Mental health problems in the mountains: needs, assets, and recommendations for managing mental health problems in mountain-focused wilderness-based education and related fields

Abstract

Background: Through controlled exposure to stress, wilderness-based education programs can buildcapacity for adaptive coping and produce long lasting improvements to participants' quality of life.However, stress can also overwhelm them, resulting in the emergence and exacerbation of mental health vulnerabilities in the field. However, empirically grounded best practices for training, pre-trip screening, and protocol/policy for mental health specific to the wilderness context are not well developed. Aim: The aim of this study was to assess needs and assets, and develop recommendations for training, pre-trip screening, and organizational protocol/policy to assist with successful management of mental health problems in mountain-focused, wilderness-based education and related fields such as outdoor leadership, guiding, environmental education, snow safety, search and rescue, and wilderness therapy. Methods:A pragmatic, two phase, sequential mixed methods approach was utilized to explore this topic within the context of an overarching collaborative community based participatory research (CBPR) framework with organizational partners: National Outdoor Leadership School, Outward Bound USA and Canada, the Wilderness Risk Management Conference, and the Alaska Mountaineering School. A preliminary quantitative study utilized a cloud-based survey to determine baseline characteristics for 64 wilderness-based educators, guides, outdoor leaders, snow safety professionals, and search and rescue personnel. Qualitative interviews with 16 experienced and prepared key informants addressed the study aim in more depth, consistent with partnering organization priorities, in the tradition of CBPR. Findings: Mental health topics and skills are underemphasized in current training, and training was found to be of less value than personal and professional experiences with mental health. In the future, mental health should be increased and emphasized, possibly through the utilization of existing resources such as the stress continuum or curriculum such as Psychological First Aid as well as practical training opportunities that emphasize experiential learning around mental health. Current screening can present both risks and benefits for clients, instructors, and organizations. Nondisclosure and the impacts of stigma and prejudice on the interpretation and utilization of mental health screening information were major concerns. However, screening can guide preventive and proactive efforts, and build working relationships with potential participants. Future screening should be used to inform participants about course stress, encourage disclosure, and direct curriculum development. Multi-step screening, utilizing multiple interactions with participants before the course, was identified as a utilitarian way to facilitate improvements for future screening. In protocol/policy, field management of mental health problems is underemphasized relative to evacuation, resulting in overutilization of disruptive evacuation processes. While many organizations do well at responding to instructor mental health needs after incidents such as a fatality in the line of work, inconsistencies in implementation can create unintended barriers to instructor self-care. Future protocol/policy should prioritize instructor mental health by addressing inconsistencies in implementation, removing barriers to self-care and guiding the deployment of resources such as responsive staffing or free counseling benefits. Implications: This study contributes uniquely to the literature by providing an empirically-based perspective into a little researched topic, and multiple avenues for implementation of findings such as increasing mental health content and experience-based training, utilization of multi-step screening processes, and consistent implementation of organizational protocol/policy in support of client and instructor mental health. Recommendations for implementation address weaknesses and build upon strengths already present in training, screening, and protocol/policy. Overall, practice and research in this area are in need of further investigation and development. Future dissemination, research, and practice development could help develop measures or resources to support the improvement of training, screening, and protocol/policy across wilderness-based education and related fields.