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
“Has stigma changed
since the start of the
war”— the answer
appears to be “no,” at
least based on in-theater
Mental Health Advisory
Team (MHAT) data
collected since the start
of the war.
health professionals or I don’t think it’s going to work. Or, I think I can handle it
on my own, which is the construct that Ron was talking about.
We have looked at several questions. One is whether stigma has decreased since
the start of the war. We have had massive education campaigns. We have a post
deployment health assessment process and post deployment health reassessment
which came into effect a couple of years after the start of the war. Has it made a
dent in stigma Are there differences between the Reserve and Guard with respect
to stigma and changes in stigma since the start of the war Finally, what other
constructs should be considered
So in the first question — “Has stigma changed since the start of the war”—
the answer appears to be “no,” at least based on in-theater Mental Health Advisory
Team (MHAT) data collected since the start of the war. I think this is very consistent
with what Ron showed in the civilian population between 1992 and 2002. We have
done three samplings in Afghanistan and every year since the start of the war in Iraq.
There are some Reserve and National Guard differences. We are finding that the
active component seems to have higher rates of stigma than in the National Guard.
I think that may have to do with organizational differences in terms of the higher
OPTEMPO deployment cycle, short dwell time, and the fact that there probably are
some cultural differences to seeking care in the active component compared to the
National Guard. Once the National Guard members come back and demobilize,
they are particularly interested in getting care after they have been home for several
months.
There are other relevant constructs around receiving help that are in need of
investigation. Mark Brown and Alisha Creel have done analyses of these constructs
in their work recently, as has Tom Britt. There are some other interesting things
including perception of how I would be viewed versus how I would view others who
seek help from a mental health provider. This is work that Sebastian Schnellbacher
did during his residency at Tripler Army Medical Center. It is very interesting that
the perception that I would be seen as weak does not correlate with the perception
that I would see another soldier as weak if they sought mental health care. Again,
the perceptions of stigma are very individual and personal.
There are three factors to consider when we talk about the concept of stigma:
stigma, barriers, and then attitudinal perceptions. Then there is the difference
between perceptions of how I would be treated versus how I would treat others if
they seek treatment. We have not seen much of a dent in stigma over time. How
is stigma going to change, in society at large or in the military culture, if we have
not made much progress since 1992, despite a large change in the way in which we
perceive mental illness
One of the questions I am grappling with now in my clinical practice is, “Just
what is mental illness, exactly” For instance, if you believe Ron Kessler’s data from
the National Comorbidity Study, half of everyone in this room will in their lifetime
have a mental illness.
How many people in this room have a close relative who has a mental health
problem
This means that mental illness is part of the fabric of what it means to be human.
Then the question arises: Is there anything that we can do as mental health professionals
to change the way in which society views mental illness, and in what way
are we as mental health professionals contributing to the problem
It is possible that we are contributing to stigma at times in subtle ways which