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
America’s heroes will have across the board or not—which way it is going to flow
in the broader social sphere.
DR. ENGEL: I think this whole notion of stigma is very important. I will establish
that right up front. We have to think a great deal about unintended effects.
The military, where I lived most of my life, is fundamentally a culture built around
collectivism, if you will. It is about small group function to accomplish dangerous
tasks. Bruce Link said something about the functions of stigma in some fashion, the
idea that stigma reinforces norms, that stigma extrudes, if you will, disease. There
are potential ramifications of the idea that we could completely de-stigmatize some
of these things. You could have these problems and continue on and make them
irrelevant to your ability to stay on in the military.
While we could become more open-minded about our policies, it is going to be
awfully tough to completely take that out of the mix. If we do, we may find ourselves
in a place that we did not want to be as far as the military goes. By the same token,
I think we should be looking for ways to better deliver care. Along the lines of what
Simon Wessely said a moment ago, we have to rethink how we consider therapy.
We have to think along the lines of what is acceptable to our population. We have
to think about choices and we have to think about preferences which, again, we are
not accustomed to in the military. We do what we are told.
If we are ever going to reach out to the large fraction of people who do not seek
mental health care, I think we have to address the nature of the problem, which is
that right now we are pretty limited on what we can offer in terms of acceptability
to many of the people we are seeing.
DR. SLONE: I work with Matt Friedman at the National Center for PTSD. My
role here is a bit different. I am the Associate Director for Information and Communication
so I do a great deal of work trying to actually take what we learn from
research and get it out to the general public so that it does do some good on the
education level.
I want to remind everyone to think outside the box and to remember that this
is not just a public health model or a clinical model; there might even be another
level in between because the problems are very different. Our thinking about treatment
really needs to cover a wide range of areas, not only the public health policy
issues or clinical issues, but different things that we do not normally think about
such as social media and contacts, and advertising. We cannot just think that one
solution is going to fit everything. We need the variety because there are a variety of
problems. With policy you need to look at what good you can do for the average
person, for the greater sum of people. But interventions for the smaller groups are
just as important, and we need to continue to test on those levels as well.
DR. CROW: I am the clinical psychology consultant to the Army Surgeon
General. I am also Director of the Warrior Resiliency Program which is an Army
Medical Command program. Today I heard several references to mental illness in
the course of presentations. Sometimes it concerns me when I hear that, particularly
if the parameters of the term are not real clear.
I do have a real interest in how we might be able to use concepts and perspectives
of resilience and life skills as a way to address problems of living. I get concerned
when we talk about de-stigmatizing mental illness or imply that is what we are talking
about. It almost seems to require that our beneficiaries by definition have to be
sick in order to access our services. I would rather see that we look at ways to make
what we have to offer available in a less illness-based kind of a model.