One of service members’ most frequently cited barriers to mental health care is stigma, perceived shame or disgrace attached to something regarded as socially unacceptable. Nearly 60 percent of service members who have mental health symptoms do not seek care. While they may readily see a physician if they have a physical ailment, they often do nothing when it comes to their mental health. As providers, you know that mental health is just as important as physical health when it comes to overall wellness and fitness, especially given that mental health concerns can manifest as physical symptoms and vice versa, all of which can interfere with fitness for duty.
One way for providers to address this is to frame overall wellness as including both mental health and physical health during interactions with service members. This technique may help combat mental health stigma and make it easier for service members to recognize a need for help.
Making the stigma link:
Because mental health conditions are not as visually obvious as physical injuries or wounds, service members may regard mental health symptoms as “less real.” They may also believe that emotional distress reflects a weakness or character flaw. Service members may feel they should be able to control their mental health symptoms and just “snap out of it.” A service member would probably never think a cancer patient should “try harder to feel better,” but might be quick to think a person with depression should do just that. These common misperceptions and falsehoods about mental health (public stigma) can affect how service members with mental health symptoms perceive themselves (self-stigma).
Because research suggests that service members with mental health symptoms perceive greater stigma than those without symptoms, it is beneficial for providers to address and mitigate patient self-stigma to reduce treatment resistance and enhance treatment adherence.
- Knowledge is power: Make a point of assessing patients’ expectations and attitudes about receiving mental health treatment to identify specific concerns and misconceptions they might have. This will present an opportunity to educate the patient on the realities of mental health conditions and the potential benefits of treatment.
- Dispel common myths: Some examples of information you might relay include:
- The prevalence of certain mental health disorders to allow the patient to understand that they are not alone.
- Mental health disorders are treatable and treatment is an effective way to recover.
- There are biological aspects of mental health disorders (e.g. low serotonin levels can contribute to depression) and some disorders are linked to genetic predispositions. This might help service members see that the development of their disorder is not something they can directly control.
- Re-think wellness: Motivate your patients to think about their overall wellness as including both mental health and physical health. It may help to emphasize that health exists on a continuum, and there are some things one can do to influence one’s health, and other aspects are out of one’s direct control. Likening mental health to physical health in this way serves to destigmatize mental health disorders and empower people.
- Draw parallels between mental health and physical health: Sayings such as, “You wouldn’t ignore a broken arm,” and, “You shouldn’t ignore a mental health concern,” can help patients understand that mental health symptoms are just as important to take care of as physical symptoms.
- Emphasize that voluntary help-seeking may reduce career impacts: Nearly half of service members identify career concerns as a barrier to seeking mental health care. Remind patients that proactive and preventive actions can minimize potential career impacts related to mental health. Mental health symptoms that go unchecked and worsen over time can result in command-directed evaluations, which tend to result in more duty restrictions than self-referred evaluations.
Stigma encourages isolation and shame, and ultimately acts as a barrier to getting into care. As providers, we can take steps to dispel stigma and encourage our patients to engage in care. Download and print this barriers to care infographic as a handout for patients or post in your clinics.
Restivo is a health systems specialist at the Psychological Health Center of Excellence. She has a master’s degree in criminal justice with a specialty in victimology and substance abuse.
The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.