dissertation final submitted draft

Work-based Research and Dissertation

MENTAL HEALTH SUPPORT FOR

PRIVATE MILITARY SECURITY COMPANIES

IN THE 21st CENTURY

A dissertat ion submitted to the faculty of

Buckinghamshire New Universi ty

Department of Securi ty and Resi l ience

Submitted by Student 21200319

March 2014

In part ial fulfi lment of the requirements for the degree of

MSc in Business Continuity, Securi ty and Emergency Management

Module Code: SF701

Supervisor Gail Rowntree


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ABSTRACT

As global conflicts spread there has been a surge in demand for Private Military Security

Company’s (PMSCs) that are being deployed into hostile environments. In today’s

competitive market place where these PMSC’s chase lucrative contracts, often the last

priority for the owners is the psychological welfare of their workforce. This research

examines aspects of mental health issues surrounding operators in these roles, by assessing

the attitudes and varying contributing factors of all concerned.

An excellent response from members of the industry contained within the anonymous

feedback exposed several interesting trends and revealing data, which is verified and argued

during interviews with key figures in mental health care and PMSCs. The key study

outcomes were that 80% of operators believed that their positions would be at risk if their

employer knew that they were seeking mental health support. There were numerous

insightful comments regarding attitudes, especially around the stigma of mental health issues

being perceived a weakness in the industry remaining a significant barrier to change. Both

management and operators believed that more should be done towards mental health support,

but only 11% of companies had a full program while 22% had nothing at all. Accountability

amongst PMSCs is debatable with 51% not signatory to any best practice code of conduct.

The study analysed the level of care currently available, its suitability, what stressors are

unique to PMSCs and what the commonly used coping strategies and offers

recommendations on how mitigations, coping strategies, interventions and therapies could be

improved.

A thorough review of the contemporary literature into the subject matter highlighting gaps

and themes which were then used to formulate quantitative surveys distributed through social

media networks to both operators and management in PMSCs. The major implications for

this study is that the findings may be used by those keen within the industry to build

resilience and make improvements in Psychosocial Risk Management. This study has served

to build upon existing research in the specific subject area by providing deep insight of the

attitudes with PMSCs and an understanding of their unique stressors faced.


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ACKNOWLEDGEMENTS

I would like to express my gratitude and appreciation to the following that have all supported me

in this research. Firstly to my employer at the Government of Ras Al Khaimah and His Highness

Sheik Saud bin Saqr al Qasimi for support and authorsing financial funding for this course. The

mentoring and encouragement of my dissertation supervisor Gail Rowntree and all of the

Security and Resilience Department at Buckinghamshire New University under the leadership of

Philip Wood and ably supported by Richard Bingley and Gavin Butler. A special gratitude to the

enlightening interviewees who provided expert insight and to all of those management and

operators from the industry who took the time to complete the surveys and for revealing the depth

of feelings in the answers. To Peter Reynolds for encouraging me to attempt the course and for

his support throughout. And lastly a debt of gratitude to my parents Ron and Jenny Bomberg

who are celebrated their 50th wedding anniversary on the same day that this paper is submitted, a

true example of resilience.


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TABLE OF CONTENTS

ABSTRACT ...................................................................................................................................................................I

ACKNOWLEDGEMENTS ..................................................................................................................................... II

TABLE OF CONTENTS ......................................................................................................................................... III

LIST OF FIGURES AND TABLES .....................................................................................................................VI

ACRONYMS ........................................................................................................................................................... VIII

GLOSSARY ................................................................................................................................................................IX

INTRODUCTION .......................................................................................................................................................1

1.1 BACKGROUND ............................................................................................................................................. 1 1.2 THE AIM ....................................................................................................................................................... 2

1.3 RESEARCH OBJECTIVES ............................................................................................................................. 2

1.4 RESEARCH QUESTIONS............................................................................................................................... 3 1.5 SAMPLE GROUP OVERVIEW ...................................................................................................................... 3

1.6 SUB GROUPS ................................................................................................................................................ 4 1.7 OVERVIEW OF CHAPTERS .......................................................................................................................... 4

1.7.1 Literature Review Chapter...................................................................................................................4

1.7.2. Methodology Chapter ......................................................................................................................5 1.7.3. Findings Chapter ..............................................................................................................................5

1.7.4. Discussions Chapter ........................................................................................................................5

1.7.5 Conclusions and Recommendations Chapter ...................................................................................5 1.8 SUMMARY .................................................................................................................................................... 6

LITERATURE REVIEW..........................................................................................................................................7

2.1 INTRODUCTION............................................................................................................................................ 7 2.2 THE HUMAN ELEMENT OF BUSINESS CONTINUITY ............................................................................... 7

2.3 ATTITUDES TOWARDS MENTAL HEALTH CARE ..................................................................................... 8 2.4 GROWTH OF PRIVATE MILITARY SECURITY COMPANIES ..................................................................... 8

2.5 EXTERNAL INFLUENCES AND OPERATING ENVIRONMENTS OF PMSCS............................................. 8

2.6 ACCOUNTABILITY ..................................................................................................................................... 10 2.7 STRESS ........................................................................................................................................................ 11

2.8 RESILIENCE TO STRESS ............................................................................................................................ 12

2.9 EMOTIONAL INTELLIGENCE AND GENDER ............................................................................................ 13 2.10 EXPOSURE TO HOSTILE ENVIRONMENTS............................................................................................... 13

2.11 STRESSORS ................................................................................................................................................. 14 2.12 STRESS PHYSIOLOGY................................................................................................................................ 14

2.12.1 Cortisol........................................................................................................................................... 14

2.13 COPING STRATEGIES ................................................................................................................................ 15 2.13.1 Cognitive ......................................................................................................................................... 15

2.13.2 Social Support ................................................................................................................................ 15

2.13.3 Sense of Belonging ........................................................................................................................ 16 2.13.4 Humour............................................................................................................................................ 16

2.13.6 Relaxation ....................................................................................................................................... 16

2.13.7 Normalisation and Routine .......................................................................................................... 16 2.13.8 Holistic Approach.......................................................................................................................... 17


Student 21200319 Page iv

2.13.9 Physical ........................................................................................................................................... 17

2.13.10 Improving Stress Coping Skills in PMSCs ................................................................................ 17 2.14 EXISTING STUDIES IN THE SUBJECT MATTER. ..................................................................................... 17

2.15 POST -TRAUMATIC STRESS DISORDER .................................................................................................. 18

2.15.1 Causes ............................................................................................................................................. 18 2.15.2 Symptoms ........................................................................................................................................ 18

2.15.3 Treatment ........................................................................................................................................ 19 2.16 POST -TRAUMATIC GROWTH AND RESILIENCE ..................................................................................... 19

2.17 TRAUMA RISK MANAGEMENT (TRIM) ................................................................................................. 19

2.18 PSYCHOSOCIAL RISK MANAGEMENT..................................................................................................... 20 2.19 TRAINING AND BRIEFINGS....................................................................................................................... 20

2.20 PSYCHOLOGICAL FIRST AID .................................................................................................................... 20

2.21 ADDITIONAL CONSIDERATIONS .............................................................................................................. 21 2.22 CONCLUSIONS OF LITERATURE REVIEW .............................................................................................. 21

METHODOLOGY ................................................................................................................................................... 22

3.1 INTRODUCTION.......................................................................................................................................... 22

3.2 ETHICAL CONSIDERATIONS ..................................................................................................................... 22

3.3 THEORY ...................................................................................................................................................... 23 3.4 APPROACH ................................................................................................................................................. 23

3.5 JUSTIFICATION........................................................................................................................................... 23

3.6 PILOT SURVEY........................................................................................................................................... 24 3.7 QUESTIONNAIRES...................................................................................................................................... 24

3.8 OPERATORS SURVEY RATIONALE .......................................................................................................... 24

3.9 COMPANY SURVEY RATIONALE ............................................................................................................. 29 3.10 INTERVIEWS ............................................................................................................................................... 33

3.11 SUMMARY .................................................................................................................................................. 34

FINDINGS .................................................................................................................................................................. 35

4.1 INTRODUCTION.......................................................................................................................................... 35

4.2 LIMITATIONS.............................................................................................................................................. 35 4.3 PRESENTATION OF SURVEY DATA.......................................................................................................... 36

Further information and comments supplied:.............................................................................................. 51

4.4 INTERVIEWS ............................................................................................................................................... 51 4.4.1 Interview with “A” ............................................................................................................................ 51

4.4.2 Interview with “B” ............................................................................................................................ 52 4.4.3 Interview with “C” ............................................................................................................................ 52

4.4.4 Interview with “D” ............................................................................................................................ 54

4.5. SUMMARY ....................................................................................................................................................... 54

DISCUSS IONS .......................................................................................................................................................... 56

5.1 INTRODUCTION.......................................................................................................................................... 56

5.2 REVIEW OF METHODOLOGY.................................................................................................................... 56 5.3 SUMMARY OF THE RESEARCH QUESTIONS AND OBJECTIVES ............................................................ 57

5.4 KEY FINDINGS OF THE STUDY RESULTS................................................................................................ 57

5.5 APPRAISAL OF THE SURVEY’S BACKGROUND DATA........................................................................... 58 5.6 DISCUSSIONS ON RESEARCH QUESTION ONE: ...................................................................................... 60

5.7 DISCUSSIONS ON RESEARCH QUESTION TWO: ..................................................................................... 63 5.8 DISCUSSIONS ON RESEARCH QUESTION THREE: .................................................................................. 67


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5.8.1 Accountability ..................................................................................................................................... 68

5.8.2 Training/Recruitment......................................................................................................................... 71 5.9 SUMMARY OF MAJOR FINDINGS ............................................................................................................. 71

CONCLUS IONS AND RECOMMENDATIONS............................................................................................ 72

6.1 INTRODUCTION.......................................................................................................................................... 72 6.3 MITIGATIONS ............................................................................................................................................. 73

6.3.1 Awareness ............................................................................................................................................ 73 6.3.2 Accountability ..................................................................................................................................... 73

6.3.3 Recruitment and Vetting .................................................................................................................... 74

6.3.4 Training/Briefing ................................................................................................................................ 74 6.3.5 Acclimatisation Stopover Prior to Deployment............................................................................. 75

6.5 COPING STRATEGIES ................................................................................................................................ 75

6.5.1 Teamwork............................................................................................................................................. 75 6.5.2 Manageable Rotations in Theatre ................................................................................................... 75

6.5.3 Life Support ......................................................................................................................................... 76 6.5.4 Communications ................................................................................................................................. 76

6.5.5 Self-Development................................................................................................................................ 76

6.5.6 Support Networks ............................................................................................................................... 76 6.5.7 Physical Exercise................................................................................................................................ 77

6.5.8 Routine and Normalisation ............................................................................................................... 77

6.5.9 Decompression Stopovers Leaving Theatre................................................................................... 77 6.6 SUPPORT ..................................................................................................................................................... 77

6.6.1 Post Traumatic Incident Support ..................................................................................................... 77

6.7 HORIZON SCANNING................................................................................................................................. 78 6.8 RECOMMENDATIONS FOR FURTHER RESEARCH................................................................................... 78

6.9 MATRIX ...................................................................................................................................................... 79 6.10 CONCLUSION ............................................................................................................................................. 81

REFERENCES .......................................................................................................................................................... 82

APPENDIX A: METHODOLOGY FLOW CHART .................................................................................................. A-2 APPENDIX B: RESEARCH ETHICS CHECKLIST – POSTGRADUATE STUDENTS ............................................ A-7

APPENDIX C: SCREENSHOT OF SURVEY AGREEMENTS................................................................................... A-8

APPENDIX D: EXAMPLE OF INTERVIEW CONSENT FORM ............................................................................... A-9 APPENDIX E: AUTHORS EXPERIENCE AND REFLECTIONS ON PMSCS AND MENTAL HEALTH CARE.... A-10

APPENDIX F: FURTHER COMMENTS SUBMITTED BY SURVEY RESPONDENTS ........................................... A-13 APPENDIX G: TRANSCRIPT WITH INTERVIEW “B” ......................................................................................... A-18

APPENDIX H: TRANSCRIPT WITH INTERVIEW “D”......................................................................................... A-24


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LIST OF FIGURES AND TABLES

FIGURE 2.1: MASLOW’S HIERARCHY OF NEEDS 20

FIGURE 2.2: YERKES-DODSON STRESS CURVE 23

FIGURE 2.3: THE EFFECTS OF STRESS ON THE HUMAN BODY 26

TABLE 3.A : CHART OF THE RESEARCH METHODOLOGY 37

TABLE 4.A : THE TOTAL NUMBERS SAMPLED 50

FIGURE 4.1: SURVEY ENTRANTS WORKING IN PMSCS 51

FIGURE 4.2: SECTORS OF THE PMSC INDUSTRY THAT OPERATORS WERE WORKING IN 52

FIGURE 4.3: NUMBER OF YEARS’ EXPERIENCE THAT OPERATORS HAD IN HOSTILE

ENVIRONMENTS 53

TABLE 4.B: OPERATORS W HO HAD PREVIOUSLY MILITARY EXPERIENCE 53

FIGURE 4.4: REGIONS THAT OPERATORS HAD WORKED IN 54

FIGURE 4.5: THE LEVEL OF IMPORTANCE THAT OPERATORS PUT ON MENTAL HEALTH 54

FIGURE 4.6: OPERATORS W HO HAD RECEIVED MENTAL HEALTH SUPPORT 55

FIGURE 4.7: OPERATORS WHO BELIEVED THAT THEIR POSITION WOULD BE AT RISK IF THEY

SOUGHT MENTAL HEALTH THERAPY 56

TABLE 4.C: COPING STRATEGIES THAT OPERATORS WOULD EMPLOY AFTER A TRAUMATIC

EXPERIENCE 56

FIGURE 4.8: OPERATOR’S PERCEPTION ON WHETHER THERE HAS BEEN AN IMPROVEMENT IN

MENTAL HEALTH 57

TABLE 4.D: OPERATORS PRIORITIES OF MENTAL HEALTH W ELL-BEING 57

FIGURE 4.9: OPERATORS WHO BELIEVED THAT COMPANIES SHOULD BE CONTRACTUALLY

OBLIGED TO PROVIDE MENTAL HEALTH SUPPORT 58

FIGURE 4.10: COMPANIES WITH EXPERIENCE OF OPERATING IN HIGH RISK AREAS/CONFLICT

ZONES/HOSTILE ENVIRONMENTS 59

TABLE 4.E: LENGTH OF TIME THAT COMPANIES HAVE BEEN ESTABLISHED 59

TABLE 4.F: NUMBER OF OPERATORS THAT COMPANIES HAVE 59

FIGURE 4.11: REGIONS THAT COMPANIES ARE OPERATING IN 60

TABLE 4.G: DOCUMENTS THAT COMPANIES ARE A SIGNATORY TO 61

FIGURE 4.12: COMPANY MANAGEMENT THAT THOUGHT THE APPROACH TO MENTAL HEALTH

CARE HAD IMPROVED IN THEIR INDUSTRY 62

TABLE 4.H: MENTAL HEALTH AND COPING STRATEGIES THAT COMPANIES HAVE IN PLACE WITH

REGARDS TO THEIR OPERATORS 62

TABLE 4.I: WHAT EMPHASIS COMPANY MANAGEMENT PLACE ON THE MENTAL WELL-BEING OF

THEIR OPERATORS 63

TABLE 4.J: COMPANY MANAGEMENT PRIORITIES OF MENTAL HEALTH SUPPORT 64

FIGURE 4.13: COMPANY MANAGEMENT OPINION ON WHETHER MORE SHOULD BE DONE TO

SUPPORT MENTAL HEALTH IN PMSCS 64

TABLE 4.K: MANAGEMENT OPINION ON WHETHER PMSCS SHOULD BE OBLIGED TO PROVIDE

PSYCHOLOGICAL SUPPORT 65

FIGURE 5.1: LENGTH OF TIME COMPANIES HAVE BEEN ESTABLISHED 69

FIGURE 5.2: NUMBER OF OPERATORS THAT COMPANIES HAD 70

FIGURE 5.3: ALL RESPONDENTS ON WHETHER MENTAL HEALTH CARE SHOULD BE A

CONTRACTUAL OBLIGATION 70

FIGURE 5.4: CURRENT PROCEDURES THAT PMSCS SURVEYED HAVE IN PLACE FOR MENTAL

HEALTH SUPPORT 71


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FIGURE 5.5: HOW IMPORTANT IS MENTAL HEALTH CARE IN THE ROLE (OPERATORS AND

MANAGERS RESULTS COMBINED) 72

TABLE 5.A: THE EMPHASIS THAT COMPANY MANAGEMENT SAID THAT THEY PLACED ON THE

MENTAL W ELL-BEING OF ITS OPERATORS 72

TABLE 5.B: THE PERCEPTION FROM OPERATORS ON WHETHER THEIR POSITIONS WOULD BE AT

RISK, IF THEY SOUGHT MENTAL HEA LTH SUPPORT 73

TABLE 5.C: PRIORITIES THAT OPERATORS DEEMED WERE IMPORTANT FOR MENTAL WELL-BEING

75

FIGURE 5.6: COPING STRATEGIES THAT OPERATORS WOULD EMPLOY AFTER A TRAUMATIC

EXPERIENCE AT WORK 76

FIGURE 5.7: SIGNATORY DOCUMENTS THAT COMPANIES ARE AFFILIATED TO 79

FIGURE 5.8: OPERATORS WHO PERCEIVED THAT THEIR POSITION WOULD BE AT RISK IF THEY

SOUGHT MENTAL HEALTH THERAPY 82

TABLE 5.D: THE NUMBER OF RESPONDING OPERATORS WHO STATED THAT THEY HAD RECEIVED

MENTAL HEALTH SUPPORT 83


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ACRONYMS

ASIS American Society for Industrial Security BCSEM Business Continuity, Security and Emergency Management

BSI British Standards Institute

CBT Cognitive Behavioral Therapy

CISM(U) Critical Incident Stress Management (Unit)

CPR Cardio-Pulmonary Resuscitation

CSR Corporate Social Responsibility

DALY Disability Adjusted Life Year

DFID Department For International Development DR Disaster Recovery

EI Emotional Intelligence (Also known as EQ)

EOD Explosive Ordinance Disposal

EMDR Eye Movement Desensitisation and Reprocessing

EU European Union

GP General Practitioner

HSE Health and Safety Executive HMF Her Majesty’s Forces

ICoC International Code of Conduct for Private Security Service Providers

ICO Independent Commissioners Office

ICRC International Committee of the Red Cross

IP Internet Protocol

IPCC Independent Police Complaints Commission

ISO International Standards Organisation IT Information Technology

MARSEC Maritime Security (Organisation)

NASA National Aeronautics and Space Administration

NGO Non-Governmental Organisation

NLP Neuro-Linguistic Programming

NoK Next of Kin

OPSEC Operational Security

ORM Operational Risk Management OSM Operational Stress Management

OSA Official Secrets Act

PAS Publically Available Specification

PRM Psychosocial Risk Management

PSC Private Security Company

PTG Post-Traumatic Growth

PTE Potentially Traumatic Event RAND Research and Development (Corporation)

RPO Recovery Point Objective

SAMI Security Association for the Maritime Industry

SCEG Security in Complex Environments Group

SRAD System Requirements Analysis Document

TA Territorial Army

TriM Trauma Risk Management

UN United Nations UNMAS United Nations Mine Action Service


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GLOSSARY

Coping Method; A constantly changing cognitive and behavioural efforts to manage external

and/or internal demands that are taxing the resources of the person (Lazarus & Folkman, 2005).

Management; PMSC owners, CEO’s, country managers and those in positions of influence or

decision makers.

Mental Health; Describes a level of psychological well-being, or an absence of a mental

disorder. Which includes an individual's ability to enjoy life, and create a balance between life

activities and efforts to achieve psychological resilience. It can also be defined as an expression

of emotions, and as signifying a successful adaptation to a range of demands (WHO, 2005).

Operators; Refers to those who are employed by PMSCs. Their roles include; it can include

diplomatic protection, convey safety, static site guarding, covert security, maritime anti-piracy

tasks, de-mining and explosives ordinance disposal.

PMSC; Private Military Security Company (PMSCs) are private business concerns that provide

military and/or security services, usually armed, and in post-conflict areas (ICRC, 2014).

PRM; Psychosocial Risk Management is a program that addresses the full mental health needs of

an organisation and mitigates risks associated with psychological issues (Leka, Cox & Zwetsloot,

2008).

PTSD; Posttraumatic stress disorder is an anxiety disorder that may develop after a person is

exposed to one or more traumatic events, such as military combat (Breslau, 2009).

Respondent M/012; Denotes comments entered by the twelfth respondent to the management

survey.

Respondent O/123; Denotes comments entered by the one hundred and twenty third respondent

to the operators’ survey.

Stressor; Physical, psychological, or social force that puts real or perceived demands on the body,

emotions, mind, or spirit of an individual (Lating, 2012).

http://en.wikipedia.org/wiki/Quality_of_life

http://en.wikipedia.org/wiki/Mental_disorder

http://en.wikipedia.org/wiki/Mental_disorder

http://en.wikipedia.org/wiki/Psychological_resilience

http://en.wikipedia.org/wiki/Anxiety_disorder

http://www.businessdictionary.com/definition/psychological.html

http://www.businessdictionary.com/definition/social-force.html

http://www.businessdictionary.com/definition/put.html

http://www.businessdictionary.com/definition/demand.html

http://www.businessdictionary.com/definition/individual.html

Work-based Research and Dissertation Introduction Chapter

Student 21200319 Page 1

INTRODUCTION

1.1 Background

“Our people are our most important asset” (Stein & Book, 2009 p166)

This popular catchphrase is frequently used by organisational leaders, but rarely given full consideration.

Business Continuity, Security and Emergency Management (BCSEM) planning is often meticulous and

makes provision for all manner of contingencies, but seldom caters for the largest variable in the equation,

which is the human element and its bearing on performance when exposed to heightened levels of stress

and trauma (Puri, Khurana & Seth, 2010).

The purpose and focus of this research is to assess attitudes, approaches and levels of mental health care

currently provided to an industry that operates in a high risk/stress environments, namely Private Military

Security Companies (PMSCs). It will examine the external factors and stressors that have a bearing on

those individuals who routinely operate in hostile areas and may frequently be exposed to Potentially

Traumatic Events (PTEs) as part of their role (Dunigan, Farmer, Burns, Hawks & Setodji, 2013). The

study will seek to uncover the coping methods and strategies employed by operators within PMSCs and

will examine the widely varying levels of care and support mechanisms currently provided, which are

said to range from zero to well-structured programs (Buckman, Sundin, Greene, Fear, Dandeker,

Greenberg & Wessely, 2011). It will critically assess the issue of psychological care and stigma by

examining the varied approaches to a problem that is frequently regarded as taboo and is often suppressed

(Blais, Renshaw & Jakupcak, 2014). Finally it will seek to identify improvements for pathways to mental

health support and future care initiatives.

