How the Military is Addressing Stigma around Mental Health

Nearly 60% of military service members suffering from mental health problems don’t seek help.1 The stigma against seeking help can pose a significant barrier for veterans suffering with these issues. Fortunately, you or someone you care for can overcome the undeserved shame stigma causes and find support.

In this article you will learn:

  • What the military and the Department of Veterans Affairs (VA) are doing to address stigma.
  • The definition of stigma.
  • The causes of mental health stigma.
  • Why stigma in the military is a serious issue.
  • How to find help overcoming stigma and obtaining treatment.

What the Military is Doing to Combat Stigma

man in group therapy getting comfortedThe military is making several efforts to overcome mental health stigma. For example, they have taken steps to reduce fear service members may have in honestly answering questions about their mental health.

In order to obtain a clearance to access classified information, service members must complete a 127-page questionnaire called “Standard Form 86.”2 Question 21 of that form asks, “In the last seven years, have you consulted with a health care professional regarding an emotional or mental health condition, or were you hospitalized for such a condition?”

Some applicants fear answering “yes” to the question may result in their clearance being denied or revoked.3 An ongoing effort to alleviate that fear is underway through the publication of clarifying guidelines. These guidelines emphasize that a “yes” answer is only required if mental health services were court-ordered.2

Another effort began several years ago with replacing narrow readiness definitions with new “gray” areas to accommodate the realities of mental health issues among service members. Formerly, a service member with a mental health concern was labeled either “fit” or “ill” (and thus unfit for duty). New designations classify them as either:

  • Ready.
  • Reacting.
  • Injured.
  • Ill.

These new categories expand the number of  responses and options for professional intervention from only psychologists to include chaplains and military leaders.4

The military now strives to bring mental health issues out for open discussion. Service branches invite speakers from many walks of life to talk with military service members about mental health. For example, Heisman Trophy winner Herschel Walker visits bases to speak of his own mental health issues and the stigma of seeking help.5

The military continues its effort “to improve the lives of our nation’s service members, veterans, and their families by advancing excellence in psychological health care, readiness, and prevention of psychological health disorders.”6 To increase mental health access for its members, the military offers a wide range of providers. These include:

  • Psychologists.
  • Psychiatrists.
  • Clinical social workers.
  • Psychiatric nurse practitioners.
  • Behavioral health technicians.
  • Unit-embedded behavioral health providers.
  • Primary care behavioral health consultants and facilitators.
  • Non-clinical providers like chaplains and family life counselors.
  • Linkages to a host of community providers.7

Defining Stigma

The VA defines stigma as “a mark, blemish, or defect; a symbol of disgrace, shame or reproach and often involves fear of that which is different.”8  In the military context, this is a “marked identity” you may be internalizing.9

Stigma originates from a variety of settings:

  • While the military seeks to address it, institutional stigma involves policies and procedures that make seeking treatment needlessly challenging.
  • A public context of stigma refers to a prejudice of “individuals with mental health problems as dangerous, unpredictable, and responsible for their condition.”10
  • The social context of stigma entails what you believe your friends, family, and coworkers may think of you when you admit to having to a problem.
  • The public, institutional, and social contexts of stigma help form the individual context of stigma.

Causes of Mental Health Stigma

These different contexts help explain the cause of mental health stigma. Fearing institutional repercussions, adopting the public’s prejudice toward mentally ill people, and feeling ashamed of how friends and family may perceive your issues combine to create an individual’s stigma from within.

Several factors cause stigma in a military context to be especially unique.9

  • Enlistment screening of such mental illnesses as schizophrenia and bipolar disorder makes them even more uncommon among service members. At the same time, they experience a higher incidence of problems like post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).
  • Compared with the civilian sector, service members’ home lives and work lives are more intertwined, heightening the possibilities of their employer’s awareness of personal mental health issues.
  • Men may perceive greater stigma than women when seeking help, and the military employs a disproportionate number of young men.
  • Such military unit norms and values as “shared mission, leave no soldier behind” add a unique form of public stigma on military service members. A service member may not want their peers to think they can’t rely on him or her.

In spite of the military’s efforts to reduce the impact of institutional stigma, fear remains. For example, service members may be assured that over 99% of those who do answer “yes” to Question 21 have no adverse action taken.2, 3

Nevertheless, the question remains confusing to many and misconceptions about its impact remain.2 Also, a military culture “that emphasizes self-reliance and toughness” may cause some to feel they must “do their best to cope by themselves with negative affect and difficult emotions.”10

Why Stigma in the Military is a Concern

If you are experiencing a mental health condition, you are not alone. According to one study, nearly a quarter of non-deployed U.S. Army personnel met the criteria for a mental disorder.12

Mental health issues pose vital threats to military readiness and individuals who choose to serve their country.

