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Issue: Stigma as a Barrier to Mental Health Care
5/14/2009 -

Many service members who need and deserve proper mental health care fear negative consequences or perceptions and take no action to seek treatment. Troops struggling with stress, anxiety, or depression may not visit a mental health care provider because they think their buddies or command will treat them differently for doing so. Some may not realize that they may have a problem. This stigma persists as a barrier to providing help to those who need mental health care in all populations, not just in the military.

There is no shame in seeking help. Many military leaders have come forward to talk about their own experiences with post-traumatic stress or depression and how they have benefitted from help they have received. A wealth of mental health programs and services have been created by DoD and partnering organizations.

Is this enough in a military environment? Has DoD taken the right approach in addressing this issue? What programs and resources are working? Which ones aren’t working? What will it take to convince service members that they will see no negative consequence as a result of seeking mental health care?

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Comments (15)
Cecily david at 2009-05-14 14:16:57 wrote:

Continue to educate that it is OK to seek help for mental health issues . Culture needs to change. It is OK for grown men to cry .
MAJ Remington Nevin at 2009-05-15 02:55:14 wrote:

The current paradigm for mental health and the focus on “stigma” conveniently shifts the burden of responsibility to the service member, while ignoring contradictory institutional ethos, such as the Army Values' emphasis on "selfless service", which every Army recruit understands requires placing "the welfare of the nation, the Army, and your subordinates before your own".

Variations of this ethos are found across all the services, are teach the importance of loyalty to one's unit and the mission above all other considerations, including health. This ethos is strongly at odds with the recent emphasis on self-referral and self-identification for mental health care, particularly if a service member reasonably anticipates that such action will render him or her to be found unsuitable for a deployment. These actions would be viewed as weakening the unit, increasing the risk to one's comrades.
The current epidemic of suicides among the Army ranks is clearly related to deployment; and is very likely related to the repeated deployment of individuals at increased risk of suicidi through pre-existing mental health problems.

Yet DoD is continuing to deploy thousands of such personnel, many on multiple tours; many of whom are on multiple psychotropic medications; and many of whom have a consistent history of treatment and counseling which ends or is interrupted immediately upon deployment.

Many of these personnel would have been clearly disqualified for deployment in prior years; but current operational considerations and the needs of the services have overruled such medical caution.

Until DoD admits that reliance on self-report of mental health problems is at odds with its core ethos, the current epidemic of suicides will likely continue unabated.

In the interim, DoD should commit to the letter and spirit of Public Law requiring comprehensive medical examinations prior to deployment (as opposed to ineffective Pre-Deployment Health Assessments); and clarify whether physicians do indeed have the independent authority to identify a service member as "non-deployable", not subject to being overruled by commanders whose interests must realistically be focused primarily on operational considerations, not the health of individual service members.
harry gonzalez at 2009-05-22 15:08:45 wrote:

I can appreciate the importance of self-advocacy and seeking professional help. Throughout my long-road I have informed my command as to my progress and prognosis, never knowing their intentions. Foolishly I trusted them. I retire in Mar 2010.

Keep your friends close, keep your superiors closer...

This is the unedited reality.

hg
Tracy Connor at 2009-05-26 15:18:28 wrote:

The message that there is no shame in seeking mental health care is not enough. As described very well in MAJ Nevin's 5/15 post, the military ethos is one of prioritizing self care below selfless service. The message needs to be that a servicemember who recognizes in him/herself a need for mental health treatment has a duty, a responsibility on par with his or her other duty obligations, to seek mental health care as needed. The unit, mission, service branch, and nation are not actually served by individuals with mental health conditions foregoing care. Also as pointed out by MAJ Nevin, the onus for referral can not fall only on the individual. Educated, experienced, worldly adults often are unable to identify a need for mental heath care in themselves. To expect a group of people who are under extraordinary strains in several life domains (and are often young, without functional family support, and early in their educations)to self identify just asks for trouble. Personnel in leadership positions at all levels need to be trained to recognize and skillfully intervene and refer servicemembers for care. I know a handful of USMC Majors who currently hold or recently held leadership positions (e.g. Battery CO) who remain entirely unfamiliar with the mental health resources available to their Marines. Civilian non-profits are abuzz with the lack of communication and confusion and are looking to create simple, accessible, one-point referral for mental health care. The DoD and the service branches should be embarrassed that they have not already met this need. I have heard repeatedly that Onesource is the place to go for that; however, I challenge anyone who does not know exactly for what they are looking to find comprehensive information on Onesource/Tricare/MHS websites -- internet research savvy people in perfect mental and physical health would have trouble.
Melinda at 2009-06-03 09:54:18 wrote:

As a person who has gone for help I have a lot to say on this subject.

