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

Conference Recommendations 107
you want to go there, especially when we are dealing with soldiers, and airmen, and
sailors. We want to and do have emotion.
The other point I want to make is why stigma It could be the individual, but it
could be the system. We need to be able to discriminate between individual stigma
and system stigma. If it is an individual, then maybe it is a lack of knowledge. Why
are they feeling stigmatized, or why do they represent a stigmatic situation If it is
a lack of knowledge, then we have the education issues. If it is a belief, we have a
whole different world, because beliefs are not going to be argued. Beliefs are going
to be discussed. We need to develop relationships like Doug was talking about to
get over the beliefs.
Second point, if it is systemic stigma, then we have to look at what we have
created. What are the policy and funding silos that have created a system of stigma
Have we politicized the stigma so that we are now fighting in a political arena
because it is cost-effective not to treat and not to promote mental health care
DR. BATES: My recommendations utilize a broad comprehensive integrated
resource-type model, shifting the culture towards a strength-based focus. What types
of skills could we develop in our service members that would counter stigma How
can we identify standardized outcomes that cover the range of stigma and access
to care issues, so that we can look at them more broadly across the services How
can we leverage the tremendous resources available across the services components,
including the VA
We recently put together a model of psychological fitness for the Chairman and
the Joint Chiefs of Staff. We also advocated a model based on the conservation of
resources model, where it is important to identify all the resources we have and
leverage them appropriately. The military has a tremendous range of resources we
can bring to bear on this problem. We have potential to integrate across our DoD
Health and Service Agencies, like Force Health Protection and Readiness, DCoE,
and Military Community and Family Policy. I think synchronizing efforts in DoD
alone could go a long way.
DR. KESSLER: We need to do treatment retention experiments. There is a book
by Don Meichenbaum, called Facilitating Treatment Adherence. It was written in
the late 1980s, and it was directed at behaviors like getting black men to take their
hypertension medication. Meichenbaum saw dramatic effects in keeping people in
treatment.
We need to understand why people come into treatment. The reason people
come to treatment is not the same reason they stay in treatment. Many people come
with one presenting complaint and the next thing you know they are talking about
something completely different. We have got to figure out how to get people to stay
in treatment to successfully market treatment.
In the U.S., only about 20% of the people who have a serious mental illness in a
year get effective treatment. That is because 40% never get any treatment at all. Of
the six out of ten who get treatment, four drop out. That means that we lose 40%
because we never get them in the door, but we lose another 40% after they are in
the door, which is a crime. Which 40% is the easiest one to hold on to We could
triple the effect of the system if we could keep people in treatment. We have got to
do systematic studies to define best practices to keep people in treatment.
DR. PESCOSOLIDO: Recommendation one: I think we need to rethink some of
our research questions and, at minimum, supplement the way that we think about
some of these processes. First of all, it is not help-seeking. In our studies, 25% of the