Section G Mental Health

Nov 18, 2025
8 min read

Index

Introduction
Building a Positive Mental Health Culture
Trauma Responses at Sea: Acute Stress Reaction vs PTSD
Recognising Common Mental Health Presentations
- 4.1 Anxiety
- 4.2 Panic Attacks
- 4.3 Depression and Low Mood
- 4.4 Self-Harm
- 4.5 Unhealthy Eating Habits
- 4.6 Alcohol Misuse and Acute Intoxication
- 4.7 The “Unhappy Sailor / Royal Marine” (Temperamental Unsuitability)
Core Clinical Skills: Listening, Validation and Immediate Support
Decision-Making in the Maritime Context: Retain, Refer or CASEVAC?
Pathways of Care: DCMH, TRiM and the Role of Command
Looking After the Caregiver: Recognising Stress in Ourselves
Key Clinical Reflections and Practical Takeaways
Conclusion & Call to Action

1. Introduction

Mental health in military and maritime environments is both a clinical priority and an operational necessity. Long deployments, isolation from family, exposure to trauma, and the pressures of command all increase psychological risk. When distress goes unnoticed or unsupported, it can compromise individual wellbeing, team cohesion and ultimately mission effectiveness.

At Kraken Medical, we work with clinicians, medics and organisations who operate in exactly these high-demand settings. The notes behind this article reflect real, applied experience from Royal Navy practice: promoting positive mental health, spotting early warning signs, managing crises, and knowing when to escalate to specialist care.

This blog distils those competencies into a structured, clinically grounded guide that can support both healthcare professionals and line managers responsible for their people.

2. Building a Positive Mental Health Culture

A strong mental health culture doesn’t begin in clinic – it starts on the mess decks, in briefings and in routine conversations.

Awareness and education

Awareness campaigns and workshops help normalise mental health conversations, covering stress, resilience, anxiety, depression, self-harm and alcohol use.
Educational sessions on coping strategies, sleep, self-care, and when to seek help empower personnel to act early rather than waiting for crisis.

Destigmatising help-seeking

Open discussions, including appropriate sharing of lived experience by leaders and colleagues, challenge the idea that seeking help is a sign of weakness.
Providing clear information on available resources (onboard, within Defence and externally) ensures people know where to turn.

Creating a supportive peer environment

Encouraging peer support and “checking in” on each other’s wellbeing reinforces the message that mental health is everyone’s business.
Promoting self-care – physical activity, rest, nutrition, boundaries and work–life balance where possible – is framed as performance-enhancing, not indulgent.

This cultural groundwork makes it far more likely that individuals will speak up early, giving clinicians and leaders a much better chance of intervening effectively.

3. Trauma Responses at Sea: Acute Stress Reaction vs PTSD

Operational environments bring a higher risk of exposure to traumatic events. Distinguishing Acute Stress Reaction (ASR) from Post-Traumatic Stress Disorder (PTSD) is essential for appropriate management.

Acute Stress Reaction (ASR)

ASR is a short-term, immediate response to a traumatic event. Typical features include:

Intense anxiety, fear, confusion or dissociation
Intrusive thoughts and images
Physical symptoms such as tachycardia, hyperventilation and tremor
Sleep disturbance and hypervigilance

ASR is considered a normal response to an abnormal situation and often settles over days to weeks as natural coping mechanisms take effect.

Approach:

Provide immediate support, reassurance and psychoeducation about normal stress responses.
Encourage expression of thoughts and feelings; avoid forced debriefing.
Monitor closely; if symptoms persist or worsen, consider onward referral.

Post-Traumatic Stress Disorder (PTSD)

PTSD is a persistent, impairing condition where symptoms last at least a month and intrude into daily functioning. Key features include:

Recurrent intrusive memories, nightmares and flashbacks
Avoidance of reminders, places or conversations related to the trauma
Negative mood and cognitions: guilt, shame, persistent fear, distorted beliefs
Hyperarousal: irritability, exaggerated startle, poor concentration, sleep problems

Not everyone exposed to trauma will develop PTSD, but when it does occur, it can be profoundly disabling.

Approach:

Recognise the pattern early.
Provide empathetic support and education about PTSD.
Facilitate timely referral for evidence-based trauma-focused therapy and specialist assessment.

