University of Southern California Dissertations and Theses

Assessing mental health barriers faced by Air Force law enforcement veterans

(USC Thesis Other)

Assessing mental health barriers faced by Air Force law enforcement veterans

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content

Assessing Mental Health Barriers Faced by Air Force Law Enforcement Veterans
by
Fernando E. Bernal

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

December 2022

© Copyright by Fernando E. Bernal 2022
All Rights Reserved

The Committee for Fernando E. Bernal certifies the approval of this Dissertation

Dr. Alison Muraszewski
Dr. Jennifer Phillips
Dr. Kimberly Hirabayashi

Rossier School of Education
University of Southern California
2022

iv
Abstract
The focus of this study was the United States Air Force Security Forces and Office of Special
Investigations law enforcement veterans’ experiences with mental health while on active-duty
status. The purpose was to understand how the work environment affects mental health and
identify resources and barriers to mental health support. The literature reviewed the historical
context behind mental health in the armed services, barriers to mental health care, existing
strategies and solutions to mental health care, and the conceptual framework. The literature noted
that while the United States Armed Forces and the United States Air Force made improvements
to recognizing and addressing mental health, barriers to care and stigma are still present,
preventing service members from seeking care. This study used interviews to present the
participants’ experiences. The findings indicated there were services available and participants
discussed their understanding of them, yet they were concerned about the overall effectiveness
and access to these services. Participants also identified several helpful resources, such as family,
friends, and leadership. Nonetheless, friends, leadership, provider availability, length of time
between appointments, work schedules, and overall culture regarding mental health were barriers
to seeking care. This study generated three recommendations for practice.

v
Dedication
To my brothers and sisters who serve or served in our armed forces. I hope together we can
continue to raise awareness on the importance of mental health in our military. Thank you for
your commitment to our country and for preserving and fighting for our nation’s freedoms.
Remember you are never alone.

vi
Acknowledgements
First and foremost, praises to my Almighty God for guiding me on this journey and for
continuously reminding me of Mark 9:23, “If you can’?’ said Jesus. ‘Everything is possible for
one who believes.”
I would like to take this time to thank my wife Lindsey Bernal, Leandro Bernal, and
Isabella Bernal. Thank you for your steadfast support, love, and motivation during this journey.
It was not easy, but you stood by me to the very end despite the long nights of studying and
writing. This accomplishment is largely in part to your support. You are my why!
To my committee chair and members, Dr. Kimberly Hirabayashi, Dr. Alison
Muraszewski, and Dr. Jennifer Phillips, thank you for all the support and guidance during this
journey. You have all challenged me to be a better writer and thinker; I am a better person
because of it. Dr. Muraszewski, thank you for your mentorship during this program, for telling
me I was good enough and that I would graduate from this prestigious program. You listened to
my frustrations and, at times, my wanting to stop, but you always saw my potential from the first
day of class on campus in 2019 and continued to challenge me. You helped bring out the best
version of myself during this program.
I would like to acknowledge a couple leaders, mentors, and friends who continued to
support me and provide me with guidance, wisdom, and a sounding board during this journey:
Dr. Safa Rashid, Dr. Amy Link, Lt Col. Steven Torres, Maj. Christina Kuhn, Mr. Michael
Schnable, and Mr. Shannon Robinson.

vii
Table of Contents
Abstract .......................................................................................................................................... iv
Dedication ........................................................................................................................................v
List of Tables ................................................................................................................................. ix
List of Figures ..................................................................................................................................x
Chapter One: Introduction to the Study ...........................................................................................1
Context and Background of the Problem .............................................................................1
Purpose of the Project and Research Questions ...................................................................3
Importance of the Study .......................................................................................................4
Overview of Theoretical Framework and Methodology .....................................................4
Definitions............................................................................................................................5
Organization of the Dissertation ..........................................................................................6
Chapter Two: Literature Review .....................................................................................................8
Historical Context ................................................................................................................8
Barriers to Mental Health...................................................................................................12
Existing DoD and USAF Strategies and Solutions to Support Mental Health ..................18
Conceptual Framework ......................................................................................................25
Summary ............................................................................................................................27
Chapter Three: Methodology .........................................................................................................29
Research Questions ............................................................................................................29
Overview of Design ...........................................................................................................29
Research Setting.................................................................................................................30
The Researcher...................................................................................................................30
Data Sources ......................................................................................................................31
Data Collection Procedures ................................................................................................33

viii
Data Analysis .....................................................................................................................33
Validity and Reliability ......................................................................................................34
Ethics..................................................................................................................................35
Limitations and Delimitations ............................................................................................36
Chapter Four: Findings ..................................................................................................................37
Participants .........................................................................................................................37
Mental Health State............................................................................................................39
Participant Understanding of Mental Health Services .......................................................42
Research Question 1: How Did the Work Environment Affect the Mental Health of
SF and OSI Veterans While They Were on Active Duty?.................................................44
Research Question 2: What Resources and Barriers Influenced SF and OSI Veterans
to Seek Mental Health Support While on Active Duty? ....................................................48
Summary ............................................................................................................................59
Chapter Five: Recommendations ...................................................................................................61
Discussion of Findings .......................................................................................................61
Recommendations for Practice ..........................................................................................65
Recommendations for Future Research .............................................................................73
Limitations and Delimitations ............................................................................................74
Conclusion .........................................................................................................................75
References ......................................................................................................................................77
Appendix A: Interview Questionnaire ...........................................................................................86
Appendix B: Mental Health and Program Referrals ......................................................................88
Appendix C: Recruitment Email ....................................................................................................89
Appendix D: Interview Invitation Email .......................................................................................90

ix
List of Tables
Table 1: Table of Characteristics of Respondents 38
Table 2: State of Mental Health During and After Active Duty 40

x
List of Figures
Figure 1: Conceptual Framework 27

1

Chapter One: Introduction to the Study
The Veterans Health Administration (VHA) reported in a 2014 study that 60% of
veterans who screened positive for mental health issues did not seek care while on active duty,
indicating a significant underutilization of mental health services (Sharp et al., 2015). Prior
studies found that mental health stigma and barriers were directly associated with the rise in
suicide rates among veterans and active-duty service members (ADSM; Coleman et al., 2017).
Members who did not utilize mental health services while on active duty risked exacerbating
their distress, which translated to more significant problems; in 2017, 6,139 veterans completed
suicide (U.S. Department of Veterans Affairs, 2019). These findings highlight the importance of
identifying the resources and barriers that prevent or reduce help-seeking behaviors in a military
population. This study explored United States Air Force (USAF) Security Forces (SF) and Office
of Special Investigations (OSI) law enforcement veterans’ experiences navigating resources and
barriers when seeking mental health care while on active duty. Additionally, this study explored
why SF and the OSI law enforcement veterans did or did not utilize some of the services
provided.
Context and Background of the Problem
Service in the United States Armed Forces is not an ordinary job; it is difficult,
demanding, and dangerous. Service members are often at risk of suffering from serious physical
and emotional injuries (Morin, 2011). The United States Armed Forces is an all-volunteer force
that makes up approximately 1% of the U.S. population, with 330,678 of those members serving
in the USAF (Air Force’s Personnel Center, 2021). The field of focus for this study was the
USAF, specifically SF and OSI law enforcement veterans’ experiences with mental health while
on active-duty status.
2

Security forces airmen are trusted to deliver and execute integrated base defense and law
enforcement skills in a constantly changing environment that enables them to have a safe and
secure operating environment stateside, overseas, and at deployed hostile locations. The OSI
consists of enlisted, officer, and civilian special agents. The OSI is the only agency with both law
enforcement and counterintelligence authorities, enabling the agency to effectively identify,
exploit, and neutralize criminal, intelligence, and terrorist threats across the globe on multiple
domains. Often, the SF and the OSI deploy to hostile locations at a moment’s notice or respond
to life-threatening situations, which exposes them to potentially life-changing events. They are
trusted and expected to perform with little to no supervision, often in remote and hostile
locations. Law enforcement officers are exposed to a higher rate of violence, aggression, death,
and threat to life and have greater chances of developing invisible wounds and traumatic
memories (Warren, 2015). They often internalize psychological distress symptoms because of
the shame associated with seeking help (Warren, 2015).
Mental health conditions can affect anyone at any time, yet they are frequently neglected
due to stigma, beliefs, and skepticism about the effectiveness of treatment and medication
(DeFraia et al., 2014). Unfortunately, the stigma surrounding mental health conditions continues
to be a problem for ADSM and veterans despite efforts from Congress and military leaders to
reduce it (DeFraia et al., 2014). Delaying mental health services until after active duty can have
adverse consequences, reducing veterans’ quality of life and leading to suicide. Since 2008, the
number of veteran suicides has exceeded 6,000 per year (U.S. Department of Veterans Affairs,
2019). Many studies examined mental health stigmas, barriers, and perceptions among both
veteran and active-duty populations generally, but this exploratory study is the first to look
specifically into Air Force law enforcement veterans’ experiences with mental health while on
3

active duty. This problem was selected because many ADSM and veterans in our law
enforcement community are fighting an invisible wound.
Purpose of the Project and Research Questions
The purpose of this study was to obtain a detailed account of how the work environment
affected SF and OSI veterans’ mental health while on active duty. Additionally, the study sought
to identify resources and barriers to mental health support. Other career fields in the USAF
identified a critical barrier for those seeking help as the unintentional spread of reprisal through
military leaders and peers (Gibbons et al., 2014). Additionally, social constructs in the work
center played a role for those seeking assistance due to fears that speaking out would harm
military careers (Gibbons et al., 2014). Research validates that fear, as 60% of ADSM felt that
their unit leadership might treat them differently if they sought help, and another 52% felt
members of their unit would have less confidence in their ability to do their work (Hernandez et
al., 2014). Logistical barriers service members identified were those related to treatment and the
difficulty of securing an appointment, specifically after-hours appointments with a psychologist
or licensed counselor (Acosta et al., 2018). Members of OSI and SF are vulnerable to mental
health crises because of their job’s traumatic events. Throughout this dissertation, to further
understand the resources and barriers to mental health issues these veterans faced during active
duty, this study explored the following two research questions:
1. How did the work environment affect the mental health of SF and OSI veterans while
they were on active duty?
2. What resources or barriers impacted SF and OSI veterans’ decisions on seeking mental
health support while on active duty?
4

Importance of the Study
This study is important as there is a need to understand the role resources and barriers
played in those seeking mental health help for ADSM. There is a need to study how ADSM view
seeking mental health help and the relationship between attitudinal and logistical barriers created
by leaders and peers. This study focused on those who served as ADSM in SF and the OSI and
are now separated or retired from active duty.
Based on the rise in suicides among veterans and ADSM, the consequences of not
examining this problem are problematic. The percentage of USAF members with mental health
problems is extensive, and only 23% to 40% ADSM in the USAF reported receiving any mental
health treatment (Kim et al., 2011). Furthermore, evidence highlighted a concerning trend among
those not seeking mental health assistance. According to the Department of Defense’s 2020
annual suicide report, the military recorded 384 suicides among ADSM, which was an 8%
increase from the previous year. Of those 384 suicides, the USAF reported 81 among ADSM,
with eight of those suicides being in the SF career field (U.S. Department of Defense, 2020).
Overview of Theoretical Framework and Methodology
The theoretical framework used for this dissertation is social cognitive theory (SCT),
which is a learning theory that explains human behavior in terms of a three-way, dynamic model.
The theory describes the influence of the individual’s experiences, environmental influences, and
factors on an individual’s behavior and how they continually interact (Bandura, 1989). This
theory is appropriate to examine the problem of practice because SCT helps explain how
personal experience and observation of others’ actions and experiences influence individuals’
decisions and actions (Bandura, 1989). Using SCT to look at this problem of practice help us
understand the influence of resources and barriers on individuals’ behavior. This theory aids in
5

analyzing how the participants learned through observation and whether their observations led
them to seek mental health help, providing an understanding of the barriers that OSI and SF
members face when seeking mental health help.
This research utilized a qualitative approach to provide multiple contexts for
understanding the problem of practice through open-ended and conversational communication to
obtain data (Anderson, 2010). Qualitative research provides an intimate relationship between the
researcher and what is studied while demonstrating participants’ experiences, allowing for
comparisons of the results received from individuals (Denzin & Lincoln, 2000). Qualitative
research provides advantages to the researcher, such as the ability to interact with the research
subjects in their own language, create a descriptive capability based on primary and unstructured
data, and provide results that can help create new ways of understanding (Anderson, 2010).
These benefits allow the researcher to describe existing experiences and provide the researcher
with the participants’ perspectives (Anderson, 2010).
Definitions
This section presents key concepts used throughout the text that are central to
understanding the problem at hand. Veterans, ADSM, and military leaders perceive the phrase
“mental health stigma” differently. According to Acosta et al. (2014), mental health stigma is a
perception or internalized biased attitudes created by interactions with other ADSM when
dealing with mental health. The VHA explains that a veteran is a person who served in the active
military, naval, or air service and that, by definition, any individual who completed a term of
service for any branch of the U.S. Armed Forces classifies as a veteran (U.S. Department of
Veterans Affairs, 2019). Critical to this paper is understanding logistical and attitudinal barriers
regarding mental health. The descriptor “attitudinal” refers to beliefs, feelings, and behavioral
6

tendencies toward socially significant objects, groups, persons, things, or events, often resulting
from one’s experiences (Hogg & Vaughan, 2017). “Logistical” refers to barriers like human
resource shortages, provider shortages, and failures in the referral process (Vail et al., 2018).
Organization of the Dissertation
The following chapter will provide an overview of the literature, focused on the
theoretical framework of SCT and its application to SF and OSI law enforcement veterans’
experiences with resources and barriers when seeking mental health care while on active duty.
The framework is based on Bandura’s (1989) SCT, the influence on individuals’ experiences,
environment, and behavior, and how these interact in their thought processes (Bandura, 1989).
The first section reviews the background and historical context of mental health care in
the armed forces. It provides the contextual background on how mental health in the armed
forces and the Air Force evolved, highlighting progress and the shortfalls regarding barriers to
care. The second section covers attitudinal and logistical barriers to seeking mental health. This
section provides the readers with an understanding of the causes behind veterans not seeking
mental health assistance while serving on active duty.
The third section covers current strategies and solutions to aid members seeking mental
health help. This section presents the strategies and initiatives in place by the USAF and the
Department of Defense (DoD) to promote mental health help and awareness to prevent future
logistical and attitudinal barriers.
The third chapter will present the design of the study, which utilized narrative analysis as
a form of qualitative research. Narrative inquiry takes the stories from the interviewees and
makes them raw data (Butina, 2015). Butina (2015) drew on how this approach involves inquiry
directed at producing data in narrative form or narratives of the human experience. Additionally,
7

this chapter will describe the research questions, detail the rationale and process for selecting
participants, and explain data collection procedures. The fourth chapter will present the results of
the data analysis. The final chapter will present a discussion of the results, implications, and
recommendations for research and practice.

