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
level it is as simple as this: if people who walk into a room get poked in the eye with
a sharp stick, they do not walk into the room anymore and they tell their friends,
“Don’t go to that room.” That is especially true in military or other predominantly
male and performance-directed contexts.
To expand it a step further, psychology and psychiatry are both professions based
on what is comfortable for the provider, which is to be in a room and to write scripts.
That is really easy to do compared to say, going into a coal mine. Or, even worse, you
conduct psychotherapy on a comfortable couch because you get to sit with coffee
and talk to people as opposed to working with the media on the consultant level.
We need to consider being much more multi-faceted in the kinds of things we train
mental health professionals to do. If we moved more toward education and skillbuilding
in our continuum of care we could become de-stigmatized as a profession.
As we help people become more resilient, then everyone goes for that at some level,
and we are easily moved to the next step.
I would also say that we have known all this throughout my whole career. I was
trained as a community psychologist so it was pushed on me a little more. The question
is, “Why don’t we do those things” Why are we stuck doing the same things
wrong and looking at societal stigma and other things that we already know from
the past how to change
DR. HAMMER: Part of the problem is that there is a perception that we should
just give a pill and it will be alright. Treating PTSD is hard work both for the patient
and for the therapist. If you are going to do it you had better get down in the mud
with the patient and be willing to get dirty. It is not going to be comfortable. It is
not going to be easy. Our responsibility is to acknowledge that and to dig in and
get better at it.
DR. FRIEDMAN: I do not agree with some of the comments that have been
made. I think that many people in this room do know about getting down in the
mud and going where the patient is. I do not think we need to be preached to about
some of that. I also do not agree that we have nothing to offer. If we get people to
come in, I think we have a great deal to offer. However, there are two different levels
on which we have to have this discussion. One is on the traditional patient/doctor
clinical discussion.
However, the other discussion that is in some ways more important is at the
public health level, where the mental health team is not a psychologist, a psychiatrist,
a social worker or nurse.
It is someone who understands how to use the media, someone who is a sociologist
or an anthropologist. We are starting to learn that. It is not what we were
trained to do but many of us realize that it is what we have to do.
I do think there have been efforts to increase capacity. The treatment that is
available is better, so I cannot agree with some of these negative characterizations
of what we have to offer and what we are trying to do.
DR. ESTROFF: I do not want to be misunderstood. Most of us who work, and
have done research in the public mental health system in the US know that the quality
of care is not great. I have to say in the several weeks that I have been trying to
learn about what goes on in the armed services, I am pretty impressed. I have been
to all the websites including Wounded Warriors and Battlemind. These are amazing
so I am not saying that the armed services do not have things to offer people. It
is part of the general situation when you are out of theater and back home. Sure,
there are people who can do it but it is not widespread. We know the quality varies