The Bell Podcast episode featuring BCTK.
• SUPPORT S.B. 21  This bill allows homeless youth to receive mental health treatment without requiring parent permission. This speeds up the process for treating these teens who have too often faced trauma, abuse, and neglect. The bill also contains legalities about transporting teens from hospitals without psych units to appropriate care facilities. It quickly passed through Senate committee and the Senate floor. It has been received in the House. Stay tuned for action!
• SUPPORT H.B. 77 which mandates insurers cover a mental health examination each year in the same way they cover physical health examinations. While this bill is not expected to move this year, we do hope it starts conversations on furthering B4Stage4 thinking around early detection and intervention of mental health issues.
• Support H.B. 44 which would allow firefighters to join Crisis Intervention Training through CIT Kentucky. This bill also appropriates funding for Post-Trauma Stress Injuriy and Post Trauma Stress Disorder for firefighters. It has been assigned to the House Appropriations & Revenue Committee. Stay tuned for news on this bill!
• Support H.B. 305 to establish an official Mental Health Flag in Kentucky. This bill has been assigned to the House State Government Committee but hasn't been given a hearing date yet.
  • More information on this from the Pete Foundation.

This list is not comprehensive of all legislation related to mental health and wellness, but we've done our best to highlight the most important ones.

16,078 screenings in 2020!

That's record-breaking.

The entirety of 2019 had 4,773 screenings. This is a 234% increase in screenings in a single year.

What does it mean? People are thinking about and checking on their mental health more than ever. And they're turning to MHA Kentucky to do it.

Three-quarters of people screened positive for moderate to severe symptoms of a mental illness. More than half were not receiving any kind of treatment when they took the screening.
People are waiting too long to seek or receive treatment, even a mental health screening.

These screenings are reaching our youth in Kentucky in ways no other efforts have. 11-17 year olds were the most common takers of our screenings, making up 33% of them. 18-24-year-olds are the second most common at 29% of takers. These groups are more likely to research information online and to experience mental health issues for the first time. Thankfully, our screenings have good self-help information and link them to hotlines, care providers in their area, and more.

Over 9,000 people reported "Loneliness and Social Isolation" contributed to their poor mental health.
We must find new and engaging ways to connect with each other, especially for students and young adults.
​
The COVID-19 pandemic and its related issues have hurt our collective mental well-being. Now is the time to have awkward conversations with our kids, our loved ones, even ourselves. Help is always available at 1-800-273-8255 or text "MHA" to 741741.

Resources to start:
Talk to Kids
When Is It Time To Talk
Talking to Adolescents
MHFA "Awkward Conversation" Archives

Kentuckians want access to mental health resources. We're responding to that need by providing even more materials in the coming months. We're also advocating for funding and regulatory to changes that improve the mental health system. We're elevating best practices and evidence-informed interventions at all stages. You're a part of all of it.

You can continue to help by spreading the word, taking a Mental Health First Aid course, joining us for QPR training (registration to come), and staying engaged. See the many ways below you can get involved this week.

by Maggie Almasri

Resources, learning tools, and activities for children and parents at-home in quarantine.

Many people are struggling during this time. With a lot of daycares not open due to the pandemic, we understand how difficult this can be for parents.  We hope this guide will help parents better understand coping methods for their children and provide them with fun at-home activities to deal with boredom. 
​
Activities For Children: 
- Outdoor Activities 
 -Indoor Activities
 -Crafts
 -Involves Food
       
Additional Free Resources:
 -Educational
 -Entertainment

Tips for Parents:
-Understanding coping methods

Have tips and ideas that aren't in our original post? Send them to mhaky@mhaky.org and we'll be happy to add.
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By Casey Malley

​Summer 2020 may cause for a change in summer plans, but there are still ways for your children to enjoy their time off school, instead of laying on the couch all day complaining that they are bored and that there is nothing to do.
 
Here is a list of 10 different options to do with your kids, while proactively social distancing from others!

1. Virtual Summer Camps!  As summer is a time to go visit different zoos, museums and aquariums are a fun place to learn about the world around us, many are offering virtual camps and tours to keep your young ones curious about the world around them.
           