8

Chapter Two: Literature Review
This chapter focuses on the literature’s application to the problem of USAF SF and OSI
law enforcement veterans’ experiences with resources and barriers when seeking mental health
care while on active duty. Addressing the problem is important because, as evidence has
highlighted, a rise in suicides can impair operational readiness posture and overall quality of life
for ADSM during and after service commitment (Coleman et al., 2017). The armed services
population is a subculture unlike the civilian world and consists of ADSM and veterans (Paivio
& Pascual-Leone, 2010). This literature review has four sections: reviews of the historical
context behind mental health in the armed services, barriers to mental health care, existing
strategies and solutions to mental health care, and a thorough discussion of the conceptual
framework.
Historical Context
When looking at the historical context involving the ADSM in the USAF, it is imperative
to look at mental health over the last 2 centuries. The first sections will cover mental health in
the 20th century and how its view evolved through World War II and the Vietnam War. The next
section will present mental health statistics during the 21st century. Additionally, this section
will present information on how the number of suicides continues to rise. The final section will
close with commonalities among Western allies and compare the United States to other armed
forces countries and their similarities to ours concerning suicide and mental health stigma.
Mental Health in the 20th Century
During World War II, more than half a million ADSM suffered from psychiatric
disorders because of combat (Decuers, 2020). United States Army policy during World War II
dictated that any service member with mental health disorders had to be expelled, which led to
9

high attrition rates (Pols & Oak, 2007). Research showed that 40% of medical discharges during
World War II were due to psychiatric conditions (Decuers, 2020). During the battle of
Normandy, which involved a joint invasion of France alongside our Allies, armed forces
psychologists noted that troops’ combat effectiveness declined significantly after 30 days of
combat, and after 45 days, troops were in near vegetative states (Decuers, 2020).
Due to high attrition rates caused by mental health disorders, the armed services became
receptive to implementing programs aimed at more mental health services (Pols & Oak, 2007).
At the start of World War II, 35 psychiatrists were involved with the U.S. Armed Forces; this
figure changed by the end of the war, rising to nearly 1,000 (Pols & Oak, 2007). During World
War II and the early stages of the Korean War, post-traumatic stress disorder (PTSD) was not a
formal diagnosis (Palmer et al., 2019). During these wars, the premise was for the psychiatrist to
attend to combat fatigue and return soldiers to duty as quickly as possible (Palmer et al., 2019).
Due to the limited knowledge of PTSD and mental health, there was little treatment available
(Palmer et al., 2019).
During and after the Vietnam War, veterans’ health and well-being were described as
reasonably poor (Pols & Oak, 2007). This finding caused the next observable shift in mental
health help for ADSM and veterans (Pols & Oak, 2007). As many doctors continued to advocate
for an increase in mental health services for our war veterans, their efforts paid off with the third
edition of the American Psychiatric Association’s journal (Pols & Oak, 2007). The PTSD
diagnosis was added to the Diagnostic and Statistical Manual (DSM-III) through an effort to
reintroduce war neurosis into the official psychiatric nomenclature, aiding in all future research
on mental health (Scott, 1990). The disorder has a variety of symptoms, such as nightmares and
flashbacks that cause the individual to relive traumatic events of their past, which often manifest
10

in outbursts of anger, rage, insomnia, and depression (Decuers, 2020; Iribarren et al., 2005).
These behaviors lower the quality of life as many individuals with PTSD suffer from avoidance
and fear of speaking on these issues (Decuers, 2020). The next section will address current
statistics on mental health among ADSM during the 21st century.
21st Century Mental Health Statistics
The difficulties ADSM and veterans face regarding mental health issues since World War
II brought attention to the role of attitudinal and logistical barriers in seeking help. Since the Iraq
war in 2003, the ADSM most in need of mental health care did not seek it because of fear of
embarrassment, difficulties with fellow subordinates or leaders, or interference with career
opportunities in the military (Pols & Oak, 2007). Despite advances in increasingly efficient and
sophisticated mental health treatment methods, it is still difficult to reach ADSM and veterans
struggling to cope.
The military has made improvements in ADSM medical care. Mental health care is still
lacking, which is evident by the rates of severely wounded combatants suffering from mental
health disorders. Statistics showed that 80% of those who died of combat wounds during the
major wars and the 80% who survived between WWI and the Iraq and Afghanistan wars took
home mental trauma and committed suicide (Lieberman, 2020). In 2009, Congress mandated the
establishment of a DoD suicide prevention task force tasked with identifying and addressing
suicide trends through mental health education programs (Neuhauser, 2011). During the
investigation, the task force found stigma a critical barrier for ADSM accessing mental health
help (Neuhauser, 2011).
The percentage of USAF personnel with mental health problems is high, yet only a small
number report receiving help (Kim et al., 2011). In 2014, only about 21% of ADSM in the USAF
11

sought mental health or primary care for mental health issues (Barr, 2014). From 2019 to 2020,
the armed forces reported an 8% increase in its suicides (Gnau, 2021). A 2009 USAF study
found that ADSM suicides between 1990 and 2004 averaged 42 deaths a year and never
surpassed 62. In 2019, the number rose to 82 suicides a year (Gnau, 2021). In 2020, the Air
Force saw that number decrease by 1, totaling 81 suicides (DoD, 2020). The United States is not
the only country with a mental health crisis. The next section will cover commonalities among
Western allies pertaining to mental health and how, although geographically separated, many
similarities exist.
Commonalities in Western Allies
Research has shown that despite the policy, procedural, and cultural differences, the
armed forces of the United Kingdom, Australia, New Zealand, Canada, and the United States
shared similar concerns about stigma and barriers (Gould et al., 2010). All countries expressed
the same pattern of concerns about stigma and barriers to mental health when caring for service
members and cited that unit leadership might treat members differently if they asked about
seeking mental health help (Gould et al., 2010). Additionally, data revealed a consistent pattern
of response for all the countries (Gould et al., 2010). The similarities in responses could be
attributed to the close historical ties and working partnership between them (Gould et al., 2010).
Gould et al. (2010) presented results from a qualitative review survey of the armed forces
of the United Kingdom, Australia, New Zealand, Canada, and the United States. The three main
topics of concern among respondents were that unit leadership might treat them differently, that
they would be seen as weak, and that their careers would suffer. They also identified concerns
about barriers to care, namely difficulty getting time off work and not knowing where to get
help. Additionally, the survey highlighted that these Western countries cited stigma and
12

embarrassment as additional barriers to care (Gould et al., 2010). Despite these western
countries’ differences in culture, military policy, medical services, and programs, they all shared
similarities and statistics regarding mental health barriers (Gould et al., 2010). While
improvements have been made, the next sections in this study will present the barriers to mental
health that ADSM faced.
Barriers to Mental Health
Security forces and OSI veterans who sought care throughout their careers on active-duty
status faced many logistical and attitudinal barriers to care. When examining SF and OSI law
enforcement veterans’ experiences with logistical and attitudinal barriers to seeking mental
health care while on active-duty status, it is important to look at key terms commonly used to
discuss this problem of practice and how each barrier affects the decision to seek help.
Additionally, to understand these barriers, it is important to understand current research on why
ADSM do not seek assistance. This section will present literature on logistical and attitudinal
barriers faced by SF and OSI veterans seeking mental health help while on active duty. This
section of the literature review will look at key terms, barriers to mental health, and how these
topics relate to attitudinal and logistical barriers for ADSM.
Key Terms
Key terms play a significant role in understanding the relation of the problem of practice
to the conceptual framework used. Important key terms related to this study are “mental health,”
“logistical,” “attitudinal,” and “environment.” Mental health is the cognitive, behavioral, and
emotional well-being of how people think, feel, and behave (Legg, 2020). The World Health
Organization defined mental health as “a state of well-being in which the individual realizes his
13

or her abilities, can cope with the normal stresses of life, can work productively and fruitfully,
and is able to make a contribution to his or her community” (Galderisi et al., 2015, p. 1).
The proper application of the medical definitions of the terms “attitudinal” and
“logistical” will provide the reader with additional context to the problem of practice.
“Attitudinal” refers to a set of beliefs, feelings, and behavioral tendencies toward socially
significant objects, groups, persons, things, or events often resulting from one’s experiences
(Hogg & Vaughan, 2017). “Logistical” refers to barriers identified, such as human resource
shortages, provider shortages, and failures in the referral process (Vail et al., 2018). The
“environment” is “the conditions that surround someone or something; the conditions and
influences that affect the growth, health, progress, etc. of someone or something” (Merriam-
Webster, 2013). Understanding the term “environment” is important to the study because of its
use in the theoretical framework and throughout the research. The next section covers mental
health stigma and the armed services’ views on it.
Stigma at different levels can manifest into more serious issues, thus acting as a barrier to
seeking help. Military leaders and the members’ coworkers created challenges and barriers,
sometimes unintentionally, by creating a stigma when seeking help (Gibbons et al., 2014).
Alarcon et al. (2010) explained that leaders and coworkers in the USAF significantly shape their
subordinates’ perceptions and attitudes. Leaders in the USAF receive training on fostering a
better environment based on respect for one another, creating an inclusive environment to seek
help when needed (Gibbons et al., 2014). Additionally, ADSM believe the stigma created a
perception of leaders having less confidence in members’ ability to perform their regular duties if
they seek help (Hernandez et al., 2014).
14

Mental Health Stigma
Many studies have focused on the stigma associated with mental health diseases, naming
it the reason ADSM do not seek assistance. Stigma regarding mental health directly contributes
to attitudinal and logistical barriers to seeking mental health help. Sharp et al. (2015) described
stigma as a belief relating to an attribute that is deeply discrediting and which can occur at
individual, interpersonal, and sociocultural levels. Research has found two types of stigma
associated with the term: public stigma and self-stigma. Corrigan and Watson (2002) explained
that public stigma is the general public’s reaction to individuals with a mental illness, and self-
stigma is the internalization of the general public’s portrayals of individuals with mental illness
and the belief in that portrayal.
Looking at stigma in a military setting, researchers categorized it into three distinct
contexts: public, institutional, and individual (Acosta et al., 2014). Public context is associated
with military norms and culture (Acosta et al., 2014). Institutional context is associated with
military policies and mental health treatment programs (Acosta et al., 2014). Individual context
is about ADSM internalizing the happenings of their environment (Acosta et al., 2014). The
armed forces may unintentionally create public and self-stigma beliefs concerning seeking help
for mental health problems because of its culture, rules, and conduct learned and experienced
while serving (Sharp et al., 2015). An example is how policy is written using specific
terminology that dissuades the ADSM from seeking help, contributing to mental health stigma.
Terminology used in these policies contains words such as “mental incompetence,” “defective,”
and “mental defects” (Acosta et al., 2014).
Carter (2012) described the military culture as disciplined, tough, authoritarian, and
masculine, comprised of individuals who value self-service and refuse defeat. This culture can be
15

seen in how the armed forces and the USAF develop a warfighter mentality and ethos in every
member when they take the oath of enlistment at basic military training. Additionally, military
culture emphasizes self-discipline and mental toughness (Carter, 2012). The military’s mental
health stigma can stem from that type of mentality, creating common sayings such as “I do not
need help” or “I can handle things myself,” which directly contribute to the cultural beliefs and
attitudes influencing people’s perceptions of those who seek help and the behaviors of those
wanting help (Gibbons et al., 2014).
Evidence suggests that the members’ leadership and peers will perceive them as weak
and indolent if they seek treatment (Gibbons et al., 2014). According to Hernandez et al. (2014),
60% of service members felt that their unit leadership might treat them differently when seeking
help, and another 52% felt members of their unit would have less confidence in them to get the
job done. All these factors directly contribute to the environment surrounding ADSM and
potentially lower the number of those wanting help, thus influencing their decisions to not seek
mental health help. The next paragraph highlights logistical and altitudinal challenges veterans
faced while on active duty that are attributed to not seeking help because of the lack of
confidential reporting and the negative perception caused by policies.
Logistical and Attitudinal Barriers
It is essential to highlight some logistical and attitudinal barriers associated with ADSM
seeking mental health care and how they apply to this literature review. One attitudinal barrier is
the lack of confidential reporting that ADSM perceive. Patients’ problems are considered deeply
personal and private, highlighting how confidentiality is the foundation of effective mental
health care (Engel, 2013). Confidentiality has been a reason for ADSM not disclosing problems
they face (Farnsworth, 2020).
16

A key contributing factor has been the failure of the armed forces to place adequate
boundaries between the workplace and the mental health provider (Engel, 2013). Department of
Defense policy, DoD 6025.18-R explains that covered entities are allowed to disclose protected
health information of ADSM for activities deemed necessary by appropriate military command
authorities to assure the proper execution of the military mission (Neuhauser, 2011).
Additionally, it states that information may be disclosed for both fitness for duty and to carry out
any other activity necessary to the proper execution of the armed forces’ mission (Neuhauser,
2011).
A review of the DoD health program budget for the fiscal year 2021 revealed predictions
for the future of health care across all branches. It explained that the USAF would see shrinking
budgets and personnel due to economic and political influences (Booz Allen Hamilton, 2021). In
2019, the DoD announced that it would cut about 18,000 military medical billets throughout all
branches as part of a health care reform (Jowers, 2021).
At present, the Air Force does not have sufficient mental health personnel to meet the
ADSM care needs(Booz Allen Hamilton, 2021). A 2020 report published by the DoD Inspector
General (IG) found that the DoD was not consistently meeting ADSM outpatient mental health
access to care standards (DoD IG, 2020). An average of 53% of ADSM and their families who
were identified as needing mental health care and referred to the purchased care system were
unable to receive care (DoD IG, 2020). The report further identified that a lack of medical
staffing, inconsistent and unclear access to mental health care policies, and providers lacking
visibility of patients needing help delayed access to care for thousands of people (DoD IG,
2020). Research showed that the DoD did not consistently meet outpatient mental health access
17

standards because of Tri-Care referrals for ADSM prior to the new budget; with the new
transition to the Department of Health Health services, this statistic will worsen (DoD IG, 2020).
These circumstances force ADSM to seek assistance outside of the military, which
proves difficult as not many providers off base accept Tri-Care insurance (Booz Allen Hamilton,
2021). The member is stranded or must pay for help out of pocket. Inadequate funding creates
difficulty for doctors and limits medical resources, which creates a lack of services and directly
impacts mission readiness, quality of life, and morale. Cutting the budget for health programs
will make it more difficult for ADSM who seek help because of the limited resources that will be
available.
A study investigated the perceptions of stigma and barriers among active-duty officers
and enlisted Air Force nursing personnel when accessing mental health services. The most
frequently identified barrier was difficulty getting time off work for treatment, with
approximately 41% of respondents feeling this way (Hernandez et al., 2014). Approximately
21% of respondents also identified difficulty scheduling an appointment as another barrier
(Hernandez et al., 2014).
Another study of how U.S. Army personnel viewed mental health highlighted evidence
that service members perceived a variety of attitudinal and logistical barriers (Naifeh et al.,
2016). The study stated that soldiers experienced financial constraints and difficulty scheduling
and attending appointments when looking at logistical barriers (Naifeh et al., 2016).
Additionally, an attitudinal barrier addressed was stigma-related concerns and negative attitudes
toward mental health professionals (Naifeh et al., 2016).
It is important to understand that the availability of professional mental health care in the
Air Force can vary due to a difference in military bases’ location and size. A larger base might
18

have more professionals and services than a more geographically remote one (Mandriota, 2022).
Mandriota (2022) explained that the demand for mental health services can exceed the supply of
licensed clinical mental health providers in some areas, causing longer wait times for treatment.
The author noted that members who did not utilize mental health services have an elevated risk
of suicide, which can be attributed to the lack of access to mental health care or ineffective
treatments (Mandriota, 2022; U.S. Department of Veterans Affairs, 2019). These were some
examples of logistical and attitudinal barriers’ impact on ADSM seeking mental health help. The
next section will cover the existing strategies and solutions pertaining to mental health in the
DoD and USAF.
Existing DoD and USAF Strategies and Solutions to Support Mental Health
This section will cover strategies and solutions currently in place by the USAF and the
DoD to promote mental health help and awareness for ADSM. These strategies and solutions are
aimed at preventing future logistical and attitudinal barriers associated with mental health in the
USAF. Strategies and solutions discussed in this section include promoting resilience in the
USAF, the types of mental health programs available, and current and possible mental health
strategies to address stigma.
Promoting Resilience
One strategy the USAF and the DoD use to address mental health is promoting resilience.
The USAF defines resilience as “the ability to withstand, recover and/or grow in the face of
stressors and changing demands” (Meadows et al., 2015, p. 1). The senior leaders in the USAF
established a task force named Operation Arc Care (OAC), which aims to review resilience
programs for mental health and the strategies USAF leaders use to combat mental illness
(Barnett, 2021). The task force focuses on three phases. The first is developing a common
19

operating picture by collecting data, evaluating policies, and examining resources. The second
phase is the subsequent use of the information collected to help shape the department’s resilience
strategy. Finally, the task force recommends solutions allowing leaders to adapt the programs
and services that best serve ADSM needs (Barnett, 2021).
With its three-phase approach, OAC plans to remove policy barriers and identify
initiatives to improve the experience of care for ADSM in the USAF (Barnett, 2021). The overall
intent is to create a USAF resilience strategy that will differ from traditional strategies and give
leaders tools to become adaptive and promote resilience to eliminate barriers for those seeking
mental health help (Barnett, 2021). Other programs that promote resilience are the creation of
Wingman Day and the promotion of physical health.
Wingman Day is a biannual USAF-wide unit-level event with activities that emphasize
informational awareness, accountability, team building, and communication skills for selected
topics such as suicide prevention, resilience, and health and well-being for those deployed
(Meadows et al., 2015). Wingman Day has been effective in educating ADSM in suicide
prevention and teaching airmen to look out for one another to reduce suicides (Meadows et al.,
2015). Wingman Day encourages ADSM to have those tough conversations on mental health
care that often were neglected because of previous stigmas (Meadows et al., 2015).
The DoD has acknowledged a need to implement more policies that will enhance human
performance, and this was evident when in 2009, they embraced the “total force fitness” model
to improve many components that impact the health and fitness levels of the ADSM (Land,
2010). One successful method has been promoting the physical health of the ADSM (Meadows
et al., 2015). Studies have shown physical activity to have a direct positive effect on the health,
well-being, and readiness of the USAF while ensuring the ADSM is physically fit,
20

psychologically fit, enhanced self-esteem, protection against depression, and reduced risks of
medical factors (Meadows et al., 2015). Additionally, promoting physical health has shown
benefits in significantly decreasing PTSD symptoms.
One study found that adults diagnosed with PTSD enrolled in a 12-week exercise
program that promoted physical health showed a significant decrease in PTSD symptoms such as
depression and better sleep quality (Tull, 2020a). The RAND Corporation recommended that the
USAF hold its organizational leaders accountable and organize regular physical activities to
provide stress relief, build unit cohesion, promote a social support system, and promote ADSM
physical and psychological well-being (Meadows et al., 2015).
The importance of resilience must not be understated, as it gives ADSM confidence and a
better sense of self. The armed forces hope to reframe how ADSM view traumatic events by
promoting resilience, creating more resilience programs, and using these programs as
opportunities for growth (Neuhauser, 2011). Promoting resilience has not been the only method
to address mental health in the USAF. The USAF continues to create new mental health
programs with specific programs aimed at addressing mental health stigma.
The RAND Corporation continues to research enhancing resiliency in military personnel
and recently compiled a review of 20 programs focusing on various factors that affect ADSM,
veterans, and their families (Weinick et al., 2011). These programs are designed to help
participants deal with life stressors ranging from deployments and reintegrating into the civilian
lifestyle (Weinick et al., 2011). Over the last 5 years, the number of ADSM seeking mental
health care has continued to increase with the development of new programs and strategies (Barr,
2014).
21