The research incorporates a wide range of sources, including contemporary literature, prevailing data,

surveys from within the industry, interviews and expert insight from therapists, company representatives

and individuals that are currently employed in these roles.

Cases in Post-Traumatic Stress Disorder (PTSD) of those returning from conflict zones and their severity

have rapidly increased in recent years (Gonzalez, 2011), in conjunction there has been a greater demand

for PMSCs with current estimates in Afghanistan alone, indicating that there are 18,000 operators

(Bloomfield, 2013). As demand for PMSCs rises globally, unless adequate support is provided there is an



increased risk of an upturn in the number of PTSD cases (Isenberg, 2010). The subject of psychological

care can often be contentious (McNally, 2003), although recently aspects of mental health in the work

place have been attaining greater prominence there and in society generally it is slowly gaining

acceptance (Louis, Burke, Pham & Gridley, 2013). Concurrently the surge in the number of PMSCs is set

to continue due to a downsizing in many national militaries (Schreier & Caparini, 2005), with their future

deployments in post-conflict zones, maritime hot-spots and hostile regions of the world (Singer, 2006).

Life insurance and medical cover have now become common place for those operating in high-risk

environments, but this rarely covers psychological support (Dunigan, et al, 2013). Greater accountability

and Corporate Social Responsibility (CSR) is slowly gaining recognition and compliance for compulsory

psychological care programs may become mandatory in the future (Stinchcomb, 2011), an example of this

is PAS1010; Guidance on the Management of Psychosocial Risks in the Workplace, which is becoming a

widely used international standard (Gallagher & Underhill, 2012).

This research will be of interest to all quarters of the PMSC industry, contract donors, insurance

companies, policy makers, mental health charities and military veterans associations. It may also be of

benefit to traditional organisations and individuals who may find themselves dealing with a “Black Swan”

event (Taleb, 2010), which is an unexpected and unpredictable crisis, for example the aftermath of a

hostage situation or terrorist attack and the associated trauma.

1.2 The Aim

To identify the level of Psychosocial Risk Management (PRM) available within the industry, analyse the

root causes of stressors, the existing cultures of PMSCs, especially in their attitudes towards mental health

and to suggest improvements in providing psychological coping and support.

1.3 Research Objectives

The research objectives are to highlight the specific dimensions and issues surrounded this topic, which

primarily will be to:

Review the available relevant literature.

Assess attitudes, stress coping strategies within the industry by form of survey questionnaires.

Gain deeper understanding through interviews with key individuals.

Consider what is adequate and what is failing.



Make recommendations built on the findings and outcomes.

1.4 Research Questions

The specific research questions that will be addressed to provide a clear focus for the study are:

Is the current level of mental health care adequate and what is the existing mindset towards it?

What are the unique stressors that PMSCs face in their operating environment and what are the

best coping strategies?

How could mitigations, coping strategies, interventions and therapies be enhanced?

1.5 Sample Group Overview

The sample group chosen for this research are personnel that operate in PMSCs. In recent years there has

been a dramatic rise in the numbers of PMSCs (Singer, 2006) with estimates that there are currently in the

region of 250,000 operating globally, chasing lucrative contracts and fulfilling roles that western

governments cannot do with their militaries alone (Gomez del Prada, 2006).

PMSCs operate in conflict zones and high-risk areas and often in a law and order vacuum. Recently there

has also been a surge in the number of maritime PMSCs, which have been created to counter the threat of

piracy towards merchant shipping, mainly off the Eastern coast of Africa (Liss, 2013a). PMSCs recruit

almost exclusively ex-military personnel and are male dominated (Jäger & Kümmel, 2009). However,

the industry also suffers from an image problem, with its operators often referred to as “mercenaries”

(Tonkin, 2011, p10). Numerous PMSCs are conceived in a short time-span and many of these immature

companies would appear to have low accountability, CSR or duty of care towards their operators,

especially in the areas of psychological support (Isenberg, 2010). Because almost all PMSC operators

have previously served in a national military force, the mental health care approach of serving personnel

and military veterans is additionally scrutinised for this research.

Following on from the Iraq and Afghanistan conflicts, PMSCs are now fulfilling roles regularly in

Yemen, Libya, Somalia and other conflict areas that fills gaps for foreign powers between military

capabilities and the commercial world (Gomez del Prada, 2006). However, their use can cause



controversy as they frequently operate in lawless post-conflict zones. The growth of the industry,

including the recent boom in maritime anti-piracy companies, is now estimated to be worth £400 billion

in awarded contracts to PMSCs (Dutton, 2013).

1.6 Sub Groups

Within the sample group there are three distinct sub groups, which will be individually examined to

ascertain whether there are any differences in attitudes or levels of care.

Personnel Security Detail

This is identified as the main group within PMSCs. Typically their tasks involve the armed close

protection of government diplomats or company management that are conducting business in hostile areas

(Gomez del Prada, 2006).

Maritime Security

This section of the industry is relatively new and was created to counter the threat from maritime piracy.

Their role involves the protection of merchant vessels, where they often spend long transits with the

constant threat of pirate attack (Liss, 2013b).

Demining and Explosive Ordinance Disposal

These companies generally work in post conflict areas that are now considered stable enough for the start

of minefield and unexploded ordinance clearance activities. The bomb disposal technician’s role is

highly dangerous and often conducted in remote areas, with only basic life support (Habib, 2008).

1.7 Overview of Chapters

This following section serves to signpost the content of the research by providing an overview of the

chapters that follow this introduction chapter:

1.7.1 Literature Review Chapter

The scope of this appraisal is to draw from a comprehensive range of sources, assessing applicable

research material, with the purpose of critically analysing previous studies relating to the topic. It starts

by assessing the broader themes in the evolution of BCSEM and its human component, the use of PMSCs



and current attitudes towards mental health care. It proceeds by narrowing to evaluate studies on the

causes of stress, an overview of the prevailing legislation and guidelines of psychological support. It

continues with the external factors that have a bearing on PMSCs, previous psychological research of

military personnel and existing levels of mental health care available. Finally it focusses on research

seeking to mitigate the risks of stress, coping strategies and future approaches.

1.7.2. Methodology Chapter

A wide array of methods are employed to conduct the research, which includes interviews with experts,

surveys that evaluate all factors regarding mental health and the culture and attitudes towards it. Much of

the research is of a qualitative nature, as unlike physical injuries following a disaster when the number of

fatalities, limbs lost or other injuries can be accurately documented, the presence of PTSD either

immediately after the event or presenting itself at a later stage can be difficult to quantify (Smith B,

Wong, Smith T, Boyko & Gackstetter, 2009). This Chapter covers a full explanation of the

questionnaires with their rationale and justification and all of the additional research methodology is

presented.

1.7.3. Findings Chapter

The presentation of results progress through the findings chapter in a logical manner, where graphs,

figures, tables and charts are used to establish understanding and interpretation of the primary data.

Poignant points from the interviews with their reflections on the survey findings are also presented.

1.7.4. Discussions Chapter

The significant points drawn from the findings are critically analysed and debated. Trends and patterns

highlighted from the surveys are compared with opinion from the interviews and conclusions of the

literature review. It refers to arguments presented in previous parts of the study and where variables exist

they are analysed for their meaning. It presents discussion of an evaluative nature that contributes

towards the outcomes which shape the research conclusions and recommendations.

1.7.5 Conclusions and Recommendations Chapter

This chapter draws from all of the main points emerging from the study, assessing their value and

considers scope for improvement. The conclusions seek to set down recommendations for change that are

likely to become evident during the research, especially with a view towards horizon scanning of what the

future may hold for the industry and its approach to PRM. The recommendations offered from this

research will be of benefit to the PMSC industry as a whole.



1.8 Summary

The research centers on the human element of operators who are exposed to high stress levels as part of

their role and examines all aspects in regards to their mental health. PMSC operators are expected to

experience some of these external pressures and PTEs (Isenberg, 2010) and this research seeks to

understand, assess and provide guidance. This will be achieved by collating and interpreting opinions

from key industry figures and feedback from the specific focus group to ascertain the existing attitudes,

stressors, coping and available therapy. A thorough evaluation of the topic will include current

procedures, interventions and therapies. This will include review of all material relating to this topic,

which can be found in the following review of literature chapter.

Work-based Research and Dissertation Review of Literature Chapter


LITERATURE REVIEW

2.1 Introduction

The scope and purpose of this literature review is to assess the existing and pertinent research material on

the mental health care of operators working for PMSCs. A thorough search and evaluation of the

available literature in this subject area will also seek to identify any gaps in this field of research. The

review starts by assessing the broader themes, which are the evolution of BCSEM and the human element

within it, the use and growth of PMSCs and current attitudes towards mental health care in the work

place. It proceeds by narrowing to evaluate studies on the causes of stress, and includes an overview of

the prevailing legislation and the guidelines towards psychological support. It continues by examining

the working environment and external factors that have a bearing on PMSCs, plus previous psychological

research of military personnel and existing levels of mental health care available. Finally it focusses on

research to find ways to mitigate the risks of stress, PTSD, including coping strategies, prevention

programs and future approaches.

2.2 The Human Element of Business Continuity

Research by Crandall, Parnell & Spillan, (2013) highlights the advancement and evolution of BCSEM

after the terrorist attacks of 9/11 and the further prominence given to it following recent crises, including

the financial crash and other natural or man-made disasters. This has served to focus corporate minds to

the idea that catastrophes can strike anywhere, at any time and that they can have a significant detrimental

impact on business functionality (Kennedy, Perrottet & Thomas, 2003). According to Barnes &

Oloruntoba, (2005), comprehensive disaster recovery planning, contingency preparation, ensuring the

integrity of supply chains and downstream operations is now starting to become common place for most

credible companies, where resilience has become a part of business strategy.

Duffey & Saull, (2008) argue that the most important constituent in organisations is that of the human

element and that it can also be highly unpredictable during a disaster. Yet despite the corporate mantras

of “Our people are our most important asset” this key component is often overlooked or given low

priority in regards to BCSEM planning (Stein & Book, 2009 p166).



2.3 Attitudes towards Mental Health Care

Angermeyer, (2006) highlights that attitudes towards mental health have improved in recent years.

However (Blais et al, 2014), state that a paradigm shift is required to remove existing stigmas, in a similar

vein that attitudes have changed in recent decades with regards to the acceptance that smoking cigarettes

damages health, gender equality, sexual orientation, or racial apartheid. This is essential so that the

subject is given the priority it deserves, especially for those who are exposed to high levels of stress as

part of their profession (Corrigan, 2004). Medical insurance cover for employees have now become fairly

commonplace and there has been an overall rise in health and safety standards and attitudes towards many

of these issues which are far advanced from where they were 50 years ago, but a further step change is

required (Mouan & Popovski, 2010).

2.4 Growth of Private Military Security Companies

In recent years there has been a dramatic rise in the numbers of PMSCs chasing lucrative contracts and

fulfilling roles that Western governments cannot with their militaries alone (Singer, 2006), with estimates

that there are currently in the region of 250,000 operators globally Gomez del Prada, (2010). They

operate in post-conflict zones and high-risk areas, often in a law and order vacuum. Recently there has

also been a surge in the number of maritime PMSCs, which have been created to counter the threat of

piracy towards merchant shipping, mainly off the Eastern Coast of Africa (Liss, 2009a). According to

Tonkin, (2011 p10) the industry recruits almost exclusively ex-military personnel and they are often

referred to as “mercenaries”. It is also claimed in by Isenberg, (2010) that many PMSCs are conceived at

short notice and these immature companies have low accountability, CSR or duty of care towards their

operators, especially in the areas of psychological support.

2.5 External Influences and Operating Environments of PMSCs

The RAND Corporation study on the health and well-being of PMSCs assessed the varying level of living

conditions and external factors and their bearing as stressors (Dunigan et al, 2013). This is compared

with Maslow’s long-standing theory of hierarchical needs, which is frequently applied in business

management to gauge well-being and for motivation of staff (Maslow, Stephens, Heil, & Bennis, 1998).

When this model is applied to PMSCs, it is apparent that many of the elements are either deficient or

difficult to achieve in their working environment.



Figure 2.1: Maslow’s Hierarchy of Needs (Source: Russell-Walling, 2008)

The physiological stage of initial needs are the basic foundations of human instinct, once satisfied, the

greater desires take priority. At the base level is breathing and as highlighted by Smith, B et al (2009), in

their study of those deployed to Afghanistan, increased levels of respiratory problems were found, due to

the dusty conditions. Food can often be of poor quality in post-conflict zones, although as Dunigan et al,

(2013) point out many PMSCs do place emphasis on providing the best available. Water, sleep and living

conditions can be of poor quality in theatre, although as Cardinali, (2011) states, there have been great

advances in life support for contractors in recent years. Maslow’s next tier up is safety and security of the

body, which is an obvious risk when operating in war-zones, but as Isenberg, (2010) argues, security of

employment is also an added stressor for many contractors. Dunigan et al, (2013), highlight the

importance of medical insurance as a vital component and key factor in operators feeling valued.

However, as Miller, (2006) raises; US contractors’ dependents faced difficulties in receiving insurance

payments, when mental health or suicide was the stated in the claim. A sense of belonging and image are

strong values for many PMSC operators according to Poisuo, (2014) and the male-orientated industry has

many internet sites dominated by macho profiles of operators displaying an alpha-male image. Maslow’s

theory has many deficiencies if applied to PMSCs and some of these can be considered for improvement

to enhance operators’ well-being. Certain deficient elements can be compensated by “trade-offs”, for

example advances in technology and internet communications or by financial compensation, i.e. a higher

pay rate for dangerous work (Isenberg, 2010).

http://listverse.com/authors/?Pauli%20Poisuo



2.6 Accountability

There are existing codes of conduct, best practices, agreements, guidelines and mandates that cover the

PMSC industry and although none of these are legally binding they are a positive step (Messenger et al,

2012). The International Code of Conduct for Private Security Service Providers has 708 signatory

companies as of 1st September 2013 (ICOC, 2013) and includes all associated members of The Security

in Complex Environments Group (SCEG). However, there is only a brief mention to duty of care in

respect of employee mental health in the document:

Section 6.2 states:

“Signatory Companies will ensure that reasonable precautions are taken to protect relevant

staff in high-risk or life-threatening operations. These will include: adopting policies which

support a safe and healthy working environment within the Company, such as policies which

address psychological health” (ICOC. 2013 p63).

According to Greenberg, (2013) in guidance drafted for Maritime PMSCs, it is envisaged that ISO:28007

will eventually contain Operational Stress Management (OSM) regulations that companies will soon be

obliged to demonstrate to shipping companies, flag States and marine insurers that they are compliant and

are providing reasonable psychological support for their operators. American National Standards

Institute of International Standards and Guidelines specify provision of; “medical and psychological

health awareness training, care and support” (ASIS. 2012 p24), which at least demonstrates a

recognition towards the topic. Although extremely comprehensive, The Montreux Document for Good

Practices of Private Military and Security Companies has no reference to mental health support

throughout and under welfare of operators only states: “Providing individuals injured by their conduct

with appropriate reparation, adopting operational safety and health policies” (ICRC 2013 p15). There is

no mention for the provision of psychological support in the Voluntary Principles for Security and

Human Rights, which only states that contracting PMSCs should recognised the rights of employees

under the International Labour Organisation’s (ILO’s) Declaration on Fundamental Principles at Work

(Voluntary Principles, 2014).

Accountability is extremely varied with PMSCs and many are willing to accept the risk of having little or

no systems in place to cater for psychological support with the view that operators are merely on short-

term contracts and they can easily be replaced if they are unable to fulfill their duties due to a stress-

related illness (Christian-Miller, 2010). By comparison, the United Nations (UN) is one body that is



leading in approaches towards PRM and Critical Incident Stress Management (CISM). PowerPoint™

lectures presented by Reynolds, (2013), gains insight to the attitude taken by the UN in the support given

to its staff when deployed into hostile areas. Their resolutions and mandates include:

Assessment of staff members psychosocial needs and status, UN resolution (A/RES/55/238)

Coordination of Stress Management and training related activities, UN resolution

(A/RES/56/255)

Pre and Post-Deployment Training, UN resolution (A/RES/57/155)

Preventive and Critical Incident Stress Management, UN resolutions (A/RES/47/226)

UN Mandates created by Critical Incident Stress Management Unit (CISMU)

2.7 Stress

Stress is defined by Lazarus, (2006), as anything that poses a challenge or a threat to our well-being.

However, Yerkes & Dobson, (2007), recognise that certain levels of tolerable stress are not only

acceptable, but known to be beneficial and stress itself should not be confused with a normal workload

pressure argues Nordqvist, (2009). According to Bernstein, (2013) stress in the workplace is said to cost

businesses in the US between $150 to $300 billion annually, so from a business continuity perspective it

is a very important factor that is not given full priority (Wallace, 2009).

Figure 2.2: Yerkes-Dodson stress curve (Source: Cohen, 2011)



Controllable amounts of stress can be healthy and productive as demonstrated with Yerkes-Dodson law

and stated by Staal, (2004), in the NASA research on stress, cognition, and human performance. Where

lower levels of stress result in under-stimulation, higher levels in stress responses and an acceptable

amount “Eustress” is found to be the optimum level.

Stress can also have an effect on critical decision making, for example in the case study of an over-

worked doctor in a hectic accident and emergency reception of a hospital, who under the stresses of the

job accidently misplaced the decimal point for an infant’s morphine dose, resulting in its death (King,

2006). The consequences of PMSC operators making mistakes under highly stressful situations could

also have fatal implications (Dunigan et al, 2013). An example of where mental well-being is given

significance is the Japanese approach where some companies participate in regular Tai-Chi or similar

exercises together as a measure to promote well-being, cohesion and improve productivity (Wilkinson,

2008). This is supported in a study by Donald, Taylor, Johnson, Cooper, Cartwright & Robertson,

(2005), that also linked shortened exposure to stressors to increased work performance.

2.8 Resilience to Stress

Human beings have a natural and inbuilt resilience to stress, even when faced with extremely difficult

circumstances (Bonanno, 2004). Having an optimistic personality is advantageous when people face

stress according to Freedman, (2006). Penninx, Beekman, Honig & Deeg, (2001), state that it may be

difficult to change perceptions, but perhaps recruitment for people who operate within PMSCs should

favour individuals who see a glass as being half full, rather than half empty. Pessimists tend to have

personality traits of emotion towards a problem, which can include avoidance or denial (Wallace, 2009).

Optimists take a challenge orientated, problem focused approach (Bosompra, Ashikaga, Worden & Flynn,

2001). Other personality traits have bearing and unsurprisingly people who are impulsive, are more likely

to use alcohol or other drugs after as a reaction to stress according to Hall & Johansson, (2003). Being as

physically healthy as possible is beneficial and the mind, body, spirit concept is nothing new, with many

ancient societies recognising the link between physical health and mental fortitude (Penedo & Dahn,

2005).



2.9 Emotional Intelligence and Gender

Emotional Intelligence (EI), is also referred to as (EQ) and Slaski & Cartwright, (2003) argue its value as

a moderator to stress and also that gender is a key variable with females tending to have higher EQ’s and

that this can have a positive effect in countering stress. Hunt & Evans, (2004) claim the influence of EQ

on predicting reactions to traumatic stress and whether gender has is a key factor. As PMSCs are almost

exclusively male-orientated (Dunigan et al, 2013) the bearing this has, is echoed in research on

psychological mechanisms in acute response to trauma by McNally, (2003). Approaches towards stress

coping also vary between the sexes according to Griffin, (2006), which is fundamental in developing

potential solutions. Females tend to have a desire to help others and are stronger members of support

networks (Albrecht, Goldsmith & Thompson, 2003) and males have been known to show more anger

when faced with a stressful situation (Lonczak Neighbors & Donovan, 2007).

2.10 Exposure to Hostile Environments

In researching the root causes of stress Levine, (2006) concludes that males have a stronger “fight or

flight” instinct and stronger physical responses to stressful situations, such as higher heart rate and blood

pressure. It is not entirely known why this is, but is perhaps some form of primeval predisposition

(Trueblood, 2013). The presence of high adrenaline and being in a state of hyper-vigilance can have the

effect of being on edge constantly and being unable to unwind according to McEwen, (2005). Research

by Spierer, Griffiths & Sterland, (2009) into the PMSC sub group of bomb disposal technicians on the

human nerve system and heart rate variability, showed stress responses in tactical situations and

highlighted split second decisions under extreme pressures of those operating in high-pressure

environments, their decision making processes and the likelihood of stress induced mistakes. It

concluded that higher levels of fitness and cardiovascular capacity are greatly beneficial in this critical

decision making process and for reducing stress levels overall.

It is fairly predictable that PMSC operators may face Potentially Traumatic Events (PTEs) in their role

(Isenberg, 2010) and research has shown that training and preparing can enhance coping mechanisms

after the experience (Whealin, Ruzek & Southwick, 2008). Understanding the effects of stress and being

able to control the situation post-event has shown improvements of recovery to be an effective strategy

(Rentschler, 2007). Another resilience factor is having the funds to cope with a stressful situation and the

salaries of operators go some way to addressing that (Kempf, Ruenzi & Thiele, 2009).



2.11 Stressors

The various classification of stressors are amplified while operating in high-risk areas (Dunigan et al,

2013). Stressors include; environmental, daily, life changing, employment, chemical, foreign

environment and external influences outside of the norm, such as the harsh conditions that PMSCs

operate in. LePine, (2005) argues that where possible stressors should be viewed as challenges and

although this cognitive approach will not eliminate the stressor, it can positively impact the way it is

perceived. Other stressors facing PMSCs include people wanting to cause them serious harm and/or kill

them and long periods away from loved ones (Heaney & Israel, 2002).

2.12 Stress Physiology

Figure 2.3: The effects of stress on the human body (Source: Positive Medicine, 2014)

An operator who is healthy and has a robust immune system

is more likely to cope with stress (Segerstrom & Miller,

2004). The link between how stress affects the body

physically is well-documented (Van der Kolk, McFarlane &

Weisaeth, 2012). The interaction highlighted by Ader &

Moynihan, (2001) between psychological stress and the

immune system’s capability to protect the body, known as

Psychoneuroimmunology and as Godin & Kittel, (2004)

conclude, from a business continuity stance, the less stress

people face in their lives, the less time off they are likely to

take for illness such as colds and flu. Research by Krantz &

McCeney, (2002) suggests that people exposed to prolonged

periods of stress may be more susceptible to certain illnesses

later in life, such as coronary diseases and heart attack.

