Since the late 1990s, military mental health care providers have been routinely embedded into expeditionary units for the purpose of recognizing signs of problems early, fostering prevention and early intervention efforts, increasing access to care, and making military units more comfortable with the idea of seeking mental health care. The movement to embed mental health assets has accelerated in recent years, building on previous successes.
I’m going to provide you first-hand experience of living as an embedded psychologist for two years on an aircraft carrier. Let’s face it, there is still stigma around seeking mental health care and some of this continues to be attributed to military culture. In my case, when I arrived at the ship, the master chief’s attitude reflected the stigma of sailors being perceived as “skating” or getting out of work when they needed mental health appointments. Yet there is now data to show the positive impact of embedded providers that demonstrates otherwise – we fill a need and improve readiness, similar to findings from embedding mental health assets with other large deck ships and most recently on submarines.
While my salty master chief questioned the notion of having a psychologist on board, he was a good leader to the enlisted crew and kept an open mind. When I needed to get messages/trainings to key leaders (e.g., the Chief’s Mess), he consistently set me up for success. I think that’s because he saw time and again how I did whatever it took to keep sailors in the fight. So while he had a difficult time letting go of his stereotypes about psychologists and the sailors who saw them, over time I earned and maintained his (and others’) trust with a steady approach and solid recommendations, which were easily translatable to mission readiness. Showing him the value of mental health care at sea and working to keep the crew healthy, convinced him and the crew of the value of sailors seeing mental health professionals. This buy-in is essential for reducing the stigma that continues to keep many people out of treatment.
I won’t lie, I would let sailors complain about their supervisors – but only for about the first five minutes of any session – then it was time to get to what was really going on. That said, when the same complaints kept popping up in particular divisions or departments, I figured out how to resolve issues on a systems level. Division officers and chiefs became my new best friends. These were folks I never would have imagined spending significant periods of time with prior to my time as an embedded provider – they worked in supply, on deck, in nuclear power, etc. And as I came to better understand their spaces, practices, and needs, my effectiveness on board markedly advanced. That’s where the magic happens as an embedded provider - not just by helping the individual in front of you, but by improving processes within this complex independent (floating) city, if you will. Understanding and becoming part of the culture are key ingredients for success.
Another integral component of embedded mental health care is the normalization of interacting with the provider as a regular course of business. On the ship, various drills (e.g., man overboard, general quarters) applied to everyone. Participating in FOD (foreign object debris) walkdowns (i.e., walking the hangar bays and flight deck picking up debris – sure to save aircraft from certain destruction) also provides informal avenues to interact with the crew and their leaders, and reminds them ‘one team, one fight.’ Familiarity with the embedded provider makes it more likely that service members will seek care on their own, and that leaders will encourage and support help-seeking behavior. Having embedded providers is a win-win situation. They increase positive outcomes for patients and improve readiness for the military mission.
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Cmdr. (Dr.) Arlene Saitzyk is a Navy psychologist, and currently serves as the group psychologist for the Marine Corps Embassy Security Group in Quantico, Virginia.
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.