Late Breaking News
Stigma: A Major Deterrent for Military Psychological Health Care
As a brigade commander during Operation Iraqi Freedom in 2004 and 2005, Army Brig Gen Gary Patton was confronted with his fair share of traumatic events. And like many deployed service members, the scars of those experiences had some adverse consequences on his psychological well-being. Among the regularly occurring symptoms he dealt with after returning home were periodic sleep disturbances, anxiety, and rage, all of which made simple tasks like driving a car almost impossible.
More individuals with war-related psychological wounds like Gen Patton’s are being identified each year. Recent data from the Post-Deployment Health Re-Assessment, administered to service members between 90 and 120 days after returning from deployment, indicates that 38% of soldiers and 31% of Marines are suffering psychological symptoms.Within the National Guard, that figure rises to 49%.
Through counseling, therapy, and other forms of treatment to help develop coping skills, service members are able to return to a normal degree of functionality. Gen Patton is a prime example; he, like every member of his brigade, received mental health counseling upon redeployment. He found this counseling to be helpful, which in turn led to his steady recovery. Unfortunately, many service members view seeking help as a sign of weakness and as a major catalystfor derailing theircareers.
The stigma associated with mental illness in the United States is a potent deterrent for psychological health care, and complicates treatment and recovery. For the Departments of Defense and Veterans Affairs, this stigma has been amplified by the culture of the military that tends to perceive illness as weakness. Colonel Charles Hoge, of the Department of Psychology and Behavioral Sciences at Walter Reed Army Institute of Research, highlighted this fact in his 2004 study of service members returning from the wars in Iraq and Afghanistan. Those most in need of care perceived the highest levels of stigma. A June 2007 report from the DoD Mental Health Task Force stated that 59% of service members surveyed believe that military leadership would treat them differently if they sought counseling.
The American public recognizes the physiological and psychological stressors that are being experienced by our deployed service members engaged in prolonged battles with insurgency forces. For the last 8 years, the DoD and the VA have been very focused on understanding the science of providing the best possible health care for our service members, veterans, and their families, and the incentives and disincentives associated with their support programs. Both organizations are converging on this issue in an attempt to peel away the invisible barriers that stand between service members and psychological health care.
Last year, theVA began to expand its training programs for psychologists who treat combat veterans. This initiative adds roughly $5 million in funds and more than 150 combat-trauma qualified psychologists every year to theVA’s mental health front. In addition, theVA has established a system known as the Mental Illness Research, Education and Clinical Centers (MIRECC), which provides a range of psychological health services. MIRECC’s mid-Atlantic network, established in 2004, is uniquely focused on service members with post-deployment mental illness and is committed to clinically assessing andtreating theseissues,withaspecific focusonearly prediction and intervention.
The Department of Defense and the Department of Health and Human Services (HHS) agreed to initiate a program wherein the Public Health Service would loan hundreds of mental-health care providers to military treatment facilities across the country. These psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurses provide counseling, therapy, and psychiatric services for service members and their families.
The VA has also built a grassroots campaign to persuade veterans to overcome their fears and seek help. Screen actor Gary Sinise and television celebrity Deborah Norville have both starred in VA-sponsored public service announcements, pleading with struggling veterans to seek help, and encouraging friends and family members to reach out to them. In addition, 124 buses across the country carried advertisements promoting the VA Suicide Prevention Lifeline, which is staffed 24/7 by trained mental-health professionals prepared to deal with immediate crises.
The Department of Defense’s programs to treat mental health symptoms, research their causes, and communicate that it is OK to seek help are proliferating. The Army Resiliency Program (ARP), which has been under development with the help of researchers from the University of Pennsylvania for the past year, is an attempt to develop a holistic fitness plan for soldier in five categories – emotional, social, spiritual, family, and physical. By emphasizing five core areas, the Army is able to underscore mental fitness as a priority. In the long run, this will ingrain soldiers with an enhanced respect for psychological health and prevent them from being easily deterred from seeking help if they begin to suffer from psychological symptoms
In July of 2009, the Army began a $50 million study on the growing number of troop suicides. The study, which is being conducted in partnership with the National Institutes of Health, will work to identify genetic, demographic, medical, and other factors that can predict a tendency toward suicide among both service members and civilians. This kind of research will hopefully help to determine what leads soldiers to end their own lives and expose the barriers that prevent them from seeking help.
While the Army attempts to understand the reasons why soldiers avoid getting help, the Defense Centers of Excellence for Psychological Health andTraumatic Brain Injury (DCoE) are playing a large role in de-stigmatizing mental-health care at the service level with their Real Warriors campaign. Real Warriors features a broad-based call to action and includes information for service members, families, and employers on what to expect after a deployment. The campaign uses a variety of communication and social networking tools including public service announcements, posters, and highly interactive Web sites with service-specific content. Other Web sites like afterdeployment.org work in tandem with these programs to offer a safe place for service members to ask questions and seek advice.
The Department of Defense and VA are committed to caring for service members, veterans, and their families. As we make new discoveries about psychological illness, we will continue to pour time, energy, and resources into programs and research initiatives that will better protect our people and provide early identification and treatment for symptoms. Educating individuals about the importance of psychological health care is critical. If a service member broke a bone or suffered an injury from small arms fire while in theatre, they would naturally seek immediate medical assistance. Seeking care for psychological wounds from traumatic events should be no different.
Michael E. Kilpatrick, M.D., is Director of Strategic Communications for the Military Health System in the Office of the Assistant Secretary of Defense for Health Affairs