2.12.1 Cortisol

Cortisol is a naturally occurring hormone released by the

adrenal gland into the blood at times of stress (Lupien, 2007).

PMSCs are exposed to prolonged periods in hostile

environments, which as Wang, (2007) highlights can cause residual fatigue due to increased levels of



Cortisol, this is echoed in Raison & Miller’s, (2003) research, that prolonged high levels of cortisol can

have side adverse effects in the human body, which include decreased antibody production and the body’s

ability to fight ailments, leading to a condition known as “burn-out”.

2.13 Coping Strategies

2.13.1 Cognitive

Having cognitive approaches that mitigate or handle the stresses that an operator is likely to face is

advantageous (Limbert, 2004). For some people this can be a deeply religious belief, to help them cope,

for example in the Middle East, where deeply religious Zaka volunteers assist to recover body parts in the

aftermath of terrorist incidents, this gruesome task is undertaken because of their deeply religious values

(Solomon & Berger, 2005). A cognitive approach to coping with stress and rationalising may be a way to

counter the “catastrophising” of thoughts, as Martin & Dahlen, (2005) highlight and give the example that

many people have a fear of flying, but statistically are more likely to be involved in a fatal car accident.

In a similar fashion operators may have a fear of being involved in an insurgent attack, kidnapping or

road-side bombing, but as Christian-Miller, (2010) states that statistically the odds of this happening are

fairly small, so the fear of it is the actual stress driver.

2.13.2 Social Support

The element of social support is a key coping factor according to Ben-Shalom, Lehrer & Ben-Ari, (2005).

A good culture of camaraderie can be forged when working closely together in a challenging environment

and the military offers individuals a close network of friends (Messenger et al, 2012). However, PMSC

operators who have now left the military and may find themselves having to deal with symptoms of stress

in civilian life without being surrounded by colleagues can find it difficult (Faber, 2008). Advances in

electronic communications and social media have been a great advantage in this area, not only are

operators able to talk to friends and family instantly via a webcam, there also exists many support

websites (Preece & Shneiderman, 2009). Studies have shown that people belonging to strong social

support networks have been known to recover from injury and illness earlier (Wills & Ainette, 2012).

This has been a great advantage to those such as PMSC operators who spend long periods away from

home (Leung, 2007). There is however, also a theory put forward by Cohen, (1998) that in some cases

too much social support can have a negative effect, whereby for example an individual becomes overly

http://en.wikipedia.org/wiki/Antibody



reliant on a support network rather than moving on and helping themselves to advance and shake off the

condition and that some support networks do not promote better health and may in fact have a negative

impact.

2.13.3 Sense of Belonging

Feeling inclusive of a team, a “we’re all in this together” ethos and membership to a social support

network is an important emotional coping approach. Teamwork and a sense of belonging are important

and this is highly regarded in the military, where units have strong identities (Greenberg, 2013). However

problems can arise in transition back into civilian life, as Van Staden, Fear, Iversen, French, Dandeker &

Wessely, (2007) claim in their study, when issues occur as stress symptoms take hold and these are not

readily available. A sense of belonging can be something as small as being part of a lottery syndicate

with fellow work colleagues (Ben-Shalom et al, 2005). This basic human desire links back to one of

Maslow’s hierarchical needs covered earlier in this chapter (Maslow et al, 1998).

2.13.4 Humour

The military where the vast majority of PMSC operators have served (Greenberg, 2013) is known for

high levels of humour and is recognised as being key to maintaining moral in the face of adversity (De-

Gruyter, 2010). This coping skill is developed by those who routinely face stressful experiences for

example, morgue workers who are renowned for their dark sense of humour (Malinowski, 2009).

2.13.5 Relaxation

Relaxation as a coping resource is recognised by Van der Klink, Blonk, Schene & Van Dijk (2001) to

ease the symptoms of stress and for PMSCs operators in a prolonged high-risk environment, an effective

strategy of a period of relaxation each day, if only for a short time is highly beneficial (Messenger et al,

2012).

2.13.6 Normalisation and Routine

Normalisation and keeping to a routine is highlighted to by Lapp, Taft, Tollefson, Hoepner, Moore &

Divyak (2010), such as having the same routine on a base in Iraq, as if an operator were at home can have

an effect of stabilising a potentially stressful environment.



2.13.7 Holistic Approach

A multi-layered and holistic approach is preferable for stress management, according to Taormina & Law,

(2000), who state that there is no single solution and instead a menu of coping resources should be

applied to suit each unique individual and the differing circumstances they are operating in.

2.13.8 Physical

A physical coping strategy for operators often includes some form of physical training or sports (Peluso

& Andrade, 2005). Unfortunately in this alpha-male dominated industry many have been known to abuse

anabolic steroids (Storm, 2008) and this can lead to a psychological problem known as “roid rage” (Riem

& Hursey 1995 p255). There are many other methods for coping physically which include breathing

techniques or stress balls which are squeezed in the hand at time of tension. Physical activity such as

running releases endorphins, known as “runner’s high”, and Scully, Kremer, Meade, Graham, &

Dudgeon, (1998) also highlight using sports to effectively counter stress. This can include boxing

training and striking a punch bag, which Scully et al, (1998) claim offloads the feeling of stress and anger.

2.13.9 Improving Stress Coping Skills in PMSCs

It is important to realise that perhaps the primary stressor facing PMSCs is that they may be operating in

an environment where people want to kill, or do harm to them. This would have to be recognised as an

unchangeable stressor (Gore–Felton, 2005) and the only method of countering this would be less

exposure to the risk, which would mean less time in theatre i.e. shorter rotations with longer breaks. This

is recognised by most operators but runs counter to a desire for financial gain and increased travel and

manpower expenses for PMSCs (Messenger et al, 2012). Gore–Felton, (2005) realises that energy should

not be wasted on unchangeable stressors, and the focus should be on dealing with changeable stressors

where mitigations can be of value.

2.14 Existing Studies in the Subject Matter.

There are very few existing studies that focus on the issue of the mental well-being of PMSCs, which

further highlights the justification for this paper. A recent UK study of post-deployed troops found links

between exposure to military combat and violent offending associated in part due to alcohol abuse and a

pre-existing risk towards mental health problems (MacManus et al, 2013). Christian-Miller, (2010)

highlights the lack (or unwillingness) of insurance companies to recognise mental illness, in a refusal to



pay out life insurance on a contractor suicide, said to be brought on by PTSD (Christian-Miller, 2010).

He goes on to highlight and praise one large US contractor which created its own psychological support

program, through the company’s insurance health plan. It included a 24-hour hotline and psychologists

that debriefed contractors immediately returning from theatre and again six months later. Isenberg’s,

(2010) article is also a rare example, but his observations are often emotional “…often they do have one

thing in common with regular military personnel, namely, they frequently get screwed over” (Isenberg

2012 p3). He also makes points about accountability, duty of care and that they can be seen as a cheap

alternative despite ethical shortfalls. Both Isenberg, (2010) and Christian-Miller, (2010) highlight the vast

differences in psychological support, which is on a company by company basis and varies between

comprehensive and developed programs to none at all. A perceived lack of support is an added stressor

that operators face is and “ambiguity in their employment status at the end of contract” (Messenger et al,

2012 p864) it is argued contributes to an increased risk of mental health difficulties (Messenger et al,

2012).

2.15 Post-Traumatic Stress Disorder

2.15.1 Causes

PTSD can develop at any time after a significant act of trauma. The trigger could be sex abuse, an

accident such as a car crash, a natural disaster, or being victim of a criminal act, or military combat

(Andreasen, 2011). With PMSCs it is highly likely that operators will have experienced military combat,

either previously during military service or in contact with insurgents while working as PMSCs (Clancy,

Graybeal, Tompson, Badgett, Feldman, Calhoun & Beckham, 2006). However, it could be that they have

experienced a significant act of trauma in earlier life and exposure to military combat has been enough to

trigger PTSD (Vogt, King D & King L, 2007).

2.15.2 Symptoms

There are many symptoms which can include a combination of the following: Re-experiencing the event,

avoidance, anxiety, emotional arousal, intrusive memories, flashbacks, nightmares, intense distress,

physical reactions of pounding heart, rapid breathing, nausea, muscle tension, sweating, apathy, feeling

detached from others, despair of the future, sleep issues, irritability, difficulty concentrating, hyper-

vigilance, anger, guilt, alcohol or drug abuse, feelings of mistrust, betrayal depression, suicidal thoughts

and feeling alienated (Shipherd, Stafford & Tanner, 2005).



2.15.3 Treatment

Early intervention for PTSD is advantageous (Litz, 2004). There are a wide range of therapies and

interventions available all claiming success rates, including CBT, NLP, Hypnosis, and their effectiveness

varies depending on the individual and severity of their trauma (Foa, Keane, Friedman & Cohen, 2008).

2.16 Post-Traumatic Growth and Resilience

It should be noted that there is not always a negative outcome to experiencing a traumatic event (Tedeschi

& Calhoun, 2004). However, there is still a lot of research required to understand why individuals who

have all had the same negative experienced, could either develop PTSD, while others retain a stable

equilibrium and some even experience Post-Traumatic Growth (PTG), by improving themselves, either

through a form of spiritual awaking, a deeper appreciation for life and relating to others, or greater

personal strength and pursuing new opportunities (Nelson, 2011). PTG should not be confused with the

natural resilience of a person to withstand an act(s) of trauma and remain largely unaffected mentally

(Levine, Laufer, Stein, Hamama‐Raz & Solomon, 2009). This resilience is thought to be formed by a

combination of cognitive characteristics which include; hardiness, optimism, self-enhancement,

repressive coping, positive effect and a sense of coherence (Bonanno, 2004).

2.17 Trauma Risk Management (TRiM)

A study by Frappell-Cook, (2010) asks “Does trauma risk management reduce psychological distress in

deployed troops?” The research looked specifically at the approach of TRiM in two separate groups of

servicemen. TRiM is described as:

“A proactive peer group model of psychological risk assessment that has been used since 2010.

It aims to promote recognition of psychological illness and keep personnel functioning after

traumatic events by enhancing the understanding and acceptance of stress reactions within an

appropriate environment” (National Institute for Health and Clinical Excellence, 2010).

During the research one of the groups was TRiM experienced and other TRiM naïve, in order to highlight

any improvements in resilience to battlefield stresses with the use of a TRiM program. Whilst the key

findings of this report were that social support, and especially within the military where the regimental

system is key to providing this; it also recognised that enhancing social support of any kind is beneficial.



However, this raises questions about PMSCs, who have similar experience of being party to, or affected

by, aggressive enemy acts; but as they are on contract work this type of comprehensive regimental

support network is no longer available to them (Messenger et al, 2012).

2.18 Psychosocial Risk Management

PRM is a program that addresses the full mental health needs of an organisation and mitigates risks

associated with psychological issues. To an extent the stresses faced by PMSCs are predictable and some

mitigation can be put in place to lessen their impact. Differing coping mechanisms will support operators

in varying ways and will mean different things to each personality type; this could be something as simple

as having a soothing cup of tea, or for someone else a cigarette (Cummings, 2004).

2.19 Training and Briefings

There must be a balance with the realisation that it can be a dangerous task against a risk of over

catastrophising, as discussed in the role of catastrophising (Carty, O'Donnell, Evans, Kazantzis &

Creamer, 2011). It is important during pre-deployment that next of kin (NoK) are identified; families are

a good source of support, also a friend/work colleague who may have to inform the family of injury or

death. Thought should be given to training on this and any potential mental health impact on the

messenger (Faust, 2006).

2.20 Psychological First Aid

In the immediate aftermath of an incident, a peer led support system is highly advantageous according to

Messenger et al, (2012), however as (Johnson cited in Hiles, 2011) states; timing is everything and

forcing counselors onto individuals in the immediate aftermath of an incident may have an adverse effect.

Human instinct is to look for leadership in these situations and “defusing” by a pre-identified company

member stating to operators that the organisation is going to attend to the immediate practical needs, for

example the repatriation of a deceased team member, a considerate message of care with information on

what has happened and what is going to happen (Johnson cited in Hiles, 2011).



2.21 Additional Considerations

‘Burnout” is the development of a mental distress where prolonged exposure to multiple stressors result in

a tipping point that leads to a breakdown (Maslach, 2008). This is another business continuity issue, as

not only can key individuals be lost for periods of sick leave, but it also figures as a major legal claim

against employers, costing industry billions (Gabriel, 2000).

There is known to be a strong alcohol culture within military service (Jacobson, Ryan, Hooper, Smith,

Amoroso, Boyko & Bell, 2008) and alcohol can become a crutch for many as a coping method and

referred to as “Self-medication” (Connor-Smith & Flachsbart, 2007). Operators have also come from a

background of risk taking and people in this category are more likely to experiment with illicit drugs, as a

maladjusted coping strategy (Zuckerman, 2000).

2.22 Conclusions of Literature Review

This literature review has examined existing theories that contribute to the aspects of PMSCs and their

mental health care, including previous employment history of operators, mindsets, their working

environment, stressors, coping strategies, social support and the latest approaches to the issue. With a

lack of comprehensive material available on this subject in relation to PMSCs it is important that these

issues are given priority and weighted accordingly during this research. The scope and purpose of which

is to highlight and present existing gaps in this subject area and recommend methods that will improve the

approach of psychological support to PMSCs.

Work-based Dissertation and Research Methodology Chapter


METHODOLOGY

3.1 Introduction

This chapter outlines the rationale and research methodology applied during this study; it explains the

frameworks that have been used with the aim of investigating the relationship between mental health and

PMSCs. The research incorporates questionnaires for PMSC operators and company management,

interviews with industry front-liners plus views from experts within the mental health practitioner’s arena.

It includes an explanation of the ethical considerations, the sample group’s recruitment and

characteristics, a description of the research settings, data collection methods, analysis procedures,

interview selection methods and techniques. A flow chart of the methodology applied to this study is in

Appendix A.

3.2 Ethical Considerations

Consideration for the highest standards of ethical researching and data protection protocols were given to

this study. The research ethics checklist is in Appendix B. Permission was initially sought and granted

from the site hosts of the social media groups for the surveys to be posted within them. The

questionnaires introductions all had an opt-out and permission granted option, which is shown in

Appendix C. Any “No” responses resulted in those entries being treated as null and void. The final page

of both surveys included a thank you statement and a link to an ex-servicemen’s mental health charity,

should any surveyed individual be in need of further support. This research has been carried out with a

strict confidentiality policy. No company or individual is named herein, as the results in some cases

contain deeply personal material. Information will be held securely and destroyed once the research

process has been formally completed in accordance with Independent Commissioners Office (ICO Data

Protection Rules, 2013). Each interviewee was sent an explanation of the research, interview outline and

a consent form, which was signed prior to each interview being conducted. They were informed that if

they were uncomfortable with any of the questions that they were not obliged to answer them; that they

could stop and withdraw their permission at any time during the interview and up to two weeks beyond.

An example of an interviewee consent form can be found in Appendix D.



3.3 Theory

The theory applied to this research initially used an interpretivism approach by the examining the

perception of mental health within PMSCs and continued rationally by testing whether the current care

levels were felt to be adequate. The study as a whole was of a phenomenological nature in that all of the

participants had spent time in hostile environments; therefore the research took an inductive theoretical

line. The author to this research has experience in the fields of working in PMSCs and mental health

care; therefore this research was written from an insider viewpoint, whilst remaining professional,

independent and open minded at all times to other views. The author’s experiences are covered in

Appendix E.

3.4 Approach

Deductive research of social based reasoning was applied to this study, starting with the theories and

generalisations, before narrowing to discussions, and finally analysing them to form the conclusions. A

mixed methods approach was adopted by using a survey for operators within PMSCs and an additional

one for company management, primarily gathering the above information, the questions were then

formulated for the interviews with professionals in mental health care; and this in turn was compared to

existing studies and the Literature Review. This methodology allowed for extraction of data which was

endorsed for critically analyses of the cause and not solely the effect, by examining the history of

operators and assessing their existing mindset and attitudes towards mental health.

3.5 Methodology Justification

The increasing popularity of social media has been taken advantage of in this research, enabling the target

audience to be reached instantly and comprehensively for the survey distribution. A further advantage of

using social media sites is the existence of a perceived stigma and reluctance to discuss mental health

problems (Mittal, 2013). Therefore the justification for selecting this type of survey and distribution

method is that it could be undertaken anonymously, which was key to allowing participants to complete it

honestly and without any fear of stigma or embarrassment.



3.6 Pilot Survey

A pilot questionnaire was initially conducted and sent to four key individuals with experience in mental

health and PMSCs. The outcome resulted in several questions being adjusted and certain ambiguities

rectified. However, the main conclusion was that an additional survey needed to be formulated and

directed at PMSC management, in order to draw comparisons or any contradictions that may be presented

from trends and patterns in the operator’s data. The pilot survey process added to the validity of this part

of the research.

3.7 Questionnaires

Questionnaires formulated on SurveyMonkey™ were distributed through the social media websites and

ran for a period of three calendar months, closing on 10th December 2013. The questions were designed

to deduce themes and common threads from which conclusions could be drawn and the research

questions addressed satisfactorily. As the PMSC operators population was estimated to have peaked in

2008 at 250,000 according to Gómez del Prado, (2012) and due to the distribution methodology, there

was a reasonably high confidence in the error margins that the responses would be genuine. Therefore a

sample size from which useful data could be deemed worthwhile was put at a total of 250 for both

surveys, as this would reflect at least 0.1% of this sample group population and thought to be a size of

value. However, a potentially low percentage take up could have indicated a culture of avoidance

towards the subject matter. The length of “soak period” and variety of networking sites that the surveys

were posted on, allowed for contingency, should any participants have withdrawn permission for

whatever reason, then a realistic sample size could still be obtained. Several measures were included in

the survey design that minimised contamination and no incentives were offered for participation in these

surveys.

3.8 Operators Survey Rationale

The questions are listed below in the order which they appeared in the surveys, with the rationale and

parameters for each one written below it in italics. All questions required an answer, unless stated.

Question One

Are you working in a high-risk area/conflict zone/hostile environment?



Yes Previously Never have

Any “Never have” responses were directed to the survey end page, with those entries null and void,

meaning that only those who answered “Yes” or “Previously” (for ex -operators) participated in the

survey.

Question Two

What sector do you work in?

Mine clearance

Close protection

Maritime

Static site guard

Low profile security

Mobile security detail

Other (please specify)

This question was designed to ascertain what areas of the industry individuals had operated in and would

seek to find if variations exist in the levels of care between sub groups.

Question Three

How many years’ experience do you have in high-risk areas/conflict zones/hostile environments?

Under 1 year

1 to 2 years

2 to 4 years

4 to 8 years

8 to 15 years

Over 15 years

This viewed the level of experience that operators had.

Question Four

Prior to becoming a Private Security Contractor did you serve in the military?

Yes If No, please state

To confirm, or otherwise that the industry is almost exclusively dominated by ex -military personnel.

“No” answers required an entry to clarify where operators had gained their experience.

Question Five

What regions have you operated in as a PMSC operator?



Maritime

Afghanistan

Iraq

Yemen

Somalia

Nigeria

Central America

Latin America

Russia/ex-Soviet States

Eastern Europe

Southern Africa

Asia


This will identify which areas operators have worked in. Multiple answers were permitted.

Question Six

How do you rate mental health care in your role?

Not at all Somewhat Moderately Important Very Important

This question is designed to identify how operators feel mental health care is perceived within the

industry. This was the first question in the survey that addressed mental health and the drop -out rate at

this point was analysed to see if avoidance of the subject was a contributing factor.

Question Seven

Have you ever received mental health support?

Yes No

If Yes - Please specify

Will seek to determine what percentage of operators have received mental health support and if so, what

type and level.

Question Eight

If you sought mental health therapy would your position be at risk?

Very likely Likely Not sure Unlikely Very unlikely



This question is posed to discover operator’s perception of whether their position would be at risk if they

sought mental health therapy.

Question Nine

If you experienced a traumatic event, what would you do to cope? (Choose as many answers as you

like)

Prayer or religious act

Try to keep my routine

Spend time alone in reflection

Speak to a therapist

Drink alcohol

Speak to a mate about it

Watch TV

Do some sport

Speak to a loved one

Read a book

Nothing, I could handle the

trauma


The choices were randomised for each participant so that the answers were displayed in a different order

and were intended to attain the coping strategies that individual operators employ. It had multi-choice

answers and an “Other” box for additional coping methods used.

Question Ten

Has the approach to mental health care improved in your profession?

No Not sure Yes

This ascertained operator’s perception as to whether there has been an improvement is mental health

care within the industry. It provided further insight of attitudes towards the topic.

Question Eleven

What do you think is priority for mental health well-being?

Please rank in order from 1 (highest) to 8 (lowest)

A long term support network

De-compression stopover leaving theatre

1

2

https://www.surveymonkey.net/MySurvey_EditPage.aspx?sm=g0MU7wATo%2fwuLqCzUifW91mEG8jb%2bZfUuYc39ABv7%2bwT52G2eG9iNnVxhZfAcdKZ&TB_iframe=true&height=450&width=650



Post incident psychological debriefing

On task support

Shorter rotations in theatre

Decent life support/Living conditions

Training to recognise symptoms in yourself and others

Internet communications (Skype™/Facebook™) with friends and family

This question was randomised for each participant. It was designed to ascertain the priorities of mental

health coping mechanisms. Each answer had to be ranked in order from one (highest) to eight (lowest).

Question Twelve

Should companies be contractually obliged to provide mental health support?

Yes, definitely Yes Maybe Not really No, not at all

This took the operators perspective of whether companies should be more accountable on mental health

care.

Question Thirteen

Do you have any further information that can help with this research?

The last question was designed to capture any further information that an operator felt might be of use or

wished to make a statement. Unlike all of the other questions it did not require a compulsory reply.

3

4

5

6

7

8



3.9 Company Survey Rationale

This questionnaire is for company management and those in positions of authority or influence.

Question One

Does your company operate in high-risk areas/conflict zones/hostile environments?

Yes No Previously

Any “No” responses were directed to the survey end page and those entries were deemed null and void.

Question Two

How many operators does your company routinely have in high-risk areas/conflict zones/hostile

environments?

