Drivers of dropout and enhancers of engagement for male military veterans in therapy: practitioner perspectives

ABSTRACTMale veterans are vastly over-represented in suicide rates relative to non-veterans. A critical avenue for improving male veterans’ mental health outcomes is improving their engagement with mental health services. This study presents a qualitative investigation of mental health practitioners’ perspectives on enhancers of engagement in, and drivers of dropout from therapy among male veterans. Participants were 138 mental health practitioners across Australia, the USA, Canada, New Zealand and the UK (44.9% male; age M = 47.5 years, SD = 12 years). Participants responded to qualitative survey items inquiring about their perspectives on what works to engage male veterans in therapy, alongside common drivers of therapy dropout. Under an overarching theme contextualising the therapeutic alliance between veterans and mental health practitioners, interpretive description analyses led to eight distinct subthemes. Results highlight the range of areas in which mental health practitioners can thoughtfully adapt their practice to engage male veterans and align with military masculinities. In addition, findings underscore the range of barriers facing veterans when they seek help, which can precipitate dropout if not overcome by the right balance between practitioner engagement and veteran persistence.KEYWORDS: Male veteranspractitionerengagementdropouttherapy AcknowledgmentsThe authors wish to thank the Australian Government Department of Veterans’ Affairs (DVA) and Open Arms - Veterans & Families Counselling for their support for this study. We also thank Mark Smith for his support with recruitment, and acknowledge all participants for their valuable contribution to this research.Disclosure statementNo potential conflict of interest was reported by the author(s).Data availability statementThe data that support the findings of this study are available on request from the corresponding author, RB. The data will be stored on the servers of Orygen and provided to researchers who provide a methodologically sound proposal and who have ethics approval from a research institution. Access will be subject to approvals on a case-by-case basis.Geolocation informationParticipants were recruited from Canada, the United States, the United Kingdom, Australia, and New Zealand to complete the online survey. Data was collected and analysed at Orygen, Melbourne, Australia.Additional informationFundingThe authors received no financial support for the research, authorship, and/or publication of this article.Notes on contributorsR. BenakovicRuben Benakovic is a project manager with Orygen at The University of Melbourne. For the past year he has worked across a range of projects focused on men’s mental health and health service engagement. His research interests include psychotherapeutic engagement and social determinants of mental ill-health among men, and social connectedness as a vehicle for men’s mental health promotion.M. J. WilsonMichael J. Wilson is a project manager and PhD candidate with Orygen at The University of Melbourne. He has published a range of articles spanning men’s mental health, suicide prevention and men’s health service engagement. His current research focuses on men’s risk of suicidal thoughts and behaviours following intimate relationship breakdown.D. KealyDavid Kealy received his PhD from the University of British Columbia. He has a background in social work and public mental health service and is currently an assistant professor in the Department of Psychiatry at the University of British Columbia. He is also a Michael Smith Foundation for Health Research Scholar. His research interests include the process and outcome of psychotherapy and mental ill-health among men and young adults.S. M. RiceSimon M. Rice received his PhD from the Australian Catholic University. He is clinical psychologist, associate professor, and principal research fellow at Orygen, The University of Melbourne, leading Orygen’s research programs into Elite Athlete Mental Health and Forensic Youth Mental Health. He has as a joint clinical and research interest in men’s mental health (including the assessment of depression, anger, and risk-taking behaviours).J. L. OliffeJohn L. Oliffe received his PhD from Deakin University. He is currently a professor and Tier 1 Canada research chair in men’s health promotion at the School of Nursing, University of British Columbia. Founder and lead investigator of UBC Men’s Health Research program, his work focuses on masculinities, men’s health behaviours and illness management, along with it’s impact on partners, families, and overall life quality.P. SharpPaul Sharp received his PhD from the University of Technology Sydney, Australia. He is a Postdoctoral Research Fellow at the University of British Columbia and member of the Reducing Male Suicide Research Excellence Cluster. His research examines the influence of sociocultural and gender-related factors on men’s health and health-related behaviours.Z. E. SeidlerZac E. Seidler received his PhD from the University of Sydney, Australia. He currently works as a senior research fellow with Orygen, at The University of Melbourne, and as the Director of Mental Health Training at Movember. His areas of professional interest include boy’s and men’s experiences of healthcare, adapting services to respond to boys and men’s needs, and better understanding the high and rising male suicide rate.