From a military perspective, leaders “worry that these invisible war injuries could deplete a fighting force that’s already stretched thin.”For example, the Air Force reports that a major reason for evacuating airmen from operational theaters is due to mental health issues.13

For some, the impact of military service is profound and places a unique strain on an individual’s mental health. Events experienced might include:14

  • Being forced to kill others.
  • Watching friends and comrades suffer grievous wounds and death.
  • Having core values threatened.
  • Long separations from families.
  • Loss of freedom and control over one’s life.
  • Tremendous uncertainty and anxiety.

Servicewomen face their own unique challenges.  For example, women serving in the military face higher rates of depression, possibly due to:15 

  • Stress.
  • Pregnancy.
  • Birth complications.
  • Low social support.

In addition to the costs to military readiness and the human toll of substance abuse and suicide, mental health exacts significant monetary costs. In just the first two years after their coming home, medical care and lost productivity for service members cost over $6 billion, according to one estimate.4

Over time, the military has better understood the impact of untreated mental health issues and is taking strong measures to combat the stigma associated with it. Special focus is placed on transitioning to mental health care for military veterans.

Get Mental Health Help

standing man helping a man on the ground get upThe conversion from military to civilian life is especially challenging to service members with a mental illness. Overcoming stigma for service members and veterans involves careful strategy that recognizes the challenges of seeking help. These include:11

  • Overcoming concerns for patient confidentiality.
  • Addressing career concerns.
  • Offering real hope for improvement.
  • Ensuring greater choice and control through patient-centered care.
  • Avoiding the use of labels and stigmatizing language.

Treatment options abound for military vets. A great place to start is visiting the VA’s “Make the Connection” website. There you can hear firsthand the experiences of veterans as they challenged their own mental health issues. In partnership with the VA, programs such as Desert Hope’s Salute to Recovery and the Recovery First addiction treatment center focus on the unique needs of veterans.

If you need help immediately, the VA offers vets a crisis line available 24/7—just dial 1-800-273-8255 and Press 1. You can also send a text message to 838255.  You served your country, and many now stand ready to serve you.

 

References:

  1. Marie-Louise Sharp, Nicola T. Fear, Roberto J. Rona, Simon Wessely, Neil Greenberg, Norman Jones, Laura Goodwin (2015). Stigma as a Barrier to Seeking Health Care Among Military Personnel with Mental Health Problems. Epidemiologic Reviews January; 37 (1): 144-162.
  2. U.S Air Force: Schriever Air Force Base (2019). Security clearance: understanding question 21.
  3. Defense Logistics Agency (2017). It’s okay to answer Question 21.
  4. Dingfelder, Sadie F. (2009). The military’s war on stigma. American Psychological Association June; 40 (6): 52.
  5. U.S. Air Force: Altus Air Force Base (2019). “There is no shame in getting help. I did.”
  6. U.S. Department of Defense: Psychological Health Center of Excellence . PHCoE Strategy Framework.
  7. U.S. Department of Defense: Psychological Health Center of Excellence (2018). Helping Your Patients Understand the Types of Mental Health Providers.
  8. U.S. Department of Veterans Affairs: Office of Rural Health. Mental Health Stigma: 10 Things You Should Know About.
  9. Acosta, J. D., Becker, A., Cerully, J., Fisher, M., Martin, L. Vardavas, R., Slaughter, M. Schell, T. (2014). Mental Health Stigma in the Military. Santa Monica: Rand.
  10. Kulesza, M., Pedersen, E., Corrigan, P. Marshall, G. (2015). Help-seeking Stigma and Mental Health Treatment Seeking among Young Adult Veterans. Military Behavioral Health June; 3 (4): 230-239.
  11. U.S. Department of Defense: Psychological Health Center of Excellence (2019). Reducing Military Mental Health Stigma to Improve Treatment Engagement: Guidance for Clinicians.
  12. Kessler, R. C., Heeringa, S. G., Stein, M. B., Colpe, L. J., Fullerton, C. S., Hwang, I., … Ursano, R. J. (2014). Thirty-Day Prevalence of DSM-IVMental Disorders Among Nondeployed Soldiers in the US Army. JAMA Psychiatry, 71(5), 504. doi: 10.1001/jamapsychiatry.2014.28.
  13. U.S. Air Force Office of Scientific Research (2017). Good mental health critical to military readiness.
  14. Young, J. L. (2016). Military Mental Health: Understanding the Crisis. Psychology Today.
  15. U.S. Army: Warrior Care and Transition (2017). Depression impacts readiness:” How mental health issues affect soldiers, particularly women.