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

Stigma and Barriers to Care in Military & Veteran Populations 27
tremendously so it is about making sure that when we are working so hard to bring
them in they are going to have a good experience.
DR. HOGE: I think it is both. The reality is that there is a huge benefit in seeking
treatment. What we do in mental health and the incredible programs that have
been stood up in DoD and VA in particular, is extraordinary. The reality, though, for
many individuals who seek treatment within our system is that they have negative
experiences. There are some fundamental assumptions we make about the nature of
treatment, treatment effectiveness, and the application of evidence-based practices.
For many individuals evidence-based treatments are inflexible and end up being
detrimental because every individual has an extremely personal experience requiring
a tailored approach. There is no way we can tell that individual what they need
in order to get over that experience, to integrate it into who they are now, to once
again have meaning, joy, and purpose in their life. I sometimes try to get my residents
and cofacilitators in PTSD groups to do a moratorium on the terms, “You need to.
It’s important to consider. You need to consider.” They almost become completely
incapable of speaking when you do that.
DR. RUZEK: I work in the VA system at the National Center for PTSD. There
are people who actually do engage in treatment. In many different treatment programs
within the VA the normative experience is an attitudinal change. It would be
very interesting to see studies of people moving through the treatment process and
how that affects their views of mental health participation. In fact, what we usually
find in VA PTSD treatments are a range of experiences, including negative ones.
People who pass the threshold of five or six visits end treatment with tremendously
positive views of the treatment experience, the treatment providers, the caring of
the providers, their views about the importance of disclosure, and their willingness
to disclose.
One of the untapped tools for us to change attitudes towards treatment is to
better capture those success experiences, to magnify the perceptions of benefit, and
change the perceptions of what happens in treatment. We ought to be videotaping
testimonials about treatment. It is possible that the stigma of treatment inhibits those
successfully treated individuals from having conversations with the body of veterans
who are not seeking treatment. We want to get veterans and active duty treatment
participants talking about their treatment experiences.
DR. LINK: I am speaking as a stigma researcher and coming back to the
exchange that Sue Estroff and Matthew Friedman had. Perhaps the facts about
treatment capacity are disputed, but the extent to which capacity has not developed
through history could be due to stigma. Also, regarding the concern that if everybody
came to treatment we would not be able to take care of everyone, we might consider
a shift in our frame of reference. I was interested in thoughts about the culture and
whether you can imagine helpful interventions that have to do with the culture of
the soldiers and how they deal with each other. We could explore not just what
clinicians can do, but what the context can do to help with these kinds of problems.
DR. RADKE: I am the State Medical Director for the Minnesota Department of
Human Services and Chief Medical Officer for State Operated Services. We run all
the disability programs in the state. My perspective is from the public mental health
sector. Obviously, we know we are running a fragmented, discontinuous, gap-filled
system, or lack of a system. In spite of that people come to treatment or they are
brought to treatment. The point I want to make is that a person with schizophrenia
does not come to treatment or get brought to treatment because of their psychosis.