Mental Health Programs
The USAF and DoD created multiple programs to end the mental health crisis, such as
implementing Military Family Life Consultants (MFLCs). The program was a DoD initiative to
assign nonmilitary licensed counselors to USAF installations to provide free, non-medical
counseling to ADSM and their families, providing an alternative to military channels (Meadows
et al., 2015). The MFLCs are licensed master’s or doctorate-level counselors who provide non-
medical counseling and can assist with deployment adjustments and reintegration, crisis
intervention, stress management, and grief and loss services (Burgette et al., 2018).
Unfortunately, MFLCs cannot provide treatment for more serious mental health concerns, and if
they determine the participant’s concerns are outside the scope, they provide referrals to other
behavioral health professionals (Burgette et al., 2018). About 20% of participants reported they
did not experience a resolution to their concerns as a result of non-medical counseling (Burgette
et al., 2018). Despite that percentage, the RAND Corporation identified MFLCs as effective in
reducing stress and anxiety among those who used the program for assistance, as 92% to 99% of
participants who utilized MFLCs expressed satisfaction with the program or their counselor in
assisting with time management, stress, and anxiety (Burgette et al., 2018).
Another strategy currently in place to aid ADSM struggling with mental health and ease
their transition into society is the Airman Resilience Training, Deployment Transition Center and
Air Force Wounded Warrior Program (AFWWP). During Airman Resilience Training, ADSM
receive an educational briefing designed to improve their psychological reactions to stress during
and after deployment, helping improve their overall resilience (Meadows et al., 2015, p. 1).
Similar programs are the Deployment Transition Center, aiding those returning home from
22

deployments exposed to a significant risk of death, and the AFWWP for those suffering injuries
while deployed (Meadows et al., 2015).
One effort to break down the stigma and address barriers associated with mental health
care was creating the Real Warriors Campaign (RWC). This campaign was founded in 2009 and
supported the defense department’s psychological health center for excellence. The program’s
aim is to break the stigma while encouraging the ADSM and veterans to reach out for help when
needed (DoD, 2021). It should be highlighted that 62% of RWC’s content was tailored to ADSM
or those in the national guard, with women, officers, and post-2001 service members being well
represented in promotional materials (Acosta et al., 2018). In a recent study on the effectiveness
of RWC, the RAND Corporation found that more than 70% of content supported its messaging
and adhered to best practices while utilizing credible messaging to reach its audience (Acosta et
al., 2018). While programs address logistical and attitudinal behaviors among ADSM seeking
mental health help, the USAF and the U.S. government also created new strategies to address
these issues.
Mental Health Strategies
This section will discuss mental health strategies to address the stigma behind seeking
help. The way to address logistical and altitudinal barriers is to present research on how reducing
the number of medical providers would impair military readiness. Military leaders have shown
how during the COVID-19 pandemic, the nation turned to the DoD for its rapid capabilities to
deploy medical services and how they could effectively and efficiently help the nation (Sisk,
2020). While these plans were based on pre-pandemic assessments, Sisk (2020) highlighted that
cutting medical services in the military would have had severe consequences for the nation.
Leaders from other military services also want the Department of Health Services to conduct
23

research, ensure they can manage military hospitals effectively, and not jeopardize the best
practices outlined by the Government Accountability Office (Maucione, 2020). The goal is to
keep pace with the increasing demand for mental-health-related care in the USAF; this task is not
feasible due to the budget cuts in the USAF and the armed forces (Nielsen, 2019).
Another important strategy was changing the wording used in policy and educating those
in leadership roles to address and counter negative beliefs aimed at ADSM seeking help
(Corrigan, 2002). Recent research has shown that DoD policies unintentionally made things
more difficult for ADSM. In 2014, the RAND Corporation published research identifying 203
different DoD policies, such as mental health reporting procedures, that directly contributed to
mental health stigma (Farnsworth, 2020). The report concluded that DoD policies used negative
terminology that dissuaded the ADSM from seeking help. Some of the terminology used in these
policies contained words such as “mental incompetence” and “mental defects” and created a
conflict with reducing stigma because they promote negative attitudes and beliefs for those
seeking help (Farnsworth, 2020). Additionally, some of the policies contained language which
referred to those seeking mental health help as “acting out” or having “temper tantrums,” which
implied childishness (Farnsworth, 2020).
Air Force Instruction (AFI) 31-207, Arming and Use of Force by Air Force Personnel,
was one policy with language that carried negative connotations that can affirm negative
stereotypes about those seeking help (Acosta et al., 2014). This policy dictated a member’s
suitability to bear firearms on duty and included a list describing behaviors such as childish
outbursts of anger, sulking, pouting over minor disappointments, and irritability, with some of
these behaviors being directly associated with mental health symptoms (Acosta et al., 2014).
24

Corrigan (2004) presented research emphasizing that leaders in a position of power can
dispel stigma towards those suffering from mental health difficulties because of their ability to
impose their attitudes and beliefs onto others in their societal structure. This ability means
leaders, by virtue of their position, can reduce the stigma on mental health help by creating a
positive work center and encouraging those struggling to seek help. This strategy would be
effective as studies in the armed forces have shown that organizations providing support and a
belief of belonging can lessen the stigma behind mental health (Barlas et al., 2013). One other
initiative the DoD is starting to implement is changing the name of “mental health” departments
to “behavioral health” departments to encourage the ADSM to seek help (Neuhauser, 2011).
In 2012, the U.S. government implemented Executive Order 13625, which outlined
improving access to mental health services for veterans, service members, and military families
and established the Interagency Task Force on Military and Veteran’s Mental Health (The White
House, 2021). As of November 2, 2021, the government has announced a series of priority goals
and executive actions that will drive suicide prevention efforts, drawing from Executive Order
13625 (The White House, 2021).
One key strategy announced was increasing access to and delivery of effective care. This
strategy focuses on reducing barriers to mental health care and encouraging help seeking among
ADSM, veterans, and their families (The White House, 2021). The overall intent of this strategy
is to eliminate or lower co-payments for mental health treatments, increase the confidentiality
between the provider and individual, clarify fitness for duty standards, and enhance training for
providers while eliminating potentially discriminatory practices related to mental health care
(The White House, 2021).
25

Additionally, the White House (2021) outlined a strategy to enhance crisis care and
facilitate care transitions. This strategy is intended to improve care in emergency settings and
provide a swift transition for individuals from crisis care into follow-on settings. Another aim of
this strategy is expanding approaches to help the early identification of suicides among ADSM,
veterans, and family members, ensuring they receive the appropriate care (The White House,
2021). Another strategy to be implemented is increasing research coordination, data sharing, and
evaluation efforts. This strategy is straightforward, focusing on advancing interagency research
coordination, ensuring data integration, and encouraging the adoption of rigorous program
evaluation across all prevention programs (The White House, 2021). These efforts will help
understand the logistical and altitudinal factors that lead to suicide in the military and veteran
community. The following section looks at the conceptual framework used during the study.
Conceptual Framework
Chapter One introduced the theoretical framework of SCT, a learning theory that explains
human behavior in terms of a three-way, dynamic model. Social cognitive theory examines
individuals’ experiences, environmental influences, and behavioral factors and how these
continually interact in their thought processes (Bandura, 1989). This theory is appropriate to
examine the problem of practice because SCT helps explain how personal experience in their
environment and observing others’ actions and experiences influenced individuals’ decisions and
actions (Bandura, 1989). Therefore, SCT is appropriate for addressing this problem of practice
because it can help individuals better understand the influence of attitudinal and logistical
barriers on behavior. Also, SCT is beneficial to examining this problem of practice because it
helps explain how participants learned through observation and whether their observations
26

influenced their decisions on seeking mental health help, providing an understanding of the
barriers that affect OSI and SF members when seeking mental health help.
Social cognitive theory can be applied as a theoretical framework in different settings and
populations because it can be used to understand behavior change (Bandura, 2004). This study
used the theory to examine how logistical and attitudinal barriers affected ADSM from OSI and
SF. This study sought to examine the influence of social determinants and how past experiences
influenced the participants’ decision-making processes. Additionally, SCT allowed an in-depth
examination of how leadership and peers played into ADSM help-seeking behaviors.
Additionally, this study examined the influence of logistical and attitudinal behaviors and certain
language from policies on ADSM seeking help within their environment. Thus, SCT helped
highlight how observing others can directly impact the actions of ADSM in a constantly
changing environment.
Social cognitive theory helped examine veterans’ experiences while on active duty and as
they struggled to seek help and noted changes in their behavior based on their observations. The
theory is suitable for understanding attitudinal and logistical barriers due to interactions among
the individual, environment, and behavior. For example, SCT allows for examining how the
military culture and leadership’s views influenced the members’ help-seeking behavior. It also
helps to address how participants’ observations of the strategies and programs implemented
influenced their behavior in seeking help. Used properly, SCT can also highlight whether current
programs and strategies are addressing the mental health stigma created by DoD policy, military
culture, leadership, and peers. The illustration below shows SCT from the veterans’ point of
view and how what they see can impact their behavioral response.

27

Figure 1
Conceptual Framework

Summary
This literature review addressed the problem of practice and described USAF SF and OSI
law enforcement veterans’ experiences with resources and barriers, specifically identifying the
logistical and attitudinal barriers when seeking mental health care while on active duty. This
literature review first presented the historical context behind mental health in the armed services
and how it evolved and covered mental health throughout the 20th century. I also presented
current mental health statistics and commonalities in how Western allies view mental health.
Next, this literature review presented barriers to mental health care in the armed forces. This
section defined critical key terms, addressed the stigma behind mental health care, and closed
with current logistical and attitudinal barriers to mental health care. Next, the literature review
presented studies examining current strategies and solutions to mental health care in the armed
28

services. It presented topics on promoting resilience, current mental health programs, and mental
health strategies being implemented.
This literature review concluded by presenting the theoretical framework to be used in
the study. It described how SCT is suitable for this study and helps understand attitudinal and
logistical barriers associated with ADSM due to interactions among the individual, environment,
and behavior. Addressing the problem is important because, as evidence has highlighted, the rise
in suicides is detrimental to the operational readiness posture and overall ADSM quality of life
during and after service commitment (Coleman et al., 2017).

29

Chapter Three: Methodology
This chapter describes the method used in this study. It also describes the research
questions, design, participants, selection process, and data collection procedures. Also included
in this chapter is a description of the interview questionnaire and data analysis. The purpose of
this study was to obtain a detailed account of how the work environment affected the mental
health of SF and OSI veterans while on active duty. Additionally, the study sought to identify
what participants viewed as resources and barriers when seeking mental health support.
Research Questions
The following two research questions were addressed.
1. How did the work environment affect the mental health of SF and OSI veterans while
they were on active duty?
2. What resources or barriers impacted SF and OSI veterans’ decisions on seeking mental
health support while on active duty?
Overview of Design
This study utilized qualitative methods to explore the participants’ mental health
experiences while on active duty. Qualitative methods provide an in-depth, detailed account of
the factors that influenced the participants, identifying the resources and barriers they
encountered when seeking mental help while on active duty. Qualitative research provides an
intimate relationship between the researcher and what is studied while vividly demonstrating
experiences, allowing for a comparison of the results received from the participants (Denzin &
Lincoln, 2000). Participants were administered a semi-structured interview utilizing open-ended
questions and conversational communication to obtain data. Qualitative research can provide
many advantages, such as the ability to interact with the research subjects in their own language,
30

create a descriptive capability based on primary and unstructured data, and provide results that
can help create new ways of understanding (Anderson, 2010). This type of research allows for
describing experiences and presenting the participants’ perspectives (Anderson, 2010).
I utilized cognitive style interviews with specific targeted questions designed to trigger a
more detailed story. I utilized thematic analysis because of its usefulness in summarizing
extensive data, which provided detailed information (Nowell et al., 2017). Additionally, to
ensure credibility and trustworthiness, I utilized triangulation.
Research Setting
The goal was to allow the participants, all of whom served as ADSM in SF and the OSI,
to describe their personal narratives and experiences with resources and barriers when seeking
mental health care while on active duty status. The study took place utilizing the Zoom platform,
which afforded the participant and me the ability to be in private locations.
The Researcher
As a former SF and current OSI member in the USAF, I knew my past experiences and
current observations could influence my views on law enforcement veterans’ experiences dealing
with resources and barriers when seeking mental health care while on active-duty status. These
biased views are from my firsthand observations of fellow airmen’s experiences dealing with
mental health and having fellow airmen commit suicide. While I understand a bias exists in all
qualitative study designs, I am aware that my biases may have influenced how I interpreted the
data (Smith & Noble, 2010). While eliminating these biases is unrealistic, I reduced them by
clearly communicating the rationale for the study and selecting an appropriate research design to
meet the study’s overall intent (Smith & Noble, 2010). I strove to maintain neutrality and avoid
biased responses to questions during the interviews.
31

Data Sources
I utilized an interview questionnaire with open-ended questions designed to encourage
discussion between the participants and me. Specific questions were designed to help the
participant recollect experiences they faced. Each question was carefully designed to associate
with the research questions and utilized critical terms associated with SCT.
Participants
I interviewed 10 participants who were recruited on a first-come, first-served basis using
the LinkedIn social media platform. I selected 10 participants based on having no definitive rules
concerning sample size in qualitative research (Patton, 2002). I ceased data collection once the
data reached saturation and an adequate number of themes emerged, giving everyone an
understanding of the research (Hennink & Kaiser, 2019). The selection criteria I created focused
on the participants’ status as former ADSM in SF and the OSI and being classified as veterans. I
aimed to select male and female participants and veterans of the USAF law enforcement
community. Participants should be SF or OSI veterans, separated within the 5 years prior to this
study. Participants came from several different cultural backgrounds (e.g., career. ethnicity,
socioeconomic status, gender, religion) and were gathered through convenience sampling and
snowballing, regardless of rank, socioeconomic status, or education level.
I posted a recruitment pitch (Appendix A) on my LinkedIn social media site and several
LinkedIn networking pages. Additionally, I had LinkedIn connections share my recruitment
pitch. Participants were also referred by colleagues, military personnel, and word of mouth. I
utilized social media platforms because it was appropriate given the COVID-19 pandemic and
the ability to keep participants and myself safe. This collection method still provided an in-depth,
32

detailed account of the factors that influenced the participants, identifying what resources and
barriers impacted them when they sought mental health help as ADSM.
Participant selection criteria ensured interviewees had separated from active duty no
more than 5 years prior to this study. Participants volunteered to be interviewed, and I informed
them of the study’s purpose, risks, benefits, and nature. If individuals were interested in
participating, I verified their eligibility through an initial screening questionnaire and recruitment
email (Appendix B). It was essential to capture the views of enlisted and officer personnel as
well as males and females to understand who, specifically, was impacted and whether gender,
particular demographics, or pay grade played a role. Additionally, comparing SF and OSI career
fields helps highlight the differences and similarities in USAF law enforcement cultures.
Instrumentation
I constructed the interview questions ahead of time to serve as the guide while conducting
the interviews. This approach utilized open-ended questions designed to encourage discussion
among the participants and me. Additionally, open-ended questions gave the participant the
flexibility to describe their experiences and perspectives when dealing with mental health.
Conducting cognitive style interviews with specific targeted questions were designed to trigger a
more detailed story. The method for collecting data used an interview of 15 questions directly
associated with the research questions presented in the study with a possibility of six follow-up
questions. I previously piloted a sample of 12 questions with two veterans from SF and the OSI.
Based on the sample, I made appropriate changes based on recommendations to better align with
the study’s focus. The interview questions can be referenced in Appendix C. Additionally,
Appendix D presents the mental health and program referrals I gave to each participant prior to
the interview.
33