Under 5

6 to 10

11 to 20

21 to 40

41 to 80

81 to 150

151 to 300

301 to 500

Over 500

This identified the size of companies and sought to obtain accountability or test the theory that many are

small “start-up” companies and whether larger companies have greater accountability in regards to

mental health.

Question Three

How long has your company been established?

Under 2 years

2 to 5 years

5 to 10 years

10 to 20 years

20 to 40 years

Over 40 years

Along with question two this will identify the typical profile of PMSCs to look into the theory that many

are young companies.

Question Four

What regions is your company operating in?



Maritime

Afghanistan

Iraq

Yemen

Somalia

Nigeria

Central America

Latin America

Russia/ex-Soviet States

Eastern Europe

Southern Africa

Asia


Will identify which areas of the world PMSCs are involved in. Multiple were answers permitted.

Question Five

Is your company signatory to any of the following?

None

International Code of Conduct for Private Security Service Providers

The Montreux Document for Good Practices of Private Military and Security Companies

ISO 28007 for Maritime Security

ASIS International Standards and Guidelines


This was designed to measure accountability within the industry and through the “Other” entry identify

any further signatory documents that companies were associated with.

Question Six

Do you think that the approach to mental health care has improved in the private military security

industry?

Yes Maybe No



This judged managerial perceptions on mental health and was compared with the same question posed to

operators to identify any disparity.

Question Seven

What does your company have in place with regards to mental health and well-being? (Choose as

many answers as applicable)

Nothing at all

Training to recognise symptoms of stress

Decompression stopover leaving theatre

Good life support & living conditions

Acclimatisation stopover entering theatre

Mental health screening/Vetting

A company appointed therapist

A full psychological support program


This question was randomised for each participant. It sought to identify what level of mental health

support exists with PMSCs.

Question Eight

What emphasis does your company place on the mental well-being of its operators?

None really Somewhat Moderately Important V. important

This question was compared with the same in the operator’s survey to highlight any changes in

perception between the groups.

Question Nine

What do you think is priority for the mental health well-being of your company's employees?

Please rank in order from 1 (highest) to 8 (lowest)

Post incident psychological debriefing

Decent life support/Living conditions

1

2



De-compression when leaving theatre

Long term support network

Shorter rotations in theatre

On task support

Good communications (Skype™ or Facebook™) with friends and family

Training to recognise symptoms in themselves and others

This question was randomised for each participant. It identified what priority companies put on the

various coping methods and was compared the operator’s choices.

Question Ten

Should more be done to support mental health within the security industry?

Yes Maybe No

If Yes - Any suggestions?

This assessed attitudes from management towards mental health care and was compared to the

operator’s answers.

Question Eleven

Should companies be contractually obliged to provide psychological support?

Yes, definitely Yes Maybe Not really No, not at all

This examined whether management believed there should be greater accountability and was compared

to the operator’s views.

3

4

5

6

7

8



Question Twelve

Do you have any further information that can help with this research?

This gives opportunity for PMSC management to add their views or any additional information.

3.10 Interviews

The primary data collated from the surveys was tested and raised in interviews with key personnel from

the industry and mental health care. These comparisons were conducted at the conclusion of the surveys,

allowing for the interview questions to be formulated from the responses, to confirm trends and add depth

to the survey findings. The interviewees were selected as individuals who were identified that could help

build a picture of the issues prevalent, discuss the current approaches and provide insight for potential

improvements. They had all previously served in government-backed military and all had experience of

PMSCs, however, each one brought a unique perspective to the study. They were probed on their views

to the survey’s significant findings, the research questions to this study, their expert opinion of

experiences of the topic area and possible future solutions. These first-hand accounts were extremely

valuable in understanding the subject area from differing perspectives and for providing possible

resolutions. The interviewees were as follows:

Interviewee “A” An operator who suffered PTSD symptoms and sought therapy outside

of his companies framework due to fear of losing his job.

He had not received any support from his company in the aftermath of a traumatic event and therefore

kept his issues to himself fearful of losing employment if admitting to a mental health problem.

Interviewee “B” Former UN Agency Chief of Security

He provided insight to the approach taken by the UN in the support given to its staff when deployed to

hostile areas in comparison to that of PMSCs.

Interviewee “C” Founder of an ex-servicemen’s mental health charity who had

previously served with Britain’s Special Forces



He provides knowledgeable insight to the pressures of working in high-risk environments and the

founding of the charity.

Interviewee “D” Director of a mental health charity and former Armed Forces

psychiatrist

After a military career that specialised in mental health care, he now specialises in clinical psychiatry, has

Doctorate in mental health and advises on policy concerning PMSCs.

3.11 Summary

This research used social media as an efficient means to distribute surveys and reach the focus group

effectively. It allowed feedback to be drawn from all areas of the industry providing a broad depth of data

and feedback. Additionally it obtained the opinions from subject matter experts in mental health and

PMSCs for their expertise. The information gathered throughout the survey and interview stages has been

compared with existing works on the subject, which are covered in the Literature Review. The highest

ethical standards were applied throughout, and full duty of care has been taken with this sensitive subject.

The results of all the gathered data, evidence and statistics are laid out and presented in the following

Findings Chapter.

Work-based Dissertation and Research Findings Chapter


FINDINGS

4.1 Introduction

The results from the comprehensive questionnaires are presented throughout this chapter in chronological

order. The findings are displayed using graphs, figures and charts to aid in their interpretation and

understanding. The key points drawn from the interviews with experts offering in-depth knowledge of

the PMSC industry and mental health care are highlighted, especially where they endorse the survey data,

or help explain the trends that are derived from it.

4.2 Limitations

The social media sites used for the purpose of this study were all found to have large memberships;

however, it was clear that there is considerable duplication as the sample population subscribed to

multiple sites. Internet access was a requirement to participate, which can be an issue for certain

operators in remote areas or those on maritime tasks who would not necessarily have access while away

on ships convoy protection duties. To counter this the survey was made available for three months, as

anti-piracy convoy duties or rotations in hostile environments are never usually longer than this period

(Murphy, 2013). The questionnaires were only posted onto English speaking sites and although there

were found to be a few non-English speaking groups, it was clear that the sites used catered for the

majority of PMSC operators and offered a good representation of the industry. Consideration was given

to using the option of only allowing one entry per I.P address, but this was deemed unsuitable, as it may

have blocked entries from an overseas base with several potential participants. Because of this some

managerial data duplication may have occurred, i.e. more than one representative from a PMSC entering

data on the survey from the same company. There was also no way to stop operators who could have

entered data several times, although there is no real evidence of this or considered motivation to do so.

Other approaches that were considered but deemed unsuitable was distribution of the questionnaire by E-

mail to potential participants, as this would have compromised anonymity. None of the limitations

mentioned here are thought to have had any significant impact on the value and integrity of the data that

was gathered.



4.3 Presentation of Survey Data

A total of 30 LinkedIn™ and 19 Facebook™ well-supported networking groups were targeted for the

survey. Due to the confidential nature of the PMSC industry, these sites presented higher levels of

security than others did. For these “closed sites”, all potential associates are invite only and verified prior

to membership, therefore the sample group was deemed pure from contamination from any outsiders. All

of the groups had connections to the PMSC industry, including the sub groups, which all contributed to

receiving as wide a range of feedback as possible. The groups varied in their characteristics and ranged

from “The International Mercenary Association” to a group dedicated to raising standards in the industry;

“The Professional Security Group”. The two surveys were attempted by 459 potential participants;

however there was a high dropout rate, where many may have just been curious or realised that the survey

did not apply to them, resulting in a final total of 264 completed questionnaires.

Table 4.A: The total numbers sampled.

Survey Attempts Incomplete Completed

Operators 350 138 212

Company 109 57 52

Total responses 459 195 264

These totals are considered to be a satisfactory sample size, from which opinions on the subject of

psychosocial risk issues are considered to be a reasonable representation from within PMSC industry.

For the presentation of data shown at Figure 4.1 the full results are displayed regardless of whether the

questionnaire was completed. Only the raw data is presented throughout this chapter, all results and

significant findings are critically analysed in detail in the Discussions Chapter.



Figure 4.1: Survey entrants working in PMSCs.

The first question was designed so that the 39 “Never have” responses shown at Figure 4.1 to having

experience of working in PMSCs were directed to the final page and omitted from the study, enhancing

the integrity of the survey. The remaining 311 responses from those currently deployed amounted to

51.1%, with 48.9% having previous relevant experience.

Figure 4.2: Sectors of the PMSC industry that operators were working in.

179

132

39

0%

10%

20%

30%

40%

50%

60%

Yes Previously Never

Total responses 350

15.8%

42.7%

18.6%

5.7%

8.6%

8.6%

Total responses 279Mine clearance 44

Close protection 119

Maritime 52

Static site guard 16

Low profile security 24

Mobile security detail 24



Figure 4.2 shows the spread of main roles annotated within the questionnaires. 38 “Other role” entries

were received, of which four stated they were Explosive Ordinance Disposal (EOD) and these have been

clustered into the aligned mine clearance sub group. The remaining included; Police training/mentoring x

3, Non-Governmental Organisation (NGO), corporate security, liaison, transport, strategic advice, due

diligence, aid delivery and refugee security.

Figure 4.3: Number of years’ experience that operators had in hostile environments.

Figure 4.3 above shows that over 60% of operators have less than eight years’ experience, but a high

volume of 21.8% claimed to have over 15 years’ in the industry.

Table 4A: Operators who had previously military experience.

Answer Percentage Operators

Yes 89.4% 219

No 10.6% 26

Total responses 245

As part of the research centred on comparisons with PMSC and military service, this question ascertained

these levels, the results are shown at Table 4A. The “No” responses entered the following data; four had

served in a police force; one was a paramedic, and only ten stated that they had not served in any military

prior to joining a PMSC. This is in line with other research and was an expected response.

1924

54

67

48

59

0%

5%

10%

15%

20%

25%

30%

Under 1year

1 to 2years

2 to 4years

4 to 8years

8 to 15years

Over 15years

Total responses 271



Figure 4.4: Regions that operators had worked in. (Excluding military service)

Details of the global spread are shown in Figure 4.4. Further “Other” entries included; Sudan x10, Libya

x9, Lebanon x5, North Africa x3. These were expected results and reflect the typical world wide

deployment of PMSCs.

Figure 4.5: The level of importance that operators put on mental health care.

27.0%

43.4%

55.9%

12.1%13.7%

12.1%

9.4%

8.6%

6.6%

24.2%

20.3%

19.1%

Total responses 256 (multiple answers permitted ) Maritime 69

Afghanistan 111

Iraq 143

Yemen 31

Somalia 35

Nigeria 31

Central America 24

Latin America 22

Russia/ex Soviet States 17

Eastern Europe 62

Southern Africa 52

Asia 49

1822

26

79

105

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Not at all Somewhat Moderately Important Veryimportant

Total responses 250



Figure 4.5 shows that three quarters of the operators believe strongly that their mental health care is either

“Important” or “Very Important. However 18 deemed it was “Not at all” important.

Figure 4.6: Operators who had received mental health support.

“Yes” responses were encouraged to clarify what mental health support they had received: Counseling x5,

PTSD x4, depression x3, Combat Stress (Referring to the ex-services mental health charity) x2. Others

single answers were, Eye Movement Desensitisation and Reprocessing (EMDR), TRiM, Talking2Minds

training (a veterans mental health charity), anti-depressants, psychotherapy, NLP (Neuro-Linguistic

Programming), Bi-polar, counseling, life coaching, acceptance and commitment therapy, mindfulness

training, end of tour debrief, assessment on discharge from the Military.

Other entries of note were:

Respondent O/026;

“Debriefs after serious incidents in Northern Ireland”

Respondent O/071;

“UNMAS counseling after colleague was blown up and killed”

41

209

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Yes No

Total responses 250



Figure 4.7: Operators who believed that their position would be at risk if the y sought mental health

therapy.

Figure 4.7 covers a significant finding of this study and demonstrates the perception that at best operators

are “Not Sure” and over half believed it to be “(Very) Likely” that they would lose their job, if they

sought mental health support

Table 4B: Coping strategies that operators would employ after a traumatic experience at work.

(Multiple answers permitted)

Rank Coping Method Percentage Operators

1 Speak to a mate about it 57.2% 139

2 Try to keep my routine 53.1% 129

3 Spend time alone in reflection 41.6% 101

4 Do some sport 39.5% 96

5 Speak to a loved one 39.1% 95

6 Drink alcohol 25.1% 61

7 Nothing, I could handle the trauma 20.2% 49

8 Speak to a therapist 15.6% 38

9 Read a book 14.4% 35

10 Watch TV 9.9% 24

11 Prayer or religious act 9.1% 22

Total responses 243

7971

65

18 17

0%

5%

10%

15%

20%

25%

30%

35%

Very likely Likely Not sure Unlikely Veryunlikely

Total responses 250



The most common responses in regards to coping strategies are found at Table 4B. Of note is the top

response which is to “Speak to a mate about it”. This and a full assessment of the entries are assessed in

Discussions at Chapter 5. Additional coping strategies that operators included were:

Respondent O/160;

“Listen to music and meditate”

Respondent O/169;

“Pursue prostitutes”

Respondent O/214;

“Remain active, dwelling on past will eventually lead to some form of depression”

Respondent O/242;

“Martial arts practice have been very helpful for me personally”

Respondent O/273;

“Holiday to Bora Bora”

Respondent O/326;

“Play XBOX”



Figure 4.9: Operator’s perception on whether there has been an improvement in mental health care

in PMSCs.

A consideration was required in the perceptions of responders if they felt the approach to mental health in

PMSC’s was improving. Figure 4.9 shows that “No” replies accounted for 30.5%, “Not sure” 47.7% and

“Yes” responses 21.8%

Table 4C: Operator’s priorities of mental health well-being.

Rank Answer option Score 1

Internet communications with family and friends 5.42 2 Shorter rotations in theatre 5.14

3 Decent life support/Living conditions 4.55

4 Training to recognise symptoms in yourself and others 4.54

5 De-compression stopover leaving theatre 4.25

6 A long term support network 4.07

7 Post incident psychological debriefing 4.04

8 On task support 3.99

Total responses 227

Personal comments in regards to the responder’s priority scale on what they considered would allow a

healthier mental state was scored and results are shown above at Table 4C. Communicating with

somebody close rates highest, shorter rotations is a surprisingly high score, as it runs counter to financial

74

116

53

0%

10%

20%

30%

40%

50%

60%

No Not sure Yes

Total responses 243



gain. Decent living conditions are recognised as being advantageous; however there is poor support for

structured mental health support.

Figure 4.10: Operators who believed that companies should be contractually obliged to provide

mental health support.

There is a strong indication that operators believe support should be offered from their organisation,

results shown at Figure 4.10 support this case and supports other answers that this topic is of high

significance to them.

Figure 4.11: Companies with experience of operating in high-risk areas/conflict zones/hostile

environments.

80

67

42

17

9

0%

5%

10%

15%

20%

25%

30%

35%

40%

Yes,definitely

Yes Maybe Not really No, not at all

Total responses 215

72

26

11

0%

10%

20%

30%

40%

50%

60%

70%

Currently Never Previously

Total responses 109



“Never” responses shown at Figure 4.11 were directed to the survey final page and removed from future

results in order as not to contaminate the data.

Table 4D: Length of time that companies have been established.

Duration Percentage Companies

Under 2 years 6.8% 5

2 to 5 years 23.0% 17

5 to 10 years 37.8% 28

10 to 20 years 17.6% 13

20 to 40 years 6.8% 5

Over 40 years 8.1% 6

Total responses 74

The research established statistics around company history and time length for a variety of reasons around

support structure capability. Table 4D’s results are in-line with expectations and reflect the post Iraq and

Afghanistan “boom years” for company incorporation.

Table 4E: Number of operators that companies have.

Company size Percentage Company’s

Under 5 18.2% 14

6 to 10 16.9% 13

11 to 20 23.4% 18

21 to 40 7.8% 6

41 to 80 6.5% 5

81 to 150 11.7% 9

151 to 300 5.2% 4

301 to 500 1.3% 1

Over 500 9.1% 7

Total responses 77

The data shown in Table 4E denotes that many PMSCs in the survey are fairly small companies. This

and the results in Table 4D are commented on further in Discussions at Chapter 5.6.



Figure 4.12: Regions that companies are operating in.

A wide area of operations are shown in Figure 4.12. A further total of 13 “Other” entries included: North

Africa x2, Libya, Sudan x2, Caribbean, Tanzania, Ghana, Middle East, Sudan, Papua New Guinea, West

Africa, Mali, Ghana, Ivory Coast, Saudi Arabia, Israel and Kurdistan. The results are in-line with the

operators’ responses and highlights PMSCs global spread.

Table 4F: Documents that companies are a signatory to.

Document Percentage Companies

None 50.7% 35

International Code of Conduct for Private Security

Service Providers 43.5% 30

ISO:28007 for Maritime Security 24.6% 17

The Montreux Document for Good Practices of Private

Military and Security Companies 20.3% 14

ASIS International Standards and Guidelines 15.9% 11

Total responses (Multiple answers permitted) 107

46%

37%

43%

14%27%

34%

24%

23%

19%

26%

37%

38%

Total responses 284 (multiple answers permitted) Maritime 34

Afghanistan 27

Iraq 32

Yemen 10

Somalia 20

Nigeria 25

Central America 18

Latin America 17

Russia/ex Soviet States 14

Eastern Europe 19

Southern Africa 27

Asia 28



The topic of accountability is discussed in-depth in Chapter 5.9.1. The feedback at Table 4F reveals that

over half of company management respondents stated that their companies were not signatory to any of

the above documents. There were three other entries:

Respondent M/037;

“Voluntary Principles for Security and Human Rights”

Respondent M/046;

“UN has its own standards”

Respondent M/082;

SAMI (Security Association for the Maritime Industry)

Figure 4.13: Company management that thought the approach to mental health care had improved

in their industry.

Results at Figure 4.13 shows perception from PMSC Management that only 24.6% believe there has been

an improvement and 34.8% were not sure, while 40.6% believed that there had not.

17

24

28

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Yes Maybe No

Total responses 69



Table 4G: Mental health and coping strategies that companies have in place with regards to their

operators well-being? (Listed in order of ranking)

Rank Answer option Percentage Companies

1 Good life support & living conditions 48.4% 31

2 Training to recognise symptoms of stress 46.9% 30

3 Mental health screening/Vetting 46.9% 30

4 Nothing at all 21.9% 14

5 A company appointed therapist 21.9% 14

6 Decompression stopover leaving theatre 18.8% 12

7 Acclimatisation stopover entering theatre 18.8% 12

8 A full psychological support program 10.9% 7

Total responses (Multiple answers permitted) 151

The results from Table 4G are commented on in greater detail in Discussions at Chapter 5.9.

“Other” responses included:

Respondent M/037;

“Critical incident debriefing and treatment”

Respondent M/075;

“March on stress and GP declaration”

Respondent M/097;

“Occupational health nurse and Dr trained in PTSD councilling (sic) and mental health offering

cognitive therapy”



Table 4H: What emphasis company management place on the mental well-being of their operators.

Opinion Percentage Companies

None really 13.3% 8

Somewhat 15.0% 9

Moderately 20.0% 12

Important 25.0% 15

Very important 26.7% 16

Total responses 60 60

Table 4H statistics shows a strong emphasis that company management respondents have weighted on the

mental health of their employees. For at least one company this survey seems to have raised awareness as

stated by Respondent M/042;

“This survey has certainly been a timely reminder and something that I will be taking up with

senior management”

Table 4I: Company management priorities of mental health support. (In order of choice)

Rank Answer options Score

1 De-compression when leaving theatre 5.55

2 Shorter rotations in theatre 5.13

3 Good communications (Skype™ or Facebook™) with friends

and family 4.61

4 Long term support network 4.59



7 Training to recognise symptoms in themselves and others 3.88


Total responses 64

To compare PMSC operatives with their company’s the same questions were asked in regards to mental

health support albeit with a different accentuation. As with the operator’s responses, mental health

training or support did not rate highly as shown in Table 4I. Decent life support was one of the top

operator’s choices as opposed to the lowest of managerial priorities.



Figure 4.14: Company management opinion on whether more should be done to support mental

health in PMSCs.

An emphatic answer to this question with only a single “No” response, with 16 (29%) “Maybe” and a

high majority of 38 (69%) stating “Yes” as shown above in Figure 4.14. “Yes” responses were

encouraged to state what should be done and those entries can be found in Appendix F.

Table 4J: Management opinion on whether PMSCs should be obliged to provide psychological

support.

Opinion Percentage Companies

Yes, definitely 25.5% 14

Yes 34.5% 19

Maybe 21.8% 12

Not really 10.9% 6

No, not at all 7.3% 4

Total responses 55

Management thoughts on obligatory requirements for psychological support were surveyed and the

answers at Table 4J support a strong “Yes” and “Yes definitely” score which is encouraging. The “Not

really” scores of 6 (10.9%) or and “No, not at all” 4 (7.3%) are of a concern to this study.

38

16

1

0%

10%

20%

30%

40%

50%

60%

70%

80%

Yes Maybe No

Total responses 55



Further information and comments supplied:

Numerous additional comments were entered which provided deep insight on attitudes towards the topic.

The majority are listed in Appendix F with the more significant points that warranted additional analysis

and discussion in Chapter 5, where they are used to highlight key points and support or debate the

arguments.

4.4 Interviews

The four interviewees used for a further qualitative survey were asked their opinions on the research

questions shown above, the key findings from the surveys and then asked to give opinions to the survey

questions where applicable. Pertinent points from their interviews are entered below, with the other

poignant points located throughout the Discussions Chapter where they are used to validate key points.

Transcripts to the two interviews which were of greatest interest to the research are in Appendices G and

H.

4.4.1 Interview with “A”

‘A’ was questioned about his experiences as an operator and how he sought mental health therapy outside

of his company’s knowledge due to fear that he would lose his job. He was asked about his experiences

and what, in his opinion, could be done to improve the care. The key points noted were that, in his

opinion, many of his colleagues had some form of mental health issue, but simply refused to admit it

openly. On coping methods, he believed it was the little things that make the difference, leading as

normal a life as possible in a war zone helped, for example watching a hometown news channel or sitting

down with colleagues for a Sunday dinner together. His stated regular internet communications with

family at home had the effect of keeping him “grounded”. After privately undertaking therapy, he felt he

had the coping tools to continue working successfully within PMSCs with a more forward thinking

approach. He feels that the support was extremely beneficial, and may have led to a degree of PTG. On

long rotations in theatre, he mentioned some operators clearly push the limits to earn the extra daily rate

and stay away too long in hostile environments, when they should be taking regular breaks. He used the

analogy that coping techniques acted like “shock absorbers” on a car; therefore, if an operator was

exposed to stress or a traumatic event, the many coping methods would lessen their impact. He added

that he once tried to give up smoking in a hostile environment, which may not have been the best

opportunity to do so. His therapy with the charity had taught him not to be so hard on himself.



