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
people who get into mental health treatment are coerced by the police and by their
bosses. A third does not really understand how they got there, so I think we need
to move away from the image of help-seeking. We need to understand the process
and the key turning points. What are the identity shifts that it takes for people to
continue to take their medication or stay in treatment
All of us can think of 100 reasons why we do not want to take a pill every day.
What identity shift and acceptance does it take to become somebody who is dealing
with a chronic problem Let us study patterns and pathways, rather than study a
fictional decision to use care or not use care.
Recommendation two: We need to normalize the whole idea of mental health in
the fabric of an individual reward system that has a high level of altruism.
DR. ZATZICK: I would strongly urge that we follow people at different stages
of their careers. Look at some of whom have had treatment, some of whom have
exhibited symptomatology, and look at how well they functioned. I think that many
officers believe that the stigma is from officers. If you screen positive for a psychiatric
illness you are considered not fit for duty, or not trustworthy. We can go beyond the
belief systems, because the data is there. We just need to look at it.
Secondly, one of the greatest barriers to care is the concern about confidentiality.
Except for military chaplains and Vet Center counselors in the VA, we cannot
guarantee confidentiality. How can we find out how often the Command is actually
requesting confidential information If people felt that this was a very, very low
probability event, I think that would reduce this kind of a barrier. Internet-based
treatments, where one can have privacy, are a good resource. Web-based treatments
are getting more sophisticated and more effective.
My final suggestion is to frame PTSD as they do in Canada, where it is considered
an operational stress injury. It is not considered a psychiatric disorder. How
does the re-framing play out in terms of function, in terms of follow-up, and in
terms of future prospects
DR. FRIEDMAN: Military populations do not want to think of themselves
as being mentally ill. They are horrified by that thought. We need to find a way to
circumvent that.
What people are doing today is talking about function. Many of our leaders use
the term PTS, and actually abhor adding the D to it. They are trying to encourage the
term PTS without the D in the common parlance of the language. I like what Steven
had to say about function, because I think that is the key thing. Can they function
We need to highly encourage and improve the whole concept of embedding mental
health providers in the operational forces. It is incredibly effective when you have
your doc walking around. You can walk up, hey, doc, let me run this one by you. I
am not sleeping very well. When you have access to that you do not have to make a
huge leap to drive all the way to the hospital. You do not have to leave the culture
that you live in, and enter the medical culture. Once you cross the threshold of the
hospital or the clinic, you get into the medical world. You enter another vulnerable
place. By embedding providers, like the flight surgeon model, or the division psychiatrist
model, or the OSCAR model they are using now, you become more effective.
What they are doing in the Marine Corps now is OSCAR Extender Training.
The OSCAR program stands for Operational Stress Control and Readiness. Mental
health professionals are the OSCAR professionals, but they also have Extenders
modeled on what the TRiM program does with the Royal Marines. Extenders are
trained to be peer counselors. Part of that training involves leaders talking about