Data Collection Procedures
The University of Southern California Institutional Review Board approved this study on
March 15, 2022. As explained earlier, I recruited participants using the LinkedIn social media
platform soon after this approval and received keen interest from prospective participants. The
last week of March 2022 consisted of scheduling and explaining the research to them. The
interviews were conducted during the first week of April 2022. I focused on a cognitive style
approach to help the participant recollect experiences and observations. The interview consisted
of approximately 15 questions, with six possible follow-up questions. The interviews lasted
approximately 45 to 60 minutes. For two participants, the meetings lasted for 30 minutes, as they
did not require follow-up questions. I captured data using Zoom as my recording platform, and I
later created field notes utilizing Otter.ai. Once complete, I took the Zoom recordings and
created field notes with Otter.ai as my transcribing platform.
Data Analysis
I used a utilized thematic analysis approach because of its usefulness in summarizing
critical features of a large data set, providing a rich and detailed yet complex account of the data
(Nowell et al., 2017). I used the qualitative research method to identify, analyze, organize,
describe, and report themes from the data analysis. If used in conjunction with thematic analysis,
qualitative research methods allow for searching for themes while analyzing the narrative data
received from the interviews (Nowell et al., 2017). After transcribing the audio recordings using
Otter.ai, I took the transcripts and utilized MAXQDA to assess for reoccurring themes.
I compared each participant’s response to the other participants’ answers using
MAXQDA. I then assessed similarities and differences. I appropriately documented significant
themes that appeared more frequently using Microsoft Excel. Once I documented these themes, I
34

reviewed all transcripts and tracked the themes so I could better explain the findings. The themes
included consistent words associated with the working environment, resources, and barriers that
influenced the interviewee to seek help. I then compared These themes to SCT and its key terms
to understand resources and barriers based on the interactions among the individual,
environment, and behavior.
Validity and Reliability
I acknowledge there were threats to validity and reliability during this study. The data
obtained were reported voluntarily; this presents problems with integrity and possible
exaggeration from participants based on their bias. Participants who had a negative experience
on active duty could report how others were treated instead of their own experiences.
Additionally, one limitation could be my bias when selecting participants.
I identified several methods to ensure credibility and trustworthiness in the study. Two
approaches I utilized that enhance the qualitative research and ensure the quality, credibility, and
authenticity are triangulation and member checking (Korstjens & Moser, 2017). Triangulation
helps develop a comprehensive understanding of phenomena by looking at data from multiple
sources (Patton, 2002). Data included interview notes in different forms, such as audio
recordings and transcripts, which I transcribed manually or using Otter.ai. I freely discussed the
findings with the dissertation committee members. I conducted a thorough literature review to
help outline key terms, research methods, and theories applicable to the study.
The member checking method is also known as participant or respondent validation and
is a procedure for exploring the credibility and validity to verify or assess the trustworthiness of
qualitative results (Birt et al., 2016). To conduct member checking, I covered a range of
activities, including returning the interview transcript or data interpretation to the participants to
35

verify their trustworthiness (Birt et al., 2016). I used this method firsthand as I reached out to
several participants for clarification. Returning the interview transcript verbatim is considered a
positivist epistemological stance and is appropriate for checking factual information, which
enables the researcher to present the addition of new data and enables the participants to change
data they consider irrelevant (Birt et al., 2016). Returning the interview transcript is considered a
constructionist epistemological stance and can aid in validating previous interpretations while
also enabling the addition of data that was previously left out (Birt et al., 2016).
Ethics
At the beginning of the interviews, I informed all participants of the nature of the study,
advised that all participation was voluntary, and presented the study’s information sheet. Given
the sensitive nature of the study, I provided participants resources for the nearest Department of
Veterans Affairs hospital and local hospital in their respective cities as well as a list of general
helpful support phone numbers. The consent form provided a detailed description of the purpose
of the study and the possible risks and benefits of participating. I recorded all interviews so they
could be transcribed using Otter.ai. In addition, I informed participants of the veteran services
available to them and advised them that they could terminate the interview at any time.
I informed each participant that their identifying information would remain confidential,
and their name would not be published in any way. I paid attention to all participants’ levels of
distress during the interviews. I remained engaged with the participants and advised them they
may skip or end the interview at any time. I informed participants that this study was about
assessing mental health barriers faced by USAF law enforcement veterans while on active-duty
service.
36

Limitations and Delimitations
With the information received, this study examined how law enforcement veterans’
experiences shaped their view of mental health services during active duty. While utilizing
strategies such as thematic analysis, triangulation, and member checking to improve the validity
of the research, there are still limitations to the study. Factors outside my control are the
participants’ possible exaggeration of events, ill sentiments they faced while serving, and their
ability to recollect certain events. Another issue outside my control was their willingness to
participate in the study.
Qualitative research has several benefits, such as providing a detailed description of the
participants’ experiences and feelings to help understand the human experience in specific
settings (Rahman, 2016). It also provides subjective and detailed data collection through
interviews because of the direct contact with participants (Rahman, 2016). While some benefits
have been explained, qualitative research also has some limitations.
A limitation of qualitative research is that they tend to have a smaller sample, which
raises the issue of generalizability (Rahman, 2016). Because of this, I can have a more difficult
time interpreting the data received (Rahman, 2016). Also, qualitative research can sometimes
leave out contextual sensitivities because the focus is on the participants’ experiences (Rahman,
2016). Another limitation was the length of time it took to conduct this study. Researcher bias,
such as confirmation bias, leading questions, and wording bias, was also a limitation (Shah,
2019). I avoided these types of bias by considering all the data obtained and thoroughly
analyzing the material with an unbiased mind (Shah, 2019). Lastly, I kept the questions simple
and avoided leading questions and words that could introduce bias (Shah, 2019).
37

Chapter Four: Findings
This study explored USAF SF and OSI law enforcement veterans’ experiences of seeking
mental health care while on active duty. The study aimed to obtain a detailed account of these
experiences. The goal was to identify events and examine the relationship between the member
seeking mental health help and the theoretical framework of SCT during this study. Additionally,
this study explored why SF and the OSI law enforcement veterans did not utilize some of the
services provided while on active duty. The following research questions directed this study.
1. How did the work environment affect the mental health of SF and OSI veterans while
they were on active duty?
2. What resources or barriers impacted SF and OSI veterans’ decisions on seeking
mental health support while on active duty?
Participants
This qualitative study consisted of 10 participants who provided their accounts of the
mental health process while serving as an ADSM in the SF and the OSI career fields. The
qualitative study included three women and seven men. Two participants, both of whom were
males, served as an officer in the SF career field, and both retired with the rank of colonel. The
other eight participants served in the enlisted tier of SF and the OSI. Both SF and the OSI were
evenly represented, with 5 serving in each career field. Additionally, two participants served in
SF before laterally crossing over to the OSI.
The participants were selected based on their status as previously serving as ADSM in SF
and the OSI and having separated within but no more than 5 years prior to this study. I sought to
select male and female participants. Participants came from several different cultural
backgrounds (e.g., career, ethnicity, socioeconomic status, gender, religion), and they were
38

gathered using the LinkedIn social media platform. Table 1 annotates the participants’
demographic makeup, highlighting career field, gender, rank, separated, medically retired or
retired, and years of service. Additionally, it is important to note that eight respondents sought
mental health help while on active-duty status.

Table 1
Table of Characteristics of Respondents
Participant Career field Gender Enlisted/
Officer
Retired/Medical/S
eparated
Years of
service
1 Security forces Male Officer
(O-6)
Retired 20+ Years
2 OSI Male Enlisted
(E-7) SNCO
Medically retired 10–15
Years
3 Security
FORCES
Female NCO Medically retired 10–15
Years
4 Security forces Female NCO Separated 5–9 Years
5 Security forces Male Officer
(O-6)
Retired 20+ Years
6 OSI/Security
forces
Male SNCO Retired 20+ Years
7 Security forces Male NCO Separated 5–9 Years
8 OSI/security
forces
Male Enlisted
(E-6) NCO
Separated 10–15
Years
9 OSI Male Enlisted Separated 10–15
years
10 OSI Female Enlisted
(E-9) SNCO
Retired 20+ years

39

Mental Health State
At the beginning of the interview, participants were asked to describe their mental health
status while serving as ADSM and currently. This study sought to help better understand how the
ADSM felt mentally before and after serving. This is important to capture as one person’s mental
health can change over time, the demands placed on a person can exceed their resources and
coping abilities, and knowing this will help better understand the current state of all participants
and how the Air Force could have benefited or harmed their mental health (Centers for Disease
Control and Prevention, 2021).
Several themes were identified during the participants' time on active-duty status, such as
deteriorating mental health, anxiety due to leadership pressure, and high-risk environment. Six
participants explained they felt their current mental health state was good while separated from
the Air Force. While four participants acknowledged they still suffer some trauma from their
time in the service, many stated they noticed their mental health "deteriorate" or become "worn
out" while serving in the Air Force. They attributed this to the high stress of their jobs,
deployments, medical injuries sustained during deployments, and the overall demand of their
career fields. Table 2 shows the themes identified and how the participants responded. These
questions were intended to explore their subjective experiences regarding their mental health
during and after serving in the USAF.

40

Table 2
State of Mental Health During and After Active Duty
Themes 4. Mental health during active duty? 3. Mental health after active duty?
Deteriorating
mental health
Participant 1 (P1): "Definitely
periods of high stress and periods
of not quite understanding why I
was maybe apathetic or lost
interest in different things along
the way."
"It's great right now."
Deteriorating
mental health
(P2): "It was rough, man. It was
really rough. I was kind of
suffering in silence for a lot of
those things."
"I'm better than it's ever been.
Yeah, for sure. I mean, it was a
long road for me. You know, I
did six tours. That's been 1,000
Days of War. I got blown up and
a purple heart."
Deteriorating
mental health
(P4): "Throughout my first duty
station, Italy, completely fine.
Normal, as good as it can be.
Germany, on the other hand,
getting deployed having your
leadership against you, and just
being rubbed the wrong way. It
was like I said it was deteriorating.
Very fast."
"Well, because I'm pregnant.
Rocky, some days are good.
Other days not so much. Right
when I separated? Probably the
worst I've ever been okay, I'm
just because I had no plan. And I
was in such a dark hole that I
don't know. I went to go stay
with my mother. Because I could
not function."
Deteriorating
mental health
(P5): "It got progressively worse
towards the end last 3 years was
probably not great. So yeah, it was
on a downward spiral ."
"Not good. So I had I actually
100% disabled." "I think people
suffer in silence and they don't
feel like they have any you know
I'm just like there's tools out
there like I got a therapist and I
went to all these resources to
figure all this out and get help
and I share my story with folks."
Deteriorating
mental health
(P10): "When I first came into the
Air Force. I mean, I was fine. I
was fine. I was very, very
productive." "I did have some
tough times in my life, my
personal life. I went through
divorce and I had some death in
my family. And, you know, of
"Right now, it's good. I'm fairly
relaxed. It's probably better than
it's been in a long time."
41

Themes 4. Mental health during active duty? 3. Mental health after active duty?
course, that has a toll on your
mental health, but I recovered very
nicely." "I took on too much and
that's when my mental health
started to deteriorate."
Anxiety due to
leadership
pressure
(P6): "So I was in 2017. I was a Det
one instructor. And I don't know
what changed. But I started getting
being very like hypersensitive to
things like hyper-aware."
"Could be better."
Anxiety due to
leadership
pressure
(P7): "I would say it was a fairly
decent for the most part, it gets
worn out. Well, while you're in the
military. I think that there's there's
always somebody asking more of
you. And if you are a people
pleaser, essentially, then you can't
do everything for everybody. And
it takes a toll on yourself."
"I would explain it as normal, I
guess. Normal."
Anxiety due to
leadership
pressure
(P9): "So I would say nothing. There
was a normal level of, you know,
anxiety and pressure that comes
along with, you know, tight
deadlines, and managing
expectations both up and down."
"Good, no, no issues that I know
of."
High-risk
environment
(P3): "Poor." "Like with all my brain
injuries and stuff , there is a lack of
awareness."
"Fair."
High-risk
environment
(P8): "It was definitely a lot better
than what I'm currently going
through. But when it was worse it
was currently worse than what I'm
currently going through. So highs
were much higher in the military.
And the lows were much lower in
the military ."
"It's very hit or miss. And that's
the best way I can explain it. It
depends on when you talk to
me."

42

The next section will review participants' understanding of the mental health services
available to them while serving as ADSM and the effectiveness of those resources. This
information is important to the study as it helps to understand their knowledge and awareness of
the mental health services available to them.
Participant Understanding of Mental Health Services
During the interviews, participants were asked about their understanding of the mental
health services available to them and other ADSM. Additionally, they were asked if they felt
those resources were helpful to individuals seeking help. This information is also vital in
providing recommendations that align with the themes identified during the study, as it
highlights how the Air Force promotes mental health services. Finally, it is noted that mental
health awareness can help curb suicide rates, as shown in Chapter Two. The Air Force is
currently dealing with rising suicide rates. Between 1990 and 2004, the Air Force averaged 42
suicides a year (Gnau, 2021); this number rose to 80 completed suicides in 2020 and 81
completed suicides in 2021. It should be noted that statistics provided by the OSI disclosed six
suicides in 2020 and eight suicides in 2021 in the SF career field, highlighting the importance of
knowing about mental health services available. All interviewees acknowledged that they are
somewhat familiar with the mental health services available to ADSM.
Participant responses about the helpfulness of mental health services were mixed.
Participant 3 explained their understanding of resources available and stated, “plenty of
resources; however, how accessible they were, and the points of access that it did just didn't
seem like they were actually accessible when you tried them.” Other participants echoed the
same. Participant 8 stated they had a “firm understanding” of the resources, and Participant 10
43

also said, “there's a lot of resources.” Participant 9 explained he felt the mental health resources
were “abundant.”
While many participants understood the mental health resources available, three
explained that the law enforcement culture made it difficult to seek mental help. Participant 2
elaborated on this and explained, “mental health was a complete waste of time.” When asked to
clarify, they explained it was on them to seek mental health services because the SF culture was
always, “we'll figure it out” when dealing with difficult situations. Participant 2 added to this by
saying, “Like, no one knows what you need, and there's so many different treatments.”
Participant 4 felt the same regarding the difficulty of seeking mental health help and mentioned,
“Honestly, thinking back terrible, because, like I said, when security forces sought out treatment,
they were looked down upon labeled as useless or a problem because you're unlikely placed on
the Do Not Arm roster.” While all participants acknowledged the mental health resources
available, varying degrees of responses were recorded. About three of the respondents felt they
were not adequate. These responses will be analyzed further in this chapter.
Mental health is important at every stage of someone’s life, as it affects how one thinks,
feels, and behaves, while driving how they handle certain situations (Centers for Disease Control
and Prevention, 2021). At the beginning of the interviews, participants were asked to describe
their mental health status while serving as ADSM and currently. Their responses provide a better
understanding of how they felt mentally before and after serving, which is important because
mental health can change over time, demands can exceed resources and coping ability, and
because their statements help to better understand the participants’ state before and after serving.
Their answers also help to understand how the Air Force could have helped or damaged their
mental health (Center for Disease Control and Prevention, 2021).
44

Research Question 1: How Did the Work Environment Affect the Mental Health of SF and
OSI Veterans While They Were on Active Duty?
The first research question explored how the work environment of SF and the OSI
affected ADSM mental health. Two themes were identified during the study. The first theme is
how their job demands created a constant state of hypervigilance, which damaged their mental
health. The second theme is the effect of deployments on mental health.
Hypervigilance
Hypervigilance is one of the central features of PTSD and is explained as a state of
extreme alertness, where the individual is constantly weary of hidden dangers, both real and
presumed (Tull, 2020). Hypervigilance can leave individuals exhausted and interfere with
interpersonal relationships, work, and the ability to operate on a day-to-day basis (Tull, 2020).
Five participants explained that, while serving as ADSM, they had a constant state of
“hypervigilance,” living with adrenaline,” “being constantly on,” and “always alert,” which
contributed directly to their mental health.
Participant 1 explained that “as law enforcement, we become emotionally invested in the
career and are constantly trying to get the job done on and off duty.” He continued, “We go out
to eat, we always sit with our back against the wall or to the windows and the doors, and it
becomes so deeply ingrained in your psyche that you see those things happen.” Additionally, he
explained, “we train to stay alive; these very same things end up killing their personal lives.”
Participant 1 elaborated that “your body simply will not be able to withstand, from a
physical perspective, this hyper-adrenalized environment all the time, and it will crash off of that
high.” He closed by expressing that the reason for this crash is that ADSM do not receive the
proper knowledge and tools to recognize the signs of a hyper-adrenalized environment to better
45

mitigate the effects of what they experience. As mentioned earlier, those in the law enforcement
profession are exposed to situations that may cause emotional exhaustion and psychological
distress (Warren, 2015). As noted by Participant 1, the internalization of symptoms related to the
constant “hypervigilance leads those in the law enforcement profession towards some sort of
physical isolation without the knowledge to see those changes happening.”
Participant 8, who served in the SF and then the OSI, explained that because of the job,
they are responsible for running investigations dealing with death, and because of this, “you
naturally develop an awareness of how fragile death or how fragile life is.” He stated, “you have
to constantly be in a state of readiness.” Additionally, Participant 8 explained, “so that creates
stressors in itself because you’re never really able to unwind.” He also explained further, “Every
demand/task/job is sent with an extreme sense of urgency from your superiors,” and “it does not
matter if the job is running a death investigation or standing on post,” so “fear and sense of
urgency they send your way creates an anxiety that is very hard and difficult to get rid of.”
Participant 6 explained that he was serving as an OSI Detachment One instructor when he
started becoming “hypersensitive to things” and, at the time, did not know what had changed. He
stated he was the lead firearms instructor for the unit and would feel naked when leaving without
his gun. He explained, “I don't know why, but I think it might have been why I ended up going to
mental health treatment starting in 2018.” Participant 6 stated that in 2021, “from what I was
told, it was being in that constant state of on all the time.” Participant 6 was open about how
during those times, because of this feeling, he “didn’t want to go out” and “didn’t want to leave
the house.”
46