4.4.2 Interview with “B”

“B” was interviewed around experiences delivering Critical Incident Stress Management (CISM) training

to the UN and his long exposure of working with PMSCs and any differences of attitude from them. He

stated that the UN approach was advanced and delivered good pre and post-deployment training, assessed

its staff’s psychological needs, coordinated stress management training and offered comprehensive

support to its employees. However, he was keen to stress that the UN are well resourced and most

PMSCs simply do not have the financial depth to fund PRM programs. He believed economic pressure to

be a major factor, where small companies bidding for a contract had to cut costs and would not have

appetite or foresight to have a PRM program. Secondly, once a contract is awarded there is normally a

rush to fill up to 100 positions where doing any form of vetting or mental health awareness training would

be highly unlikely. Yet, he felt that there are many small measures which can be employed that will

improve mental health of operators. When asked his opinion on whether technologic advances could

replace face to face therapy or enhance it, he said that personal contact is always best, but in today’s ever

connected world and with the youth of today growing up and developing their communication

personalities through social media, it should certainly be researched. He mentioned the benefit of salaried

staff rather than daily pay rate limiting temptation to over stretch the length of rotations in high-risk areas,

and that Governments issuing contracts should ensure that those they hire are taking adequate duty of care

towards their operators’ mental health, and that this could be done through an audit process. He valued

teamwork highly as a coping strategy and strong bonds with colleagues were essential, this was also key

with social support networks, for example the British Legion. He had also seen good advances in

approaches towards the topic within the military, where 30 years ago it would have been swept under the

carpet.

4.4.3 Interview with “C”

“C” was questioned in his capacity as the founder of an ex-servicemen’s mental health charity, about his

experiences within PMSCs and further background of working within the British military. On

recruitment he pointed to the distinct “tier structure” within the industry with good quality and resilient

operators getting the best paid jobs where word of mouth vetting was commonplace. He felt this had

advantages, but that due to financial cuts, less qualified and often less psychologically resilient

individuals were finding their way into positions that they were not suited for. He said that military skills

were essential for PMSC operators, but that the culture towards mental health in the military carried

stigma, in that it was seen as a weakness and serviceman would commonly abstain from discussing

anything resembling emotional content. He said that there had been very little positive changes towards



this subject in the industry, and even the changes seen were done merely so companies could mitigate the

risk of being sued rather than duty of care towards their operators. He had seen certain companies turn

their backs after a serious traumatic incident, leaving the operators to fend for themselves

psychologically. Personally in the aftermath of any PTE he tries to maintain routine and focus on the

future as his coping method. Further conversation led to his covering typical ways that many seasoned

operators cope with such events, in drinking alcohol excessively to “get it out of their system” as a typical

ex-military approach. Decompression periods were felt important, so operators did not bring certain

stresses back into their family home life. There was a factor that some people stayed in high pressure jobs

longer than they should due to a desire to earn money and this was extremely detrimental to the

psychological well-being. He felt that self-development such as learning a new language or skill was a

great way to combat boredom which in itself could be a stressor or lead to having time to develop

negative thoughts, plus the effect of empowering the individual in being future focused. While employed

as a PMSC operator he developed PTSD, sought treatment outside of his company’s knowledge and later

went onto found a mental health charity. He stated that his charity had been contacted by numerous

PMSC operators who were seeking therapy outside of their company’s knowledge due to stigma and a

fear of losing employment. The interventions used by the charity adopt a holistic approach using a

combination of NLP, Timeline therapy and hypnosis, focusing on everything that is not the trauma. The

situation has got better with regards to accountability, but a PMSC can be started up easily by a couple of

mates in the bar of a special forces garrison town and next thing you know, they’re deploying dozens of

guys into harm’s way with little regard to the psychological well-being. He rated acclimatisation

stopovers prior to going into a hostile environment as a good place for training and where operators could

prepare themselves psychologically for any challenges that lay ahead. Steroid abuse he felt was a

problem and that he did not see a large issue with drug taking in theatre. He knew that some service

members lied on their mental health assessments due to a fear of being stigmatised. He said that a PTE

could trigger negative emotions that have been locked up since early childhood, when typically memories

are locked in what is known as childhood amnesia, these can develop into PTSD and these exaggerated

emotions drive the symptoms in some cases. His charity’s interventions work to neutralise these

memories by changing the perspectives on how they are viewed and dispelling these unwanted negative

emotions. These types of therapy he thought could be used to build resilience by them being delivered to

operators before they are exposed to PTEs and has also lead to people experiencing PTG in his opinion.

He felt psychological problems could surface later as many operators migrate back into a civilian

lifestyle.



4.4.4 Interview with “D”

”D” was questioned in his capacity as a leading military psychiatrist who now works with PMSCs having

written many papers on mental health care in relation to these areas. Some operators join PMSCs, as

links to military service are strong and they enjoy that lifestyle as it is familiar to them, to some they are

doing this as opposed to establishing a civilian life. These people are high risk in developing mental

health issues. However, he felt it must be stated strongly that most in the industry are doing it for the

right reason, but a minority can have a disproportionate effect on the image of the industry. Although the

salaries are good, it can be unhealthy in some circumstances if this becomes the main driver, ignoring the

risks totally instead of building a stable civilian life. He also highlighted that PMSC levels of care were

completely random, in that some pay lip service to it, and operators potentially find themselves in the

aftermath of a PTE without the same support that was on offer in the military. On accountability he is

involved in drafting guidelines for organisations that place people in harm’s way which recommends

basic screening and vetting, early detection, peer support and team leaders that are trained to spot warning

signs. Fast track treatment is imperative to the few that need it. He felt that companies should re-employ

operators after therapy as PTSD or other mental issues can be treated and they can return to a normal

working life. For psychological first aid, he thought it very important that early peer led support

immediately after and social support were available. There were some differences between the sub

groups with maritime seeking boredom avoidance and a good team spirit, seen as very important.

Training for good individual residence and a well-led team that are trauma aware was key. On

acclimatisation stopover, he thought they were good for forging a cohesive team and receiving important

briefings, but not as important as decompression stopovers exiting theatre. He feels operators should not

go straight back to family, and a stopover of 24hrs for a few beers or other relaxation is a good thing. On

routine he talks about the importance of individuals finding their own body rhythm as an important

coping mechanism which is the best way to switch the mind away from the daily stresses. There was a

definite need for better due diligence through risk assessing and vetting in order to stop a tragic event

such as an unstable operator being allowed into a hostile environment with access to weapons, especially

where alcohol was freely available.

4.5 Summary

The surveys have been well supported by members of the PMSC industry and the data returned has

revealed findings that give added substance to some of the current theories researched and being used for



discussion and analysis. These findings were further debated during the informative qualitative

interviews with nominated key industry figures. The results in some cases are emphatic and demonstrate

the importance of this subject and its bearing on individuals operating in hostile environments. The

revealing data confirms, but also reveal many interesting trends, these along with the key points drawn

from the interviews are critically analysed in the following Discussions section at Chapter 5.

Work-based Dissertation and Research Discussions Chapter


DISCUSSIONS

5.1 Introduction

This chapter builds on the data drawn together throughout this research. It critically analyses the findings

from qualitative and quantitative surveys, offers observations on what has been learnt based on the

research undertaken. The Discussions are presented in a cohesive narrative that provides context to the

study by linking the various threads and considering their value. Using the primary data of the surveys it

initially provides an interpretation of the answers using statistical data presented to highlight the key

points. The chapter then continues to offer explanation on what the significant and memorable findings

are and discusses what is believed to account for these outcomes, why they are important and the

implications for the future use in improving the approach to mental health within PMSCs. Additionally it

will review any perceived negatives from the research outcomes, where the results were not in line with

anticipated answers.

5.2 Review of Methodology

Limited previous research into the specific study area meant that material surrounding the topic was

explored in-depth for the Literature Review which provided sound background material into some of the

broader themes. The study set out to gather feedback and data that could be utilised to gauge the level of

the care available and its effectiveness. Initially it examined the stressors faced by PMSCs, collated their

most commonly used coping measures and evaluated them. The approach of using social media in

reaching out to the target audience proved to be an effective platform for distribution of the surveys.

Overall from the 459 that started the surveys 42.5% dropped out. There were drop outs at each question,

with a higher rate for the questions that took more thought and time. There were no significant dropouts

when the survey questions started enquiring about mental health, this was anticipated but did not

materialise. The interviews proved extremely useful in confirming, adding detail and clarification on

several points.



5.3 Summary of the Research Questions and Objectives

The fundamental questions raised for the purpose of this research which are critically analysed in this

chapter are:

What level of care is currently available in this employment arena, and is it adequate?

What are the unique stressors that PMSCs face in their operating environment and what are the

best coping strategies?

How could mitigation, coping strategies, interventions and therapies be improved?

5.4 Key Findings of the Study Results

The main findings from the research undertaken revealed:

The importance of a requirement for mental health support was highly recognised in the survey

feedback with 71.6% of operators stating that it was a (very) important issue. However a

noticeably lower amount 51.7% of management stated that it was.

There was found to be wide discrepancy among the responding companies for the provision of

mental health care provision, with 22% of them having “nothing at all”, the same percentage

having a “Company appointed therapist”, and only 11% having “a full psychological support

program”.

The issue of the topic being stigmatised still exists. Tellingly the majority 80% were either not

sure, or felt it (very) likely, that their positions would be at risk if their employer knew they

required some form of mental health therapy.

Peer support is highly regarded by operators with 57.2% stating that they would wish to “Speak

to a mate about it” in the aftermath of a traumatic event. However 20.2% claimed they would do

nothing as “They could handle the trauma”, with only 15.6% stating they would consider

speaking to a therapist.

Internet communications, shorter rotations and decent living standards in theatre were ranked by

operators as the highest priority to counter stress. Long term support networks, post incident

psychological de-briefing and on task support regarded as the lowest according to survey

responses.



Over half of the companies surveyed (51%) were not a signatory to any code of conduct or best

practice, which has raised the question of accountability for their employees’ issues.

There were many revealing and informative comments submitted by members of the PMSC

industry which have contributed towards this research. An example of the mindset that exists,

which is a barrier to seeking therapy is offered by Respondent O/287;

“The macho culture found in these environments deters people from speaking out about mental

health issues. We've all seen people who are clearly suffering mental anguish, yet they are

allowed to continue operating”

The major findings are assessed in greater detail throughout this chapter together with all of the other

significance points.

5.5 Appraisal of the Survey’s Background Data

In the following section the findings are analysed and discussed in the order that the questions were

posed. The volume of operators having less than eight years’ experience (60.5%) most likely reflects the

industry “boom” years where both Afghanistan and Iraq post-conflict related security tasks were at their

height. Alternately it could indicate that levels of burn-out are high, and working in these environments is

time-limited and potentially has a “shelf-life”. It should be also noted here that some previous operators

will have moved into management roles within PMSCs (Interviewee C). The percentage of operators that

had previously served in the military was very high (89.4%) and confirmed previous expectations. The

transition to civilian life can be difficult for some ex-servicemen (Interviewee D). However, many

operators feel comfortable taking up a PMSC role after leaving the military, as it is where their skills and

backgrounds are recognised among their peers, where a similar culture, mindset and language exist

(Dunigan et al, 2013).



Figure 5.1: Length of time companies have been established.

As discussed, the majority of companies surveyed and shown in Figure 5.1 were found to be relatively

young which seems to coincide with a peak of the post-conflict Iraq war era.

Figure 5.2: Number of operators that each company had.

The data displayed in Figure 5.1 denotes that half of the companies had fewer than 20 operators. This

combined with the information from Figure 5.2 shows that many were also small organisations; perhaps

meaning that they would not have necessarily invested in a PRM strategy. This point was also stressed in

Interviews B and C.

Figure 5.3: All respondents on whether mental health care should be a contractual obligation.

5

17

28

13

5 6

0%

5%

10%

15%

20%

25%

30%

35%

40%

Under 2years

2 to 5years

5 to 10years

10 to 20years

20 to 40years

Over 40years

Total responses 74

1413

18

65

9

4

1

7

0%

5%

10%

15%

20%

25%

Under5

6 to 10 11 to20

21 to40

41 to80

81 to150

151 to300

301 to500

Over500

Total responses 74



Operators and management have similar thoughts as to whether PMSCs should be contractually obliged

to provide mental health support. This is raised by Respondent O/214;

“Changes in contracts would help, as every day demands all have varying degrees of stress

levels - which contribute to anxiety, depression and loneliness.

5.6 Discussions on Research Question One:

Is the current level of mental health care adequate and what is the existing mindset towards

it?

Observations on attitudes towards mental health care are that in recent years there has been a greater

societal acceptance of the issues (Angermeyer, 2006). This has filtered through to the military who are

now implementing PRM programs (Interviewee D), but as the survey data reveals, levels of care in

PMSCs remain inconsistent at this stage. Sizeable differences exist with 21.9% of companies having

“Nothing at All” which is twice as many of those who had “A full psychological support program”; that

said, 21.9% also had a “A company appointed therapist”. Only seven (10.9%) of companies surveyed

have a full support program, this highlights the industry’s deficiency in this area and lack of consistency

and was also raised on by Interviewee B. Interviewee A makes the observation that social media sites

reveal a “Mindset” and “Group think” that is still to fully and openly embrace mental health care without

fear of embarrassment or associated stigma. This is reinforced through comments offered throughout the

survey.

26%

35%

22%

11%

7%

37%

31%

20%

8%

4%

0%

10%

20%

30%

40%

Yes,definitely

Yes Maybe Not Really No, Not atall

Total Responses 270

Management

Operators



Respondent O/169 uses many expletives to reinforce his opinions, which are as valid as the others.

“There is no info that can help the layman work out which headshrinkers are gen (sic) and which ones

are bluffing/useless/wankers/eejits (sic). Fucking lunacy”

Figure 5.4: Current procedures that PMSCs surveyed have in place for mental health support.

A linguistic text analysis of all of the responses from both surveys produced key words that would be

expected to be prominent in discussions on mental health, but two words that stood out as being

repeatedly used were “Support” and “Value”. The significance of this can be interpreted that operators

value support highly. An example from Respondent O/232;

“Solid team support”

21.9%

46.9%

18.8%

48.4%

18.8%

46.9%

21.9%

10.9%Total responses 64 Nothing at all 14

Training to recognise symptoms ofstress 30

Decompression stopover leaving theatre12

Good life support & living conditions31

Acclimatisation stopover enteringtheatre 12

Mental health screening/Vetting 30

A company appointed therapist 14

A full psychological support program 7



Figure 5.5: How importantly PMSCs rate mental health care in the role.

There was very little difference between the operators and management response in data presented in

Figure 5.5 showing that three quarters of responders believe strongly that mental health care is either

“Important” or “Very Important” which is fairly emphatic. However, 7.2% of operators and 13.3% of

management replied “Not at all”, which again reflects the negative approach towards mental health from

some quarters of the industry. The graph at Figure 5.5 shows data clearly weighted towards claims from

company management on the emphasis they put on the mental health of their employees. This is not

really backed up by investment or positive actions, as demonstrated in Figure 5.4 and points made

strongly in all of the feedback.

Table 5.A: Operators’ perception on whether there has been an improvement in mental health care

within PMSCs.

Opinion Percentage Operators

No 30.5% 74

Not sure 47.7% 116

Yes 21.8% 53

Total responses 243

The answers in Table 5.A are inconclusive and show that the perceptions remain mixed and at best are

unclear.

8%10%

12%

30%

39%

13%15%

20%

25%27%

0%

10%

20%

30%

40%

50%

Not at all Somewhat Moderately Important V. Important

Total responses 310

Operators

Management



Table 5.B: The perception from operators on whether their positions would be at risk, if they

sought mental health support.

Opinion Percentage Operators

Very likely 31.6% 79

Likely 28.4% 71

Not sure 26.0% 65

Unlikely 7.2% 18

Very unlikely 6.8% 17

Total responses 250

The results from this question shown at Table 5.B. are remarkable, revealing the level of work that is

required for operators to have confidence in asking for support without a fear of losing their position.

This was also a major issue raised by all Interviewee’s, that the current mindset is a significant barrier for

improving the level of mental health care within the industry. It is reinforced in comments posted in the

survey; a lack of CSR from PMSCs is raised by Respondent O/116;

“I think that the concept of contract working is the key problem. Drop anything about mental

health and you are on your own. There is no responsibility from the org/comp to care for ex -

employees. In and out policy, human merchandise”

Respondent O/250;

“As a result of a bombing I have occasional nightmares. Alas I cannot go to the Dr as

it would affect my employability, so like everyone else we soldier on”

5.7 Discussions on Research Question Two:

What are the unique stressors that PMSCs face in their operating environment and what are

the best coping strategies?

As concluded in the Literature Review, Maslow’s theory highlights that many of the basic human needs

are not met or satisfied while operating in a hostile environment and these added stressors could have an

effect on PMSCs mental health (Maslow et al 1998). This was commented on by Interviewee A, who

stated;



“Even the smallest issue can be amplified when working in a war-zone”.

The theme is also raised by Respondent O/294, who points to the welfare of maritime operators;

“Diet and nutrition contribute to and mental well-being - my experience working in maritime

security has been that dietary considerations are not covered in contracts and food on ships is

often lacking serious nutritional value. Protein levels especially, help to maintain good levels of

mental and physical awareness; this leaves operators at risk of losing focus and ability to

function properly in high-stress situations”

Table 5C: Priorities that operators deemed were important for mental well-being.

Rank Answer option Score

1 Internet communications (Skype™/Facebook™) with

friends and family 5.42

2 Shorter rotations in theatre 5.14


4 Training to recognise symptoms in yourself and others 4.54

5 De-compression stopover leaving theatre 4.25

6 A long term support network 4.07



Total responses 227

On the question of ranking the eight choices in order of priority to personal mental health well-being

Table 5.C shows an interesting first was “Internet communications (Skype™/Facebook™) with friends

and family”. This highlights the importance for communications, either to loved ones at home, with

friends or groups of like-minded individuals to those working in the industry. Social media has been a

great advance for operators within PMSCs, as it offers instant communication, a sense of belonging and a

comfort zone where operators can freely air their views with peers; forming an effective social support

network. However, what happens if individuals become overly reliant on it, could they suffer withdrawal

symptoms? For example, a maritime operator may often find him/herself on a convoy in the Indian

Ocean for several weeks without an internet connection, whereas, before he/she had been in constant

communications with their support network several times a day. The effects of this would vary

depending on the individual, but are an unknown quantity that may warrant further study. The second



placed result of “Shorter Rotations in Theatre” which as Interviewee C stated should be top based purely

on the high risk of working in this industry, as less time exposed to dangers diminishes the risk, and

therefore the stressor. However this would be opposed to an operators desire to earn money. Decent life

support and living conditions were the third choice. When operating in hostile environments these can

make the task more manageable from a stress level point of view according to Interviewee B. The

remaining answers ranked as expected.

Figure 5.6: Operators most commonly used coping methods following a PTE.

1) The highest answer of “Speak to a mate about it” (57.2%) was significant as it highlights the key

requirement of the “rapport” that is needed when individuals are discussing their own personal

matters. Interviewee C rates rapport as being a major factor for his charity’s interventions to be

effective.

2) “Try to keep to my routine” was second (53.1%) and was echoed by Interviewee A who repeated

that post incident he would try to “crack on as normal” meaning sticking to a routine as a way of

coping and maintaining a sense of normality.

3) A high number (41.6%) entered “Spend time alone in reflection”. This is widely recognised by

mental health professionals Whealin et al, (2008) and commented on by Interviewee C that it is

beneficial to have issues brought out in any way possible rather than being bottled up.

25.1%

39.5%

9.1%

39.1%

9.9%

14.4%57.2%15.6%

53.1%

41.6%

20.2%

Total responses 243 (multiple answers permitted) Drink alcohol 61

Do some sport 96

Prayer or religious act 22

Speak to a loved one 95

Watch TV 24

Read a book 35

Speak to a mate about it 139

Speak to a therapist 38

Try to keep my routine 129

Spend time alone in reflection101Nothing, I could handle thetrauma 49



4) Engaging in physical activity was also rated highly (39.5%). The benefits of this to counter stress

are well known (Scully et al, 1998), but with caution on operators who maybe prone to steroid

abuse and the phenomenon known as “roid rage” where steroid abusers have been known to

display signs of aggression. This issue was also highlighted as a problem by in interviews A, B

and D.

5) “Speak to a loved one about it” (39.1%) reinforces the advantages of social media and recent

year’s technological advances such as Skype™; again it promotes communicating with someone

with whom the operator already has a rapport.

6) Drinking alcohol (25.1%) was a high percentage and a figure that was expected, as most

operators come from the military which has a culture of drinking (Interviewee A). This in itself is

not necessarily a maladjusted coping strategy, and can be viewed positively as a way of

unwinding and relieving tension unless done repeatedly and excessively.

7) A larger than expected (20.2%) replied that they “could handle the trauma”. This is a significant

and interesting outcome. It would warrant further enquiry should an individual answer this on a

pre-employment questionnaire for example.

8) Only 15.6% said they would consider speaking to a therapist, which shows the level of reluctance

towards seeking mental health care that exists.

9) Reading a book was not a surprisingly high choice at 14.4%.

10) Watching TV was a low response at 9.9%. This and playing video games of an evening is

probably considered as a routine stress coping/boredom relieving strategy, more than a reaction to

a traumatic experience.

11) Prayer or other religious act was a slightly higher figure than anticipated at 9.1%.

The 14 “Other” entries ranged from practicing martial arts to pursuing prostitutes; this is a known

maladjusted coping strategy. None of the respondents entered drug use during the survey, which

was surprising as Interviewees A and C claimed that a number of operators used recreational

drugs as a coping strategy while on leave. Many PMSCs on US contracts have to conduct

mandatory drug testing; this is not the case on other tasks (Interviewee B). Maladjusted coping

was raised in Interview C “Living on the edge and being addicted to adrenaline, some guys’ need

fixes, which leads to risk taking and this had become their new norm”



5.8 Discussions on Research Question Three:

How could mitigations, coping strategies, interventions and therapies be enhanced?

