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

Stigma and Barriers to Care in Military & Veteran Populations 25
heading toward 50% among the OIF and OEF cohort. Whatever their belief system
is about stigma, mental health, or psychotherapy, people are coming in for treatment.
That may have some very interesting effects in terms of how they feel about
themselves for doing this.
I found it interesting that if you thought that medication did not help, you were
more likely to seek counseling. If you thought that therapy did not work, you were
more likely to go for medication. Again, beliefs are clearly affecting behavior. It is
also interesting that the beliefs about medication and psychotherapy, and beliefs
about treatment were completely independent of perceptions of stigma or barriers
to care.
When they did a multivariate analysis, they found that the people who had
reported greater unit support in theater and good unit cohesion were less likely to
endorse those barriers to care or stigma items. People who had negative beliefs about
mental health care were more likely to endorse them. This group is now looking at
some data about social support among families, and it seems important in treatmentseeking,
so this social support factor is something we ought to talk about as well.
To summarize, we need to understand the unique contribution of PTSD to suppressing
treatment-seeking in terms of the avoidance, the alienation, and the lack of
social support. Erroneous beliefs about treatment further exacerbate this.
I am going to finish with results from Nina Sayer’s structured-interview study of
44 veterans. In addition to asking why they did not seek treatment, researchers also
asked, “What would make things better What would make it easier for you to come
in for treatment” Remember not everyone in this group was treatment-seeking even
though they all perceived themselves as having a PTSD related disability. One of the
key items was a recognition and acceptance that PTSD is a treatable problem and
that help is available. Secondly, recognition that getting help is socially acceptable,
and that the system of care is trustworthy, delivering confidential care, would encourage
help seeking. Finally, social networking with other vets, peer-to-peer programs,
as well as incorporating family and employers, are very important areas of emphasis.
Hopefully I have added a few things on the table for our discussion. Thank you
very much.
DR. ESTROFF: Part of what I have been thinking about for the first two sessions
is this emphasis on getting people into care, that this is what we need to do. We
have already agreed that the system needs to be improved, the care is not optimal,
and we do not have capacity. Despite this, we have emphasized, “This is what they
need to do. They need to come to us.” If we want to do something concrete, I would
argue that we need to improve the quality of care and have greater capacity. To me
there is an obvious disconnect. If they come to a place that is not so good they are
not going to come back. It is a question of what you are fore grounding and what
you are back grounding. Coming to care in a system that you perceive as toxic or
ineffective is sometimes worse than not coming. At least in our research, people talk
more about symptoms of treatment rather than symptoms of illness.
DR. BELL: One other serious problem I have seen is this notion of media epidemiology.
I think the public gets its ideas about prevalence not from science, but
from distorted media reports. This drives people in the wrong direction which is
a serious problem in terms of help seeking behavior. My sense is that we scientists
do not market our knowledge well, so people are walking around with the wrong
ideas about what is going on.
DR. HOBFOLL: I want to follow up on Dr. Estroff’s comment. At an important
When they did a
multivariate analysis,
they found that the
people who had
reported greater unit
support in theater and
good unit cohesion
were less likely to
endorse those barriers
to care or stigma
items.