Deployments
For the participants, deployments played a critical factor in their mental health. Not only
do deployments contribute to hypervigilance, but they can also have other lasting effects because
of the exposure one might encounter while deployed or being away from family and friends.
Participant 1 explained that many people in these career fields expect everybody to react in the
same way to stressful situations but stressed, “we are all different in how we react.” Participant 1
provided an example of how people came back from a deployment and say, “I do not know why
he is freaking out. I was standing right there next to him, when the thing blew up. You know,
you're a different person.” He elaborated, “You react to the environment based upon your unique
mix of genetics.” Participant 1 also explained that these feelings sometimes take years to
manifest into something larger, citing “sometimes, there's stigma, stigmatization, and then the
other part may be that we sometimes just don't realize what's going on, and we just have to suck
it up mentaly, and we press onto the objective, right.”
Participant 2, when asked about stressors, mentioned that deployments were “really
rough” for him. Participant 2 joined the OSI shortly after the 9-11 attacks and did six tours,
totaling approximately 1,000 days of war. In 2004, Participant 2 suffered injuries from an
explosion, giving him a brain injury that caused PTSD, earning him a purple heart. He explained,
“I was kind of suffering in silence for a lot of those things.” He elaborated further and stated he
was the poster boy for PTSD in the OSI for a while, and for nearly 2 decades, “I was able to hide
it for a long time because, you know, I would travel alone by myself and stay in hotels, and I
would come home. Just keep it long enough to get on the road again kind of thing.”
Other participants also expressed deployments’ effect on their overall mental health.
Participant 3 said, “obviously deployments” when asked about stressors in their career fields.
47

Participant 4 stated, “My little brother almost lost his life, when I was deployed, in a horrific car
accident.” They explained that during this time, they received a lack of leadership support while
deployed, which made the stress of being away greater. Participant 8 stated, “I completed my
deployment, post-deployment health assessment, and I basically answered it truthfully, to which
a provider contacted me and talked to me about the things and then recommended that I go seek
or talk to behavioral health.”
Participant 5, who deployed conducting combat operations in Afghanistan, explained his
father noticed he was not the same after returning from his deployment and that he almost
wrecked his car three times. He explained that people underwent brain scans before and after
combat deployments:
They've done brain scans of people in a combat environment, and the brain is super
excited. That's got all these bright colors on it, and, so, what happens if you do that for a
sustained period, 4 months, 6 months a year, your brain is in that heightened excited state
that entire time.
He concluded by saying,
The brain is still in that excited state after you've returned, and those symptoms can go on
for up to a year, and, so, it takes a long time for your brain to normalize, you know,
physically, physiology, physiologically, it takes a long time.”
Because of his deployment and its aftereffects, Participant 5 said that he was temporarily
reassigned, due to his mental health, to give him time to take care of himself. The data show
deployments’ impact on participants due to what they are exposed to and their career field’s
demands.
48

Research Question 2: What Resources and Barriers Influenced SF and OSI Veterans to
Seek Mental Health Support While on Active Duty?
Research Question 2 sought to explore the resources and barriers participants
encountered when seeking mental health support while on active duty. Regarding resources,
three themes were identified. The first theme pertains to the role of family for those seeking help.
The second theme is the impact of friends on those seeking help. The final theme looks at
leaders' positive impact on those seeking mental health help.
Resources
During the research, participants identified several resources that had a positive impact
on them when seeking mental health support while on active duty. This section will present data
on the influence of family, friends, and leadership.
Family
During the study, four participants explained that their families supported them when
seeking help by just being there for them. Participant 2 explained that his spouse supported his
seeking help and told him, “You know, I get it. You've been through some horrible shit that no
one should have to go through. And if you want to do the work and get better, I'm going to be
here with you.” Participant 4 echoed that response and explained that her family was very
positive about her seeking help. While Participant 5 expressed that mental health was not really
talked about among his peers, his father was supportive. He explained his experience with his
father: “It was good. Yeah, man, my dad always did always see different since I came back from
Afghanistan. Yeah, they've been wanting me to go see somebody for a long time.”
I asked Participant 1 about his current mental health, and he provided a robust response,
which he attributed to a supportive family. He stated,
49

It's great right now. I am blessed in many ways. I’ve got obviously a very supportive
family, and I've been through different experiences in my career, educational and
operational, that shone a light on different aspects of mental health that I needed to
address and helped me maintain a certain stability about it.
Participant 1 was also asked about significant stressors he faced throughout his career and
explained that stressors are different for everybody. He responded that he overcame these
stressors because “I also have a great support system in my family.”
Friends
Two participants shared that the views of their friends influenced them positively when
seeking help. Participant 3 expressed to the researcher how 50% of her friends were totally
supportive and expressed how “amazing” it was. She elaborated and stated, “My best friends
were for it because they're like my brother, my sister. So, my best friends and my family were all
for it.” Participant 8, who sought help, explained, “My close friends were completely supportive,
and then I also had passive friends, and this was a good indication for me, too.” I asked the
participant to dive deeper and elaborate, and he responded, “I also had passive friends that
basically reached out to me and asked about my experience, and it was more along the lines that
I could tell that they wanted to seek mental health.” He added,
But they also were worried about the repercussions of it. So, from my peers, I received
support and curiosity because I knew that they wanted mental health as well, and they
wanted to know what the outcome would be for seeking mental health.
Participant 8 felt the people around him did influence him to seek help and explained,
50

Hey, these are good people, this person is just like me. And then I found out that they had
sought mental health. Then, it kind of gave me the green light, like, hey, if they can seek
mental health, and why can't I?
While many close friends and family members supported many of the participants when
seeking help, some participants expressed their friends’ views also influenced them negatively.
The participants’ responses evidence how family’s and friends’ views can either negatively or
positively impact help-seeking behaviors.
Leadership
Participants felt their leadership supported them when seeking mental health help while
on active duty. This could be in part because of the slight differences in the culture in each career
field. Participant 6 stated, “Very supportive. You know, everyone's like, yeah, man, you got to
take care of you, you know. Boss, just let us take stuff off your plate. Delegate better, you know.
stuff like that.” Participant 6 stated that leadership supported him and told him, “Knock that off.
You need to take care of yourself first.” Additionally, he explained he was viewed as a leader
and said,
I think, they, later on, they're like, ‘Hey, boss, you kind of inspired me to go.’ And, so, I
got a little bit of like, okay, it was the right thing to do to be open about this, you know.
So, I don't know what they got, if I influenced them, but, like, I think that I did.
The next section will look at barriers participants faced while on active duty, including
how the views of friends, family, and leadership hindered them from seeking mental health help
while on active duty.
51

Barriers
From the research, eight participants elected to receive mental health care while ADSM.
These participants identified and shared some of their experiences. This section will present the
barriers they identified. Some participants felt their friends and leadership were barriers to
seeking mental health help. The participants who sought mental health assistance explained that
there were not enough providers to meet the demand of those seeking help. Many explained that
the length of time between appointments was a significant logistical issue. They explained this
was in part due to the demand providers faced, and if the person seeking help was not deemed
high risk, their appointment would be scheduled later. Another theme participants identified was
difficulty securing an appointment due to their work schedules. Additionally, I asked participants
about their perceptions of the Air Force and law enforcement culture towards mental health in
terms of creating a barrier to care.
Friends
Earlier sections addressed the positive impact of family and friends ad on participants
when seeking mental health help while on active duty. However, four participants explained that
their friends were also a barrier to doing so. Many participants expressed that their friends’ views
influenced them negatively. During the interview, the female respondents in SF expressed
concern over their male friends finding out about them seeking help. Participant 3 stated, “I think
it's probably wrong, but just how I feel, but most of them are male, my male counterparts, and I
don't want them to view me as not being up to par with them.” Participant 4 explained they “lost
so many friends” because they were actively seeking help and were painted in a negative light
because of it. She also stated, “They have to now pick up my slack because I'm not doing my
52

half.” Participant 3 went on to add, “Like, if I can't hang with the boys and meet their same
requirements, like, I cannot do the mission either. So, I would say that was a huge one
Participant 5 explained that peers never really talked about mental health. He added that
the reason was that, “yeah, once again, our career field, you're acknowledging weakness.”
Participant 2 echoed similar sentiments concerning peers and leadership finding out about
someone seeking mental health help. He stated, “Because of that problem, you know, and so it
changes everything, your professional relationships or personal relationships.”
Leadership
While participants expressed that friends were a barrier to care, another theme that
emerged was the negative impact created by leadership’s views of those seeking mental health
help while on active duty. Participant 1, who served as an SF commander in a high leadership
role, explained he noticed that Air Force leadership is sometimes focused on the symptoms but
not the disease. Some participants felt that if someone found out they sought help, their career
would be finished. Participant 5 stated that “career implications” prevented them from seeking
help early on. He felt that if leadership found out that, “as an officer, you sought mental health
help, your career would be finished.”
Participant 3, who served as a supervisor in SF stated about leadership that “the Air Force
is more concerned with liability than it is for being proactive and preventing mental health issues
and our troops.” Participants from both sides explained that the career fields could become
political and were about appeasing leadership. Participant 8, who served with the OSI, also said,
“They don't really get to the nitty-gritty of what true mental health is because to them, it's just
like to appease their leader for saying, ‘Hey, we have to fill these obligations for mental health.’”
53

Participant 10 explained they never told their leadership about their issues and did not
openly share their struggles until they reached a higher leadership role where they felt they could
have an impact. Participant 2, a female law enforcement officer, explained that most of their
friends were male, and while they were seeking help, they did not tell anyone for fear of
leadership viewing them as less than.
Two participants expressed concerns with how Air Force leadership treats mental health
and explained they promote it because of the fear of liability if something occurs. Participant 8
stated that leaders are “more concerned with liability than being proactive.” Additionally,
Participant 5, who did not hold back, provided their leadership perspective, stating,
I think they're supportive, but in a lot of ways, I think it's lip service. Lip service, and it's
it's kind of cover your ass lip service. And, you know, for a lot of leaders and stuff,
mental health is, like, “Oh, Johnny's, you know, Johnny's having a bad day. Go get him a
frickin psych evals of the, you know. If he blows his brains out, I don't get fired as a
commander.”
Participant 5 felt leaders sent individuals for help because of the repercussions they could face if
a suicide occurred. Participant 4 expressed that she lost confidence in leadership with anything
dealing with mental health because of the way she perceived leaders addressing it.
Provider Availability
Among the eight participants who sought mental health care, most echoed the same
frustrations about provider availability. Participants elaborated on how some providers were so
busy that it often took weeks to be seen because of the number of patients requiring services.
Participant 10 held a high leadership role in the OSI and explained that they actively sought
mental health help. I asked about their experience in seeking help and if they had any scheduling
54

difficulty with their provider. They explained, “Yes, yes, provider availability because they're
busy, which isn't a bad thing because that means people are using them in the Air Force, and
that's what we want.” Participant 10 also explained, “I think I actually, at one point, the first time
around, stopped because I couldn't get another appointment in a reasonable amount of time. So, I
just didn't go.”
When asked, three participants explained they were unable to choose their provider and
stated they preferred someone of their same gender or attempted to get a new provider, but the
referral process took entirely too long. Participant 3 added to this and explained, “That was a
huge barrier as well. Instead of just going in there and being able to establish a relationship or
establish, like, rapport with the counselors.” Participant 6 stated that he did not initially feel he fit
with his provider but said, “She was the only one that's available.” Participant 5, who served as a
Squadron Commander in the SF career field opened up about their experience with mental health
help. When asked about the challenges in seeking mental health help, they explained “Well, just
to reiterate, Right, one of the challenges was just getting on the guy's schedule, because he was
swamped.”
Some participants who worked in the SF career fields explained that one limitation to
scheduling appointments was that working the night shift made it difficult to stay awake and
attend meetings. Most participants explained that they would like to see more mental health
providers embedded in their career fields due to the lack of provider availability. Participant 1
and Participant 5 both explained the benefits of seeing mental health providers embedded within
a unit. They explained these providers could help build trust and cohesion in a unit. They both
attributed this experience to their time serving with an Army Special Operations Command.

55

Time Between Appointments
During the interviews, participants were asked about some of the logistical challenges
they faced when seeking mental health help. Participant 8, who sought help after a recent
deployment, explained their difficulties with appointment scheduling. They stated, “I think that
that's [a] huge issue because there were major issues logistically. Unless you are on suicide
watch, it may be a month or two months until you see your provider.” Many other participants
expressed the same sentiment about higher-risk patients being prioritized. Participant 8
elaborated on their experience and offered a summary of when they initially filed a request to
seek mental health help. They started the scheduling process around the fall after returning from
a deployment. They expressed that it was not until June the following year that they saw a
provider. Participant 8 added,
My different appointments, they would be months out, and that's not the provider’s fault.
It's just they are, you know, a handful of people, and they have X amount of clients, so
their hands are tied, and I know that they want to do help, but also it's like they have to
take quantity over quality.
Participant 6 explained the need for more Air Force mental health providers because of
the time it takes to secure an appointment. Participant 2 stated, “unless you're in a crisis like
they're afraid you're about to kill yourself, it's going to take you a little while to get in.”
Participant 10 also mentioned that if one were not “an emergent situation,” one would usually be
waiting, which contributed to “some logistical issues with scheduling.” Participant 10, who
sought help, said, “The first time around, I stopped because I couldn't get another appointment in
a reasonable amount of time, so I just didn't go.”
56

While participants acknowledged they understood the mental health resources available,
they explained that provider availability and lengthy period between appointments made
accessing the resources very difficult. Participants explained that they understood that the lack of
availability was not the providers’ fault and attributed this to a high volume of patients, which
causes the medical system to be task-saturated. Participant 3 explained plenty of resources are
available, and they are improving but not fast enough. Participants also expressed their views on
how their work schedules made it difficult to seek mental health help.
Work Schedule
I asked participants about their experience with seeking mental health appointments, and
four explained some scheduling conflicts because of their work schedules. Participant 7
explained that scheduling a mental health appointment was difficult because they worked the
night shift. They explained, “The only appointments available were Tuesday in the afternoons,”
which caused them to be awake for almost 40 hours just to attend the appointment. Participant 7
stressed, “the biggest logistical issue was scheduling conflicts.” One participant who was
medically retired explained that everything in the SF career field makes it difficult to seek mental
health help, from “long hours” to the “night shift.”
Participant 4 felt the Air Force culture regarding mental health depended on the career
field. They explained, “People that work back office 5 to 6 jobs, or 8 to 5 jobs, would actually
promote mental health because they have the availability compared to shift workers.” The
participant provided more detail and mentioned, “They need bodies. Whether you're ammo,
whether you're maintainer, whether you're security forces, if you're a shift worker. You don't get
the same privileges as being in medical or working back office position.” Participant 3 felt the
57

same way, explained it was impossible to get help, and stated, “Night shift. You're on night shift.
You're done. You're done.”
Participant 8 explained that securing an appointment was not convenient. They explained
they only got a couple of sessions with mental health because of the difficulty of contacting
them. He explained, “With people that have normal lives, have kids or work that's demanding,
and then you throw that, how inconvenient it is to seek mental health.” Because of the difficulty
in reaching out and scheduling appointments with mental health and the participants’ obligations
regarding work, they stopped being seen. It was clear from talking to several participants that
shift work hinders those seeking mental health help. Additionally, some participants faced
challenges trying to schedule an appointment due to working normal jobs. The next section will
look at the mental health culture in SF and the OSI careers.
Mental Health Culture
The next theme uncovered during the data analysis was the environmental culture
towards mental health that the participants observed in the Air Force and law enforcement career
fields. During the interviews, participants were asked about their perception of the Air Force and
law enforcement culture toward mental health. This section will discuss the cultural factors
participants identified as barriers to seeking mental health help. While more than half of the
participants felt the Air Force had done much to improve the culture of mental health in its ranks,
those in SF felt differently. Four participants in SF felt the career field had a poor culture when it
came to promoting mental health, citing they feel it is more driven by liability and leaders’
protecting their own interests. Participant 5, who served in high leadership roles with SF
acknowledged some facets of the Air Force and SF support mental health and stated he felt “it's
not a real commitment to long-term mental health care. I feel like it's just real kind of cover your
58

ass kind of culture, and then they don't commit the resources required to really take care of the
force.”
Participant 5 felt that changes recommended for SF would be turned down because of
funding or the culture of not wanting to change. When looking at change, participants from both
career fields felt that change in the law enforcement community was difficult, mainly due to the
older generation. Some mentioned that programs and changes in the Air Force do not always
filter down to those who need them. Participant 10, who served as one of the highest OSI leaders,
explained,
I think a lot of people, especially the older generations are still not comfortable talking
about things. I think some of the newer, you know, our new generations, or younger
generations don't have as much of an issue with it. So, I'm hoping that it'll change.
Additionally, she expressed that while some individuals become uncomfortable talking about
mental health, “we need to make it okay, and I think that was the biggest challenge. And, you
know, and I always said, this is a culture change.”
Five participants stated that the current culture makes it difficult to want to seek mental
health help. Participants 3 and 4 noted that if one’s weapons are taken away, one will be viewed
as ineffective, and people will know that something is happening. Some participants felt that if
seeking help would be career-ending, both on the enlisted and officer side. Participant 5 stated in
regard to people knowing about someone’s mental health, “Once that gets out, you’re frickin
dead to the community. If you're deemed having any issues whatsoever, our community is so
small, especially an officer world; you're finished.” Participant 5 described the SF culture:
“From Day 1 to the day I left, it was always this culture of we eat our own.”
59

