stigma and barriers to care - Uniformed Services University of the ...

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Stigma and Barriers to Care — Caring for Those Exposed to War, Disaster and Terrorism
edge or misunderstandings or stereotypical thinking that is just wrong. There is also
leadership and how it manifests itself in the different clinical and public contexts.
DR. PESCOSOLIDO: I have two quick points from the micro to the macro. The
micro goes to Tom Bornemann: A number of researchers around the room have data;
and we would like to know what you would like to see from it that might help you
in what you are doing. For the macro, I would like to go to Doug Zatzick’s point,
what is the model and what is the study that is really going to push our understanding
and our ability to change it forward
DR. KILPATRICK: I would like to talk about erectile dysfunction. In a serious
way, I think it might be a good metaphor for us because it used to be pretty stigmatizing,
but now you cannot watch TV without having people telling you that they have
it and are coming forward for treatment. If we can do it for erectile dysfunction, we
can do it for mental health problems.
DR. RUZEK: One of the things that struck me is the importance of getting to
the places and people that individuals do go for help. We know that they do not go
to mental health providers. They are seeing and talking with chaplains. They are
in primary care. And, for example, in acute trauma they are going through ERs, so
there are places where conversations are happening.
Wendi Cross’ presentation is a warning sign for that because that means there are
huge training needs, and that training is labor intensive. Quite apart from time constraints,
there are training and competency factors that are important. The answer to
that may be something that Matt Friedman raised, which is technology. I think that
web programs and soon to be iPhone apps—those kinds of things—can be put in the
hands of those providers. Those technologies will shape what they deliver, perhaps
making it easier to accomplish the goal without complex skills-training regimens.
DR. ARNOLD: I am from the Graduate School of Nursing at USUHS, Psych/
Mental Health Nurse Practitioner Program. I like the contact concept. One of the
most impressive things that I saw recently was a one- or two-star general who came
to our campus and spoke about the personal impact that mental health had had on
him in regards to having a son who committed suicide and having another son who
had a traumatic brain injury.
Being able to hear that from somebody at that level is impressive for change. I
know the DoD made an announcement two years ago that they want people coming
in to get treatment for mental health. It is their duty. But when you think of
the number of years prior to then when that was not the case, we are not going to
change that overnight. Unless it comes from the top down, we are not going to see
that kind of change.
DR. CREEL: I am in the Department of Preventive Medicine at USUHS. I want
to think tomorrow about identity and social roles and how those play a role, and
how we can use them for intervention. Also, efficacy beliefs, both in terms of whether
we believe that there is something that can be done for us or for others, and how
that plays a role in terms of stigma.
DR. SCHOR: I am the Acting Director of the presidentially mandated National
Center for Disaster Medicine and Public Health, the purpose of which is to address
education and training and competencies in disaster medicine and public health at
the domestic level.
I am disliking the word stigma more and liking stigmatizing or stigmatization
better because I am thinking that in a couple of interesting ways they are very
disparate. There was mention of social networks. We have talked about them as