I had suicidal Ideation at the time only I was new to my unit so nobody knew what my normal behaviors were. One thing my new command did know was that my Mom died 2 months before my arrival because when my commander at Keesler requested to extend my report no later than date because my mom was dying it was declined. Keesler was home for me. My mom died only a few days later. The only time I took off of work was the holidays because I assumed I had to go back then. While in the middle of grieving for my mom and trying to get my Dad used to doing things for himself I had to PCS. My new Supervisor put me to work the morning after I arrived. I didn't even get time off the recieve my household goods. Things just got worse for me very quickly. I had a plan to just make it all go away. My kids noticed I wasn't right and asked if they did something that made me sad all the time. I decided to go for help at the Lifeskills clinic.

After I made my first appointment I decided that I should let my supervisor and commander know I was going. I didn't give a reason other than I wasn't dealing with my moms death very well. I just thought it was the responsible thing to do.

Before I told them I was trained to go TDY for special support for the launch of the Space Shuttle. My AEF was coming up and I was happy I finally would be able to deploy since I had never gone.

After I told them I became the trouble Airman. I went from absolutely no disciplinary actions in my file except for fitness to 2 years later having 2 LORs and 3 LOCs. I also have recieved 2 - 3 EPRS even though I am in charge of our Unit Safety/ORM which recieved positive comments from our ORI and consistently is praised by the safety office as the best they've ever seen. I turned in 2-3 pages of good bullets each year for absolutely no reason. I have ratings of 3 on two EPRs and was told my next one would probably be a 2. I worked harder and accomplished more during this assignment than any other. I will be Medically retired in July partly due to the way I was treated by my chain of command while trying to recover from a major depression and PTSD which I think was triggered by seeing my mom die. I will not recieve the honors of retirement after 19 years and 4 months of service. Yes I get to retire but without ceremony and with no medals. People tell me I served honorably but I feel no honor in being treated as a criminal for seeking medical treatment for Depression and other problems.

It took me a long time but my point is....If it is a good thing to ask for help, why do we treat people who do it as if they are less than everyone else? How can you justify treating someone who was responsible enough to get help like the are incompetent after years of proving they are very capable and competent? It should raise a red flag when someone getting treatment suddenly starts getting disciplinary actions and substandard ratings. Shouldn't the chain of command be held accountable for making life almost unbearable for people who are already thinking life isn't worth living. Discipline does not correct mental health issues it aggravates them.
During the time I was at my lowest after I told not one person including my supervisor asked how I was or if there was anything they could do to help. Instead of making me feel like I was a person of worth I was made to feel underserving and worthless. I wanted to finish my career honorably at 20+ years and I don't even get that. I tried to help by telling my story but noone wanted to listen because I am overweight. I have to say I find it very disappointing that people veiw someones weight problem as more critical than the possibility of saving just one airman. Suicides will never decrease in the Air Force until the chain of command realizes discipline isn't the answer ...It is a last resort....Care and understanding is the answer I have done my duty by talking to my chain of command and people in my squadron. It is a shame no one listened.
Sam at 2009-06-04 09:53:58 wrote:

Concerning suicide prevention I have two recommendations that I believe would have an immediate impact.

1. At a minimum, implement a satellite program relocating non-married military members residing in the barracks that currently reside in three and four person rooms, into an open squad bay environment with assigned Non commissioned officers. During the early 1980 and before in the military, this was standard policy in all the branches of the US military and it prevented and saved thousands of lives from potential suicide and countless other potential behavior problems, wise and savvy NCO’s had an eyes on approach to the health and welfare of their junior military members and could determine and prevent many potential mental health problem before they got out of control. In today’s military, NCO are not billeted anywhere near their junior military members and I believe this situation has created a lack of leadership environment, that could easily be prevented with greater direct contact. I understand this would not be a very popular solution in today’s military, but I believe the ends justify the means.