Participant 6, who served in the Air Force for 20 years and was a member of the OSI,
noticed early on that “there was a stigma, huge stigma.” However, he felt the mental health
culture is much more accepted now, and one can seek help proactively. Participant 7 felt the
same in regard to the culture of mental health in the Air Force. As a member who served in SF
for 6 years, he stated, “I think the Air Force tries to take a take action towards mental health as
far as they put a lot of programs in place to try to address mental health and try to get people to
voluntarily go seek help with mental health.” With regard to being in SF, he felt there was a “real
stigma to have mental health assistance while you're in security forces. Well, you get cast aside,
really.” He elaborated, “You take away your weapons, now you can't work, so everybody else
around you sees you. Now, you're feeling extremely outcast because everybody's looking at
you.”
Participants from both career fields expressed the same sentiment regarding the work
culture and seeking mental health help, saying seeking help would hurt the mission and would be
seen as not doing their jobs. Participant 5, when asked about the culture of SF, stated, “We eat
our own” and that the career field has an identity problem. While the participants felt the overall
Air Force culture regarding mental health was improving, the culture in law enforcement made it
difficult because of the issues they discussed in the interviews. The next section will look at how
SCT was the appropriate theoretical framework for this study.
Summary
This chapter presented the findings from interviews with 10 veterans who served in the
SF and the OSI career fields as ADSM. They were selected based on their status as having
served as ADSM in SF and the OSI and having separated in the 5 years prior to this study. The
study began with participants describing their mental health status when they served and
60

currently. Additionally, participants were asked about their understanding of the mental health
services provided. Participants noted there were services available and discussed their
understanding of them, yet they were concerned about the overall effectiveness and access to
these services.
This chapter discussed the resources and barriers participants discussed regarding seeking
mental health help. Participants identified several resources that had a positive impact on them,
such as family, friends, and leadership. In terms of barriers to care, they described their
challenges and experiences when seeking help. These participants discussed friends, leadership,
provider availability, length of time between appointments, work schedules, and overall culture
regarding mental health.

61

Chapter Five: Recommendations
The purpose of this dissertation was to explore USAF SF and OSI law enforcement
veterans’ experiences navigating resources and barriers when seeking mental health care while
on active duty. Two research questions guided this study:
1. How did the work environment affect the mental health of SF and OSI veterans while
they were on active duty?
2. What resources or barriers impacted SF and OSI veterans’ decisions on seeking
mental health support while on active duty?
This chapter discusses the findings related to the theoretical framework of SCT and
current literature. The chapter presents recommendations and implementation plans for the Air
Force law enforcement career fields based on the findings and discussions. The
recommendations focus on the barriers the participants encountered when seeking help while on
active duty. The chapter concludes with the study’s limitations, delimitations, and suggestions
for future research.
Discussion of Findings
This study’s qualitative interview data identified how the work environment affected the
participants’ mental health and help-seeking actions. Furthermore, the following sections will
present the resources and barriers to the mental health care process the interviewees noted. I
address these barriers and present several recommendations to address these issues.
Social Cognitive Theory
As discussed earlier, SCT is a learning theory that explains human behavior in terms of a
three-way, dynamic model. The theory describes the influence of continuous interactions among
individuals’ experiences, environmental influences, and factors on their behavior (Bandura,
62

1989). This theory was appropriate for this study because it allows for examining the problem of
practice by helping to explain how personal experience and observing others' actions and
experiences influence individuals' decisions and actions (Bandura, 1989). I concluded that
several of the participants’ experiences influenced them positively and negatively in terms of
seeking mental health assistance. Each finding presented below connects to SCT in that the
participants' decisions about seeking help were influenced by their positive and negative
observations of others' actions and experiences. Those observations led them to decisions based
on the outcomes they observed. Additionally, the identified resources and barriers also shaped
their help-seeking actions. The next section presents significant findings to address the first
research question on how the work environment affected SF and OSI veterans’ mental health
while on active duty.
Significant Findings Related to the Work Environment
The participants' collective experiences uncovered several job demands that affected their
mental health. The two key findings related to a state of hypervigilance and deployments.
Hypervigilance
During the study, participants explained that hypervigilance damaged their mental health.
Hypervigilance is one of the central features of PTSD and is explained as a state of extreme
alertness, where the individual constantly fears hidden dangers, both real and presumed (Tull,
2020b). Hypervigilance is one of the most disabling factors of PTSD because the body and mind
are not designed to operate in a constant state of high arousal (Tull, 2020b). Those in SF and the
OSI face a constant state of hypervigilance caused by their career fields’ demands, and this
hypervigilance affects their functioning in areas outside the scope of their normal duties.
63

According to research, hypervigilance can leave individuals exhausted and interfere with
interpersonal relationships, work, and the ability to operate on a day-to-day basis (Tull, 2020b).
Deployments
While the SF and OSI career fields create a constant state of hypervigilance because of
stressful demands, deployments can amplify this state, as ADSM serve in faraway countries
(Vinokur, 2011). Deployments were the second factor that negatively impacted the participants’
mental health while on active duty. Not only do deployments contribute to hypervigilance, but
they can also have other long-lasting effects because of events or situations one might encounter
while deployed or away from family and friends. Deployments expose service members to
traumatic events and extraordinary demands while away from familiar surroundings and stable
social networks that could help them deal with the mission of war (Vinokur, 2011).
Participants explained that the deployed environment keeps one “constantly on” and
“always alert,” and remaining in this state of hypervigilance for long periods can affect mental
health and hinder the ability to engage in day-to-day activities. Research has shown that the
demands of deployments can compromise mental health, which could lead to poor physical
health, drug and alcohol abuse, divorce, inadequate parenting, and suicide (Vinokur, 2011). The
following section will discuss findings to address the second research question on the resources
and barriers the participants encountered related to seeking mental health support while on active
duty and its application to SCT.
Significant Findings Related to Resources and Barriers
During the study, participants identified several resources and barriers that positively and
negatively influenced their decisions to seek mental health support. The reoccurring themes in
their statements were the availability of care providers, scheduling conflicts, the time between
64

appointments, and stigma. Additionally, participants were asked how their observations of their
peers influenced them to receive mental health help applicable when connecting this study’s
results to SCT.
Resources
When seeking mental health help, seven interviewees explained they had a positive
experience with family, friends, or leadership when seeking help. However, some also explained
that they had negative interactions that influenced them when seeking help. Participant 3
explained her original decision to seek mental health was discouraged because of the negative
experiences she observed of her peers being turned away when seeking help. Per SCT, that
experience highlights how her decisions and actions were influenced by personal experience
observing how others handled the situation and decided not to seek help initially (Bandura,
1989).
A previous Air Force study investigated the perceptions of stigma and barriers among active
duty officers and enlisted Air Force nursing personnel when accessing mental health services.
Interestingly, this study’s participants provided responses similar to those from the Air Force
study. During the study on 211 Air Force nursing personnel, 46% agreed that receiving mental
health care would harm their careers (Hernandez et al., 2014)
Barriers
The second problem the interviewees identified were barriers to care, such as provider
availability, scheduling conflicts, the time between appointments, and mental health stigma. The
eight participants who sought mental health help explained how these barriers influenced them.
Participant 8 felt seeking mental health was a complete “waste of time” because providers were
busy and could only see him once a month; he felt they were not listening. Based on his
65

experience, he said, “No, man. Like, I don’t need any of this at all.” Participant 10, who sought
help, said, “the first time around, I stopped because I couldn't get another appointment in a
reasonable amount of time, so I just didn't go.” Based on their observations, the participants’
decisions and actions were influenced by their personal experiences (Bandura, 1989).
I asked the participants about their perceptions of the Air Force and law enforcement
culture towards mental health. They felt the Air Force had greatly improved the mental health
culture within its ranks. They stressed that the Air Force had developed more programs to create
a supportive culture. Participants who worked in SF feel the career field has a poor mental health
culture, finding that their strategy protects leadership by providing an avenue to decrease
liability. Some stated that if people sought help, the culture made it difficult to access it, which
influenced some participants.
Some participants stated that having their weapons taken away meant they would be
viewed as ineffective, and people would know they were facing difficulties, dissuading them
from seeking help. Some participants felt that if they sought help, their careers would be
effectively over, both on the enlisted and officer side. Participant 10 explained how the biggest
challenge when addressing mental health and promoting it is “we need to make it okay.” In
summation, each finding disclosed a connection to SCT, recognizing the decisions of the ADSM
seeking help were influenced through positively and negatively observing others' actions and
experiences seeking help and, through those observations making a decision based on the
outcome observed (Bandura, 1989).
Recommendations for Practice
This section will cover recommendations from this study’s results. While these
recommendations are designed for Air Force leadership and medical services, they might also
66

benefit other large organizations. Additionally, this research can assist other armed forces
branches and federal, state, and local law enforcement levels.
Recommendation 1: Address Mental Health Stigma in Air Force Law Enforcement Career
Fields
The first recommendation addresses mental health stigma in Air Force law enforcement
career fields. I recommend utilizing the awareness, desire, knowledge, ability, and reinforcement
(ADKAR) model. If utilized appropriately, this model can help organizations limit resistance by
focusing on employees or stakeholders to drive change while clearly defining their objectives
and measuring progress during stepped plans (Hiatt, 2006). The ADKAR model helps to
discover gaps in behavior changes, and research has shown it useful in identifying why the
desired changes are not materializing (Bandar, 2010).
Utilizing this approach can help to reduce the stigma or resistance ADSM face when
seeking help. As stated, many participants explained that their leadership’s and peers’ views of
mental health encouraged or dissuaded their help-seeking efforts and sometimes felt that mental
health was almost forced on them. These approaches will revitalize the way the Air Force views
and promotes mental health to eliminate stigma. The ADKAR model is based on the
understanding that organizational change can only happen when individuals change. The
ADKAR model presents the desired change in parts to enable everyone to understand where the
change is failing and address that impact point (Bandar 2010).
The first step is understanding the ADKAR model and how it works. Once this
understanding has been established, the next step is to use certain types of nudges to address
stigma and let ADSM know it is acceptable to seek help. Hiatt (2006) stated, “Awareness is the
first element of the ADKAR model and is achieved when a person is aware of and understands
67

the nature of change, why it is needed and the risks of not changing” (p. 5). In this first step,
highlighting statistics on mental health is important. Doing so requires more research on the
logistical issues with provider availability and barriers to care, as participants stressed “provider
availability” as the largest logistical hurdle when seeking help. Stakeholders must be aware of
how lower provider availability reduces ADSM efforts to seek help and could cause the suicide
rates in the Air Force to stagnate or rise. As presented in the literature review, there were 80
completed suicides in 2020 and 81 completed suicides in 2021 (Gnau, 2021). The SF career field
saw 8 suicides in 2020 and 6 in 2021 (Gnau, 2021).
The second element in the ADKAR model is desire. Many scholars have argued that this
is the most difficult of the five building blocks to achieve because desire is ultimately a personal
choice (Tapi, 2021). In the ADKAR model, desire requires reinforcement and continued
communication to ensure that changes are successful (Tapi, 2021). As leaders it is important to
create buy in and make sure the ADSM understands how this change could help them in their
day to day life, once this is accomplished it reinforces and drives the ADSM to want to change.
This helps give them the desire needed to make a change.
The third element in the ADKAR model is knowledge, which consists of “our current
knowledge level, our capacity to learn, the availability of resources, the access to needed
information” (Hiatt, 2006, p. 29). To have effective change or implement new ideas, it is
imperative to provide members with knowledge to change and knowledge to perform the change
(Tapi, 2021). Some participants explained they felt their career field has an identity problem with
a culture of stigma, a “suck it up mentality,” and the notion that “we eat our own.” It’ is
imperative that ADSM, leaders, peers, and stakeholders know that talking about mental health
and seeking help is normal. The literature review presented the evolution of how mental health
68

has become more positively viewed. It is important to provide knowledge on how the PTSD
diagnosis was accepted into the Diagnostic and Statistical Manual (DSM-III), which
reintroduced war neurosis into the official psychiatric nomenclature, paving the way for all
future research on mental health (Scott, 1990). Educating personnel with this information will
demonstrate progress toward eliminating stigma.
The fourth element in the ADKAR model, ability, is where knowledge translates into
action (Tapi, 2021). In this phase, learning is applied in a practical setting, such as in training or
real-world application (Tapi, 2021). The first way this can be done is provide the same level of
training to all members of the USAF and go away from supervisor specific training, this will
guarantee everyone receives the same amount of training and knowledge when it comes to
dealing with mental health. Being able to provide all ADSM with the same level of training will
improve the knowledge on how to appropriately spot and assess when someone is struggling,
providing a first layer of care and intervention. Doing this will make sure stakeholders and the
ADSM are able to translate their knowledge into action. This leaves no gap in a ADSM ability to
understand and recognize the early signs and symptoms of mental health.
The final ADKAR model component is reinforcement, which is used to sustain change
(Tapi, 2021). Reinforcement is essential and can include rewards, recognition, and internal
satisfaction. Addressing this problem of practice, reinforcement would take the form of an
annual decrease in the suicide rate, a healthier and more sustained Air Force, and retention of the
ADSM (Tapi, 2021). If the organization does not reinforce the change of addressing mental
health stigma, there is a risk that the investment and efforts will not yield results and the potential
for regression because the change was not fully embraced or realized (Tapi, 2021).
69

Recommendation 2: Improve Access to Mental Health Care
The second recommendation is to improve access to mental health care. As Chapter Two
presented, a review of the DoD’s health program budget for fiscal year 2021 revealed that the
DoD, in 2019, announced it would cut about 18,000 military medical billets throughout all
military branches as part of sweeping health care reform (Jowers, 2021). Additionally, a report
published by Booz Allen Hamilton in 2021 explained that the USAF would see shrinking
budgets and personnel due to economic and political influences (Booz Allen, 2021). These cuts
would be detrimental for ADSM who seek any type of specialized care. The recent cuts appear to
have already impacted the Air Force as some of this study’s participants explained the difficulty
of securing mental health care appointments because of provider availability, the length of time
between appointments, or difficulty securing an initial appointment.
Participant 8 explained that it took almost a year to be seen by a mental health provider
after disclosing that they were struggling and needed help. The first step is to increase the
number of medical billets throughout the military and increase the budget. Continuing to provide
ADSM with limited mental health care or forcing them to seek assistance off base will further
degrade mission readiness.
During the interviews, some participants explained that they would like to see more
embedded mental health professionals in their respective career fields. Two participants drew on
experiences they had while assigned outside of the command and highlighted the benefits of
embedded mental health providers. Embedding mental health providers in Air Force law
enforcement career fields would significantly improve access to care. Their presence would also
assist ADSM with scheduling conflicts due to their work schedule.
70

In 2018, the Air Force started Task Force True North (TFTN) to improve well-being and
resilience among airmen and their families through initiatives designed to engage them early;
one form was providing embedded mental health providers (DiNicola et al., 2020). These
initiatives have been undergoing beta testing at four pre-determined locations: Whiteman Air
Force Base (AFB), Minot AFB, Joint Base Elmendorf-Richardson, and Beale AFB (DiNicola et
al., 2020). The embedded mental health teams are comprised of a licensed clinical social worker
and a mental health technician and are structured to conduct unit circulation, education, and
limited scope counseling within the unit and promote resilient and help-seeking behavior
(DiNicola et al., 2020). The Air Force intends for these resources to enable early intervention for
situations where airmen might not seek help until their problem manifests into something bigger
and requires intervention (DiNicola et al., 2020). Many participants hope this concept can spread
to their respective work centers. Participant 2 stated, “People weren't seeking mental health help
until they got in trouble,” effectively hitting rock bottom. He noted that individuals would find
themselves in trouble for alcohol use. The TFTN, as outlined, would provide the early
intervention needed.
During the beta testing, participants received embedded mental health providers
positively and praised their mental health technicians because of positive interactions during
educational events (DiNicola et al., 2020). While positives were highlighted, participants also
noted some limitations of the initiative, including the providers’ lack of knowledge about the Air
Force culture and prior experience with the military (DiNicola et al., 2020).
During the interviews, participants explained that trust was a significant factor when
discussing their mental health. It should be noted that the RAND Corporation, during an
evaluation of the TFTN, concluded that many of the embedded providers connected with the
71