4. Recognising Common Mental Health Presentations

4.1 Anxiety

Anxiety is common in high-pressure environments. Warning signs include:

Excessive, uncontrollable worry and inability to relax
Physical symptoms: restlessness, muscle tension, racing heart, sweating
Irrational fears or phobias; avoidance of specific situations
Sleep disturbance, racing thoughts and difficulty concentrating

Supportive response:

Provide a calm, non-threatening environment and active listening.
Offer psychoeducation on anxiety and its physical manifestations.
Teach simple breathing and relaxation techniques.
If anxiety is severe or persistent, encourage professional assessment.

4.2 Panic Attacks

Panic attacks are acute episodes of intense fear with prominent physical symptoms:

Rapid heart rate, chest pain, shortness of breath
Trembling, sweating, dizziness, nausea
Fear of dying, losing control or “going mad”
Feelings of detachment or unreality

Immediate support skills:

Stay calm and composed; your affect sets the tone.
Move the individual to a safe, quiet space.
Reassure them that panic attacks are time-limited and not dangerous in themselves.
Guide slow, controlled breathing and grounding exercises (e.g. focusing on the five senses).
Remain with them until symptoms subside and follow up afterwards.

4.3 Depression and Low Mood

Depression can be easily masked in disciplined, high-functioning settings. Key indicators include:

Persistent low mood, emptiness or hopelessness
Loss of interest in previously enjoyed activities
Changes in appetite and sleep (increase or decrease)
Fatigue, low energy and reduced motivation
Poor concentration, indecisiveness
Feelings of guilt, worthlessness or self-blame

Response:

Initiate non-judgmental, open dialogue.
Validate experiences and express genuine concern.
Explore risk, including suicidal thoughts; if present, develop a safety plan and escalate appropriately.
Provide information on available support and encourage professional help.
Arrange follow-up contact to avoid individuals “falling through the net”.

4.4 Self-Harm

Self-harm is a serious sign of psychological distress and must never be minimised.

Key signs:

Unexplained cuts, burns, bruises or scars
Persistent use of concealing clothing in all conditions
Withdrawal and social isolation
Verbal expressions of hopelessness or a desire to escape emotional pain
Access to or preoccupation with sharp objects or other means of harm
Sudden, marked changes in mood or behaviour

Immediate management:

Approach with empathy and zero judgment.
Listen actively; allow the individual to tell their story.
Express clear concern for their safety and wellbeing.
Work collaboratively on a safety plan (coping strategies, safe contacts, crisis lines).
Remove or restrict access to means where safe and appropriate.
Encourage – and where risk is high, facilitate – urgent professional support or emergency care.
Ensure ongoing follow-up, not just a one-off intervention.

4.5 Unhealthy Eating Habits

While less detailed in the notes, unhealthy eating habits can signal distress, attempts at control, or emerging eating disorders. Clinicians and leaders should be alert to:

Extreme dieting or restrictive eating patterns
Bingeing, purging or misuse of laxatives
Obsession with weight, shape or “clean eating”
Marked weight loss or gain
Impact on functioning, energy levels and mood

Early, supportive conversations and appropriate referral can prevent progression to more severe pathology.

4.6 Alcohol Misuse and Acute Intoxication

Alcohol is culturally embedded in many military settings, increasing the risk of misuse.

Signs of acute alcohol intoxication:

Slurred or incoherent speech
Unsteady gait and poor coordination
Impaired judgment and risky behaviour
Confusion and disorientation
Flushed face, nausea and vomiting

Immediate priorities:

Ensure safety: prevent falls, accidents or confrontation.
Position the person to minimise the risk of choking if vomiting occurs.
Encourage hydration and rest in a safe environment.
Monitor level of consciousness and vital signs; if concerned, seek urgent medical care.
Avoid additional substances, including sedative medications.
Provide education on risks and signpost to support for alcohol misuse if a pattern emerges.

4.7 The “Unhappy Sailor / Royal Marine” – Temperamental Unsuitability

Not all distress presents in overt mental health language. The “unhappy” or temperamentally unsuitable service person may show:

Increased irritability, mood swings or withdrawal
Declining performance, motivation and reliability
Frequent interpersonal conflict or disciplinary issues
Pervasive negativity, cynicism or low morale

This may reflect:

Underlying mental health conditions
Poor role fit, burnout, or value conflicts
Personal stressors (family, finances, relationships)

Best practice:

Encourage open conversation and active listening.
Involve Divisional Officers and Chain of Command for assessment and planning.
Consider adjustment of duties, additional support or formal referral.
Keep mental health considerations central rather than framing the issue purely as misconduct.

