"Walkabout” to Build Trust, Reduce Stigma

A group of soldiers fixing an engine
Photo by Justin Connaher
By Tim Hoyt, Ph.D.
January 27, 2020

The “walkabout” is a hallmark of front-line military psychology. Walkabouts are informal individual or small group health promotion activities initiated by behavioral health providers outside the clinic setting in which at least one principle of psychological wellness is discussed. Walkabouts do not establish formal provider-patient roles and are not documented in the medical record. These activities can be conducted by both credentialed providers and behavioral health technicians.

Although no clinical trials have been conducted on walkabouts, this technique of engaging service members in their natural environment (such as in the motor pool, on guard towers, or while smoking cigars) has been used for several decades. Walkabouts provide an opportunity for behavioral health providers to observe operational conditions as they relate to the psychological state of a military unit, get members of the unit used to seeing and talking to behavioral health personnel, take advantage of opportunities for short teachable moments that focus on wellness and resiliency, and gather information for leadership on ways to mitigate operational stress.

For example, an informal chat during routine weapons maintenance might provide an opportunity for a platoon sergeant to ask a psychologist about ways to decrease personality conflicts in the shared tent. Or providers engaging in physical training alongside other service members can give them the opportunity to ask a question “for a friend” who is struggling with relationship problems during the unit’s deployment. Positive interactions in these informal settings, help to demystify the process of seeking care for psychological concerns. Service members may be more likely to subsequently seek formal care during a crisis, which could in turn decrease the stigma of help seeking among other unit members.

Getting out of the clinic and into the work spaces of military personnel is crucial for front-line behavioral health personnel to establish relationships with service members and commanders. Too often, medical officers can be perceived as not being “one of us” by service members and leaders alike because of tendencies to stay secluded in clinics. Spending a few hours in the motor pool may not make a psychologist an expert at military vehicle maintenance, but junior service members will see that the psychologist is willing to meet them on their level. Leaders will see behavioral health personnel who are willing to learn about the profession of warfighting rather than narrowly focusing on their own expertise, making the leaders more likely to respond to recommendations related to psychological health. Culturally connecting in these ways can foster trust in the psychologist, give the provider a better idea of working conditions and job requirements, and erode barriers to care.

In short, walkabouts can be a great method to establish trust with service members and leaders through informal engagements that promote psychological health on the front lines. Get out of the clinic and try a walkabout today!

Dr. Hoyt is a former Army psychologist who is chief of Psychological Health Promotion and supervisor of the Combat and Operational Stress Control mission at the Psychological Health Center of Excellence.

 


The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.


Comments

  • Great plan to allow service members to talk and give feedback without reprisal or intimidating them. This can work in any place or time if the service member knows you really care about them. I remember back to my two tours of duty in Vietnam where the Captain of the ship I was assigned to made it a point to talk to as many sailors and Marines assigned to his command as he possibly could. He even had a Captains Advisory Board that was made up of enlisted and officers in his command so as to keep morale up. We had several wounded to it was important that we all made it a priority to lift up our fellow warriors. Good work doc!

    • Thank you for sharing your story about your experiences. You bring up two really important ideas of psychological safety and need to be mutually supportive.

  • I am a retired US Army officer who was the Executive Officer of the 405th Combat Support Hospital, deployed to Kuwait during the latter part of 2002 (just prior to the kickoff of OIF). We were based at Camp Doha and operated the sole US Role III(-) facility located in the Kuwait Armed Forces Hospital (KAFH) as well as staffing the Troop Medical Clinic on Camp Doha. During the run-up to the war, there were thousands of US Army and Marine Corps troops flowing into Kuwait. Since Camp Doha was primarily a forward staging base, the troops were positioned in a series of tent city camps which we referred to as the "kabals" in the desert north and west of Kuwait City, facing Iraq and the presumed lines of departure. These kabals (Camp Udari, Camp Virginia, Camp New York, etc) were very austere and the troops stationed there were focused on an assumed invasion of Iraq. Tensions and emotions ran high, but in order for the Battalion medics to send a servicemember (Army or USMC) back to the CSH for behavioral health, it required many in the chain of command to be aware of the movement. Naturally, the unjust stigma associated with behavioral health care at the time was presumed to prevent troops who needed help from seeking it. Since the kabals were so primitive, AAFES, the Red Cross and MWR would send a group of individuals out to the kabals to prevent large numbers of troops flowing into Camp Doha! They referred to this as "the rodeo" and troops could visit the rodeo and access these services weekly or biweekly at least.
    We came up with the idea of sending our behavioral health teams out as part of the rodeo. That way, if a servicemember felt the need to speak with someone, they simply had to visit the rodeo site and their peers didn't have to know they were seeking help. Our numbers of consults grew and we were convinced that we were accomplishing our mission of "Conserving the Fighting Strength" in another dimension of wellness.

    • Thanks for sharing this innovative approach to walkabouts and stigma reduction!

      -- Dr. Tim Hoyt

    • What a wonderful and very proactive way to meet people where they are and give them what they need. Thank you for sharing this story.

    • I would sooo love to do this work. It's important that our troops understand they will not be retaliated against for seeking MH care. That stigma is as old as all get out. I'm an old Veteran and know about the stigma of trying to get MH care. My job made it horrible when needing time off for appointments. Having folks "on the ground" so to speak and in with the troops is a wonderful idea. It really does my heart good to see we are moving in the right direction while taking care of "Our" force. Thank you for the "Rodeo" story. This is valuable and powerful. I hope this is still being used.

  • It would be nice if leaders were provided with techniques known by mental health specialists so they too can gage the cognitive state for their personnel. I'm making the assumption that the mental health specialists have some kind of checklist or techniques they use to gage the individual's mental state. As an analogy operational leaders are provided with a procedure and checklists to watch for cold weather and heat injury signs. It would be nice to have equivalent for cognitive health as well. As leaders we can help in this process since we walk around a lot.

    • Appreciate for your thoughts on this! Actually, two interesting initiatives have recently been published that help to get these kinds of behavioral health risk management tools into the hands of commanders. 

      The first, the Behavioral Health Readiness and Suicide Risk Reduction Review (R4 for short), gives unit leaders at the company and platoon levels a tailored tool to assess potential factors that might drive suicide risk. https://www.ncbi.nlm.nih.gov/pubmed/31755531

      The second, the Leader Suicide Risk Assessment Tool (LSRAT), provides specific mitigation recommendations that commanders can implement to decrease the impact of behavioral health factors. https://www.ncbi.nlm.nih.gov/pubmed/32074327

      Thanks again for commenting! 

      -- Dr. Hoyt

       

  • While these methods of reducing stigma are a step forward. It may help members get to know the professionals treating them on a more personal level, however, there will still be a stigma regardless of what happens unfortunately. Seeking help not only can effect how you are perceived but can also affect what rights you may or may not have. Due to changes in various laws as well as policies governing how mental health providers can annotate their finding, military members can find themselves losing rights protected by the Constitution of the United States (2nd and 4th amendment).

    • Mental health stigma continues to create barriers to care. Thankfully, recent research shows that rates of stigma in the military are decreasing overall. At the level of specific units, all of the military Services are working toward greater integration of mental health providers through embedding these personnel in front-line units. These efforts can help to make sure that Service members seek care before it becomes a crisis. Thanks for your comment on this!

      -- Dr. Hoyt

       

  • Thank you for sharing this information. What are the best practices for walkabouts?
    Thanks!

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