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
this group, thinking about stigma being first, and then other barriers being second.
Most of what we are talking about is other kinds of barriers, of which stigma is one
important one. Maybe we want to shift the sequencing.
The second is that we broaden the perspective domains that we are discussing.
This is not a criticism, it is an observation. I think there is a bias of our discussion
that is a product of the constellation of people here. There has been a great deal of
discussion about research, primarily, because many of the people here live in the
world of research. There has also been a bias about medical systems and health care
systems, because that is where most of the people here live. However, many of the
concerns that we are talking about do not play out in these systems or in research.
They play out in the workplace, in schools, in jails, in decisions and choices that
leadership make, whether that is politic leadership or organization leadership. A
future recommendation is to broaden our scope.
The third recommendation is to expand our discussion of issues of history
and culture in the discussion. We have not had much discussion about the role
of otherness, shame, blame, power dynamics, and those kinds of things as part of
this dynamic. The final recommendation is that we make sure that we include a
wide array of expertise as we begin to make recommendations to the field. Many
of these issues include our areas of expertise. We should also include faith issues,
anthropology, linguistics, social marketing, and communications. There are many
very professional fields that have a great deal to contribute.
DR. HOLLOWAY: I recommend that we investigate ways of integrating our
service delivery toward primary care. It may not be obvious how to do it so we may
want to try several different models. My overall statement is that the system that
we have now, to go back to Simon Wessely’s point, is not working. We will all feel
better if we admit that.
The other thing I would like to focus on is that we take care as we develop our
expansion into new areas—examine what the real potential is rather than what we
believe about the potential. The chaplaincy does not have, by the way, confidentiality.
Number two, the chaplaincy right now is badly split between the Fundamentalist
Churches and the traditional churches. The Fundamentalist churches are refusing
to provide religious care to soldiers who are not of their particular domain. Those
battles are part of what it means to contact the chaplain. It is not just a chaplain. It
is which kind of chaplain, which place, and it becomes a large bureaucratic struggle.
In each of these cases we need to examine what the real facts are on the ground.
For instance, the overall misstating of facts here was striking. The Surgeon General
cannot use a diagnosis to overrule anybody. He is a Staff Officer; he is not a Command
Officer. Number two, it was stated that people follow orders within the service.
Commanders would love it if people commanded and followed orders. But let me
tell you, Commanders know that they are giving orders to people, and that people
act like people.
DR. REISSMAN: Suppose you have a physical injury instead of a psychological
illness There is a whole literature on safety climate, and changing the climate, which
is how people talk to each other about what is going on in an organization. How
culture gets into climate is not always so straightforward. That relates to what some
people were talking about earlier with injury.
I think we also need to think one step beyond those who are in the active component.
We need to think about those who are in the reserves, including the Guard
who come in and out of this kind of activation. How do we work psychological