Check out this USA Today article below and Jamestown Settlement’s website  to see what children museums are offering online programs!

• https://www.usatoday.com/story/travel/10best/2020/04/27/kids-activities-childrens-museums-offer-online-quarantine-programs/111582436/
• https://www.historyisfun.org/webcasts/

            Check out Birch Aquarium’s website to enroll your children in its online summer camp!

• https://aquarium.ucsd.edu

 
2. Camping!  
As some areas start to open up for the summer, this is  a perfect time to take your kids camping. Camping is not only a great time to spend quality time together, it is also a great time to teach your young ones some useful tips of survival. Teaching young ones how to build fires, make a tent, fish, or even make a meal over the flame, it is a fun and interactive time spent with nature. The link below takes you to all the different states to help you find out what campgrounds are open near you! https://thedyrt.com/magazine/local/campground-closures-list-covid-19/#state parks
Even if you are not the most outdoorsy type of people, camping can also be a blast in your backyard! Setting up a tent, making hotdogs over a fire and enjoying s'mores, catching lightning bugs, playing different campfire songs and games and much more,  this can be a time to have the whole family be outside and enjoy each other’s company. Even if you're just in your backyard, there is just something different than sleeping on a sleeping bag compared to one's bed- as it can create stories for years to come.

3. Pool closed? No problem!  

• As pools seem to not be opening up this summer, there are still fun ways to cool off from the hot sun. Make or buy a slip-and-slide, as this can be the hit of the summer.

• Or go to the local store and buy a sprinkler, where it can have your kids running around for hours.
• Water balloon fights are always a fan favorite, as this is a fun way to release some steam from being locked up at home for months :)

 
4. Sign Up for your local library Summer Reading Program!  
Many different schools and districts are offering reading programs, to get its students engaged with each other and to keep their minds working. The link below takes you to Kentucky’s summer reading programs, along with the reminders of the importance of reading. https://kdla.ky.gov/librarians/programs/summerreading/Pages/default.aspx

5. Wild Safari Drive Thru! Looking for  a little bit of a roadtrip to the safari? Stay in your car, and watch and feed all of the exotic animals.

6. Biking  
This is a perfect time to teach your kids how to bike, and if they already do, this summer is a great way to enjoy time together and take some rides along different trials throughout Kentucky. Not only is this a fun activity for everyone to do, it is also a great way to stay active during the summer, as biking is a great workout.

7. Drive- In Movie Theaters!  
As the weather is starting to get warmer consistently, enjoy time in your car, socially distant from others, by enjoying new films coming out this summer at a Drive- In Movie Theater. Put all the seats down in the car and lay in the trunk of your car with blankets or bring lawn chairs and blankets to set up outside your car to enjoy the film!

8. Become a Scientist! Dedicate one day of each week to experimenting different science  experiments. This is not only fun, but teaches your kids problem- solving issues, while doing hands on activities. 
 
Some examples can be making volcanoes, slime, homemade ice cream, view the different density of liquids, make a balloon blow up with yeast, and so much more!

9. Master the Kitchen!  
Try new recipes in the kitchen. Have each person in the family find a recipe and have them be in charge of cooking it for everyone (help the kids out, obviously). This can be a great way to venture out people’s appetite and change the family’s eating habits!

• Buy a cookie kit from a local bakery to not only enjoy tasty desserts, but support local restaurants! The link below has some examples of cookie kits mainly in Louisville, but outside of the Louisville area!
  • https://louisvillefamilyfun.net/2020/03/where-to-get-cookie-kits.html 

10. Make a garden! Make a garden in your yard, and teach your children the responsibilities of taking care of the plants. Teach them how to weed out an area for the soil, how to properly plant each plant, how to make sure no animals get into the plants, and some basics of yard work. Don’t be afraid to get our hands dirty.   
You can also make a birdhouse and put it out by the garden, along with a bird feeder, to bring nature into your yard, and see all the different kinds of birds that come into your yard. 

If you want to share your kids' activities with us, please post on social media with #MHAKY or send photos to mhaky@mhaky.org. Feel free to email us with YOUR tips and tricks.