Respondent O/024 believes that recruitment issues increase PMSCs risk;

“Risk mitigation in recruitment for task by companies needs to be better”

Discrete counseling is put forward by Respondent O/031;

”Guys need to know that they can go for mental health support and that no one knows that have

done this”

Respondent O/094 also provides opinion of what is required;

“Recommend approach based on life coaching and mindfulness training modalities, which

focus on present and future (rather than past) and avoid mental health treatment stigma”

Respondent O/118 highlights the need for a strong rapport with those who are offering therapy;

“Get GP’s and phyciatist (sic) to have a better understanding of ex-military and the issues they

have encountered and are suffering”

Respondent O/132 mentions the need for operators to have a certain level of resilience, but also

recognises a need for appropriate levels of care;

“This industry is operated and supported by risk takers. If too much emphasis is placed on

feelings and well-being, the atmosphere will change. We are here because we choose to be and

many of us feel as though we belong here. I feel that being rough and tough is better than being

psychologically coddled. With that said, if someone needs help, it should be quickly identified

by one's self and his team mates and assistance rendered ASAP”

Confidential support is also highlighted by Respondent O/284;

“Mental healthcare would be more warmly considered by people in this industry if the

services offered were discrete and undocumented or anonymous”

Respondent O/291 points to better recognition to mental health issues;



“Lack of training in combat stress by medical staff, needs to be rectified”

There should also be realisation that this is a risky task, without over traumatisation. Interviewee C

recalls;

“That a proposed contractor pulled out at the joining phase when asked to provide DNA,

proof of life questions and next of kin details which is routine in case of death or being taken

hostage. This is a form of natural selection and for those who withdrew the task was not for

them”

5.8.1 Accountability

CSR obligations for those companies that employ operators in hostile environments should have greater

gravity according to Interviewee B and Respondent O/214;

“Companies have an obligation to monitor the welfare of their work-force and not just take it for

granted, that all ex-military are robots”

Figure 5.7: Signatory documents that companies are affiliated to. (Multiple responses permitted,

except the “None” option)

The survey statistics shown at Figure 5.7 reveal that over half the management responders stated that their

companies were not signatory to any of the above documents and this raises questions of accountability.

If companies were signatory, as is mandatory for PMSCs wishing to tender for contracts with the US

Government for example (Interviewee A) they are then eligible to be audited and to demonstrate

35

30

1417

11

0%

10%

20%

30%

40%

50%

60%

None ICoC Code TheMontreuxDocument

ISO:28007Maritime

ASISStandard

Total responses 69



compliancy in all areas, including the provision for mental health well-being. Interviewee D is involved

with drafting mental health advice for the next version of ISO:28007. Awareness of the issues is raised

by Respondent M/033 who states;

“This topic and survey is necessary to share with international organisations that work in the

same area”

Interviewee A makes the claim that;

“Some companies pay lip service to these standards and merely see them as adding a kite mark

of credibility in order to strengthen their corporate image”

As covered in the Literature Review the above agreements can also be strengthened with regard to mental

health care provision.

Figure 5.8: Operators who perceived that their position would be at risk if they sought mental

health therapy.

This statistic strongly reinforces the theory that operators seeking mental health support are in real fear of

losing their employment by admitting perceived weaknesses. The current situation serves to drive the

problem underground where individuals will refuse to admit a problem. Companies must be persuaded

that seeking therapy should not jeopardise an employee’s position, rather a way of avoiding future risk.

So although as highlighted in Figure 5.1 there is recognition by all in the industry that mental health is of

79

7165

18 17

0%

5%

10%

15%

20%

25%

30%

35%

Very likely Likely Not sure Unlikely Veryunlikely

Total responses 250



importance, there is an anomaly with the data displayed, that at best operators who sought therapy would

be “Not Sure” or feel “(very) likely” that they would lose their position of employment.

Table 5.D: The number of responding operators who stated that they had received mental health

support.

Answer Percentage Operators

Yes 16.4% 41

No 84.0% 210

Total responses 251

A slightly higher than expected proportion of operators (16.4%) said that they had received mental health

support. It is not known if this figure is inflated by those who had suffered issues being drawn to the

survey which was entitled “Psychosocial Risk Management and the PMSC Industry”, equally, however, a

number could have ignored the survey and avoided the subject. Of the 41 that replied “Yes”, 31 entered

data in the text box, which asked them to state what type of care they had received. Of note was

Respondent O/124, who claimed he was obligated to receive treatment after an incident, indicating that

he felt he didn’t need it, perhaps touching on the associated stigma;

“Was compulsory, didn't ask for it”.

Respondent O/159 alludes to seeking support of his own accord;

“My own therapist”

Also does Respondent, O/212;

“Privately secured psychoanalysis”

And Respondent O/284;

“Discrete counseling services”

It is not stated exactly why the above respondents sought treatment in this way, but “Interviewee D”

stated that his charity regularly treats PMSC operators discretely without the knowledge of their

employers for fear of embarrassment or losing their position.



5.8.2 Training/Recruitment

These mitigating actions are all areas for improvements that can be made as was commented on in survey

feedback. The opinion of Respondent M/014 is;

“Some people that are supposedly trained to assess people are questionable. I have found

from experience and this part of the process needs stronger critical analysis”

Respondent O/079 highlights this requirement;

“There should definitely be more than a short power point on stress management at induction!!!”

5.9 Summary of Major Findings

This research used Skype™ effectively to conduct the interviews, which due to geographical locations of

interviewees was a practical and workable solution. Recent news reports point to trials that are being

under taken using that method for some Doctors appointments (Sky News, 2014) and there already exists

smart phone apps for mental health interventions and therapies (National Clinical Director of Mental

Health, 2014). Today’s younger generation are developing their cognitive behaviour and communication

skills through social media, although research suggests that human rapport and interaction are a preferred

option. Does the future lie here? For example, would it be suitable to provide an operator with therapy

using this method, especially if he were in a remote or hostile area of the world. The overriding factors

that are highlighted in the research are stigma, accountability and fiscal constraints, which are covered in

the following Conclusions and Recommendations Chapter.

Work-based Dissertation and Research Conclusions and Recommendations


CONCLUSIONS AND RECOMMENDATIONS

6.1 Introduction

This final chapter incorporates the key findings identified within this study and presents the

conclusions and recommendations to it. Interpretation of the accumulated evidence is offered in all of

the research areas. The conclusions reflect all of the key points that were raised from the literature

review, the survey data and feedback and the interviews from key individuals. They focus on the

prime aim of the research which was to identify the level of mental health care available within the

industry, the existing mindset towards it and to make suggestions for consideration based on the

outcomes.

The conclusions initially comment on mitigations that could be implemented to negate or reduce the

risk of mental health issues to PMSC operators. Following this it proceeds to highlight coping

strategies and measures that can be employed to lessen the impact of stressors. Finally it will

comment on interventions and engagements that can be initiated as response to a PTE. Some of the

recommendations offered may take a lengthy timescale and require fiscal commitment; others require

no financing and can be implanted swiftly. Recommendations for improvement are made throughout

this chapter and are presented in a matrix at the end which takes into account resources required such

as costs, timeframes, responsibilities for adaptation and their likely effect.

6.2 Comparative Analysis of Existing Studies

The relatively few studies and available theories into this specific subject area have all highlighted the

issue of stigma as being a significant barrier to receiving mental health support. They all centred on

military combat and its effects on mental health, as the vast majority of operators have previous

experience there. These analyse the possible numbers of those likely to be effected by PTSD and its

bearing towards PMSCs (Christian-Miller, 2010) (Greenberg, 2012), (Isenberg, 2012), (Dunigan et al,

2013). This study differs in that it takes a deeper assessment of the cause rather than the effect of the

key issues, analysing a deeper understanding of the attitudes that are held by members of the industry

towards the subject. It has examined the key overriding factors that have a bearing on this subject

matter which are; stigma, fiscal considerations, and accountability. It has also served to provide a

deeper understanding of the attitudes that are held within PMSCs towards mental health which is key

to providing future solutions to the issue.



6.3 Mitigations

These are all actions that can be considered by organisations, companies and operators prior to any

deployment to negate or lessen the impact of stressors or potential trauma. These numerous

mitigations can reduce the risk of stress, should all be considered on merit and incorporated into a

PMSC’s risk assessment. Many of these mitigating actions echo the adage that “prevention is the best

cure”.

6.3.1 Awareness

Societal attitudes towards mental health have improved in recent years and the anonymous survey

carried out for this study reveals that the majority of operators and companies within the PMSC

industry hold it in high regard. However, it will take some time before greater understanding and a

full acceptance of its importance and the role it plays in organisational resilience is fully appreciated.

Learning how to recognise potential stressors, the symptoms of mental health issues, how to develop

effective coping strategies and where to find support if required, should all be promoted by industry

led initiators. The culture, mindset and “Group think” that exist within certain areas of the industry

are still strong barriers to seeking care and warrant further efforts to educate and make operators

aware. For example, a worrying 20% of operators claimed they “could handle the trauma” after an

incident. Much more is required to educate and overcome the stigma or embarrassment that plagues

the issue of mental health care.

6.3.2 Accountability

A PMSC can be started easily, that said some of these companies have gone on to be established and

reputable organisations. This research revealed that many of these companies are young and

relatively small, and in addition to this, over half of the companies were not signatory to any form of

guidelines or best practice mandates. They had little or no accountability and scant incentive to cater

for mental health care, as they compete with rival companies for lucrative contracts. Greater

accountability by PMSCs would help to advance levels of care; these improvements should be driven

by greater accountability by those clients issuing the contracts to PMSCs. Contracting Governments

have a responsibility when issuing contracts and a duty to the psychological care of operators that

they deploy to hostile environments. Auditing by the vendors who award contracts to PMSCs in the

conflict zones, should confirm that they are providing appropriate levels of mental health support to

their staff. Stronger emphasis should be given to support in all of the commonly subscribed best

practice guidelines and mandates. Companies should state to their operators, that if seeking help they

would not be in jeopardy of losing their position and offer a route to counseling and therapy even if

done discretely, without the company’s knowledge if desired. It should be a contractual commitment

that any contractor asking or receiving psychological support would not have their employment



terminated. The duty of care should also be extended for a reasonable length of time into the future

and offer a route to counseling or therapy which again could be received without the company’s

knowledge if required. It is easy to see that accountability and PRM programs are low priority for

PMSCs as they chase contracts, therefore as mentioned, those issuing the contracts are key to the

solution in regards to accountability. Insurance companies could also improve their CSR by

providing more comprehensive cover for mental health and offering incentives and better premiums to

companies that have full PRM programs.

6.3.3 Recruitment and Vetting

The role of a PMSC operator can be an arduous and fraught with challenging circumstances, but is

offset by financial compensation, which can be lucrative. There is a distinctive tier structure based on

the quality of operator which has a direct link to the quality of person and pay scales. As budgets

become more competitive with many companies in the market place vying for contracts, so pressure is

put on the standard of recruitment. With 90% of operators having previously served with a military,

there is also a high chance many will already have experienced combat and been exposed to PTEs,

therefore some operators may already present symptoms of PTSD or other mental health issues.

Operators have to be fit for purpose to conduct the task at hand and vetting is often conducted through

word of mouth with a management member either personally knowing the operator from their ex-

military unit or speaking to a friend that has. This can have its advantages, but serious consideration

should also be given to a more formal procedure to cover criminal record checks and a higher level of

due diligence. Even the larger companies treat vetting and background checks as a very low priority,

especially when in a rush to recruit and mobilise a large volume of operators in a compressed time

frame to satisfy contractual obligations. Some form of screening on attitudes towards mental health

and coping strategies should be sought during any recruitment for PMSC work. For example the 20%

of responders that answered “Nothing, I could handle the trauma” would warrant further scrutiny as to

their suitability to operate in a hostile environment. Another observation was that operators fall into a

category of being risk takers, they are fairly well paid and do a high-pressure job and would therefore

it could be argued fall into a category of being more susceptible to recreational drug abuse.

6.3.4 Training/Briefing

Many of the survey responses on training pointed to a requirement for improvement in these areas.

Ideally the minimum baseline that PMSC should implement is a lecture on recognising the symptoms

of stress, how to develop coping strategies and routes to where further care could be found if required.

At the very least, a hand out or email sent to operators with this basic information at time of

mobilisation is desirable. Further training should also be considered for those who have been

identified to inform NoK of bereavement of a team member, as the stressors placed on these would be



greater. It is critical that it is made clear, that independent and wholly confidential treatment

pathways on any mental care concerns should be made available to operators to ensure that they are

not dissuaded from requesting help. This can be conducted in conjunction with an acclimatisation

stop over prior to deployment.

6.3.5 Acclimatisation Stopover

Preparing one’s self mentally prior to deploying into a hostile environment gives an operator time to

focus, for PMSCs that are well-structured and have their own facilities this can be the place where

PRM briefing and training takes place prior to deployment. These periods are advantageous in

gearing up and preparing an operator mentally prior to deployment. It can be an important

psychological stepping-stone prior to entering the hostile environment, in a similar fashion that first

responders to tragic incidents steel and prepare themselves to a PTE.

6.4 Coping Strategies

These are measures that will either improve quality of life while deployed, lessen the effect of daily

stressors, counter “burn out” symptoms, or act as a “shock absorber” to a PTE. This study has

highlighted that coping strategies are uniquely individual, personally chosen by each operator. They

must want to engage with these strategies in the same way that therapy cannot be imposed on

operators or they may simply reject it. The coping strategies vary widely from meditation, artwork

and yoga to the maladjusted coping strategies of pursuing prostitutes, excessive alcoholic drinking or

even narcotics abuse. Maladjusted coping/reactions to stress maybe difficult to police, except in the

case of drug and alcohol testing, but at least education should be available on their negative effects

and to where support can be found on these addictions.

6.4.1 Teamwork

A sense of belonging is a basic human need which can be more acute while in a hostile environment,

as survey feedback identifies a sense of belonging are high on many operators priority, it is important

as a coping mechanism and PMSCs should promote an “Esprit De Corps”. There are many small and

inexpensive or free steps that PMSCs can do to give their operators a sense of belonging, for example

a lottery syndicate or a regular team sport.

6.4.2 Manageable Rotations in Theatre

There is a juxtapose position between a desire for financial gain for operators and exposure to the risk.

This is recognised by companies and operators alike, those on flat salaries throughout a calendar year

do not have the temptation for unreasonable long periods in hostile environments. Salaried rather



than a daily rate of pay would take away the temptation of operators to spend longer in theatre for

financial gain. This may be controversial and difficult to facilitate, but should be considered by all

PMSCs and policy makers. In a similar fashion that it is important for operators to relax and de-stress

on a daily basis, prolonged periods exposed to the stresses of a hostile environment may ultimately

lead to burn out or other psychological issues.

6.4.3 Life Support

Good living conditions and support including food, sleeping and washing facilities are important in

hostile environments. This is a controllable anti-stressor that can be achieved with some thought and

moderate costs to PMSCs. By providing the best living conditions and food available this can soften

the impact of other uncontrollable stressors. It would also have the effect of operators feeling valued

by their employer, which is another key point for improving morale and well-being overall.

6.4.4 Communications

It is clear that communicating as a coping strategy and or after a PTE is key. Good communications

with friends and family should be maintained during rotations in order to keep operators “grounded”.

Access to internet communications is an important means for operators to communicate and be

involved in much needed support networks.

6.4.5 Self-Development

This coping mechanism can take the form of learning a foreign language, undertaking an academic

program or learning a new skill. As well as being an effective boredom countermeasure, it has the

effect of empowering the operator by focusing on the future.

6.4.6 Support Networks

The revolution in social media has meant that support networks are readily available to operators who

have internet access, which is now becoming more available even to some of the remotest corners of

the globe. It can offer instant connection to like-minded people, a sense of belonging and camaraderie

which is key to many as a human instinct. However, a small minority of the internet groups observed

had a maladjusted mindset and septic environment where any form of mental health support was

deemed a weakness. Facebook™ and LinkedIn™ sites should be engaged with, as they are often

where new employment opportunities are advertised and are very well subscribed to.



6.4.7 Physical Exercise

The use of sports as a coping strategy is a good way for operators to fill time. The promotion of a

healthy body and mind should be promoted and PMSCs should make every effort to provide facility

for this. As part of a daily routine operators should engage in a form of physical training.

6.4.8 Routine and Normalisation

Keeping to a routine is something that many operators subscribed to and is endorsed. This included

simple things, such as sitting down to a Sunday dinner together, watching a home town local daily

news broadcast. Many of these small steps seem to contribute to improving quality of life and state of

mind while in a hostile environment and make an operator feel normal. Finding a body rhythm that

works for each individual is key as a coping strategy.

6.4.9 Decompression Stopovers Leaving Theatre

These pauses before heading onward, often to family at home can have a beneficial effect of

unwinding for an operator, rather than arriving back home to family in a hyper-vigilant state, which

can cause friction in those relationships.

6.5 Support

The following section addresses actions post event, either after a PTE, or on the presentation of PTSD

or other mental health symptoms.

6.5.1 Post Traumatic Incident Support

It is recognised that early interventions are advantageous; however, offering support during the

immediate aftermath of an incident can be overwhelming. This cannot be forced upon operators as it

may have the opposite effect and they may reject it. The provision of adequate mental health support

should be made available by PMSCs post incident to ensure that contractors and their family’s needs

in this area are met. Operators indicated that “Speaking to a mate” was highly rated in the aftermath

of a PTE. This type of rapport is key to any intervention and PMSCs should consider training up

operators so that they can be effectively delivered in theatre. This peer-led support system, where

those receiving the initial help and have a strong rapport is highly advantageous. Confidentiality was

also shown to be important to many operators, as barriers to care of embarrassment and related stigma

are still evident, discrete support services may be the best approach to use in these situations.



6.6 Horizon Scanning

The world 50 years ago had far different attitudes and fortunately there have been advances in how

health safety and CSR is applied in the work place, but there still requires a paradigm shift to allow all

barriers to mental health care to be removed and a greater acceptance of psychological support

without stigma. Looking into the future it is difficult to predict how technological advances may

affect the approach to mental health care, but today’s younger generations are growing up and

developing much of their cognitive behaviour and communications skills through social media.

Therefore it does follow that coping advice, interventions, counseling and therapies could be delivered

through this media. There already exists mobile phone apps that claim to aid in applying mental

health therapy and interventions; further research is required in their effectiveness and their

development. Mental health professionals should look into developing therapies that can be delivered

through these mediums.

Other recent technological advances of note that could have future bearing on PMSCs are recent

recommendations for UK Police Firearms Officers to deploy with body-worn video cameras for

accountability and evidence collection. It may be a while before this is made compulsory for all

PMSC operators, but future developments and calls for this type of accountability may introduce new

stressors for operators. Whilst already under extreme pressure and under certain life threatening

scenarios, they may now also find themselves with the added pressure that any recorded mistake

could end in a prison sentence in a far flung part of the globe.

6.7 Recommendations for Further Research

The use of social media as a support network for PMSCs.

The existence of mental health Apps for smart phones has come with the recent explosion of in the

use of social media (National Clinical Director of Mental Health, 2014). A worthwhile study would

be on its use a coping strategy, its influence and bearing on those that join groups. What happens if

people become overly reliant on it and cannot connect for a period of time?

The transition from PMSC contractor to civilian life.

There are numerous studies on the transition from the military into civilian life (Van Staden et al,

2007). (Frapwell-Cooke, 2010), (Buckman et al, 2011) (Blais et al, 2014). However, when

individuals migrate from the military to a PMSC they are in effect still in a military culture. Research

is required to study the effects after leaving a PMSC and moving into civilian life?



6.8 Matrix

The actions and initiatives shown in the matrix start with mitigations (green), coping strategies

(amber), followed by post PTE actions (red). In each of these sections, they are ranked in hierarchical

order taken from the outcomes and findings from this research. The responsibility, likely costs and

time to implement are all displayed, but naturally there a many variables in these factors. It is

important to bear in mind that each circumstance is unique and these points should be taken and

considered on a case-by-case basis, as each situation and coping strategies is very individualised.

Key:

M = PMSC Management $ = Negligible T = Immediate

O = Operator $,$ = Moderate T,T = Mid term

1 = Signatory Documents $,$,$ = Expensive T,T,T = Long term

2 = Contract Vendors

3 = Policy Makers Mitigations

4 = Mental Health Charities Coping Strategies

5 = Industry Organisations Post PTE Actions

6 = Insurance Companies

Example:

A decompression stopover ranks sixth as a coping strategy (Amber) that would be implemented by

PMSC management, (M) it would take minimal time to arrange (T), but would be costly ($,$,$).



Action Jurisdiction Costs Timeframe

A Full PRM Program M,2,6 $,$,$ T,T

Awareness M,1,2,3,4,5,6 $,$ T,T,T

Accountability M,2 $,$ T,T,T

Internet Communications M, $,$ T

Good Living Conditions M $,$,$ T,T

Training M,5 $ T,T

Contractual Changes M,2,6 $,$,$ T,T

Adequate Insurance M,2,3,6 $,$,$ T,T

Vetting M,2,5 $,$ T,T

Acclimatisation Stopover M,O $,$ T

NoK Bereavement Training M,O,4 $,$ T,T

Auditing M,1,2,3,5,6 $,$,$ T,T,T

Addiction Advice M,4,5 $ T

Narcotics Testing M,2,4 $,$,$ T,T

Social Support Groups M,O,4,5 $ T

Shorter Rotations M,O,1,2,3,5,6 $,$,$ T,T

Decent Life Support M,2 $,$,$ T,T

Physical Training O $ T

Good Food M,O $,$ T

Decompression Stopover M $,$,$ T

Routine and Normalisation O $ T

Esprit De Corps M,O,4,5 $ T,T

Daily Relaxation Period O $ T

Self-Development O $,$ T,T

Discrete Counselling Service M,4,5 $,$ T,T

Psychological First Aid M,O $,$ T,T

Incident Support M,O,2 $,$,$ T,T,T

24-Hour Help Line M, $,$ T,T,T

Psychological Follow Up M,2,3,6 $,$,$ T,T,T



6.9 Conclusion

This study has taken a broad look at the wider issues surrounding PMSCs and the psychological well-

being of its operators. The conclusions and recommendations are all inclusive and many may seem

obvious, common sense and may be already be in place. The human element is key to the success of

all organisation, these are put under the microscope for individuals in hostile environments due to the

role being undertaken. The wide use PMSCs is likely to continue, as more and more we see those

performing demanding roles that Governments cannot fulfill with their military’s alone. They are

likely to be under greater pressure to operate in more remote and seemingly lawless areas of the

world, often with broken infrastructure that occurs post-conflict. Ex-military personnel that dominate

these PMSCs bring skills such as; discipline, fitness and training, conveying many good qualities that

are conducive for operating in complex environments. However, this can be offset by a “Bravado”

culture, where asking for help in mental health matters is regarded as a weakness. There is no doubt

that the role can be tough, demanding and the industry must recruit operators that are resilient and fit

for purpose. Most operators can be open to long exposure to the risk, the associated stress and may

even experience traumatic incidents and continue to function perfectly well, leading a normal life.

