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 leading response
was they do not
think mental health
counseling would
help.
damage. Many people narrowly escaped with their lives and little else. There were
some people who were killed. We located people who had been affected by the fire
storm and interviewed them three to eight months after the fire.
An earthquake occurred in 1991 in the San Gabriel Valley of California. Even
though it was a moderate earthquake in terms of deaths, injuries, and economic
damage, it was particularly difficult psychologically because there had been four
earthquakes in that same general area within a short period of time. We were
interested in the cumulative trauma that might magnify the effect of a moderate
earthquake. Again, involved adults were screened and interviews were conducted
between four and seven months after the earthquake.
The final disaster I will discuss is the L.A. Riots project. It was the largest civil
disturbance in quite some time in the United States. There were a number of people
killed, many injuries, and much damage. Due to widespread media coverage, the
effects were not limited to South Central L.A. but incorporated the whole of L.A.
County. We over-sampled from South Central L.A., the main area of civil disturbance.
Then we conducted these interviews in both English and Spanish. There
were 1,200 people interviewed overall, with a high participation rate in this study.
What I want to illustrate here is that among these people with PTSD across a range
of different disasters, fewer than 50% in each of those four studies sought mental
health care.
I am poaching on terrorism territory here, but we were involved in a study of
the Pan Am 103 bombing and it was a disaster initiated by terrorists. I want to
spend a little time going over the predicate for this. Before 9/11 there were more
deaths associated with this act than any terrorist attack in U.S. history. The Office
for Victims of Crime, which is part of the Justice Department, developed some
special services for family members in this case. They approached us at the National
Crime Victims Research and Treatment Center to do an assessment study of the
service utilization and how satisfied people were with services to make recommendations
for changes in policy. The salient point is that to get into this study,
every single one of these people had had at least one relative killed in that plane
crash. For me, this is as bad as it gets in terms of suffering a loss, because there is
no way anybody can ever bring that person back. Secondly, if you are looking for
a blameless victim situation, this would probably be it. Nobody is going to blame
a parent for their child’s death in this context. Further, the circumstances are so
tragic that you could argue that maybe mental health stigma would not be such
an issue. Who is going to blame somebody for coming forward to get treatment
under these conditions
Notwithstanding, only 6% of these family members said they had utilized
unlimited, conveniently located, free counseling, covered by the Office for Victims
of Crime, despite 48% of the sample reporting emotional or behavioral problems
severe enough that they considered mental health counseling. Most people who got
unspecified treatment thought it was helpful.
We asked, “People don’t always seek mental health counseling even after losing
a family member in this type of terrorist crime. What do you think are the most
important reasons family members do not seek mental health counseling in a case
like this one” The leading response was they do not think mental health counseling
would help. They have negative attitudes about mental health counseling. Secondly,
they have good support from family, friends, religion, etc. Thirdly, denial, inability to
admit they need help. Stigma is not far from the top, followed by, “they don’t want