For ages, there has been an association between stigma and help-seeking within the armed forces. This stigma is decidedly prevalent in not only the armed forces but also the criminal justice system, which has no policies of dealing with prisoners suffering from mental illnesses (Slate, Buffington-Vollum & Johnson, 2013). Within the armed forces, recent quantitative reviews bring out factors contributing to this association (Sharp et al., 2015). While scholars often ignore the contribution of qualitative literature to this area, germane research often reveals an understanding of complicated social constructs associated with the stigmatization of seeking help during mental illness. The use of qualitative literature ensures the synthesis of findings with other studies, thereby, forming a divergent perspective regarding the evidence of barriers related to stigma and the facilitators of seeking mental health. Within the armed forces, mental health is a pressing issue. The depression rate among veterans stands at 31 percent, a figure five times higher than that encompassing the entire population of the U.S. (Eisenzimmer, 2012).
Predominantly, five themes are responsible for the stigma of seeking mental health within the armed forces. These factors include individual health beliefs, an inability to discuss the matter with relevant individuals openly, career concerns, personal and anticipated stigma experience, and the influencing factors of the stigma. As such, many veterans are returning home from combat having been discharged from service. However, they face serious challenges, especially in assimilating back to society. Many are suffering from PTSD and depression, leading to suicidal ideation, homelessness, and substance abuse. Therefore, this paper aims to identify the barriers and stigmas associated with why veterans are not seeking treatment for mental health.
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Inasmuch as there are various research findings concerning the immense psychological needs of individuals serving in the armed forces, few of this personnel use mental health services despite showing symptoms of mental problems. Fundamental to such occurrences is the perpetuation of stigma-related barriers to degrees higher than other barriers such as practical and logistical ones. Commonly defined, stigma relates to and encompasses various elements that cumulatively define a deeply discrediting attribute that reduces the value of an individual from a whole and usual one to a tainted and discounted one (Coleman et al., 2017). Close research indicates that there are various types of stigma, which are thought to integrate thus creating impediments to the process of seeking help while mentally ill. Within the armed forces, however, stigma has had linkages with desirable attributes of behavior such as self-sufficiency, toughness, and the ability to maintain combat readiness at all times.
Within the armed forces, a perpetuation of public stigma stems from concerns regarding preferential treatment from leaders within a unit, which may lead to condensation and ill performance within a unit resulting in a loss of confidence (Iversen et al., 2011). Research shows that such concerns are rampant within the armed forces of the US, Australia, the UK, Canada, and New Zealand. Public stigma within the armed forces often endorses leadership and organizational experiences. Within disciplined forces, it is common to find a relationship between high ratings of unit togetherness and cohesion going hand in hand with lower levels of stigma. Contrariwise, negative connotations and behavior causing embarrassments among members of a unit often lead to the stigma which is related to mental health. As a result of public stigma, internalization may occur, which presents itself as an understanding of societal dissociation leading to difficulties and impairments in self-efficacy and self-esteem and glaring feelings of demoralization and shame (Coleman et al., 2017).
On the other hand, aside from internalized and public stigma, structural discrimination can bring about stigma and the resultant barriers to seeking mental health. Structural discrimination within the armed forces often manifests through disadvantaging a set of individuals through rules and regulations, in this case, personnel suffering from mental health issues. A good example here is the belief that individuals with mental health illnesses do not have a healthy career option since they may be unaware of how and where to find help and not having the needed resources to access this help. As such, systematic review findings also concur with this example since it highlights the military as a subgroup disproportionately deterred by stigma in regards to the impact of mental health-related stigma and the choice of seeking help across populations. While there are prevalent and consistent representations of public stigma within the armed forces, studies show that are little to no correlations between public stigma and subsequent use of mental health services or the inclination to seek help. For this discourse, there are numerous reasons such as the implementation of divergent measures of stigma examination; the use of poor quality examination methodologies; and the fact that among individuals suffering from public stigma, few disclose their use of mental health services or may not be aware of their conditions.
The most prevalent stigma-related barrier to seeking mental health services among the armed forces is non-disclosure. This theme alludes to the link that represents a number of behaviors, which reduce or delay the motivation to seek help. Non-disclosure is often characterized by phrases such as “sucking it up” or “carrying on” among others and is often attuned to the militaristic culture of self-sufficiency and solving problems individually. In many cases, military officers are unable to recognize their problem, which leads to non-disclosure. Such denial often stems from a lack of paying attention to symptoms that require urgent review and the analysis of other co-morbid somatic symptoms. Until a “crisis point,” victims experiencing non-disclosure rarely divulge their experiences and ignore difficulties relating to their illnesses coupled with the public stigma associated with it. Often, within the units of the armed forces, leadership determines the reaction of team members when one has a mental illness diagnosis. As such, depending on the leader’s perception and attitude towards mental health, victims can choose to either keep silent or disclose their mental struggles.
Individual beliefs concerning mental health are also stigma-related barriers. This theme often alludes to common internalized stigma, whereby, self-detrimental mantras such as “I am a danger to others” or “I am insufficient” are the order of the day. Such individuals are often susceptible to seeking treatments and favors; consequently, deterring them from the real problem, which is mental health and the seeking of help to mitigate its occurrence. In terms of gender, some studies illustrate the susceptibility of women compared to men in having internalized stigma. In addition to individual beliefs, experiences of stigma are also a barrier to the seeking of help regarding mental health within the armed forces. Personal experiences and fears regarding seeking assistance in relation to stigma experiences are decidedly rampant. Primarily, experiences such as lack of understanding by peers and loss of respect from them lead to feelings of guilt, blame, and shame, which resultantly deters victims from seeking further help.
The final barrier is career concerns. Often, this theme on career concerns often leads victims to worry about how treatment will influence career advancement. Moreover, the possibility of discharge often affects victims immensely. Fundamentally, health difficulties often point to a lack of confidence not only among peers but also the superiors. Studies reveal that while a member of a unit is absent, confidentiality often reduces tremendously. In addition, high-ranked officers often feared the questioning of their leadership prowess in light of disclosed mental health difficulties (Coleman et al., 2017). On the other hand, low-ranked officers often express the possibility of non-deployment and an inability to advance in terms of a professional career. Due to such dynamics within the military, as well as strict policies and regulations such as restrictive duties to those deemed severely mentally ill, various barriers to seeking proper mental health within the armed forces persist.
References
Coleman, S., Stevelink, S., Hatch, S., Denny, J., & Greenberg, N. (2017). Stigma-related barriers and facilitators to help seeking for mental health issues in the armed forces: a systematic review and thematic synthesis of qualitative literature. Psychological Medicine , 47 (11), 1880-1892. doi: 10.1017/s0033291717000356
Eisenzimmer, R. (2012). Code 51: Keeping Suicidal Veterans Safe in the Emergency Department. Journal of Psychosocial Nursing , 50 (12), 30-35.
Iversen, A., van Staden, L., Hughes, J., Greenberg, N., Hotopf, M., & Rona, R. et al. (2011). The stigma of mental health problems and other barriers to care in the UK Armed Forces. BMC Health Services Research , 11 (1). doi: 10.1186/1472-6963-11-31
Sharp, M., Fear, N., Rona, R., 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 (1), 144-162. doi: 10.1093/epirev/mxu012
Slate, R., Buffington-Vollum, J., & Johnson, W. (2013). The Criminalization of Mental Illness: Crisis and Opportunity for the Justice System: Second Edition . Durham, NC: Carolina Academic Press.
