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

Conference Recommendations 97
10
Conference Recommendations
Robert J. Ursano, M.D.
DR. URSANO: We have much work to do thinking about and making recommendations
that we want to capture. Our goal is to limit the discussion to recommendations,
and we will try to put them into a bullet form. I want us to think about
the question, “What constitutes the level of the burden of disease” The top two
items in the burden of disease within the military, number one is injury, and number
two is mental disorders. So what are our targets
Please remember that psychiatric responses to disaster, war, and terrorism occur
in different places. We have the question of mental disorders and also the question
of resilience. We have the question of distress responses, and we have health risk
behaviors, which include things like changes in use of cigarettes, changes in use of
alcohol, and issues of driving and road traffic accidents. These are all targets for prevention
and intervention in which stigma and barriers to care can impact outcomes.
The issue of distress responses is particularly important; it falls into the category
of mild to moderate disorders in some of the studies Ron Kessler has done, which,
number one, indicate that they need treatment because of their trajectory of course.
Number two, they also impair performance, and in DoD we are in a performance
activity. In the nation, if one addresses the question of safety workers, such as police
and firefighters, the question of performance in terms of national security is much
more important than disease, because people get sacrificed as individuals in order
to protect the continuity of the nation.
Please remember there are disorders, there are distress responses, and there is
how we intervene for them. How do barriers to care interfere with these factors and
with health risk behaviors Think about driving accidents, motor vehicle accidents,
as one example of that. Across the spectrum, of course, there are also all types of
psychosocial responses that have an impact, from sleep problems, to demoralization,
to scapegoating and blaming, all of which are outcomes in an organization and a
population we are concerned about because they affect performance activities.
There was a study that Chris Warner did, in which he asked people, “If we
change this, will it matter to you” And he found differences among those who were
deployed and those who were not. In addition, he found that if we tell you that
your family is concerned about you, it has the highest impact. The issue of trying
to identify what may be most effective for overcoming barriers to care is one target
The issue of
distress responses is
particularly important;
it falls into the
category of mild to
moderate disorders
in some of the studies
Ron Kessler has done,
which, number one,
indicate that they need
treatment because
of their trajectory
of course. Number
two, they also impair
performance, and
in DoD we are in a
performance activity.