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
The findings showed
that on both the
perceived stigma scale
and the perceived
barrier scale, the people
with PTSD were much
more likely to endorse
these items.
opposition to treatment-seeking. A pride in self reliance exists, and the mental health
problems are much less important than maintaining a job or a family.
Treatment-discouraging beliefs get into the perception that those who have not
shared in the combat experience simply cannot understand it. “If they haven’t been
there, they just aren’t going to be able to understand and help me.” Some other
beliefs include, “Treatment doesn’t work,” “I’m relinquishing control,” and “They
could lock me up if they knew how crazy I feel sometimes.” This view was prominent
among the older veterans, the Vietnam vets that need treatment.
Some of the other stigma issues you have heard about include, “Treatment is
for those who are weak, incompetent,” or “It’s only for the really disturbed and I
certainly don’t fit in that category.”
There are system concerns, including limited resources. However, perhaps for
the first and only time in history, the different veterans groups have agreed that
they do not want their mental health treatment outsourced. They do not think that
a community-based civilian provider could possibly provide the kind of treatment
that a VA practitioner could provide.
Knowledge barriers also pose a significant problem. Veterans do not understand
what treatments and resources are actually available. Many OIF and OEF vets do
not know that they have five years of eligibility at the VA, no questions asked. The
area of military sexual trauma is an important issue that has not been mentioned
yet, and it is very stigmatized. Access barriers have also been highlighted. The onerous
paperwork one must complete, taking time off from a job, and, particularly for
women, childcare issues are all cited as access barriers.
Finally, the authors described the “invalidating post-trauma social environment”
affecting people who have had bad experiences becoming unwilling to take another
chance that they may not receive support. Vietnam vets in particular who had a
very negative homecoming are not going to risk outing themselves and going for
treatment. This may represent PTSD withdrawal, but it is partly related to suffering
with a stigmatized health condition.
The third study I am going to talk about was done at the National Center for
PTSD by Rob Pietrzak and Steve Southwick. This study involved a questionnaire
that was mailed to a thousand military returnees in Connecticut. They had a 27%
response rate to questions on a wide variety of issues including barriers to care and
beliefs in mental health treatments. The majority of the population were aged 20
to 30, white, with some college, married, serving in the Army, mostly Guard and
Reserves, and in theater during 2004 and 2006, having completed one or two deployments.
Most of them were working, so it was a fairly functional group of people.
The findings showed that on both the perceived stigma scale and the perceived
barrier scale, the people with PTSD were much more likely to endorse these items.
Interestingly, those people who were positive for depression or substance misuse
were not more likely to endorse items on these scales. At least in this cohort, PTSD
seemed to be uniquely predictive of endorsement of stigma and barriers to care.
Another element that was done very nicely by these investigators was asking
specific questions about psychotherapy and psychotropic medications. Again, the
people with PTSD, in contrast to people with the other mental health problems, were
much more likely to express negative beliefs about psychotherapy and psychotropic
medications.
Despite these stigma issues, people are coming in for treatment. The VA’s market
penetration has traditionally been about 20% of veterans. It is now over 40% and