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

Conference Recommendations 101
ence. Many of the people with the more serious problems do not have a vocational
career to begin with.
This would be interesting for two reasons; one is to be able to provide some
data for people who may be reluctant. Two, to actually look at how, and why, and
where those changes were made. Given that every injury, including an injury to your
psyche, is going to have some effect, if I am a reluctant soldier I want to know the
ins and outs. I think right now we have a very gross understanding of it, in general,
but not a real sensitive specific understanding.
DR. URSANO: So to capture it: understand the trajectory of vocational consequences.
DR. KESSLER: One thing that was said in passing yesterday was about resilience
training, and if it could be packaged. People get badges for these things they go
through. If there were a way in which having resilience training was something to
check off as you went through it, as if it was a skill that you now have. I can imagine
packaging mental disorder training so that there is not a distinction of the people
who are trying to maximize the upside, and get back to a baseline. Another thing is
that in the civilian world there are many people who do not want to go to mental
health care through their employer-sponsored health plan so they pay out-of-pocket.
The military has now put in place this new program where you can get telephonic
psychotherapy without the therapist knowing who you are. I think both sides are
being worked in that regard.
The thing I wanted to say before, which occurred to me in regard to Sue Estroff’s
comment. There were an enormous number of interesting ideas here yesterday, but
the one that I went away with, and I kept mulling over, was the critical comment by
Dean Kilpatrick about Viagra. Here we have another thing that is a very embarrassing
male-oriented kind of thing. It is feeling as though you are not strong any more.
Yet there is a flood of people going in for that kind of treatment, despite it being
embarrassing. How come What is the difference One difference is this: everybody
believes Viagra works. I think this is not true for mental disorders.
There is another kind of stigma that we have not talked about. We talked about
the stigma of being mentally ill and the stigma of people knowing you are in treatment.
There is also the stigma of the processes of care. There exists this image of
what it is to be in treatment. There is some work that needs to be done to market
a more positive image of being in treatment. It actually can help you. If people had
the sense that psychotherapy works as well as Viagra, we would have a long line of
people waiting for psychotherapy. In terms of practical research, there are several
things that we need to do.
I think the very first thing that has to be done is research on treatment dropout.
Once you get somebody into treatment, why is it that such a high proportion of
them say, “You know, on second thought, I would rather be depressed than go back
to see this guy.” We have to figure out what it is that makes people drop out. Is it
something about the kind of patient Is it something about the kind of processes of
care Is there something we can do to improve the way we are doing things Why
is it that more people are more willing to go to chaplains than go to psychiatrists
Years ago, NIMH had an Indian Mental Health Service Program to train chaplains.
It was collaborative care between people who were in the non-medical system and
the medical system to make it more palatable. How can we package treatment in a
way that people would find more palatable
The second thing we have to do is figure out how to sell mental health treatment.