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

Conference Recommendations 117
like data. I think there is power in the personal story. How can we appeal to both
the researchers and the policy makers
DR. GOLDENBERG: What do primary care physicians think about psychiatric
illness And is it stigmatized there Is the psychiatry clerkship a place where stigma
reduction can happen, or does it happen just by exposure We talked a great deal
about exposing people to patients with psychiatric illness. Is that a place where
stigma reduction or promotion happens
DR. TYLER: During the Cold War and first Gulf War, I studied fatal training
accidents involving armored track vehicles in deployed organizations in Germany.
What struck me the most was the wonderful way that soldiers of all ranks took care
of each other in these perfectly horrible situations. I think there needs to be more
examination of how that happens, and what makes it work.
DR. BENEDEK: I was very much impressed by Dr. Pescosolido. What I learned
from her was that we have made some progress regarding stigma in some pieces of
mental illness, and we have gone backwards in others, particularly with substance
abuse.
I also would echo the importance of figuring out what causes people to drop out
of treatment. What is the tipping point that makes people enter treatment It may be
very different for different people. It is supposed to be different for different people.
DR. NAIFEH: Are we trying to make it so that every single person who could
potentially benefit from treatment is both willing and able to seek treatment, and
stay in it for the full course Is that realistic Is it even desirable And if not, what
are we willing to tolerate What is a realistic and desirable goal in terms of getting
people to seek services and to stay in services At what point does the cost outweigh
the benefits
DR. GUIMMOND: As a child-focused person, I have been thinking about how
children are integrating messages about mental health. There are so many concerns
about over-treating or over-labeling kids.
DR. BIGGS: What can we do to change the perception of threat that someone
with mental illness might have or impose Ultimately, we are talking about helping
the individual man or woman. The perspective I have is that there are three things
that need to be kept in mind. How does he or she see the world How does the world
see him or her And how does that person see himself That is the ultimate focus.
MS. DICHTEL: From a nursing perspective, I think stories are important, and
I think buddies are important.
DR. SCHOR: I am not sure that we have emphasized a total workforce development
approach. What skills do people need to have at different work force levels
I have not heard risk communication mentioned. That may be primary prevention,
but the way in which you discuss this risk may actually mitigate the impact of the
injury and how it is perceived. I am not sure that we have emphasized that enough.
DR. HOWE: Sonja Batten pointed out that from the focus groups, a reason for
a person not getting treatment has to do with security concerns. What we have not
addressed at all is the possibility of changing that structure. I may be optimistic
but it can be changed. What I am talking about is the military’s structural policy of
how it handles confidentiality. In the early days of HIV infection, there was a new
policy that came out when it was essential for the military to identify the source of
HIV. They made some new rules regarding confidentiality for people who would
acknowledge, for example, that they were gay. Similarly, there used to be a concern
about commanders going on fishing expeditions. That has been changed as a matter