Leveraging non-specialty personnel for mental health support in large-scale combat operations: A scoping review

The shift from counterinsurgency to large-scale combat operations (LSCO) presents new challenges for delivering military mental healthcare, including resource limitations, disruptions to medical evacuation, and degraded network connectivity. The anticipated constraints in LSCO may delay access to specialty care, necessitating scalable approaches to address mental health care needs. To explore how mental healthcare needs have been addressed in similar contexts, this scoping review aims to chart the literature on interventions administered by personnel without formal mental health specialization or credentials in military or comparable operational settings. The review followed Arksey and O'Malley's five-stage methodological framework to chart, collate, summarize, and report relevant findings. A systematic search strategy was used to identify literature from four databases (PubMed, CINAHL, PsycINFO, and Embase), and the authors conducted a full-text screening. Twenty-three studies met the inclusion criteria and informed the development of the conceptual model. Interventions were categorized by personnel role and mapped onto the Stress Continuum Model. The model offers a scalable, mission-adaptive approach that accounts for personnel roles and practice scopes. Rather than prescribing a fixed solution, the conceptual model provides leaders and medical planners with flexible, evidence-informed options. Findings illustrate how leaders, informal peers, trained peers, and non-specialty medical personnel may be incorporated into a role-based psychological support strategy for austere environments, including during LSCO.