Barriers to Care

The Department of Defense (DoD) strives to better understand the barriers to care that service members face regarding mental health diagnoses and treatment. Seeking care early can help service members address mental health conditions in a timely manner, increase their psychological health literacy, improve their understanding of the Military Health System, and dispel myths regarding seeking mental health care. Despite the benefits of seeking mental health care, approximately 40-60% of military personnel who experience mental health problems do not seek mental health services [ Reference 1 ]; the underutilization of these services may be ascribed to barriers to mental health care related to:

Click on the buttons below to learn more about barriers to care.

  • Individual

    Barriers related to the individual

    The lack of perceived need for mental health treatment and the preference for self-management (i.e., use of other stress coping strategies) among service members may have contributed to the underutilization of mental health services [ Reference 2 ]. The 2011 Health Related Behaviors Survey of Active Duty Military Personnel, the largest anonymous survey that gathers data on some of the most important behavioral health issues affecting the well-being of the U.S. military, noted that in the previous 12 months, service members used coping strategies such as:

    • Talking to a friend or family member (72.2%)

    • Exercising or playing sports (65.7%)

    • Engaging in a hobby (66.1%)

    • Thinking of a plan to solve the problem (82.6%)

    • Spending time by themselves (70.5%)

  • Social Networks

    Barriers related to social networks

    Service members have reported that their social networks significantly impact their decision to seek mental health care [ Reference 2 ]. Social factors that may hinder service members from seeking mental health care include:

  • Treatment

    Barriers related to treatment

    Factors that may impede service members from obtaining the treatment they need, or may contribute to treatment drop out include:

    Medical Mistrust [ Reference 2 ] [ Reference 4 ]

    • Personal negative attitudes about mental health

    • Lack of confidence in treatment effectiveness (e.g., “friends and family may be more effective in helping”)

    • Lack of trust in mental health providers and the mental health care system

    • Fear of psychotropic medication side effects

    Structural Barriers [ Reference 2 ]

    • Scheduling issues (e.g., inconvenient clinic hours)

    • No time off work

    • Transportation issues

    • Cost concerns

    • Lack of knowledge on mental health service locations

  • Institutional Factors

    Institutional barriers

    Institutional barriers are displayed in the intended and unintended discrimination toward people with a mental health diagnoses that manifests in a range of DoD and service-specific policies [ Reference 3 ]. In the 2014 report titled, “Mental Health Stigma in the Military,” RAND Corporation identified ways that DoD policies can potentially increase barriers to care, including mental health care stigma, in the military [ Reference 3 ] [ Reference 5 ]:

    • Uses negative terminology (e.g., describes behaviors of people with mental health disorders as “childish outbursts”)

    • Prohibits actions or implies incompetence

    • Limits privacy

    • Has non-mental health professionals determining fitness

    • Reduces people with a mental health diagnoses to a label (e.g., “mentally ill person”, “a psychotic,” or “a schizophrenic”)

  • Stigma

    Stigma

    Mental health care stigma in the military context is unique due to the military’s emphasis of certain qualities in service members (e.g., stoicism, strength, independence); service members often believe that seeking mental health care can hinder their ability to embody these qualities.

    • Mental health stigma is a dynamic process by which a service member perceives or internalizes this brand or marked identity about himself or herself or people with mental health disorders [ Reference 3 ].

    • While research indicates that mental health care stigma remains a significant concern for service members, particularly those in need of mental health treatment, there are mixed findings about how it impacts treatment seeking or mental health service use [ Reference 3 ] [ Reference 4 ].

    • Rates of perceived stigma among service members have consistently been problematic. In response, DoD has sustained efforts to reduce mental health stigma including campaigns and programs [ Reference 3 ].

    Mental Health Stigma in Key Contexts

    Mental health stigma has been linked to four key interrelated contexts:

    Military Context: four key interrelated contexts: Individual Service member - Social: Family, Friends, Unit - Public: Military norms, Military culture - Institutional: Military policies, Military programs, Treatment system.
    Figure 1: According to RAND Corporation (2014), stigma exists in interrelated contexts. The institutional and public contexts make up the military context.

    Forms of Perceived Stigma Resulting from Key Contexts

    The stigma created within the key contexts can take many forms [ Reference 3 ]:

    Type of Stigma

    • Self-stigma
    • Public stigma
    • Structural stigma

    Definition

    • Individuals’ perceptions of themselves [ Reference 3 ]
    • The public (mis)perceptions of individuals with mental illnesses [ Reference 3 ]
    • Institutional policies or practices that unnecessarily restrict opportunities because of psychological health issues [ Reference 3 ]

    Impact of Stigma on service members
    Mental health care stigma can have short-term and long-term impacts on service members [ Reference 3 ]:

    • Readiness
    • Seeking help to address early symptoms
    • Intention to seek treatment
    • Beliefs and attitudes about treatment
    • Treatment-seeking
    • Quality of life
    • Reintegration
    • Well-being

References

  1. Sharp, M., Fear, N.T., Rona, R.J., Wessely, S., Greenberg, N., Jones, N., & Goodwin, L. (2015). Stigma as a Barrier to Seeking Health Care Among Military Personnel With Mental Health Problems. Epidemiologic Reviews, 37, 144-162.

  2. Hom, M. A., Stanley, I. H., Schneider, M. E., & Joiner, T. E. (2017). A systematic review of help-seeking and mental health service utilization among military service members. Clinical Psychology Review.

  3. Acosta, J., Becker, A., Cerully, J.L., Fisher, M.P., Martin, L.T., Vardavas, R., Slaughter, M.E., & Schell, T. (2014). Mental Health Stigma in the Military. Santa Monica CA: RAND Corporation.

  4. Vogt, D., Fox, A.B., & Di Leone, B.A. (2014). Mental health beliefs and their relationship with treatment seeking among U.S. OEF/OIF veterans. Journal of Traumatic Stress, 27,1-7.

  5. Centers for Disease Control and Prevention (n.d.). Communicating With and About People with Disabilities [PDF document]. Retrieved from https://www.cdc.gov/ncbddd/disabilityandhealth/pdf/disabilityposter_photos.pdf.