ADSM and enhanced overall willingness to seek services because of the rapport and trust built
during interactions (DiNicola et al., 2020). Participants 1 and 5 explained that they observed how
providers were connected while assigned outside of SF. While still in the beta test phase, this
initiative, with some modifications, could be beneficial to the Air Force law enforcement career
fields. While some ADSM would prefer to receive help from a provider who understands the Air
Force culture and is familiar with the stressors and challenges of their career fields, this would be
an easy adjustment (DiNicola et al., 2020).
When looking at improving mental health access, another recommendation for the Air
Force to address scheduling conflicts and provider availability is to shift its focus to a
telemedicine approach. Telemedicine would directly address the issues of a decreased operating
budget and low provider availability. The practice of telemedicine began in the late 1950s and
early 1960s and has been used for decades in most clinic settings; the emergence of the COVID-
19 pandemic reinforced a need for this service (Kichloo et al., 2020). According to the Centers
for Medicare and Medicaid Service, telemedicine is “a service that seeks to improve a patient’s
health by permitting two-way, real-time interactive communication between the patient and the
physician at a distant site” (Kichloo et al., 2020, p. 1).
Telemedicine provides patients with high-quality healthcare through a cost-effective
approach, showing this practice would be beneficial as budget cuts across the DoD and the Air
Force take shape (Kichloo et al., 2020). Telemedicine would benefit SF and OSI members by
increasing access to mental health services at their home station or while deployed. Participants
explained that scheduling conflicts due to their work schedule and provider availability are a
barrier to care. Telemedicine would instantly address these two issues and give service members
an opportunity to speak with a provider before an issue can manifest into a crisis. Telemedicine
72

can also increase the number of patients a provider can see and afford them a more flexible
schedule.
Recommendation 3: Increase the Number of Resiliency Days and Promote Physical Fitness
The final recommendation is to increase the number of resiliency days as needed.
Currently, the Air Force conducts biannual Wingman Days with activities that emphasize
informational awareness, accountability, team building, and communication skills for topics such
as suicide prevention, resilience, and health and well-being for those deployed (Meadows et al.,
2015). Wingman Day has been successful because of its effectiveness in educating ADSM in
suicide prevention and teaching airmen to look out for one another while reducing suicides
(Meadows et al., 2015). Participants in SF addressed scheduling conflicts and the ability to
attend scheduled appointments because of their shift work. Increasing these resiliency days
would give opportunities for those who missed these events.
It should be noted that the OSI currently conducts monthly standdown days known as
Developing Our 300 (DO300), designed to focus on the health and well-being of OSI special
agents, support staff, families, and teammates by giving everyone the opportunity to take a
tactical pause and focus on themselves and teammates once a month. Additionally, DO300 gives
OSI members the opportunity to identify when they are becoming overwhelmed or task-saturated
and when challenges at home or work make it difficult to focus on the mission. It opens up a line
of communication among peers for a healthy work environment. Therefore, DO300 should be
recommended to the SF career field due to its success in the OSI.
Aside from increasing the number of resiliency days and/or incorporating DO300
monthly, the USAF should promote ADSM physical health. Addressed during the literature
review was how studies have shown physical activity to have a direct positive effect on the
73

health, well-being, and readiness of the USAF while ensuring the ADSM is physically fit,
psychologically fit, enhanced self-esteem, protection against depression, and reduced risks of
medical factors (Meadows et al., 2015). Continuing to do this also means giving members the
opportunity to the ADSM the ability to accomplish this.
Ways to promote a culture of physical health for the ADSM is creating opportunities
which encourage the service member to remain physically fit. One way of doing this is
incorporating events such as a team hike that build unit cohesion and promote fitness during
resiliency days or DO 300 events. Other methods include giving those working a shift schedule,
such as mid shift or day shift an opportunity to work out during the duty day, this will allow
members to find a break during the duty day to work on their fitness and remain mentally ready.
When promoting any resource, it is imperative to give everyone a sense of belonging and
purpose. Overall, it is recommended that SF, OSI, and the Air Force continue to look for
opportunities and proactive ways to promote mental health. The following section will provide
recommendations for future studies based on the research presented herein.
Recommendations for Future Research
As a result of this study, recommendations for future research include a further
examination into the barriers ADSM face in Air Force law enforcement career fields. Emphasis
should be on increasing the sample size and conducting a mixed-methods study. With a well-
established baseline of participant responses, a mixed-methods approach with a larger sample
will provide a better understanding of the problem of addressing mental health among ADSM.
One difficulty I noted was the structure of how the questioning. I suggest better structuring the
questions asked during the study to provide better organizational flow. One final
74

recommendation is to reorganize the interview questions to provide participants with a more
free-flowing discussion.
Limitations and Delimitations
With the information received, this study examined how law enforcement veterans’
experiences shaped their view of mental health services during active duty. Despite utilizing
strategies such as thematic analysis, triangulation, and member checking to improve the validity
of the research, there are still limitations to the study. Factors outside my control are the
participants’ possible exaggeration of events, ill sentiments they held while serving, and their
ability to recollect events. Another issue outside my control was their willingness to participate
in the study.
Qualitative research has several benefits, such as providing a detailed description of the
participants’ experiences and feelings to help understand the human experience in specific
settings (Rahman, 2016). It also provides subjective and detailed data collection through
interviews because of the direct contact with participants (Rahman, 2016). While some benefits
have been explained, qualitative research also has some limitations.
A limitation of using qualitative research is that this type of research tends to have a
smaller sample, which raises the issue of the findings’ generalizability (Rahman, 2016). The
smaller sample complicates interpreting the data and identifying themes (Rahman, 2016). Also,
qualitative research can sometimes leave out contextual sensitivities because the focus is on the
participants’ experiences (Rahman, 2016). Another limitation was the length of time it took to
conduct this study. Researcher bias, such as confirmation bias, leading questions, and wording
bias, was also a limitation (Shah, 2021). I avoided these types of bias by considering all the data
and thoroughly analyzing the material with an unbiased mind (Shah, 2021). Lastly, I kept the
75

questions simple and avoided leading questions and words that could introduce bias (Shah,
2021).
To make a study more manageable and relevant to the problem of practice, I established a
set of delimitations, which are decisions on what to include and exclude (Creswell & Creswell,
2018). Due to time limitations and restricted access to the active-duty population, this qualitative
study only engaged veterans who previously served as ADSM. I decided to interview only 10
participants, which limited the results’ generalizability. Increasing the sample size may have
provided broader perspectives.
Conclusion
In 2014, the VHA reported that 60% of veterans who screened positive for mental health
issues did not seek care while on active duty (Sharp et al., 2015). Further, Kim et al. (2011)
found that only 23% to 40% of ADSM in the USAF report receiving mental health treatment. To
understand this underutilization, this qualitative study explored the views of 10 veterans who
served in the Air Force SF and OSI law enforcement career fields regarding why they did not
utilize services provided while on active duty. The research revealed that the work environment
affected the participants’ mental health. All interviewees acknowledged they were somewhat
familiar with the mental health services available, but the accessibility of these services remained
a concern.
Participants felt the Air Force had improved the culture regarding mental health, but
stigma persists in the law enforcement career fields. In career fields where perception means
everything, the participants’ observations and personal experiences of these perceptions shaped
their decision to seek help. One component of SCT is observing others' actions and experiences
and deciding based on the observed outcome. Some participants’ experiences encouraged them
76

to seek mental health assistance, while others dissuaded them from doing so. Across the Air
Force, mental health has improved significantly, and resources are more readily available.
Nonetheless, stigma still is present, barriers are very apparent, and access to care remains a
significant problem due to work schedules and provider availability.

77

References
Acosta, J., Becker, A., Cerully, J., Fisher, M., Martin, L., Vardavas, R., Slaughter, M., & Schell,
T. (2014). Mental health stigma in the military. RAND Corporation.
https://doi.org/10.7249/RR426
Acosta, J., Huang, W., Edelen, M., Cerully, J., Soliman, S., & Chandra, A. (2018). Measuring
barriers to mental health care in the military: The RAND barriers and facilitators to care
item banks. RAND Corporation. https://doi.org/10.7249/RR1762
Air Force’s Personnel Center. (2021). Demographics. https://www.afpc.af.mil/About/Air-Force-
Demographics/
Alarcon, G. M., & Edwards, J.M. (2010). The relationship of engagement, job satisfaction and
turnover intentions. Stress and Health, 27(3), e294–e298.
https://doi.org/10.1002/smi.1365
Alqahtani, Bandar. (2010, October 4–6). Improving safety behavior using ADKAR model [Paper
presentation]. Society of Petroleum Engineers Middle East Health, Safety, Security and
Environment Conference and Exhibition, Manama, Bahrain.
https://doi.org/10.2118/136500-MS
Anderson, C. (2010). Presenting and evaluating qualitative research. American Journal of
Pharmaceutical Education, 74(8), 141. https://doi.org/10.5688/aj7408141
Bandura, A. (1989). Social cognitive theory. In R. Vasta (Ed.), Annals of child development. Vol.
6: Six theories of child development (pp. 1–60). Jessica Kingsley.
Barlas, F., Higgins, W. B., Pflieger, J. C., & Diecker, K. (2013, February). Department of
Defense health related behaviors survey of active duty military personnel. Department of
Defense.
78

Barnett, R. (2021, February 10). Department of the Air Force leaders focus on resiliency. U.S.
Air Force. https://www.af.mil/News/Article-Display/Article/2499862/department-of-the-
air-force-leaders-focus-on-resiliency/
Barr, L. (2014, May 28). Air Force mental health programs encourage seeking help. Air Force
Surgeon General Public Affairs. https://www.af.mil/News/Article-
Display/Article/485084/air-force-mental-health-programs-encourage-seeking-help/
Birt, L., Scott, S., Cavers, D., Campbell, C., & Walter, F. (2016). Member checking. Qualitative
Health Research, 26(13), 1802–1811. https://doi.org/10.1177/1049732316654870
Burgette, L., Trail, T. E., Martin, L. T. F., May, L. W., Mahmud, A., Nanda, N., & Chandra, A.
(2018). An evaluation of U.S. military non-medical counseling programs. Rand Health
Quarterly, 8(2), 6.
Butina, M. (2015). A narrative approach to qualitative inquiry. Clinical Laboratory Science,
28(3), 190–196. https://doi.org/10.29074/ascls.28.3.190
Cater, J. K. (2012). Traumatic amputation: Psychosocial adjustment of six Army women to
loss of one or more limbs. The Journal of Rehabilitation Research and
Development, 49(10), 1443. http://dx.doi.org/10.1682/JRRD.2011.12.0228
Coleman, S. J., Stevelink, S. A. M., Hatch, S. L., Denny, J. A., & Greenberg, N. (2017). Stigma-
related barriers and facilitators to help seeking for mental health issues in the armed
forces: A systematic review and thematic synthesis of qualitative literature.
Psychological Medicine, 47(11), 1880–1892.
https://doi.org/10.1017/S0033291717000356
Centers for Disease Control and Prevention. (2021). About mental health.
https://www.cdc.gov/mentalhealth/learn/index.htm
79

Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical
Psychology: Science and Practice, 9(1), 35–53. https://doi.org/10.1093/clipsy.9.1.35
Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed
methods approach. Sage Publications.
Decuers, L. (2020, June 26). WWII Post Traumatic Stress. The National WWII Museum | New
Orleans. https://www.nationalww2museum.org/war/articles/wwii-post-traumatic-stress
DeFraia, G. S., Lamb, G. O., Resnick, S. E., & McClure, T. D. (2014). Continuity of mental
health care across military transitions. Social Work in Mental Health, 12(5–6), 523–543.
https://doi.org/10.1080/15332985.2013.870103
Denzin, N. K., & Lincoln, Y. S. (2000). Handbook of qualitative research (2nd ed.). Sage
Publications.
Department of Defense Office of Inspector General. (2020). Evaluation of access to mental
health care in the Department of Defense (Report No. DODIG-2020-112). U.S.
Department of Defense.
DiNicola, S. E., Ross, S. M., Crosby, B., Jensen, R., Chindea, I. A., & Straus, S. G. (2020). An
evaluation of task force true north initiatives for the promotion of resilience and well-
being within the air force. RAND Corporation.
https://www.rand.org/pubs/research_reports/RR3190.html
Engel, C. C. (2013). Suicide, mental disorders, and the US military: Time to focus on mental
health service delivery. Journal of the American Medical Association, 310(5), 484–485.
https://doi.org/10.1001/jama.2013.92420
80

Farnsworth, A. (2020, August 24). Mental health care in the military: An opportunity for
progress. Atlantic Council. https://www.atlanticcouncil.org/blogs/new-atlanticist/mental-
health-care-in-the-military-an-opportunity-for-progress/
Galderisi, S., Heinz, A., Kastrup, M., Beezhold, J., & Sartorius, N. (2015). Toward a new
definition of mental health. World Psychiatry; Official Journal of the World Psychiatric
Association (WPA), 14(2), 231–233. https://doi.org/10.1002/wps.20231
Gibbons, S. W., Migliore, L., Convoy, S. P., Greiner, S., & DeLeon, P. H. (2014). Military
mental health stigma challenges: Policy and practice considerations. The Journal for
Nurse Practitioners, 10(6), 365–372. https://doi.org/10.1016/j.nurpra.2014.03.021
Gnau, T. (2021, April 7). Military suicides increased in 2020. Dayton Daily News.
https://www.pressreader.com/usa/dayton-daily-news/20210407/281496459091946
Gould, M., Adler, A., Zamorski, M., Castro, C., Hanily, N., Steele, N., Kearney, S., &
Greenberg, N. (2010). Do stigma and other perceived barriers to mental health care differ
across armed forces? Journal of the Royal Society of Medicine, 103(4), 148–156.
https://doi.org/10.1258/jrsm.2010.090426
Hennink, M., & Kaiser, B. (2019). Saturation in qualitative research. In P. Atkinson, S.
Delamont, A. Cernat, J. W. Sakshaug, & R. A. Williams (Eds.), SAGE research methods
foundations. https://doi.org/10.4135/9781526421036822322
Hernandez, S. H. A., Bedrick, E. J., & Parshall, M. B. (2014). Stigma and barriers to accessing
mental health services perceived by Air Force nursing personnel. Military Medicine,
179(11), 1354–1360. https://doi.org/10.7205/MILMED-D-14-00114
Hiatt, J. M. (2006). ADKAR: A model for change in business, government and our community
(1st ed.). Prosci Learning Center Publications.
81

Hogg, M., & Vaughan, G. (2017). Social psychology. Pearson Education.
Iribarren, J., Prolo, P., Neagos, N., & Chiappelli, F. (2005). Post-traumatic stress disorder:
evidence-based research for the third millennium. Evidence-based Complementary and
Alternative Medicine: eCAM, 2(4), 503–512. https://doi.org/10.1093/ecam/neh127
Jowers, K. (2021, September 10). New plan scales back massive cuts in military medical billets.
Military Times. https://www.militarytimes.com/pay-benefits/2021/09/10/new-plan-
scales-back-massive-cuts-in-military-medical-billets/
Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala,
R. C., Kanugula, A. K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current
COVID-19 pandemic and the future: A narrative review and perspectives moving
forward in the USA. Family Medicine and Community Health, 8(3), Article e000530.
https://doi.org/10.1136/fmch-2020-000530
Kim, P. Y., Britt, T. W., Klocko, R. P., Riviere, L. A., & Adler, A. B. (2011). Stigma, negative
attitudes about treatment, and utilization of mental health care among soldiers. Military
Psychology, 23(1), 65–81. https://doi.org/10.1080/08995605.2011.534415
Korstjens, I., & Moser, A. (2017). Series: Practical guidance to qualitative research. Part 4:
Trustworthiness and publishing. The European Journal of General Practice, 24(1), 120–
124. https://doi.org/10.1080/13814788.2017.1375092
Land, B. (2010). Current Department of Defense guidance for total force fitness. Military
Medicine, 175, 3–5. https://doi.org/10.7205/MILMED-D-10-00138
Legg, T. (2020, April 14). What is mental health? Medical News Today.
https://www.medicalnewstoday.com/articles/154543#:%7E:text=Mental%20health%20re
fers%20to%20cognitive,%2C%20relationships%2C%20and%20physical%20health
82

Lieberman, J. A. (2020, November 16). Solving the mystery of military mental health: A call to
action. Psychiatric Times. https://www.psychiatrictimes.com/view/solving-mystery-
military-mental-health-call-action
Mandriota, M. (2022). Mental health in the military: Overcoming barriers and finding support.
Psych Central. Retrieved July 29, 2022, from https://psychcentral.com/ptsd/mental-
health-in-the-military
Maucione, S. (2020, September 16). “We’re not going back,” Air Force leadership says telework
is here to stay. Federal News Network. https://federalnewsnetwork.com/air-
force/2020/09/were-not-going-back-air-force-leadership-says-telework-ishere-to-stay/
Meadows, S., Miller, L., & Robson, S. (2015a). Airman and family resilience lessons from the
scientific literature. RAND Corporation.

