Though progress continues to be made, a significant amount of stigma remains attached to certain types of mental health issues; perhaps unsurprisingly, this remains true throughout the ranks of our military. Unfortunately, stigma may deter service members and military veterans from seeking or receiving the care they may desperately need.
An estimated 60-70% of military vets don’t receive sufficient mental health treatment within one year of diagnosis.1 In this article, you’ll learn about:
- The reasons behind stigma in the military.
- What stigma is.
- The problems caused by mental health stigma.
- What the military is doing to reduce stigma.
- Mental health help available to veterans.
Why is There Stigma in the Military?
In the military, there are a number of factors that contribute to the stigma that surrounds issues with mental health. When it comes to their career in the military specifically, certain beliefs and attitudes in the armed forces can often make it additionally challenging to seek treatment.
- Because the presence of some mental health disorders can prevent people from being able to join the military,2 some active-duty service members believe that seeking help for a mental health disorder while in the military could have negative consequences on their job.1
- Concerns surrounding loss of security clearance, the ability to handle weapons, or even discharge from the military can lead service members to avoid seeking treatment for mental health disorders.1, 3, 4
- The military prioritizes health and the ability to take on an operation at any time.1 Treatment for mental illness may involve waiting for care, a period of time to stabilize on medication (if needed), and a longer duration of treatment, which can directly impact operational readiness.1
Service members may be reassured to know that the above scenarios rarely play out.3 In those who have sought help for mental health concerns, only 3% actually experience something like the above, and less than 1% lost security clearance based on mental health alone.3
Still, stigma about mental illness could affect more than just how a service member approaches his or her career. The military functions as a group to achieve objectives, where individual members must rely on each other.1 Fitting into the group is a high priority—and the worry is that if they make their mental illness known, they believe it might make them seem “different” or less reliable.1, 5
There’s also a good deal of emphasis placed on being self-sufficient, strong, resilient, and (historically) masculine in the armed forces.1, 4 Service members often believe that they should be able to manage problems on their own, and may fear that seeking help will make them appear weak.1, 4
Finally, concerns about confidentiality can be another factor contributing to stigma.4 Military medical records aren’t subject to the same privacy as those of civilians, although there have been improvements in the confidentiality of some mental health records, including treatment for sexual assault and mild, short-term issues.2, 4
What is Stigma?
The technical definition of stigma is “a mark, blemish, or defect,” often viewed as something to be ashamed of or looked down upon. Generally, it has to do with a sense of fear about something that is different.6 Stigma plays a role in setting something apart in a negative light, and it may operate in different contexts.1
Stigma surrounding mental illness plays out in different spheres of a person’s life and can affect both active-duty service members and veterans.5 These contextual settings include:
- Individual context. This occurs when a person internalizes stigma, causing them to experience shame, low self-worth, or an unwillingness to seek help.1, 2 Examples can include thoughts like “I’m not strong enough” or “I shouldn’t need any help.”
- Social context. This involves key interpersonal relationships and the views that family, friends, others in the unit, or commanding officers may hold about mental illness or seeking help. 2 In this context, it’s observed as others potentially viewing the stigmatized individual as different, reliable, or weak.
- Institutional context. This applies when military policies or systems create a bias against people with a mental health diagnosis or those who seek treatment.2 Examples can include fears of being downgraded or discharged for seeking treatment, not being allowed to handle weapons if put on medication, forcing service members into treatment, or concerns about criminal justice actions being taken.
- Public context. This can include how society as a whole views people with mental illness, or the expected behavior within military culture.2, 5 Examples can include thinking that people with mental illness are dangerous or unable to function.
Why is Mental Health Stigma in the Military a Problem?
Stigma surrounding mental health in the military has created a massive gap between the number of people affected and those who seek treatment.1, 3
There’s a real human cost to service members not receiving treatment.2 Active-duty service members and veterans are at an increased risk of PTSD and other mental health disorders, and if untreated, may turn to substance use to deal with symptoms.7 Lack of treatment increases suicide risk as well.2
It’s a travesty that people who willingly put their lives on the line to defend the country believe they cannot get help for a mental health disorder because of how it may be perceived.
