DISSERTATION FINAL SUBMITTED DRAFT

Work-based Research and Dissertation
MENTAL HEALTH SUPPORT FOR
PRIVATE MILITARY SECURITY COMPANIES
IN THE 21st
CENTURY
A dissertation submitted to the faculty of
Buckinghamshire New University
Department of Security and Resilience
Submitted by Student 21200319
March 2014
In partial fulfilment of the requirements for the degree of
MSc in Business Continuity, Security 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 underthe 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 fromthe industry who took the time to complete the surveysand for revealing the depth
of feelings in the answers. To Peter Reynolds forencouraging 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 paperis 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 ATTITUDESTOWARDS MENTAL HEALTH CARE.....................................................................................8
2.4 GROWTH OF PRIVATE MILITARY SECURITY COMPANIES.....................................................................8
2.5 EXTERNAL INFLUENCES AND OPERATING ENVIRONMENTSOF 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

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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
DISCUSSIONS ..........................................................................................................................................................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
CONCLUSIONS 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 WHO 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 WHO 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 WELL-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 WELL-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).

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 SampleGroup Overview
The sample group chosen for this research are personnelthat 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 ofChapters
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 HumanElementof BusinessContinuity
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 AttitudestowardsMental HealthCare
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 PrivateMilitarySecurity 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 Influencesand OperatingEnvironmentsof 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).

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 Resilienceto 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 EmotionalIntelligenceand 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 Exposureto HostileEnvironments
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

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 ExistingStudiesin the SubjectMatter.
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-TraumaticStress 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-TraumaticGrowthand 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 TraumaRisk 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 eventsby 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 andBriefings
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 AdditionalConsiderations
‘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 Conclusionsof 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 PilotSurvey
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 orderwhich 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
Howmany 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 discoveroperator’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 answerswere displayed in a different order
and were intended to attain the coping strategiesthat 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

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 fromone (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 companiesshould 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 furtherinformation that an operatorfelt 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 CompanySurveyRationale
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” responseswere 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 ortest 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 perceptionson 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 greateraccountability 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.

DISSERTATION FINAL SUBMITTED DRAFT

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