2. Effective immediately! All military members who seek military legal assistance for separation or divorce must also receive a mental heath screening. If this becomes mandatory, it will automatically remove the sigma and or dogma of being portrayed as weak or inferior to their chain of command or individual peers.
Louis Edward Buckingham at 2009-06-12 16:41:58 wrote:

When you have completed all of the things that kept you busy over the years since Vietnam. You no longer surrounded by the Vets, you use to work with. All you have now is your war room at home. You need more things to do to keep your mind focus. I now have to much time to think about the war and its experiences. I will continue to focus on high energy although I can't stay still long enough, because I must be doing something. I will try this Vet groups near my home for assitance.
melissia wilson at 2009-06-16 21:18:27 wrote:

this is a very huge issue for the military. I have seen first hand the issues that a soldier faces when he is in a vulnerable position, or state of mind if you will. I don't know if it is becuause of lack of enough care givers or qualified personel or just that it is a medical condition that has only been given the recognition as a true medical condition in recent years. My family member has faced serious issues that are most certainly a medical condition. My entire family spends alot of time feeling that there is nothing that we can do to help our own flesh and blood who is in desperate need of help. It seems as though our hands are tied and our soldier is left to try to work his/her way through a system that doesn't seem to have a place for these kinds of issues. I am greatful to see that this is a subject that others are talking about and trying to figure out. I wish I knew where to get more information.

Sincerely,

Desperate in Texas
Julie at 2009-06-24 14:20:47 wrote:

I encourage all members suffering from a mental illness from whatever circumstance to utilize their local Mental Health Clinic. The brain is an organ just at the heart, liver, kidneys, etc. are and it can have problems just as the other organs can. It is "OK" to get help for your mental well-being. I saw a psychologist for many years while AD and am grateful for all the help I received.
Richard Moczygemba, COL, MC (Ret.) at 2009-06-26 17:41:16 wrote:

The current doublespeak is that "commanders may not discourage" personnel from seeking help for mental or emotional problems. There is no regulation requiring commanders to refer troops to seek mental health assistance for mental or emotional problems. Until there is regulatory language that clearly spells out what commanders must do for troops with these problems, nothing will change. There also needs to be regulatory language that spells out the requirement for troops to be allowed to engage in any and all treatment modalities, and for mental health profiles to have iron-clad protection from modification or violation.
Until someone at the four star level makes it clear that prejudice and stigmatization will not be tolerated, it will continue to be tolerated. I am tired of seeing the general officers make toothless statements with the usual platitudes, when the leadership clearly has the power to make the change happen.
The culture change will have to be ordered, mandated, and enforced, much like racial integration of the military in 1948, or it won't happen.
michael troop at 2009-07-09 16:28:04 wrote:

I do not think the army has taken the right approach at all. As a sufferer of PTSD and a civilian (GS) employee who experience a suicidal period in my life, I got to see the reaction of the commands from the patient’s side.
With all the education, the Soldiers, the Command had become complacent and desensitized to the situations to the point of no longer recognizing the signs of depression of acknowledging the calls for help. I approached the BN Commander and was told “if there was a problem, [he] would know about it” right as he slammed the door in my face. I went to the chaplain who turned and walked away. My co workers started to call me a piece of S**T to my face and tell me they want to have me fired.

This forced me further down and showed me the reality that the military does not truly care about the civilians. If they do not care about the civilians, they would not care about their Soldiers. I started to look during my recovery at what was important and found it was the NCOER and OER as well as promotion for friend, more than care of others in need.

From a victims point, I am finished with civil service after 15 years. The army has lost this asset.
http://troopm.wordpress.com
Sgt Bill Vietnam at 2009-07-10 10:57:47 wrote:

Yes indeed shame (stigma) is part of receiving mental health treatment in the first place. Everyone knows that shame is caused by the demeaning. and desparaging labels, that are used within the non-medical psych bible called the DSM IV. Also the non-medical term" "mental illness" is documented to cause stigma and shame as well. The truth here is decades ago mental health professionals. found a way to a financial bonanza. For decades they have found a way, to use unaccountable, and unreliaable non-medical terms to discribe their treatment modalities, and then reap in a fortune to "treat" these unsubstantiated "diagnoses" for a person's lifetime. The found a way to get a fortune for their increased failures. The more failure the more government grants. The stigma, and shame generated by psych labels have caused documented social problems, increased divorces, indeed increased suicides, more social problems, and underproductivity of patients. Now they want more money, to use their undocumented treatment claims with our brave American troops, and let good ole Uncle Sam pay for it.
all this would be a big joke, if it weren't so tragic. The best help for other veterans has always been other veterans: not psychs with there demeaning labels, and attitudes. Non-medical psychologists should not even be allowed on our wonderful military hospital wards. Veterans always have problems adjusting, but psychs just contribute to their problems, and make a fortune in the process.
Michael Troop at 2009-07-10 14:29:12 wrote:

Mental Health issues face an odd series of stigmas. One of those is generated by the unit’s cohesion and the feeling of being viewed as a weak link within the unit. Many suffering will maintain silence instead of exposing their vulnerabilities. Exposure usually comes from fellow soldiers identifying exposure. Still, most soldiers suffering go unidentified and escape the horror of being ID and humiliated.