Some will even experience Post-Traumatic Growth, but provision must be made for those who are in

need of psychological support. A key finding in this study was that a staggering proportion of

operators fear they would lose their position if they sought mental health therapy, yet both operators

and management recognise that this is a very important part of their role. The significant findings

from this study will contribute towards improved “Mental Health Support for PMSCs in the 21st

Century”.

Dissertation word count: 21,981



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Student 21200319 A - 2

APPENDICES

Appendix A: Methodology Flow Chart

Interview questions formulated

Interview A

conducted

Pilot survey

conducted

Survey questions formulated

Interview B

conducted

Literature review conducted

Discussions raised

Conclusions drawn

Recommendations formulated

Findings analyses

Management

survey added

Both Surveys conducted

Interview C

conducted

Interview B

conducted


Student 21200319 A - 3

A checklist should be completed for every research project which is used to identify whether a full application for

ethics approval needs to be submitted to your Faculty Ethics Committee.

1 Applicant details

Name of Researcher (applicant): Tim Bomberg 21200319

Module name and number: Work-based Research and dissertation – SF701

Name of Module Leader: Gavin BUTLER

Course: MSc in Business Continuity, Security and Emergency Management

2 Project details

Project title:

“Mental Health Support for Private Military Security Companies in the 21st Century”

Please provide a brief description of the project:

I will post some questions on some of these internet forums (stating exactly who I am and the research

reasons) to see if there is a willingness to discuss the topic of mental health, which can be associated with a

perceived stigma.

No individual or company names will be mentioned.

3 Research checklist (to check if more than minimal risk)

Appendix B: Research Ethics Checklist – Postgraduate Students


Student 21200319 A - 4

Please answer each question by checking the appropriate box:

YES NO

1. Does the study involve students within the University? X

2. Does the study involve employees of the University? X

3. Does the study involve participants who are particularly vulnerable or unable to give

informed consent: children, those with cognitive impairment?

X

4. Will the study require the co-operation of a gatekeeper for initial access to the

groups or individuals to be recruited? (e.g. students at school, members of self-help

group, residents of nursing home)

X

5. Will it be necessary for participants to take part in the study without their knowledge

and consent at the time? (e.g. covert observation of people in non-public places)

X

6. Will the study involve discussion of sensitive topics or illegal activity (e.g. sexual

activity, drug use)?

X

7. Are drugs, placebos or other substances (e.g. food substances, vitamins) to be

administered to the study participants or will the study involve invasive, intrusive or

potentially harmful procedures of any kind?

X

8. Will tissue samples (including blood) be obtained from participants? X

9. Is pain or more than mild discomfort likely to result from the study? X

10. Could the study induce psychological stress or anxiety or cause harm or negative

consequences beyond the risks encountered in normal life?

X

11. Will the study involve prolonged or repetitive testing? X

12. Will the research involve administrative or secure data that requires permission from

the appropriate authorities before use?

X

13. Is there a possibility that the safety of the researcher may be in question (e.g. in

international research: locally employed research assistants)?

X

14. Does the research involve members of the public in a research capacity (participant

research)

X

15. Will any of the research take place outside the UK? X

16. Will the research involve respondents to the internet or other visual/vocal methods

where respondents may be identified?

X

17. Will research involve the sharing of data or confidential information beyond the

initial consent given?

X

18. Will financial inducements (other than reasonable expenses and compensation for

time) be offered to participants?

X


Student 21200319 A - 5

Research that may need to be reviewed by NHS NRES Committee or an external

Ethics Committee

NA

19. Will the study involve recruitment of patients or staff through the NHS or the use of

NHS data or premises and/or equipment?

X

20. Does the study involve participants age 16 or over who are unable to give informed

consent? (E.g. people with learning disabilities: see Mental Capacity Act 2005). All

research that falls under the auspices of the MCA must be reviewed by NHS

NRES

X

If any item is checked then an application to your Faculty Research Ethics Committee is required.

Applicant:

Name (please print): Tim Bomberg

Signed:

Date:16th August 2013

Module Leader: Please check the appropriate boxes. Even if the student has answered ‘no’ to all questions in

Section 3, the study should not begin until all boxes have been checked and the form counter-signed.

The student has been made aware of the University’s Code of Good Research Practice and relevant

professional codes of conduct

The topic merits further research

The student has the skills to carry out the research

The participant information sheet or leaflet is appropriate (where applicable)

The procedures for recruitment and obtaining informed consent are appropriate (where applicable)

Comments from Module Leader: Gail Rowntree

I am happy to support Tim Bomberg in his research.


Student 21200319 A - 6

Gail A. Rowntree

Module Leader:

I confirm that work as described will be carried out in full conformity to all ethical standards and any

additional professional requirements.

Name (please print): Gavin BUTLER

Signed: [email protected]

Date: Dec, 2013

Module Leader to send completed form to the Research Unit ([email protected])

mailto:[email protected]


Student 21200319 A - 7

Appendix C: Screenshot of Survey Agreements

Operators Questionnaire Agreement

Management Questionnaire Agreement


Student 21200319 A - 8

Appendix D: Example of Interview Consent Form

Tim Bomberg

Saqr Port Authority

Government of Ras Al Khaimah

United Arab Emirates

PO Box 5130

[email protected]

Informed Consent Form

Title of Work: Mental Health Support for Private Military Companies in the 21st Century Name of Researcher: Tim Bomberg

1. I have read and understood the attached information sheet giving me the details of the study to be undertaken by Tim Bomberg

2. I have had the opportunity to ask Tim Bomberg any questions that I had about the research and my involvement in it, and I understand my role as a participant

3. My decision to take part (consent) is entirely voluntary and I understand that I am free to

withdraw at any time until 21st March 2014 without giving a reason or being penalised 4. I understand that data gathered in this study may form the basis of a report or other form

of publication or presentation in the future 5. I understand that my name will not be used in any subsequent literature, publication or

presentation, and that every effort will be made to protect my anonymity

Participant’s name (In Capitals ): Participant’s signature:

Name: Tim Bomberg Researcher’s signature:

Date: 1st March 2014

mailto:[email protected]


Student 21200319 A - 9

Appendix E: Authors Previous Experience and Reflections on PMSCs and

Mental Health Care

The author previously served in the British Army for fifteen years and subsequently went onto work

inside PMSCs in the position of a team leader with an armed mobile security team and later low profile

(covert) close protection duties. He also undertook a role as a United Nations Field Officer for the Iraqi

Referendum and Elections in a violent period of Iraq’s post-conflict era. He has trained as a master

practitioner with a UK mental health charity, which specialises in delivering interventions and therapy to

ex-service personnel and emergency first responders. His reflections are that he found the transition from

military to civilian life challenging at times and can see how some ex-servicemen find a cultural “comfort

zone” inside of PMSCs. Attitudes towards mental health in the military have changed for the better in

recent years, but this has yet to migrate into the commercial sector, namely PMSCs. The vast majority of

operators are professional and resilient and most recognise that spending too long in high-risk areas has a

detrimental effect on psychological well-being. He noted that coping strategies or boredom counter

measures were uniquely individual and that de-compression stopovers were highly recommended to stop

operators returning to families while still in a heightened state of vigilance or hyper-tension. On work

undertaken with the charity he noted that a key element to therapy being successful was for those seeking

it to have a strong rapport with those delivering it.


Student 21200319 A - 10

Appendix F: Further Comments Submitted by Survey Respondents

Management on what improvements can be made in the approach towards mental health with the

industry.

Respondent M/005;

Greater awareness

Respondent M/011;

“There is a lack of knowledge within the industry, therefore awareness and pre-employment

screening”

Respondent M/019;

“Yoga”

Respondent M/028;

“Monitoring and councilling (sic)”

Respondent M/029;

“It should be compulsory for extensive background checks, instead of using contractor supplied

referees. Often the symptoms of stress are undetectable with a test, and will only manifest in the

field”

Respondent M/037;

“Stronger vetting procedures”

Respondent M/039;

“Better pre and post-deployment screening, reference checking etc”

Respondent M/044;

“A company mental health chapter to be included in health and safety guidelines”

Respondent M/056;

“Training, increase awareness and access to counsellors”

Respondent M/069;

“The labour laws of countries individuals are contracted under need to be taken into

consideration when looking at this aspect”


Student 21200319 A - 11

Respondent M/080;

“International guidelines to support menthal (sic) health in risk works”

Respondent M/089;

“Pro-actively adressing (sic) the subject; most employees don't want to accept or recognize the

effect of their work on their mental health”

Respondent M/102;

“Support groups operated by people who have been there”

Respondent M/107;

“Proper assessments before starting work”

Additional Comments supplied at the end of the PMSC Surveys

Respondent O/322;

“Proper training prior to going to the high risk zones, people see £££ signs and go. You have

to think it through as it is enjoyable if you have a good team”

Respondent O/297;

We don't choose to be affected by trauma. It becomes part of us.

Respondent O/181;

“Many will not seek support for fear of being labelled (sic) and restricted from further

deployments. It's easier to 'suffer' alone if you want a career

Respondent O/160;

“PTSD happens to everyone in combat, time and distance help with most if not all the

symptoms”

Respondent O/152;

“Note the huge difference in aid between returning within a regiment structure, with mates and

shared experience and as an individual, with companies or TA returning alone.

The following was entered by Respondent O/005;

“Contracting companies should be made aware that this is a problem and that to simply replace

the contractor as you would a faulty piece on a car is not a solution”


Student 21200319 A - 12

Respondent M/079;

“On recruitment, the problem is most companies need to just fill posts, i.e. bums on seats and

vetting is done by word of mouth usually.

Respondent M/037;

“Medical insurance provided by companies to operators traditionally ceases when the operator

stops working for the company. Unfortunately symptoms of mental illness can appear after

employment ceases and the operator has no cover. Looking at this aspect would be of benefit

for operators, company reputations and society at large”


Student 21200319 A - 13

Appendix G: Transcript to Interview “B”

Interviewee B

Interviewer identified as R.

R & B - Ethics protocol and pre-amble…

R – I would like to interview you specifically with your views coming from a background of delivering training to

the United Nations on psychosocial risk management, their approach to it and how that differs with private military

security companies in your view. Okay?

B – Okay

R – I will start by asking you the questions to my research, which are general questions here. Is the current level of

healthcare adequate and what is the existing mind-set towards it and I am talking about private military security

companies rather than the UN there.

B – Okay if I can just start by telling you what I think was in place when I was Head of Security for the UN and then

compare it with what I believe was in place with both large and small security companies as of today. For example,

within the UN there is a Critical Incident Stress Management Unit. It was created in the year 2000 and the mandate

to that particular unit and its staff were given it by the UN resolutions, which addres s things like preventative and

critical incident stress management, the assessment of staff psychosocial needs and status, coordination with stress

management and training related activities and pre and post deployment training which are all part of UN

resolutions. You can look them up under the numbers if I can send them to you separately if you want, which are

quite formal mandate that the UN placed on this unit to look after the care and welfare of its staff and you can see it

covers quite a lot of things. The difficulty I think both medium and small private security companies have is they do

not have the assets in place. One: because they are quite costly, two: because it would have taken their eyes of what

the actual the contract they are trying to win and thus you end up with small teams and people who are probably not

as well supported from the psychosocial aspect as people who work for this really large organization with its world

wide deployment.

R – Okay so funding you think is a major. Funding and accountability you rather brushed on that as well.

B – One of the problems small companies have is they bid for a contract they don’t necessarily have the assets in

place to actually fulfil that contract until they are told yes it’s a go, this contract is a go and then they have two

weeks to get a bunch of guys together, guys and girls together to go and deploy them and to carry out the tasks.

That doesn’t allow those people gel into the teams that perhaps you and I were used to in the military i.e. you ’ve had

years of getting to know who you could trust and you can’t trust and that team building which is one of the

fundamental things of military uniform units and even to some extent in the UN where a lot of people know each

other over years, you’ve got a short notice getting together periods and thus there is probably more stress on the

individuals in those ad hoc teams that a company puts together than there is you know its maybe slightly different in

the larger companies who would tend to retain people longer and aren’t just doing it for the one contract, although

you and I both know that that is not necessarily the case that people are just thrown together for a six month

contract. That is one thing and the small companies just do not have the outle ts or the cash to be able to run, you

know a full time psychologist to do the interviews or to get the people in place. Those who are suffering from PTSD

and who have been screened and assessed.

R – Yes and but what about the people who are issuing the con tracts, does the solution or some of the answers lie

with them that they should be insisting that they’re getting the correct PRM in place?

B – The government organisations tend to take it slightly more seriously although even in the duty of care

documents that are issued by for example DFID (Department for International Development) it says nothing about

you know, the companies responsibility as of yet that I’m aware of, as of yet that you know, they have to have

certain things in place. Perhaps more pres sure should be put on donors, governments, UN for example itself. UN

issues contracts just for companies to do certain things in the security sector, when the elections come around

because they need to ramp up a hell of a lot of security people over a very short term.


Student 21200319 A - 14

R – Okay, interesting. Okay I’ll move on to the next question, and again your sort of views broadly on this and more

to do with private security companies in the UN. This is part of the research question. What are the unique stresses

that private military security companies’ face in their operating environment and what are the best coping strategies?

B – What I’ve learnt is, I’ve already alluded to in the first questions in that, you can deal with most things if you are

surrounded by a bunch of people on a daily basis that you know extremely well, that you know their families so that,

in companies it is isn’t like that. You arrive in your team from all parts of the world, you have no idea of the

backgrounds of the other people, and thus you are more inward looking rather than outward looking when you

actually go out and do a job and that places more stress on you, mentally, physically sometimes because you don’t

know whether you can rely on other members of the team. That changes over time of course but by that stage you

have been stressed to such an extent you may actually make duff decisions, because you are not quite sure what

everybody else in the team is going to do. That is a unique stressor I think, in private military security companies

and there is no large organization in some cases, to back you if something goes wrong. If you’re out in a fo ur man

team in a warehouse or somewhere or wherever it is, that’s it until you know, three four hours later if your company

comes and sends someone to get you out of there if your company once you come under attack. That must make a

difference. One of the best coping strategies, the best coping strategy I would suggest is that, there needs to be a

period of training, assessment to put the right teams together to put the right guys working with each other, to be

able to face up to those challenges.

R – Okay, very interesting. You are talking to us from Libya there, what are your sort of coping, I see you like to

watch the rugby, you like to fill the time. In some of these places, I guess boredom can be a stressor in itself, or

filling the time, or not taking your mind off external pressures.

B – Particularly at times when it is not advisable to go for a ride around time, we are certainly not capable of

walking the streets and things like that, we used to, but now people are being picked up at gunpoint alon g the street

fifty yards from our villa here. So you do tend to get cabin fever after a while and you know, twice a week you say

‘I have to get out of here, I have to go and do something’ and I totally agree with and I’ve, happily I’ve seen some of

the answers in the Libya survey is you need some sort of support externally and that includes the Skype, that

includes the communications with friends and family to those in place if only to vent at someone and then you can

know the shitty-ness of the weather or whatever it is or its either your partner, it’s your wife, it’s your girlfriend or

whatever and you need some sort of venting mechanism inside as well, but in very very small teams you really don’t

want to upset the balance and it’s all very well talking to a mate but he’s got to be a real mate.

R – Very interesting. The next research question which you probably answered most of it already, is how could

mitigations, coping strategies, interventions and therapies be enhanced?

B – The difficulty is, interventions have to be delivered by someone you trust. You have to have some sort of

training to recognize the signs. Now most of the guys and girls will recognize the signs of stress in each other and

as you well know in the uniform service people will rib each other mercilessly, endlessly in things like that and in

most cases that works. In some cases, it does not and in some cases the guy or girl really goes off the rail and he

goes tilt. The difficulty with small companies operating in these sort of environments when you’re in an oil field

300 miles off the coast, when you’re in an airplane once a week maybe, it’s quite hard to be able to intervene if

you’ve got someone who has gone tilt and your surrounded by three brigades of militias who prevent all mo vement,

what do you do in those cases? Very difficult problem.

R – Ok great. I am going to go on to some of the key findings from the research now, which I have shared with you

and get your views on them. The issue of stigma surrounding the topic still exists and tellingly, the majority of 80%

of operators were either not sure or found it very likely that their positions would be at risk if their employer knew

that they were seeking mental health therapy. That is quite a strong statistic there.

B – Which is why the work you are doing is really really important. The more that we talk about it, the more that

we force employers to consider it, the more that they’d understand that actually knowing you’ve got a problem is

80% of the solution, the easier it will be to address this problem and better the fears of the individuals who worry for

their jobs will be allayed, because if a guy recognizes he’s got a problem and needs to talk to someone about it, well

he’ll get bonus points for that. Even if he is not available for a month or so to do whatever it is that he needs to have

done, because he is actually seeking active treatment and treatment will make him a better person and operator at the

end.


Student 21200319 A - 15

R – Excellent, Okay. You’ve mentioned about teamwork and speaking to mates or people that you have got a bond

with or rapport and this reflected highly in the survey responses where peer support, the highest was 57% stating

that they speak to a mate about it after a traumatic event, however 20% said they do nothing as they could handle the

trauma, or they felt they could and only 15% said that they would consider speaking to a therapist.

B – I am actually quite surprised that 20% claim they would do nothing as they could handle the trauma that is quite

a high percentage. One of the fundamental reasons, well one of the big reasons that we have things like in the UK

like the British Legion is ‘cos the old bods from WW2, the Korean war, whatever it is, get together and share the

experience of those days, because it tends to make you feel better. Because you have a shared experience, you have

seen the dead bodies; you have seen say, sort of traumatic incidents and you are not on your own. That 20% could

do, say that they could do, you know, solve this for themselves I find quite surprising!

R – Okay, that is interesting, well you have brushed there on that social support and that social support is key and

shared experiences and bonds is also very important. Okay, what else, internet communications, shorter rotations in

theatre, decent living conditions they were all ranked high which is unsurprisingly, well surprisingly; shorter

rotations for some runs counter with the desire for financial gain. However, obviously the shorter that you are

exposed to the risk, the less chance there is of a problem. So that is a bit of a conundrum.

B – I totally agree and the individual operators that are working under private industries are under competing

pressures. One is they’ve got you know, a serious mortgage to pay off in the UK, which forces them down the road

of going to slightly longer rotation perhaps they only get, in most cases they only get paid for the time in the area of

operations or whatever it is and don’t get paid while they’re out, so they’re competing with each other , actually

forcing them down the road of taking more long term engagements and longer rotations which actually may not be

that good for their mental health. Having said that, when people join the military and things like that, we used to,

they go on exercise and after a week after two weeks in the field you’ve won the war and you go home back to your

barracks and clean up. Real operations as everybody has found out, in Afghanistan, Iraq or wherever it is go on for

months and months and months and months and months and you know, years in some cases. Therefore, you are in

or out.

R – Okay interesting. Another point from a survey we brushed on accountability is 51% of companies’ survey, or

over half, were not signatory to any codes of practice or codes of conduct or best practice.

B – I find that quite surprising. I would have thought that in those, those placing the contract actually it would be in

their interest if the companies they hire to do this stuff has actually signed up, has a proven record of t raining, and

has a proven record of being signatories to something or other to best practice if nothing else.

R – Best practices themselves don’t actually mention much about mental health care within them and it’s been said

by others and I’ve got your opinion, do some companies sign up to these papers, or best codes of practice or what

have you, to just add a mark of respectability to their company anyway, pay lip service to it.

B – Well you could question the whole thing, I just do not know, the whole ISO system as well is a topic is it not?

You know, people who if you pay enough money you can get yourself signed up to it, as long as your procedures are

in place that fine, it’s a respectability, the pressure has got to be on to get those companies to actu ally look after their

staff, both pre and post engagement. Trouble is if you are in the commercial sector, there is no encouragement for

you to do so. Once the jobs done after four months or the contracts over and finished, that is it you are looking for

new work, you are looking for other things but the guys who have actually been used are back on their own.

R – Interesting. Okay, I have to go on to a few more points here. Generally, do you see any differences in

approaches between the subgroups? By the subgroups you know we have maritime, static guarding, mobile

security, mobile security being overt or low profile, you know like different personality profiles being chosen for

low profile than static guard, is there a better sort of resilience? Is there a better emotional intelligence?

B – Well there would be if you say anything about the companies, because some tasks are a damn sight harder than

others and those who are doing mobiles and they’re driving for hours of the day and are at risk and may be attacked

at any time, one would expect them to be better trained, more capable of making rational and correct decisions and

things like that. It must be quite, it is a quite specialized job. Static guarding is not so specialised. In maritime

sector you have to have a particular personality at the end of the day, because being on lock down on the ship for


Student 21200319 A - 16

whatever it is, it could be two months, it could be three months, whatever it is you know, living, sitting in a tin box

takes a particular mindset. Personally, I could not do it but you know, especially because you do not have any

choice, you are totally reliant on your two or three teammates.

R – That’s interesting, that’s quite interesting and you know, it goes on to sort of, not part of the survey but research

for submariners and working in confined spaces and isolation for long periods of time and how that affects stress

that’s very interesting.

B – And that requires a serious psychological assessment before you do it, unless you want to have problems like,

you know for example, the XXXX incident, not that long ago.

R – Okay very interesting. Okay, moving on; your views of the future in regards to private military security

companies and mental health. I’m talking about perhaps delivery of therapy via social media, Skype or so on and so

on, body worn technology, what about things like for example the IPCC in UK recommending looking at police

officers, armed police officers and where video cameras going into instances. I know it is a bit removed from

private military security companies, but is it. You know, five or ten years’ time are we going to see that private

military security companies have to deploy with video cameras, which could be accountable?

B – I am loathe to give an opinion at the moment because I don’t know what the particular stresses on those, well I

know what the particular stress on our anyone who’s armed in the service is, but having, would you be able to forget

about having a camera and being even more accountable for every one of your actions? These days if you shoot

someone I presume in the police your still, immediately in suspicion until the enquiry is over, until the independent

police authority, the police authority has done its investigation and things like that. Will the camera aid or assist?

The camera gives a single viewpoint. It does not give the background of what is happening behind your back and all

the other things. I mean there are all sorts of arguments for and against. I am not sure it adds anything to the

equation.

