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

Conference Recommendations 109
their own experiences with traumatic stress type symptoms. It is an incredibly powerful
experience to have the Major who is the CO of your battalion talking about
his own symptoms, and his own struggles with dealing with his symptoms post
deployment. To have a Major, a Sergeant Major, a Gunnery Sergeant, and a Master
Sergeant talk about their symptoms is incredibly powerful. Encouraging leaders to
talk about their experiences is very important.
DR. SCHOR: I think that there should be a strategy for identifying the research
needs. If you do not influence the decision makers in DoD, and in Health and Human
Services to apply resources, and if you cannot sell it, then why should they want to
buy it There should be some sort of a needs assessment approach, perhaps stratified
across different areas. Education, training, policy, and clinical versus population
health all have different needs assessments.
DR. ARNOLD: You must have the leadership buy-in. I am speaking from the
perspective of a Combat Stress Control Fitness Team Leader. When we got to Iraq,
we made contact with the leadership of the units we were supporting. Soldiers from
the units that did not buy into what we did usually came to us fearing that their
leadership did not understand, and did not care. Unfortunately, that often panned out
to be true. From the leadership perspective, we need public service announcements
from all levels of leadership. Leaders need to be able to tell their service members that
coming to seek help, whether it is for mental or physical health, is compatible with
the core values of the service to which they belong. If they can convey that message
by speaking openly of personal experience, it is very moving, because the person
seeing that realizes that they can step forward. They also see it has not adversely
affected their career. They have been able to go on.
When I was in Iraq, many soldiers came to see me with their battle buddy. They
would not come on their own, but they would come with their battle buddy. Sometimes
they came in clusters. It was amazing to see how once one person got help,
and the other one saw what was going on, then they would come back individually
and seek more help. I think we need to take the battle buddy model and incorporate
it in basic training in all branches of the military.
DR. URSANO: Robert, you are suggesting two battle buddy models. One could
actually study the effect. One could study the match in attitudes between battle buddies
and see if one’s perception of stigma and barriers to care is the same as their
buddy’s. One could look to see how altering one alters the other. It is an education
and an intervention strategy.
DR. RUZEK: One priority for research would be to show the impact of psychological
programming on war-fighting performance, and other kinds of performance.
The strategy that I would like to champion is a series of RCTs comparing basic training
with psychologically enhanced basic training. Let us look at the outcomes, based
on people’s ability to perform in the field. I am quite sure that techniques like anxiety
management and buddy systems, disclosure training, and self-taught procedures
would enhance ability to perform in stressful situations. If we could implement and
demonstrate that, then we could begin to de-stigmatize psychological programming.
The second area of research I think is important is comparative research that
looks at different ways of presenting treatment and making referrals. We do not
know as much about why people are coming to treatment and what they hope to get
out of it. We need to learn more. We also need more research on what role significant
others, spouses, partners, and family members play in getting people to treatment.
There is a very important group of potential patients who are going to be recal-