The over sensitization by training has caused commands to over react, of course in good faith. What happens is they over protect the solders, special duty, isolation, light duty, bed rest, observation ect and this builds a stigma within the unit of special treatment and of mental instability. Now when the soldier is prepared to return to his unit, others view him differently, like a weaker link, lacking trust in his abilities.

Those who make it back, and support personnel, who PTSD catches up with them like mine then get to meet garrison commanders. Those have little clue to the realities of PTSD, feeling that on back in garrison, PTSD will not show itself, that it only shows in combat zones. There is one PCM in the unit I work who told me that PTSD outside combat is a sign of a soldier trying to take advantage of the military. Being I work in a WTB, you would think that the thought process would be different.

I used to work for some great GOs: Gen Casey, Gen Abrams, Gen Migs, Gen Curran, and Gen Bell. I know they most likely do not remember me but while working for them in Germany, they taught me much about what it meant to be a soldier, how to care for soldiers and how soldiers, their families and civilians should be treated. After I was medically discharge and civil service became my home, I adopted what they taught me. In today’s military, I no longer see their philosophy at work. I would so love the chance to speak with them on what has gone wrong, and what I think should happen to correct the military’s treatment of PTSD patients.

It is wrong for the armed services to dump the soldiers upon the VA, or upon the streets for other organizations to treat, without taking adequate steps to treat these issues first. It is also wrong for the military to seek UCMJ action for any offense all the way down to missing an appointment in an attempt to chapter out a WT prior to their MEB. We are hurting the wounded; we are putting them in harm’s way by removing them from pain medications suddenly, giving them Motrin, and then giving them a urinalysis in hope of finding illegal drugs or un-prescribed pain medications from another WT.

It is those in the higher ranks who speak of the successes in treatments. I was one, praising the military for what it was doing then I fell victim to my past and my PTSD gave me a ride I was not expecting. I walk the halls everyday and I see the photograph of GEN Casey and remember back to a drive he and I took to Hohenfels. He told me “the military is like a cigar, if you discard it for the bad tobacco, you will never experience all that is good about it”. It just seems as this war drags and we try to treat, we are becoming more and more complacent and have lost the last of the good tobacco.
Lew at 2009-07-11 18:57:37 wrote:

Psych "diagnoses" are not based upon any objective clinical findings, like blood, or laboratory testing. Psych "diagnoses" are merely voted upon by the Psychoprofessionals, and published in their non-medical bible, called the DSM IV. No psych "diagnosis" is based upon science, or medicine and no psych "diagnosis" is medically or scientifically accountable, or reliable. The fact is veterans "diagnosed" with PTSD couild just as well be "diagnosed" with "depression" or any of the over 330 so called
"dignoses" of the DSM IV.
The facts show that psych treatments have a dismal track record, and patients and their families suffer from stigma, and abuse caused by staff for a lifetime. Military commanders must find a better way, to obtain treatments our brave veterans. History shows that the best help for veterans is other veterans, and not from those who have shown contempt for the military, and our wonderful soldiers. Psychs have proven that they, are doing this for money, and nothing more.
TSgt Tom at 2009-07-15 19:04:48 wrote:

Let's look at the high incidence of suicide among physicians, in order to reflect more light, in regard to the same issue among our veterans. The demeaning, and career-limiting nature, of mental health lingo, prevents physicians from seeking treatment. Even after psych treatments begin, physicians continue to have a high rate of suicide, and marital problems. Physicians feel ridiculed, and humiliated. Commanders should look at the evidence here. Psych "diagnosis", and psych treatment clearly cause more problems for both physicians, and veterans that's why they both refuse "treatment", and would rather commit suicide than receive it. How psychologists who are non-medical, can be considered independent heathcare professionals, and provide "treatment" in our hospitals, and clinics no one seems to know. The record is clear, and cogent.
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