The fight against mental health stigma and barriers to care for service members

The fight against mental health stigma and barriers to care for service members
Nov 11, 2020
ICF honors veterans by helping those who serve get the psychological care they need

Not all veterans bear physical wounds. Between 11 and 20% of veterans suffer from PTSD (and nearly 175,000 active duty service members). This isn’t a new fight. The U.S. military has battled mental health stigma and barriers to care for years.

But it is a fight ICF’s public health team hopes to help the military win. We approached it from a different angle once before, through Power Dreaming—a virtual reality treatment that helps veterans gain more control over their nightmares. The stigmas, however, still stand. And until those are erased, thousands of veterans won’t get the help they need.

“It's comforting to know that the work we’ve done so far has already influenced service policy. I hope that, by changing this language, more active duty and veteran service members will seek help before they feel too overwhelmed to act.”

– Christian Evans

Challenging assumptions that mental health shows weakness

For the past three years, Christian Evans—a public health specialist who focuses on psychological stress reactions—has been part of an ICF team working with mental health professionals throughout the U.S. Military Health System. These ICF researchers addressed concerns brought about by a 2016 report on stigma—namely, negative attitudes and beliefs about mental illness interfere with service members’ willingness to seek mental health care.

Christian is more than a public health specialist. He was also a pastoral counselor—and a standup comedian. So, he has an inherent understanding of how to apply different approaches when connecting to people in different situations. “I know it’s hard for many people, especially men, to ask for help when dealing with emotional or mental health issues,” he says. “It’s especially difficult for service members who are expected to soldier on, no matter what is going on inside their heads.” Unfortunately, this attitude often stays with them long after they leave the service. The result, for too many, are experiences that are too much to bear. The suicide rate for veterans is currently 1.5 times higher than for non-veteran adults.

The answer seems obvious: destigmatize mental health issues. But reversing something so ingrained in military culture is no easy task. So, this ICF team examined over 400 mental health-related policies from each service branch—including the U.S. Coast Guard and Department of Defense itself—looking for language that might reinforce mental health stigmas. And they found that 56% of the policies included language that was potentially problematic, while only 8% used language that decreased fears of perceived weakness.

Our results, solidified in 2018, did more than challenge assumptions. They changed policy. Last year, Christian learned that, of the 169 policies originally flagged for stigmatizing language, 87 had been reissued. Of the 87 polices that had been reissued, 28 had incorporated all of his team’s recommendations and 18 had incorporated some of their recommended changes. In total, this potentially harmful language had been reduced in more than 53% of the U.S. military’s policies since our client submitted its recommendations.

It’s a dramatic improvement, but there remains work to be done. Says Rebecca Jones, an ICF public health analyst who is also part of this team, “Most of the military assesses stigma in the public, institutional, or social context. There are research opportunities to examine the gaps, and tools that can track stigma reduction on an individual level.”

Now it’s time for us—the general public—to do our part. This year, first thank veterans for their service. Then ensure they get the mental health care they need.

Learn more about ICF’s careers in research.


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