5. Core Clinical Skills: Listening, Validation and Immediate Support

Across all presentations, a few core skills are consistently protective:

Recognising distress through verbal cues, body language and behaviour changes.
Providing a safe, private and non-judgmental space for disclosure.
Using active listening: attentiveness, minimal interruption, reflective responses.
Asking open-ended questions to understand context, not just symptoms.
Validating emotions: acknowledging that feelings make sense in light of experiences.
Avoiding premature advice-giving or dismissive reassurances.
Offering support collaboratively, respecting the individual’s autonomy.
Ensuring follow-up, so the person knows they have not been forgotten.

These are simple in theory but powerful in practice, and they can be taught, coached and refined across the workforce.

6. Decision-Making in the Maritime Context: Retain, Refer or CASEVAC?

At sea, decisions about whether to retain a patient onboard or CASEVAC (casualty evacuate) are clinically and operationally critical.

When retention may be appropriate

The individual is stable, with no immediate risk to self or others.
Adequate mental health support and supervision is available onboard.
Reasonable safety measures (e.g. increased observation, buddy systems) can be implemented.
There is reliable communication with onshore specialists for advice.

When CASEVAC should be considered

Immediate risk of self-harm or harm to others.
Severe symptoms that are unmanageable with onboard resources.
Lack of appropriate expertise or facilities to provide safe care.
Clear deterioration despite early interventions.

Effective decision-making relies on close collaboration between medical staff, Command, and onshore mental health services. The priority is always patient safety, clinically appropriate care and, where possible, continuity of support.

7. Pathways of Care: DCMH, TRiM and the Role of Command

Defence Community Mental Health (DCMH) and Step 1 Treatment

The medical officer (or equivalent clinician) provides Step 1 care, including:

Initial assessment and formulation
Psychoeducation and supportive counselling
Basic coping strategies and crisis management
Ongoing monitoring of symptoms and risk

When needs exceed Step 1 capacity, the clinician:

Consults with DCMH or equivalent specialist services
Prepares clear referral documentation
Supports a coordinated handover, ensuring information flows smoothly and the patient understands the process

TRiM Practitioners

Trauma Risk Management (TRiM) practitioners provide structured, peer-delivered support following traumatic incidents. Their role includes:

Early, psychologically informed intervention
Psychological first aid and risk assessment
Facilitating structured conversations and debrief-style support
Identifying individuals who require formal mental health referral
Promoting resilience and ongoing monitoring post-incident

They are a crucial bridge between lived experience, peer support and professional mental healthcare.

Command and Protective Supervision

Command has a central role in safeguarding mental health:

Creating a culture where mental health is openly discussed and help-seeking is normalised.
Ensuring education and awareness on stress and mental illness.
Identifying and mitigating occupational stressors where possible.
Supporting access to services (time off for appointments, transport, privacy).
Showing leadership by example in prioritising wellbeing.
Coordinating crisis responses and longer-term support plans in collaboration with clinicians.

8. Looking After the Caregiver: Recognising Stress in Ourselves

Clinicians, medics and leaders are not immune to stress. Recognising our own warning signs is essential:

Irritability, emotional exhaustion or detachment
Sleep disturbance, physical tension or persistent fatigue
Reduced concentration, growing cynicism or loss of empathy

Taking action – supervision, peer support, self-care, or formal help – is not a luxury; it is a professional responsibility. Resilient caregivers are better able to support resilient teams.

9. Key Clinical Reflections and Practical Takeaways

From these competencies, several key messages emerge:

Culture first: Awareness, destigmatisation and peer support dramatically increase the chances of early help-seeking.
Recognition skills matter: Being able to spot PTSD, ASR, anxiety, panic, depression, self-harm and alcohol problems is fundamental in operational environments.
Listening is an intervention: Active listening, validation and non-judgmental presence are often the first and most important interventions.
Risk decisions must be structured: Retain vs CASEVAC decisions should balance risk, resource availability and the potential for deterioration, in collaboration with Command and specialists.
Pathways must be clear: Everyone should know how to access DCMH or equivalent services, TRiM practitioners, crisis support and routine mental healthcare.
Look after the team who look after others: Supporting the mental health of clinicians and leaders is central to sustainable care.

10. Conclusion & Call to Action

High-quality mental health care in maritime and military settings is not just about specialist clinics; it is about everyday conversations, keen observation, timely decisions and well-understood referral pathways. The skills described here – many developed in Royal Navy practice – show how much impact a well-trained medic, officer or colleague can have in moments of distress.