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Mitigating Stigma and Barriers to Care 71
“individuals should seek and receive behavioral health support to maintain fitness for
duty without fear of stigma and discrimination, be taken seriously to receive dignity
and respect from leaders, and receive screening and treatment without automatically
affecting security clearance solely on the basis of seeking care.” How many people
do you think believe that I think Captain Hammer said earlier that people have to
see that this really works for it to be real. Just because it is in the bill of rights does
not mean people will believe it.
The commander of Grafenwoehr released a statement after there were about five
suicides last year. The statement read, “We need to say it is OK to discuss mental
health, and that OK will not disadvantage one’s career.” However, in an article in
the Military Times the recommendation was to, “Protect your confidentiality given
that there are limits. Read your rights before you seek care. Use hypotheticals or
seek help from a civilian mental health care person.” So where is the safe place
Chaplains. That is the only place that confidentiality can be taken seriously, or is
inviolate. In that sense I think we have a great deal to overcome.
I want to return to stigma and discrimination. I want to raise other reasons
people might avoid seeking care. If I am in the middle of a divorce and a custody
battle, the last thing I want to do is see a shrink or get help. There may be rational
reasons people do not seek care that we do not think of if we are not in those
people’s shoes.
In an attempt to wrap up, I want to point out that we need to stop this process
of disablement and enhance recovery. I am currently working on one of the teams
that is doing a huge randomized control trial of early intervention, first-episode treatment
for schizophrenia. One of our big concerns is avoiding labeling for these young
people. However, labels are not all bad. There is a thing called label attachment
that we have seen recently with people who have Asperger’s saying, “Don’t take it
away. Don’t put us in there with the autism people.” Sometimes people are attached,
sometimes not, but we need to watch that process and try to find alternatives.
In the end I have two questions for people to consider. Maybe we are asking the
wrong question. Not “Why don’t you get treatment” but “Why would you” We
know a great deal about people who drop out of treatment, but what about the ones
who stay Maybe we need some information from them beyond demographics. The
last question I want to leave you with is one that is of interest to me. I am wondering
if there are any changes in stigma about mental health and mental illness related to
warriors and soldiers that would generalize to civilians. The thinking is that people
in the military are courageous individuals. This is an opportunity for the public to
have exposure to people who they honor and see as courageous. Can some of that
generalize to people who have not served
DR. BORNEMANN: I am pleased to be on this panel and in the interest of full
disclosure I am working with Sue Estroff, Pat Corrigan, Bernice Pescosolido, and
others on some anti-stigma work through our venue at the Carter Center. We have
been looking at effectiveness of anti-stigma campaigns and the things that work
and those that do not.
We have a major anti-stigma effort of our own as well. There is a journalism
fellowship program in which we award a one-year fellowship to mainstream journalists
and make very few requirements of them. It is not a residential fellowship.
It is modestly paid and is awarded competitively. They have to stay in their own
venue, their own media form, and then propose a piece of work. They come in at
the beginning of their fellowship year and talk to us about what they want to do,
In the end I have
two questions for
people to consider.
Maybe we are asking
the wrong question.
Not “Why don’t you
get treatment” but
“Why would you”