Unique challenges, unique solutions: end-user designed strategies to improve PTSD treatment initiation in U.S. Special Operations Forces

Abstract Background Despite the effectiveness of evidence-based psychotherapies for posttraumatic stress disorder (PTSD), uptake of treatment remains particularly challenging for some subgroups at high risk for PTSD. United States (U.S.) Special Operations Forces (SOF) Operators/Enablers are exposed to military-related trauma at elevated rates compared with conventional forces and have similar levels of PTSD. Yet, little is known about factors that affect PTSD treatment initiation among SOF personnel. This manuscript presents the qualitative findings from a sequential mixed-methods study that sought to generate culturally appropriate solutions to overcome barriers and support facilitators of PTSD treatment initiation in SOF. Methods Purposeful sampling was used to recruit 24 Operators/Enablers from all SOF components who completed the survey portion of this mixed-method study. Semi-structured interviews were conducted to identify system-level solutions that the Department of War could implement to reduce barriers and support facilitators of PTSD treatment initiation. We used rapid coding and linked potential solutions to barriers and facilitators that SOF identified through surveys. Results SOF generated 32 specific solutions that were grouped into 5 categories of objectives (ultimate goals) for SOF leadership to implement to increase treatment initiation. Most solutions addressed more than one barrier and/or facilitator simultaneously and had multiple targets. The objectives were: an education campaign that spanned the career of SOF, facilitating procedure changes including expanding treatment formats (e.g., virtual care), updates to mental health funding and staffing, simplifying the mental health referral process, and structural integration of mental health providers in SOF units. Conclusions Solutions to increase PTSD treatment initiation in SOF will need to move beyond reducing self-stigma and focus on innovative treatment delivery formats, helping providers understand SOF culture, and reducing harms of treatment seeking to Operators/Enablers’ career.