While this should be the biggest concern, there are other things to consider. Military leaders are worried about how mental health stigma stops people from seeking help because of its ability to weaken service members and the armed forces.3
Untreated mental illness is also financially costly.2, 3 Mental illness that isn’t cared for appropriately due to stigma is estimated to cost up to $32 million in productivity losses and death by suicide in active duty service members.2 Within the first 2 years after returning to civilian life, losses in productivity at work and the need for direct care to be provided can lead to costs in excess of $6 billion.3
In the last couple of decades, the military has made concerted efforts to address and reduce the long-standing stigma of seeking mental health treatment services.3 Each branch of the armed forces is taking steps to fight stigma, both independently and in conjunction with the other branches.3
How the Military is Improving Its Approach to Mental Health
In its efforts to reduce stigma, the military has made some changes to how it approaches mental health.
In 2008, a security clearance questionnaire had an alteration to Question 21.3 Question 21 asks whether a service member has ever met with a professional about any emotional or mental health issues. Previously, service members were worried that a “yes” answer would potentially take away opportunities or security clearances. It was also known to drive people away from getting help, worried that their security clearance might get revoked if they did.
The changes made allow those who have sought assistance for issues related to combat or couples counseling to not have to answer “yes.”3
Rather than classifying service members as “fit” or “ill” and therefore unfit for service, the military has instituted new classifications that views mental health disorders as shades of gray.3 Additional designations were added, including “reacting” and “injured”, to allow for the range of responses that people experience as a result of exposure to stressors such as trauma.3
One of the major changes has been that more people within the military have been coming forward and discussing their own mental health challenges, including high-ranking officers.2, 3 This initiative demonstrates that experiencing symptoms is not unusual, and that treatment will not damage a person’s career.2 (p. 68, 73) 3 (paragraph 13)
While these steps have helped to reduce the stigma, more progress needs to be made.
Mental Health Help for Veterans
Included in its efforts, the VA has developed a website called Make the Connection that focuses on reducing the stigma associated with veterans seeking mental health treatment at the VA.6
It allows veterans to watch videos on a variety of topics, including making the transition from service to civilian life, building and maintaining healthy relationships, and managing symptoms of PTSD, along with helping vets find resources for local support.8
The VA also offers mental health treatment services at many of its facilities, which you can find in their resource locator.
For veterans with co-occurring disorders (substance use and one or more mental health disorders), facilities like American Addiction Centers offer specialized programs. Both Desert Hope, a facility in Nevada, and Recovery First, in Florida, offer the Salute to Recovery program, which is designed for veterans dealing with addiction in addition to mental health disorders, including PTSD.
The program addresses common challenges that veterans face, like finding a balance between work and other areas of life, managing symptoms, learning how these issues affect the veteran and loved ones, improving interpersonal relationships, and education about PTSD.
Treatment is provided through a combination of several behavioral therapeutic techniques, 12-step and community support groups, skills training, and education groups. Many staff members are veterans themselves, which makes it easier to discuss experiences freely.
Being in the military and facing combat is hard but getting help doesn’t have to be. Resources are available. We know you or your loved one is brave: military service proves that. You or your loved one is brave enough to ask for help.
- Sharp, M-L., 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(1), 144-162.
- Acosta, J.D., Becker, A., Cerully, J.L., Fisher, M.P., Martin, L.T., Vardavas, R., …Schell, T.L. (2014). Mental Health Stigma in the Military.
- Dingfelder, S.F. (2009). The military’s war on stigma. Monitor on Psychology, 40(6).
- Psychological Health Center of Excellence. (2019). Reducing Military Mental Health Stigma to Improve Treatment Engagement: Guidance for Clinicians.
- Campbell, D.G., Bonner, L.M., Bolkan, C.R., Lanto, A.B., Zivin, K., Waltz, T.J., …Chaney, E.F. (2016). Stigma Predicts Treatment Preferences and Care Engagement among Veterans Affairs Primary Care Patients with Depression. Annals of Behavioral Medicine: A publication of the Society of Behavioral Medicine, 50(4), 533-544.
- U.S. Department of Veterans Affairs. (2015). Mental Health Stigma: 10 Things You Should Know About.
- U.S. Department of Veterans Affairs. (2019). PTSD and Substance Abuse in Veterans.
- U.S. Department of Veterans Affairs. (2020). Make the Connection.