R – They are also talking about putting police officers after a shooting incident, in 36 hours isolation, where they

have to give their statements, which in the 36 hours after an incident is where they need the social support the most,

where they need to communicate.

B – Absolutely.

R - So there is a difference of opinion there between the evidence gathering and a recognition that social support is

vital in those 36 hours after an incident.

B – I reckon we and I mean in an ideal world there should be a heck of a lot more professionals who’ve had the

mental health training to be able to assist guys and girls to get through a trauma incident. That needs to start early

after an incident. Now whether a camera will help or hinder an investigation that is up to the government. I am not

sure, I am not sure.

R – I think there is actually research that suggests a sort of a goldilocks approach to when the therapy should be

delivered. It should be offered too soon after the event, immediately after; it should not be too late, but at a specific

timing point, which is goldilocks just right. Okay I will move on to, I mean we have mentioned sort of social

support and social media and you have mentioned things like you know, associations, shared and common values.

You know this week; the internet in its entirety is only 25 years old. So you know, where are we going to be in

another 25 years when it comes to social media and social support.

B – Perhaps therapies will be able to be instantly delivered to the watch on your wrist in full HDMI wherever you

are in the world.

R – Well exactly, so I mean, so should people be starting to develop therapies and interventions that can be

delivered via those means?

B – You should discount nothing, until we have tried it, tested it and actually seen the results out of it. Hey, how do

humans learn? They try, they test, they fail, they improve, whatever. It should not be discounted, especially

because we are working more and more remote areas and you need to have the access.


Student 21200319 A - 17

R – Yeah, I think your view on this, with today’s younger generations, being brought up in a social media bubble

perhaps and it’s the way they’re developing their communication skills and it’s th e way they’re developing their

cognitive behaviour and relationships, does you know, does the future lie with delivering therapy through that

media?

B – The problem is I come from the old school, I want to see the look in the guys or girls eyes when I’m ta lking to

them, but if I feel I’m not getting some sort of feedback that makes me feel better. If I am not getting the personal,

because it is all about personal relationships at the end.

R - And rapport. But I mean, you know if that person is in a remote and hostile part of the world and it meant that

you going.

B – Hey if that is the best you can do then that is what you have to do.

R – Okay, very interesting, thanks for that. Okay teamwork we have covered, a few points here, which have come

up: humour, we have mentioned humour as a coping strategy and we have mentioned about the military before and

how that is forged.

B – The difficulty with the humour bit is it is not actually politically correct or whatever, but I do not discount it

because at the end of the day if it stops you going off the deep end it’s done its job.

R – Brilliant. Okay your views on acclimatisation stopovers going into theatre, decompression stopovers coming

out of theatre.

B – Acclimatisation what does that actually mean? Does that mean stopping somewhere halfway and getting some

cultural background.

R – Yeah maybe, a place where 24-hour, that sort of stopover perhaps where in an ideal world training could be

delivered, or if you’re going into a particularly hostile area you’re s tarting to gear up and getting your mind focused

on the job.

B – Sometimes you get more anxious hanging about rather than getting in there and getting it done. I am not sure. I

am not against it.

R – Okay what about coming out, you know rather than going straight back to your family.

B – Coming out? I think it is seriously required. One: to just detune. I can I mean, leave this in or take it out, my

first tour to xxxx as a twenty-two year old where having being spat at by women and shot at and all th e rest of it,

coming out and having time to decompress before going back to loved one’s was essential.

R – Okay, thanks very, very much for that it was extremely interesting.

B – You are most welcome.


Student 21200319 A - 18

Appendix H: Transcript with Interview “D”

Interviewee D

Interviewer identified as R.

R & B - Ethics protocol and pre-amble…

R – Okay XXXX thanks very much for joining me. I will kick off and go straight into the research questions that I

have posed for the research paper and that is, the first question is:

R – Is the current level of mental healthcare adequate and what is the existing mindset towards it?

D – And you are talking about people in the PMSCs ?

R – Yes private military security companies .

D – Across the board?

R – Yeah

D – Okay so, in my view there are a couple of challenges you see. The challenges are is, are people who go into the

industry go into the industry because they’ve left the service, they liked it, they see its good money in security

industry or do they do it because they don’t feel they fit too well in the rest of society, they try to fit in. And we

have very limited data don’t we of that available. I think probably the latest data that we have available is the

RAND report, which I am sure you have read. It’s probably the most important clearly in those who have not made

the transition from military to civilian life well are going into PMSCs and suggests that actually its more likely to be

the latter definition which is there not fitting in well. Because they are not well. Most of t hem still are obviously

but some of them go into it because they do not fit in well elsewhere, which therefore means that they are at risky if

not more risky than people in the military.

R – Okay very interesting, very interesting.

D – And that is kind of why they do it. Is the level of support enough? My view is it varies hugely amongst the

industry because some companies have put a lot of time and money into it and others have absolutely nothing at all

and pay lip service to it.

R – Okay, that is very interesting. Okay I’ll move onto question number two and that is: what are the unique

stressors that private military security companies’ face in their environment and what are the best coping strategies?

These are general questions for the industry as a whole.

D – Are you talking about the companies basically or the individuals?

R – The individuals, individuals but then, yeah let us stick with individuals at the moment yeah.

D – Okay cos I think actually one of the things I will say is, have you read our paper Messenger et al, because one of

the things that came from that is the financial draw, although it is a small sample that gives quite an insight into

exactly this question. So I think there is the, there is the lure of the money, which is a good thing but also it is not

always a healthy thing. There is a distrust of locals

R – Why isn’t it healthy XXXX?

D – What in terms of the money thing?


Student 21200319 A - 19

R – Yeah

D – Because it basically means that people may put aside some concerns they have on one side becau se, well what

they should be concerned about is the money over complex concerns, they’re real concerns. On the other hand,

what they might get working in XXXX (a supermarket) or as a plumber or as a someone involved in a regular

civilian job.

R – Which is safer and doesn’t have the same stresses or risks?

D – And have more opportunity to establish themselves in civilian life don’t they? One of the most challenging

things for military is transitioning into military life. Being a private military security contractor kind of delays or

stops that transition.

R – Do you think the high money and the high risk is there a predisposition to sort of maladjusted coping strategies?

Maladjusted behaviour?

D – Maladjusted people more like, I need to be really careful here because I think it’s important to say that most that

are going into the industry are sane, they may be reasonably adjusted but the majority are absolutely doing it for the

right reasons.

R – Quite resilient, good set of people and doing it for the right reasons.

D – But there’s an important minority that could have a disproportionately large effect on their company and also on

the industry as a whole because the XXXX incident the contractor who was reportedly hired by XXXX despite

warnings on hid mental health condition and shot and killed two colleagues and the XXXX incident when they

opened fire at XXXX, killing civilians, these have huge ramifications.

R – Yeah absolutely.

D – And an important minority who don’t cope well and who’ll be trying to take military coping strategies of talking

to your buddies, which doesn’t always work you know the whole Iraq thing has gone quite quickly, you know, your

buddies who are locally employed, three westerners employed with twenty local people working for you, y ou don’t

get the choice of who you speak to. Your back up, god forbid if you’re involved in an insurgent attack on convoy

duties, no one comes to rescue you in the same way. So I think, I think the challenges are similar but they are

different and I think most people take the military approach to it and try to but it doesn’t always work directly.

R – I have had some very interesting feedback about support within a military structure and then that not being

available inside the PMSC. Okay I will move on its how could mitigations, coping strategies, interventions and

therapies be enhanced. The whole lot in there and that includes companies and individuals.

D - One of the things I am doing is I am the President Elect of the XXXX and we are drafting up a guidelines for

organisational stress management. Now this is for all organisations that particularly/predictably place people in

harms’ way, and clearly including security companies. So I think in terms of that, the prevention key mus t be, that

initially the company have to have a policy or guideline that addresses it, they have to train their managers a little bit

about it. They have to make sure they take on the right sorts of people, and also that’s screening but then there is

some basic things you should be doing. They need to make sure that the medical certificates they get are not just

from a GP who thinks that this person works in a supermarket. Then they need to make sure that when people are

going to develop problems, which they will, that their own protection systems in place, they need to have peer

support, they need to have managers, you know, team leaders and in -country managers who are aware of mental

health issues and they need to have a monitoring type process in place to make sure that people’s health, cos people


Student 21200319 A - 20

aren’t really honest with their companies sometimes because they’re getting paid and either they’re contracting you

are is as good as your current job.

R – I think the feedback we have is that they are not going to be honest with their companies because a lot of them

are fearful of losing their position if they admit to an issue.

D – Yip and that is frankly true isn’t it? They have no contract, they have no protection. So I mean there are early

protection systems that lead to good peer support and early intervention and on the treatment side if they do get

treatment, which is pretty unlikely as you said, they get through to a fast track evidence based treatment for

whatever they’ve got going and I don’t believe the companies could hold their job open but the companies should

not be averse to taking people back on if they have received care and are better.

R – Okay that is great. Now you’ve kind of moved me on to the next point which are your views on the research

key findings and that’s: The importance of mental health care was highly recognised by the survey, with 71% of

operators saying it was very important and 51% of management which was a little b it lower but the main point is the

issue of stigma surrounding the topic and tellingly 80% of operators said that they felt it would be likely or very

likely that they would lose their position if their employer found out they were seeking therapy. What a re your

views on that? I mean it sort of barriers the pathways to care and stuff, the stigma. What can be done there about

breaking down the stigma?

D – First it is important to say that when we look at stigma in the British military and when we looked at stigma in

the civilian population, you are still looking at 70% to 75% of people with mental health problems not getting help.

So you’ve got to take into background that most people whether they’re security contractor or not, don’t like getting

help but in this industry where you don’t get help and you’ve got a problem, you’ve got a XXXX incident or a

XXXX incident so you’ve got to fit in and you got the best team possible that are mentally fit for purpose or this will

have consequences because you’re not concentrating. I think security companies, to perform to a higher standard for

their customers, need to make sure that their people have the best mental health. And if you really believe the

RAND report that 12% of ex-British security contractors have PTSD and that means they’re going to be functionally

impaired, if I’m going to Iraq or Afghanistan I want someone who hasn’t got a mental health problem, will be

mentally stable and alert and able to conduct their task.

R – Yeah well in general, well someone who’s been and sorted it out and is back and back on their feet?

D – Oh that’s absolutely fine, I don’t care what they had in the past, as long as they’re well now that’s absolutely

fine.

R – Okay I am going to skip through these quickly. We have brushed, we have touched on accountability and to a

signatory document and I know that you are doing work there, can we just sort of, I mean is that where part of the

answer lies? Is it accountability for companies that are being awarded the contracts by th e British government, the

US government, that they are all legit? That they have good PRM in place.

D – There’s a couple of questions, one is that if you’re a company that employs security contractors you need to be

interested in making sure that the people that are protecting you have the highest state of mental health they can.

That is not because you’re nice, that’s because you want them to do a good job. So there’s that point, so as a

company that employs security companies, you should be demanding a high level of mental health and if you’re a

security company as well because you want people to have a good customer focus and to perform well because

that’s good for your business, again you want to make sure that you look after your people and also the last thing if

you want to recruit the best people to your organisation you want to make sure that your providing them with a

package that makes them want to come to you and not to someone else next door. Like you said already a lot of

security contractors think it’s important.


Student 21200319 A - 21

R – Yeah that is good, so it is not just corporate social responsibility it is more.

D – It is the company and it is the companies that use security companies.

R – Okay very interesting great, ah I’m going to flick through these ques tions now. Do you see any differences in

approaches between the subgroups? By subgroups, I mean static guards, maritime security, demining, mobile

security, low profile, high profile; do you see any difference in approaches?

D – Yeah I do because; well if you’re on convoy duty and if you’re in Afghanistan the risk of traumatic exposure are

pretty high. If you happen to be in maritime security duties you know, going through the Arabian Gulf, your risk of

sunburn is pretty high. There is nothing wrong with that but the boredom factor can take over.

R – There are other stresses involved that are unique to this sub section of PMSCs in your view then?

D –In maritime security, although everyone needs to take trauma seriously, I think where you are isolated from the

usual social networks; I think the boredom factor is really important. We just did a study looking at remote area

medics, nothing to do with security industry and it is quite important in Iraq in the oil fields, one western medic and

of course they are not traumatised but they are depressed due to the isolation.

R – This all adds in XXXX and then the depression could link to something or if th ey were to experience a

potentially traumatic event in that state then they are less resilient perhaps.

D – If you happen to be on a maritime security team on a vessel in the Arabian Gulf and you’ve got to spend hours

looking out for possible attacks and pirates, you want the person to be switched on, whether they’ve got you know,

if they’ve got depression or PTSD neither are very good for functionality.

R – Okay great. Okay your views on the future in regards to private military security companies and mental health?

I’m talking about things like therapy via Skype, I’m talking about body warn technology, you know we’ve seen

things in the media recently about body warn technology, it detects insulin levels regularly, you know like heart rate

monitors and things like that but it causes our levels perhaps, ah also the body warn technology I’m thinking about

the IPCC the police report on head worn cameras for firearms policemen, is that going to be coming to private

military security companies in the near future and the added stressor of you know, if you make a mistake. There is a

lot there so what do you, where’s the future?

D – So I think the future hazards on the mental health side, rather than in, in that, as time goes on the ISO:28007, the

developing ISO:28007 will set in hopefully a guide saying, not that you have to do one thing but you have to have

support principles of protecting, preventing and treating and that, therefore if you are in deep trouble in a company

you could exercise your duty towards your contractors by following the guideline. So companies who don’t do that

are going to not basically get business and that will be good for everybody I think. In terms of the stressors I think

boredom is a key factor in terms of remote services there’s really good evidence that instant messaging, that Skype

that even text messaging self-help, that those sort of things make a difference and so if you’ve got people who are

static environments with no threat then actually if they start to develop problems t hey get to intervene early rather

than waiting until their next period of leave.

R – Yeah or it’s a hostile environment and the therapies can’t perhaps get there and so yeah technological advances

are great you know bearing in mind this is a available.

D – Yeah but I still go back to the fact that although you can deliver good therapy advice with things like Skype, the

bigger things people aren’t going to come and ask for it unless you’ve got an environment in which they can put

their hands up and which their peers can go ‘come on mate you need to get yourself up and’

R – Get yourself better?


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D –Yes and ask for help and in terms of the stressors yeah we’ve got a bit of work next week actually about the

IPCC thing about the fact that if you isolate police officers after they’ve shot you know, after 36 hours, what we

know is that, for PTSD that social support in the early environment is a key factor for whether people do well or not.

Now if you remove them from social support, preventing them from gaining an u nderstanding then you are going to

potentially cause problems.

R – Okay and talking about that sort of psychological first aid, when is the best time, is there a goldilocks sort of,

you know, is it too soon then its rejected, too late it not effective, or a just right time?

D – If you are talking about what should be done early on, then I think it is not mental health care because that is not

what, it is about buddy and leader support, because in the early days people had a good strong leader or peer. Good

leaders, really brilliant leaders and I mean, ideally good families, you when they’re back at home, who understand.

If they go on, the people who are not doing well, well then people like me become useful. But early on it’s about

provisions and good leadership and good social support, that’s vital.

R – Okay brilliant. I’m just going to go through my headings here, most of them we’ve mentioned, recruitment,

training, briefing, I’m talking about briefing and sort of without, you know over-traumatisation there has to be like a

realisation and people do they realize that they’re going into a hostile job which could, things could present

themselves and what about with packages for companies and I know some policeman have spoken about it, they

know they’re going to go and experience a particularly nasty scene or railway workers that do this and they kind of

steel themselves you know, they go somewhere and they hang their hat somewhere and they’re like ‘ok this is going

to be a bit, you know, but we’re going to get on with it.’ Can we, as obviously that is trainable?

D - You can train both individuals resilience and into companies and more importantly you can train good practices.

And the answer is that resilience mostly lies between individuals rather than in individuals. So actually if you’ve

got a well led team who are trauma aware, who know about social support, who can chat to each othe r because

they’ve practiced it and they’ve trained together so they’ve supported back in the military days, that team, is really

supporting, you know it helps each other. Individually you can train them, basically because we’ve got data from

when our troops first went to Iraq, showing that troops who have stress education debriefings do better than troops

who don’t. You can both train the group and the individual…

R – Great and as I said 90% of private security companies come from a military background so taking the best

things from that background, perhaps leaving the not so best things behind is good. Okay we have mentioned

teamwork; I am going to skip through these now. In my coping strategies I have researched humour, which again I

think is a great thing that has come from the military and is classic in some people who have worked in some testing

environments. Your views on acclimatisation stopovers going in to theatre and decompressions coming out?

D – Going in I think, going in is more about gearing up for the task ahead, the team, so if you’re going in as a single

operator, I’m not sure stopping over is necessary but I don’t think there’s much to it, other than getting a good

briefing so you can begin to acclimatise.

R – Gear up, okay.

D – Yeah gear up. I think the decompres sion thing done in the right place I think it is really important and I don’t

think it has to be 36 hours in a 5 star hotel but I don’t think you should be flying back from just out of an incident to

arrive back at home 14 hours later.

R – To bring that to your family perhaps arriving back in a heightened state of hypertension is not a good thing.

D – Yeah so it doesn’t have to be a five day stopover, but 24 hours teams tracking through, a couple of beers I think

is decidedly a good idea.


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R - Right okay, I’m just racking through these other coping strategies, so sort things like self-development,

normalization and routine people have spoken about, you know again maybe it’s a boredom thing but taking their

mind off being in a hostile environment, learning a language or doing a degree course is a good coping strategy. I

see you nodding there so that is in agreement?

D – Yeah in avoiding boredom.

R – Yeah okay. We have spoken about transition from military to private companies and then onwards to civvy

street, there’s not really been any research out there going forward from the next leap is there, which would be one

of my sort of recommendations for future research.

D – Have you spoken to XXXX?

R – Yeah great I have spoken to XXXX, really good, really useful, probably where I got that idea from. Okay,

attitudes, awareness, you know I am talking about sort of improvements now. I guess it’s all about awareness, I

mean I’m looking at society how it was 50 years ago with attitudes towards females in the work place, sexual

equality, racial equality you know, health and safety in the workplace. We have come a hell of a long way; it just

needs that sort of paradigm shift again.

D – It’s also equally about managers being aware of what to look for and they have to be overly tested. If someone

comes back and having been in a war zone for six weeks in the first few weeks of their job when they hit the floor in

XXXX (A Supermarket) it should not be funny, it should be a sign that they need to go see a doctor. If it happens

six months later by all means they need to go to a doctor, that’s it.

R – Okay that is quite a good; I like that because that is quite a good, its normal you know, it is interesting, very

interesting.

D – Very, that is sort of behaviour is typical and a perfectly normal reaction to military combat.

R – Great okay, approaches to change and I’m talking about the military and generally.

D – I don’t know how, I think we’ve shown evidence of the military over the last ten years, the thing that hasn’t

gone away, but it has crept down but the danger really is people have become overly concerned, the parents have

become overly concerned, it’s about getting that balance really.

R – Okay interesting I like that, not being overly concerned about it and again most guys that worked in this industry

and I’ve worked in the industry, are resilient you know, can get on with it, are quite mature and what have you.

Okay I am going to rattle through these now: relaxation as a coping strategy I mean, things like Tai Chi, yoga you

know it’s not everybody’s cup of tea.

D – My point is that there was a paper of research on the US marine corps, basically showing that in the US marine

corps combat team, the combat team sort of went out there prepared with stress management were better having

gone through a the operational tour than those who hadn’t. But of course, it might just work and for some people, it

mightn’t. If you do not do Tai Chi well you can try. Give it a go, if it does not work then maybe it is not for you.

R – I mean my view, obviously I am after your view, is that coping strategies are completely unique. You know if it

is listening to music in the evening or playing war games or doing Tai Chi or doing yoga or doing art, you know

coping strategies are completely unique.

D – I am not sure they are unique. In general if you can find ways to do some exercise that gets your body in a

rhythm that’s going to be good for you, whether that Tai Chi or running or swimming or exercise bike that must be

it, but actually in general if you take exercise, you’re probably going to do better than those who don’t, but again if


Student 21200319 A - 24

you can find time for watching some television, just something to switch your mind off, that’s probably going to be

of more use to you than not doing it.

R – Yeah okay. I used to watch the travel channel in Baghdad, in the red zone, in the villa and I was there. I was in

the Seychelles or wherever the travel channel was that evening, pure escapism. Okay we have spoken about

maladjusted coping. Physical training as a coping strategy we know is good, but then I want to talk about steroid

abuse and I have seen a culture of that and I’ve brushed on a culture of that and something called ‘roid rage’ you

know, is this something you’ve come across? In the military and in PMSCs.

D – Well the military there’ve been challenges because it’s more difficult for drug testing, although it does go on

and there are companies that are on the border of being druggy and not druggy, but yeah absolutely the steroid craze

is not just in the security contractors, you know bodybuilders there’s lot of evidence that for that group of people it’s

clearly not the best thing to have.

R – Yeah okay, good stuff and then going on I’ve just heard lots of things about support and life support in country

you know food, sleeping you know, for the companies just the little things, how that sort of aids coping. It might

just be the little things that all add up to a contractor.

D – I think, I think you’re right. All the little things do add up but I think there’s probably a threshold where you

know, once you’ve got a reasonable place to have some down time and you’ve got a room and a television you

know when you relax. There are certain points where having luxuries are not necess ary but the basic level, I think is

important.

R – Okay that’s great. Why is it that many guys will experience the same PTE in companies with some developing

PTSD you know, why some and not others? Why is it that sort of eight guys can experience an event and two of

them, six of them being totally okay, one of them present the symptoms fairly soon after and one six months down

the line. Your views on that? I mean if you have the answers to that, you would be a millionaire I guess?

D – Yes it is very individual, but that important you have mental analysis of risk factors and there, that gives you

some clues. There are predisposing factors in your childhood proven and proven experiences and what the nature of

the event do you see it being challenging or exciting or is it something that you think you can’t cope with and there’s

what happens to you after, you know are you the sort of person who isolates yourself anyway or are you going to get

down the bar, have a couple of drinks and talk it through.

R – Okay there is a lot of stuff, that is very interesting and then the last couple of points: psychological first aid we

have spoken about and then yeah training, that is it XXXX those are all my questions. Do you have anything sort of

further there to add or?

D – No thank you very much I’ve got to disappear, thanks for that and I will have a look at what you’ve sent me and

when you have finished your report I’d really be interested in it.

R – Yeah great. Have a look at what I sent you last night and any comments you have on it, anything you want to

add that would be really useful. Brilliant. Thanks very much XXXX really appreciate it.