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

Mitigating Stigma and Barriers to Care 73
deliver that care is very foreign to most people. We had to learn how to have respect
for spirituality, which was trained out of me 40 years ago. “Do not talk about religion
or politics.” Well, religion and politics are an important part of people’s lives.
We just have to figure out how to do that and do it in a respectful way. Those are
some of the lenses through which I make my remarks today.
I saw the Glenn Close PSA that Pat Corrigan talked about. It was sent to us
by the group that produced it. When they sent it to us they also sent some trailers.
They were not shown publicly, but they were interviews with the participants. They
were the most powerful images that you could ever imagine, showing the compassion
and the manner in which these families worked things out in such a natural
way. If you want to really go after stigma you have got to make it real for people.
Most people know somebody with a mental illness, are living with someone with a
mental illness, or have a mental illness. If we could get those natural moments out
to people, it would have a substantial effect.
Somebody who entered their professional career as an Army medic at the end
of the Vietnam War when we were receiving veterans home can tell you it is vastly
different now than it was then, and in a good way. We did not do a good job of
receiving those people home and we are still experiencing some of the effects of
that. I cannot imagine that this type of meeting would have been held in 1971. I
applaud the efforts of those who have tried to make a difference by moving these
issues out into the sunlight so that we can understand them better and serve these
people better on their arrival home.
People are empowered as a group, not just as individuals, in the military environment,
which once again speaks to culture. One of the overarching themes in any form
of real, legitimate social change is the vital role of leadership. We have learned some
other things in terms of mitigating stigma in the military. Soldiers who rate their
leaders more highly and report higher unit cohesion are also reported to have lower
scores on both stigma and perceived barriers to care. Positive leadership and unit
cohesion can reduce perceptions of stigma and barriers to care even after accounting
for the relationship between mental health symptoms and outcomes.
One of the areas that I think has unique challenges to the military, and maybe
you could add police and firefighters to that, is the career repercussions of seeking
care, which Sue Estroff brought up earlier. Everybody recognizes it but I am not
sure we operationalize it. What does it mean There is this career kiss of death for
those who seek help. Is it a one-time opportunity and you can either never get rid
of it or you can go on to serve When I was still working in the government we had
a big fight with the Central Intelligence Agency (CIA) over security clearances and
people who had sought mental health care, even people who had been successfully
treated. We did not win that fight back then.
An area of consideration when addressing stigma in military populations and
first responders is the public policy angle. Both of the previous speakers talked
about this as well. Recently, after decades of struggle, we have ended one of the
most obvious structural forms of stigma, which was the lack of insurance parity
for the treatment of mental illnesses. Why did that fight go on for so long when the
information showed that not only was it the right thing to do but it was the smart
thing to do It was a cost-effective thing to do.
Another sensitive area is illustrated by the example of a veteran, a former
Marine, who had suffered tremendous physical injuries but who had a hard time
reconciling the fact that he also had PTSD. That raises a very troubling question. We