How a Video Game Community Became a Mental Health Support System for Military Veterans
A group of gamers built a peer support program to help each other through crises. Their efforts could help inform how other online communities support the mental health of their members.
Ever since video games became mainstream decades ago, there have been questions about their negative effects: Are they addictive? Can violent games lead to violent real-world behavior? How do they impact sleep, academic performance, or interpersonal relationships? All valid questions with no shortage of studies attempting to answer them.
But can video games—and the communities that form around them—also have positive effects? That’s what Michelle Colder Carras, PhD ’15, a senior associate in International Health and the Center for Global Digital Health Innovation, has been working to understand.
Colder Carras researches digital well-being and how people can balance the benefits with potential drawbacks. In a study published in July, she evaluated how one gaming community implemented supports and interventions for members experiencing mental health crises.
How Digital Communities Foster Connection
Online spaces like forums, chat rooms, social media, and video games offer individuals a way to connect that may not be as easy—or even possible—in real life. Most digital communities allow members to remain anonymous and make it easy to find others who share their interests, values, and identities—including ones they don’t express outwardly in their everyday lives.
The communities that form around video games are facilitated by the new ways of interacting online that have come about over the last several years. To collaborate, players often use tools beyond the game, such as platforms like Discord, where groups can converse via text or voice chat. These platforms also allow gamers to stay connected when they’re not playing.
When Colder Carras began looking at the effects of digital media in 2011, “the idea of online communities as being a potential benefit was really not something we thought of in public health,” she says in an episode of the Public Health On Call podcast. But as the COVID pandemic brought many digital communications into the mainstream, there has also come a broader understanding that these forms of communication can help people. For one, connecting mostly anonymously with like-minded peers can make some people feel comfortable opening up about struggles they might otherwise keep to themselves.
How a Community of Veteran Gamers Built Their Own Crisis Intervention Program
When he returned from military service in Iraq, U.S. Army Captain Stephen Machuga found that playing video games took his mind off the severe anxiety he was experiencing. In 2015, he founded Stack Up with the goal of using video games to help other veterans and active duty military. The organization sends games and consoles to deployed units and veterans, funds trips to gaming events, and more—all with the mission of supporting mental health.
What Machuga didn’t anticipate was that this initiative would also end up including a 24/7 crisis intervention program. As more veterans, active duty military members, and civilians joined Stack Up’s Discord server to play games together, Colder Carras says, they quickly realized that many members faced challenging life situations—like relationship loss or financial ruin—and felt overwhelmed and unable to cope. What’s more: they trusted each other—peers with shared experiences and love for video games—to help them through crises and mental health struggles.
So the members of Stack Up came up with a way to help themselves: Two first responders in the community created the Stack Up Overwatch Program (StOP), which officially launched in 2018, to offer 24/7 peer-based mental health and crisis support. The group worked with the PsychArmor Institute—a nonprofit that educates people on how to support military members and veterans—to formalize the nearly 40-hour training process of becoming a StOP volunteer.
The volunteers went through “similar types of training that community health workers or paraprofessional frontline health workers might go through,” Colder Carras explains. Through private text-based and voice chats, StOP volunteers helped members access traditional mental health care, lent a listening ear during moments of distress, evaluated the person’s risk of suicide, and counseled them during crises.
Evaluating StOP as a Public Health Researcher
Colder Carras learned about StOP at a gaming convention, where Machuga staffeded a booth for Stack Up. This was exactly the type of program she had been wanting to study since pursuing her PhD in public mental health. But studying StOP as an outside observer didn’t feel right; instead, Colder Carras joined the community herself. Transparently as a researcher—who the members came to refer to as “Doc”—Colder Carras worked with Stack Up members to develop the methods and ethical guidelines by which she’d evaluate the program’s effectiveness.
She and her co-authors believe theirs is “the first public health evaluation of an online, community-developed peer support and crisis intervention delivered through Discord.” Nearly 100 surveys and interviews captured in 2020, and analysis of approximately 180,000 chat messages from 2016–2020, showed that, overall, StOP provided meaningful support to members who used it.
In particular, the research found that:
- Meaningful, anonymous, and always-accessible peer support made StOP an important source of connection, support, and information.
- Users felt comfortable using StOP to discuss private issues with peers and were generally satisfied with the sense of community.
- Participating in StOP helped reduce users’ anxiety and increase their ability to cope.
- Participating in StOP reduced the symptoms that caused users to seek help during a crisis.
- Nearly all user posts were responded to by StOP volunteers quickly—within five minutes.
- Volunteers benefited from the mutual support provided by other volunteers.
Translating Findings Beyond StOP
The idea of training peer health workers is not new to public health; the analysis of StOP provides further evidence that it’s not only what services are being delivered, but who is delivering them. “We learned that the people who were delivering the intervention, the peer supporters, almost all of them identified as having the lived experience of some type of mental health problem,” such as PTSD, depression, or anxiety, Colder Carras says.
Colder Carras is encouraged not only by StOP’s effectiveness but the way in which it was developed and executed. “It's a great example of a grassroots program that has the right amount of clinical involvement from someone who is also a member of the community,” she says. She and her fellow researchers believe their insights could be used to inform other research around digital peer support and suicide prevention, and make it easier for other online communities to develop programs to support the mental health of their members.
In the meantime, Colder Carras is continuing her research on video games—both their benefits and drawbacks—from a public health perspective. She’s currently working with Bohemia Interactive Studio, developer of the military simulator game Arma Reforger, on an upcoming tournament that will draw awareness to mental health and gaming. They’re also exploring possibilities for a future research project around gaming and mental health using the same game.
“It’s difficult to create well-controlled studies around video games,” Colder Carras admits, but she’s committed to the work. It’s like doing research on hard mode.
Aliza Rosen is a digital content strategist in the Office of External Affairs at the Johns Hopkins Bloomberg School of Public Health.