Merriam-Webster. (2013). Crowdsourcing. In Merriam-Webster.com dictionary.
Morin, R. (2011). The difficult transition from military to civilian life. Pew Research Center.
https://www.pewresearch.org/social-trends/2011/12/08/the-difficult-transition-from-
military-to-civilian-life/
Naifeh, J. A., Colpe, L. J., Aliaga, P. A., Sampson, N. A., Heeringa, S. G., Stein, M. B., Ursano,
R. J., Fullerton, C. S., Nock, M. K., Schoenbaum, M., Zaslavsky, A. M., Kessler, R. C.,
& the Army STARRS Collaborators. (2016). Barriers to initiating and continuing mental
health treatment among soldiers in the army study to assess risk and resilience in
servicemembers (Army STARRS). Military Medicine, 181(9), 1021–1032.
https://doi.org/10.7205/MILMED-D-15-00211
83

Neuhauser, J. (2011). Lives of quiet desperation: The conflict between military necessity and
confidentiality. Creighton Law Review, 44, 1–1003.
Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to
meet the trustworthiness criteria. International Journal of Qualitative Methods, 16.
Advance online publication. https://doi.org/10.1177/1609406917733847
Paivio, S. C., & Pascual-Leone, A. (2010). Emotion-focused therapy for complex trauma: An
integrative approach. American Psychological Association.
https://doi.org/10.1037/12077-000
Palmer, B. W., Friend, S., Huege, S., Mulvaney, M., Badawood, A., Almaghraby, A., & Lohr, J.
B. (2019). Aging and trauma: Post traumatic stress disorder among Korean War veterans.
Federal Practitioner: For the Health Care Professionals of the VA, DoD, and PHS,
36(12), 554–562.
Patton, M. Q. (2002). Two decades of developments in qualitative inquiry: A personal,
experiential perspective. Qualitative Social Work: Research and Practice, 1(3), 261–283.
https://doi.org/10.1177/1473325002001003636
Pols, H., & Oak, S. (2007). WAR & military mental health. American Journal of Public Health,
97(12), 2132–2142. https://doi.org/10.2105/AJPH.2006.090910
Rahman, M. S. (2016). The advantages and disadvantages of using qualitative and quantitative
approaches and methods in language “testing and assessment” research: A literature
review. Journal of Education and Learning, 6(1), 102.
https://doi.org/10.5539/jel.v6n1p102
Scott, W. J. (1990). PTSD in DSM-III: A case in the politics of diagnosis and disease. Social
Problems, 37(3), 294–310. https://doi.org/10.2307/800744
84

Shah, S. (2021). 7 Biases to avoid in qualitative research. Editage Insights.
https://www.editage.com/insights/7-biases-to-avoid-in-qualitative-research
Sharp, M. L., Fear, N. T., Rona, R. J., Wessely, S., Greenberg, N., Jones, N., & Goodwin, L.
(2015). Stigma as a barrier to seeking health care among military personnel with mental
health problems. Epidemiologic Reviews, 37(1), 144–162.
https://doi.org/10.1093/epirev/mxu012
Sisk, R. (2020, April 9). Military’s plan to cut 18,000 medical billets is on hold during pandemic.
MilitaryTimes. https://www.military.com/daily-news/2020/04/09/militarys-plan-cut-
18000-medical-billets-hold-during-pandemic.html
Smith, J., & Noble, H. (2014). Bias in research: Table 1. Evidence-Based Nursing, 17(4), 100–
101. https://doi.org/10.1136/eb-2014-101946
Tapi, C. (2021, January 21). The ADKAR model of change: The ultimate guide to leading
organisational change. The Human Capital Hub. Retrieved June 8, 2022, from
https://www.thehumancapitalhub.com/articles/the-adkar-model-of-change-the-ultimate-
guide-to-leading-organisational-change
Tull, M. (2020a). How exercise can help your PTSD mentally and physically. Verywell Mind.
https://www.verywellmind.com/exercise-for-ptsd-2797465
Tull, M. (2020b, July 27). Hypervigilance in PTSD and other disorders. Verywell Mind.
https://www.verywellmind.com/hypervigilance-2797363
Under Secretary of Defense for Personnel and Readiness. (2020). Annual suicide report for
calendar year 2020. U.S. Department of Defense.
https://www.dspo.mil/Portals/113/Documents/CY20%20Suicide%20Report/CY%202020
%20Annual%20Suicide%20Report.pdf?ver=0OwlvDd-PJuA-igow5fBFA%3d%3d
85

U.S. Department of Veterans Affairs. (2019). National veterans suicide prevention report. Office
of Mental Health and Suicide Prevention.
Vail, B., Morgan, M. C., Dyer, J., Christmas, A., Cohen, S. R., Joshi, M., Gore, A., Mahapatra,
T., & Walker, D. M. (2018). Logistical, cultural, and structural barriers to immediate
neonatal care and neonatal resuscitation in Bihar, India. BMC Pregnancy and Childbirth,
18(1), 385. Advance online publication. https://doi.org/10.1186/s12884-018-2017-5
Vinokur, A. D., Pierce, P. F., Lewandowski-Romps, L., Hobfoll, S. E., & Galea, S. (2011).
Effects of war exposure on air force personnel's mental health, job burnout and other
organizational related outcomes. Journal of Occupational Health Psychology, 16(1), 3–
17. https://doi.org/10.1037/a0021617
Warren, T. A. (2015). The effects of frequent exposure to violence and trauma on police officers
(Publication No. 3716211) [Doctoral dissertation, Walden University]. ProQuest
Dissertations and Theses Global.
Weinick, R. M., Beckjord, E. B., Farmer, C. M., Martin, L. T., Gillen, E. M., Acosta, J., &
Scharf, D. M. (2011). Programs addressing psychological health and traumatic brain
injury among U.S. military servicemembers and their families. RAND Corporation.
https://doi.org/10.1037/e525482012-001
The White House. (2021, November 2). Fact sheet: New strategy outlines five priorities for
reducing military and veteran suicide [Press release].
https://www.whitehouse.gov/briefing-room/statements-releases/2021/11/02/fact-sheet-
new-strategy-outlines-five-priorities-for-reducing-military-and-veteran-suicide/

86

Appendix A: Interview Questionnaire
Interview questions RQs addressed
1a. When did you join the United States Air Force?
1b. How long did you serve in the United States Air Force?
1c. Did you retire or choose to separate? (Why?)

2. What made you join the OSI/SF?
3. How would you describe your mental health as it is right
now?

4. How would you describe your mental health while serving
as an active-duty service member?

5. How would you describe the Military culture in your
career field?
2
6. What is your perception of the Air Force’s culture towards
mental health during the time you were on active duty?
6b. law enforcement Culture?
2
7. What experiences have helped shape your definition of the
culture?
2
8. How did your environment influence your thoughts about
yourself? Others? The world?
2
9. How do you feel about mental health services in Military
law enforcement?
1
10. What kind of significant stressors have you experienced
while on active duty? (deployment/separation from
family/work demand/poor leadership)
1
11. How was your experience when observing how others
were treated when seeking mental health help?
2
12. What is your understanding of the resources available for
seeking mental health when you were on active duty?
1
13. Do you feel the resources are helpful for those seeking
help?
13b. Do you know of the mental health services available
to service members?
1
14. Have you ever observed a peer seeking mental health
services?
14b. What was your experience observing them seek help?
Overall process?
14c. Did it influence you to seek mental health services?
1
15. Have you ever sought out mental health help while on
active duty?
2
Follow-up probes (If member has received mental health
services)

16. What was your leadership’s view on you receiving and
seeking mental health services?
16b. Peers receiving help?
2
87

Interview questions RQs addressed
17. What was your peers’ influence on you on receiving and
seeking mental health services?
2
18. Where were some of the challenges/experiences you faced
while seeking mental health help?
2
19. What were some of the logistical challenges you faced
when seeking mental health services?
19b. What was your experience with securing an
appointment with a medical provider about your Mental
Health on base?
19c. Did you need to see an off-base provider?
1
20. What was your experience with the length of time
between your initial appointment and follow-up
appointment with mental health?
20b. Did this influence you in any way?
1
21. What kind of support did you receive from friends and
families when seeking help? Was it a positive or negative
experience?
21b. Did it make you second guess receiving help?
2

88

Appendix B: Mental Health and Program Referrals
Veterans Crisis Line: A confidential, free hotline for veterans and their families and
friends. Call 1-800-273-8255 (Press 1) or connect via chat or text (838255).
PTSD Program Locator: Find specialized VA PTSD treatment programs near you. (U.S.
Department of Veterans Affairs)
Veteran Combat Call Center: A 24/7 hotline where you can talk with another combat veteran:
1-877-WAR-VETS (1-877-927-8387): Help for Veterans with PTSD – Learn how to earn
how to earn how to enroll for VA health care and get an assessment. (National Center for PTSD)
24/7 Outreach Center for Psychological Health & Traumatic Brain Injury : Get help for
traumatic brain injury and other psychological health issues. Call 1-866-966-1020 or connect
through chat or email. (DoD’s Defense Centers of Excellence)
Military OneSource: Call 1-800-342-9647 for confidential counseling, non-medical
services, and other resources for veterans and their family members. The line is open 24/7.
Vet Centers: If you are a combat veteran or you experienced sexual trauma during your
military service, you can speak with a therapist at your local Vet Center for free, without an
appointment, and regardless of your enrollment status with VA. Just bring your DD214.
Veterans of Foreign Wars (VFW): The VFW is a non-profit veterans service organization
that is specifically for eligible for veterans and service members. It is dedicated to veterans’
service, advocacy, and various programs for. There are many locations throughout the country,
please visit vfw.org to find a local post/center. It is a great place to socialize and connect with
other
Veterans and service members suicide crisis hotline: 1-800-273-8255, Distress: 1-877-476-7734,
Combat Call Center: 1-877-WAR-VETS
89

Appendix C: Recruitment Email
Hello,
I am Fernando Bernal, a doctoral candidate in the Rossier School of Education at the
University of Southern California, conducting research on the problems faced by United States
Air Force Security Forces and the Office of Special Investigations law enforcement veterans’
experiences with logistical and attitudinal barriers when seeking mental health care while on
active duty. This research has been approved by the Institutional Review Board.
You are invited to participate in the study, if you are a United States Air Force veteran
and served with the Security Forces or the Office of Special Investigations. Neither your name,
nor any identifying information will be linked to your responses, which are completely
anonymous. I hope that you will consider completing this interview! The interview will take
approximately 45–60 minutes to provide your thoughts, observations, and experiences. Please
follow this link for more information on how to participate and schedule an interview: (LINK
WILL BE PROVIDED)
All respondents who participate will be entered in a drawing to receive a $100
Amzon.com gift card.
If you have any questions, please feel free to contact me at fbernal@usc.edu or
+49015229851880
Thank you in advance for your participation.

90

Appendix D: Interview Invitation Email
Hello,
Thank you kindly for reaching out and wanting to participate in this very important
research study. Please take a moment to review the consent form attached with very important
information. In this email, you will also find more background information on this important
study.
I plan to be as accommodating as possible since your participation is vital to this study.
The interview will be conducted via Zoom, and the login information will be sent once a meeting
has been finalized. The meeting should take approximately 45 minutes to complete. The
interview will have 15 questions directly associated with the selected research questions
presented in the study, with a possibility of six follow-up questions.
Attached are available times (Eastern Time); please let me know three possible time slots
which work best for you. Once determined, send me back a confirmation email with the
calendar. If you would like to view the questions prior to the interview, I can provide those.
The purpose of this study is to identify the role attitudinal and logistical barriers inhibit
help seeking among SF and OSI law enforcement veterans while on active duty. Security forces
and Office of Special Investigation members are a vulnerable population to our mental health
crises because of their job’s traumatic events.
Service in the United States Armed Forces is not your ordinary job; it is difficult,
demanding, and dangerous. Service members are often at risk of suffering from serious service-
related injuries, both physical and emotional (Morin, 2011). The U.S. Armed Forces is an all-
volunteer force that makes up approximately 1% of the U.S. population, with 330,678 of those
members serving in the USAF (Air Force’s Personnel Center, 2021). The field of focus for this
91

study is the USAF, specifically SF and OSI law enforcement veterans’ experiences with mental
health while on active-duty status.
The VHA reported that 60% of veterans who screened positive for mental health issues
did not seek care while on active duty, indicating a significant underutilization of mental health
services (Sharp et al., 2015). Studies have linked mental health stigma and barriers to being
directly associated with the rise in suicide rates among veterans and ADSM (Coleman et al.,
2017). Members who did not utilize mental health services while on active duty risked
exacerbating their distress, which translated to more significant problems; in 2017, 6,139
veterans completed suicide (U.S. Department of Veterans Affairs, 2019).
The consequence of not examining this problem is the continuing rise in suicides among
veterans and ADSM. The percentage of USAF members with mental health problems is
significant, and only 23% to 40% ADSM in the USAF reported receiving mental health
treatment (Kim et al., 2011). Furthermore, in 2020, the military recorded 377 suicides among
ADSM, which was an 8% increase from the previous year (Gnau, 2021). Of those 377 suicides,
81 were among USAF ADSM (Gnau, 2021).

Abstract (if available)

Abstract The focus of this study was the United States Air Force Security Forces and Office of Special Investigations law enforcement veterans’ experiences with mental health while on active-duty status. The purpose was to understand how the work environment affects mental health and identify resources and barriers to mental health support. The literature reviewed the historical context behind mental health in the armed services, barriers to mental health care, existing strategies and solutions to mental health care, and the conceptual framework. The literature noted that while the United States Armed Forces and the United States Air Force made improvements to recognizing and addressing mental health, barriers to care and stigma are still present, preventing service members from seeking care. This study used interviews to present the participants’ experiences. The findings indicated there were services available and participants discussed their understanding of them, yet they were concerned about the overall effectiveness and access to these services. Participants also identified several helpful resources, such as family, friends, and leadership. Nonetheless, friends, leadership, provider availability, length of time between appointments, work schedules, and overall culture regarding mental health were barriers to seeking care. This study generated three recommendations for practice.

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

The experience of Eritrean refugee women in addressing their mental health needs

PDF

Intersectional equity in higher education leadership: leveraging social capital for success

PDF

Unpredicted but not unexpected: developing prepared health and human services crisis leaders

PDF

Primary care physicians' experiences working within the patient-portal to improve the quality of patient care

PDF

Military spouse well-being during the COVID-19 pandemic

PDF

A faith-based nonprofit organization’s implementation of strategic planning: A qualitative study

PDF

Barriers to practice: primary care patient experience and quality health outcomes in the Veterans Health Administration

PDF

Assessing administrators’ perceptions of implementing trauma-informed care in K−12 schools

PDF

Improving student-athlete mental health services: addressing the mental health needs of college student-athletes

PDF

Understanding burnout in non-denominational clergy: a social cognitive approach

PDF

Evaluation of mental health support and needs for emergency department providers

PDF

Impact of training on leader's ability to effectively lead during a crisis

PDF

Navigating the storm: the impact of Hawaiian culture on stress, burnout, and retention of Hawaii’s acute care nurses during the COVID-19 pandemic (2020–2022)

PDF

Gender-based leadership barriers: an exploratory study of the underrepresentation of women of color in technology

PDF

Toward a surplus of leaders: how church members understand volunteer church leadership

PDF

Students’ sense of belonging: college student and staff perspectives during COVID-19

PDF

Post-incarceration challenges: examining barriers to reentry post-release

PDF

Preventing excessive force incidents by improving police training: an evaluation study of a use-of-force training program

PDF

Corporate innovation labs: exploring the role of university research park innovation lab leaders

PDF

The barriers and challenges associated with mental health help-seeking behaviors of police officers in the United States: a descriptive study

Asset Metadata

Creator Bernal, Fernando Eduardo (author)

Core Title Assessing mental health barriers faced by Air Force law enforcement veterans

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2022-12

Publication Date 09/02/2022

Defense Date 08/29/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Air Force,Barriers,hypervigilance,Mental Health,OAI-PMH Harvest,Office of Special Investigations,Security Forces,Suicide,Trauma,Veterans

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Hirabayashi, Kimberly (committee chair), Muraszewski, Alison (committee member), Phillips, Jennifer (committee member)

Creator Email fbernal@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC111637621

Unique identifier UC111637621

Legacy Identifier etd-BernalFern-11172

Document Type Dissertation

Format application/pdf (imt)

Rights Bernal, Fernando Eduardo

Type texts

Source 20220906-usctheses-batch-977 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu