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
Stress and fear
contribute to
reluctance to seek
care because of fears
of reprisal, and fears
of being labeled
because care may
lead you to be
“outed’ with a
problem that people
would stigmatize.
there is something wrong with the community because they need outside help. I raise
this as an example of creating an intervention for a problem that can also create new
barriers and new problems.
Stress and fear contribute to reluctance to seek care because of fears of reprisal,
and fears of being labeled because care may lead you to be “outed’ with a problem
that people would stigmatize. There are many disincentives in the system for people
to access care. If mental health services are not co-located with other services, people
can tell what problem you have just by what room you go into. We have also had to
try to do collaborative care in which we empower professionals of other disciplines to
do some of the basic mental health work. The organizational implications of mental
health have to do with job evaluations, someone’s position, and how people with
mental illness are viewed.
Since this is also about terrorism it would not be fair to ignore it since it was the
source of so much money for so long. We can think of terrorism as a subset of disaster.
There is the attacker and what they look like or what group they represent. There is
the situation that the attacker caused and the inadvertent fallout from that, both of
which interact to form a profiling event. A very simple way of looking at that would be
the anthrax and World Trade Center disaster and the Pentagon disaster of 9/11, 2001.
Crime statistics, especially near places like convenience stores and gas stations, showed
that more people of Middle Eastern descent were being beaten up after these events
happened because they were now the face of the enemy, even though these people were
part of the communities. When anthrax killed workers at the postal service, people
were afraid of their children being exposed to postal workers’ children because they
were concerned they would get anthrax, as if it were transmittable person-to-person.
Labeling occurs not only for groups associated with the attacker, but also the victim.
There is fear of contagion associated with the victim and concern you might be the next
target.
DR. HOBFOLL: The different talks bring up a number of issues for comparison.
The military is a closed system. It is all-controlling. Your records are available as part
of your performance. Society is an open system, and I think that makes a big difference
for stigma because within the military context, it is possible to change policy rather
immediately. For example, you could set up a system to reward going for behavioral
treatments that enhance your skills, and society cannot do that in general.
I also want to point out that there is almost nothing in our society that is opposite
of stigma, especially American culture. The use of the honorific was made absent by
the founding fathers in the United States. Part of our problem should be creating an
opposite notion to stigma when there is not even a lexicon for it and it has fallen out
of the culture.
DR. RADKE: The National Medical Director Council and the American Association
for Psychiatrists have tried to use the public health model, but there are significant
barriers in doing that. There are clinical barriers where the clinicians are focused
on active treatment and rehabilitation. They are not interested in early intervention
because they have no time and there is no money for that. There are administrative
barriers where there are silos created by policy that do not allow for the application
of a model. And there is a political barrier where disenfranchised populations such as
people with serious mental illness, or children and adolescents, have no say in the political
will for using the public health model. Those are additional concerns beyond the
stigma that have come to mind as I was listening to the talk.
DR. HOLLOWAY: The military is not a closed system. It is an open system that is