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Mental Health Stigma Reduction Toolkit

Addressing Mental Health Stigma

All providers can play a critical role in eliminating mental health stigma in the delivery of care to service members and their loved ones.

What is Mental Health Stigma?

Military service members can experience complex and unique challenges associated with mental health stigma.

  • Mental health stigma is a social phenomenon that involves:1
    • Negative attitudes or beliefs about individuals with mental health and substance use conditions.
    • Prejudices and stereotypes that minimize the strengths and resiliencies demonstrated by individuals who are successfully living with and managing these conditions.
  • Self-stigma is the internalization of public stigma.2
    • Service members may feel they failed to demonstrate the critical attribute of resiliency.3
    • Self-stigma can pose additional barriers to seeking care for mental health and substance use conditions.1

The Impact of Stigma on Care

It is important to reduce stigma around suicide or general mental health concerns, so that service members are empowered to seek mental health treatment.

  • In a recent analysis, only a third of military suicide decedents had received mental health care prior to their deaths.4

Stigma may adversely impact a patient’s care and outcomes:

  • Mental health stigma may lead to worsening mental health symptoms and lower self-esteem.5
  • People facing mental health stigma may be reluctant to seek treatment or may drop out of treatment early.5
  • Patients’ anticipation of stigma within the healthcare system can act as a barrier to care.6
  • Self-stigma at baseline of treatment is associated with poorer recovery outcomes over time.7

Some healthcare providers could perpetuate stigma through:6

  • Pessimistic views about their patients’ likelihood of recovery
  • Belief they lack the skills to work with patients who have mental health problems
  • Avoiding or minimizing interactions with such patients

These behaviors can contribute to a stigmatizing healthcare environment.

Examples of Stigmatizing Language and Behavior

The language used to describe mental health and substance use issues is important. Language has the power to contribute to stigma or encourage help-seeking behaviors and empower recovery.

Examples of stigmatizing language and behaviors include but are not necessarily limited to:

  • Defining someone by their condition
  • Making judgments about someone based on their condition
  • Expressing pessimism about someone’s potential because of their condition
  • Using inaccurate or even harmful language (i.e., overly graphic language) toward an individual with a mental health or substance use concern

Strategies for Eliminating Stigma in Care Delivery

Alternatives to Stigmatizing LanguageProviders should encourage help seeking behaviors and dispel stigmatizing language.

Some considerations when approaching conversations about patient diagnoses and treatment or when describing patients in clinical documentation:

  • Person-first language. Recommended for general use. When using this language, the provider is seeing the person for all that they are, with a complex identity and diverse experiences.8 You are not simply identifying the patient as their diagnosis.
  • Identity-first language. Some people identify with their disability or diagnosis in a way that is beneficial. They share a sense of community, culture, and pride with others who share their diagnosis.9 An example of identity-first language is when a person with a substance use disorder identifies themselves as an ‘alcoholic’ or an ‘addict,’ and considers this identity and the community of others with this identity to be important to their recovery.
  • Shared decision-making. Providers should collaborate with patients and their family and caregivers around treatment, considering all benefits and risks associated with care so they can make informed choices.10

Generally, providers should use person-first language when referring to patients but remain respectful of a patient’s use of identity-first language.9 If appropriate, providers can discuss with patients to determine how they would prefer to be referenced, as this can be individual.11 It is important for the provider to adjust their approach and language to the patient’s needs, preferences, and wishes.

Steps providers can take steps to eliminate stigma:

  • Education. Seek education on specific diagnoses you encounter in the Service members you treat. Research suggests that education reduces stigmatizing attitudes among mental health providers.12
  • Examination of Bias. Engage in self-examination for potential stigma-related misconceptions and biases linked to individuals with mental health conditions.6
  • Care for the Caregiver. Research suggests that healthcare providers who are experiencing burnout may be at higher risk than other healthcare providers of holding stigmatizing views of patients.13,6

Suicide Prevention and Lethal Means Safety

It is important to reduce stigma around suicide and general mental health concerns, so that service members are empowered to seek mental health treatment. In a recent analysis, only a third of military suicide decedents had received mental health care prior to their deaths.4

  • Lethal means include all objects that an individual can use to inflict self-directed violence. These include:14
    • Firearms
    • Medications
    • Any sharp objects
  • The goal of lethal means safety interventions is to create distance between an individual and the means to harm themselves.15
  • Healthcare providers can talk to patients about the following lethal means strategies:15
    • Locking firearms in cases or safes, or with cable locks
    • Storing firearms and ammunition separately
    • Storing firearms outside of their homes
    • Storing medications in lockboxes

Read more about Lethal Means Safety:

The Defense Suicide Prevention Office (DSPO) provides a Lethal Means Safety Toolkit, with a number of resources, including a detailed guide to lethal means safety practices: https://www.dspo.mil/Tools/Resource-Library/lethalmeanssafety/

Other general suicide prevention resources from DSPO contain resources and information:

Research has shown that increasing the time and distance between a person in suicidal crisis and their access to lethal means can reduce suicide risk and save lives.

For more information: https://www.mirecc.va.gov/visn19/lethalmeanssafety/

Resources

The resources below provide additional education and information on eliminating stigma in the delivery of care as well as resources for service members and their loved ones.

Real Warriors Campaign | Real Strength

The Department of Defense’s Real Warriors Campaign (RWC) is a public awareness initiative health campaign designed to encourage psychological health help-seeking among active duty service members, veterans, and their families by decreasing stigma, increasing psychological health literacy, and opening doors to access to care that encourages members of the military community (service members, veterans, and military families) to seek help for psychological health concerns

Military OneSource provides 24/7 support and information on housing, financial, legal, medical, and psychological services
– State-side: 800-342-9647
– Overseas: 800-342-9647
– Collect: 484-530-5908
www.militaryonesource.mil

988 Suicide and Crisis Lifeline provides free and confidential support for individuals in crisis. If you or someone you know is struggling or in crisis, call or text 988 or https://988lifeline.org

Military/Veterans Crisis Line provides free, confidential support for service members and veterans in crisis. Dial 988, then press 1 or text 838255 to chat live with a counselor.
www.veteranscrisisline.net

inTransition offers specialized coaching and assistance for active-duty service members, National Guard members, reservists, veterans, and retirees to help them adapt to their transitions between systems of care.
– State-side: 800-424-7877
– Overseas: 800-748-81111 (in Australia, Germany, Italy, Japan, and South Korea only)
www.health.mil/inTransition

Policies

References

Last Updated: September 11, 2023
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