The Department of Defense (DoD) strives to better understand the barriers to care that service members face regarding mental health diagnoses and treatment. Seeking care early can help service members address mental health conditions in a timely manner, increase their psychological health literacy, improve their understanding of the Military Health System, and dispel myths regarding seeking mental health care. Despite the benefits of seeking mental health care, approximately 60-70% of military personnel who experience mental health problems do not seek mental health services the underutilization of these services may be ascribed to barriers to mental health care related to:
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Barriers related to the individual
The lack of perceived need for mental health treatment and the preference for self-management (i.e., use of other stress coping strategies) among service members may have contributed to the underutilization of mental health services [ Reference 2 ]. The 2011 Health Related Behaviors Survey of Active Duty Military Personnel, the largest anonymous survey that gathers data on some of the most important behavioral health issues affecting the well-being of the U.S. military, noted that in the previous 12 months, service members used coping strategies such as:
Talking to a friend or family member (72.2%)
Exercising or playing sports (65.7%)
Engaging in a hobby (66.1%)
Thinking of a plan to solve the problem (82.6%)
Spending time by themselves (70.5%)
Barriers related to social networks
Service members have reported that their social networks significantly impact their decision to seek mental health care [ Reference 2 ]. Social factors that may hinder service members from seeking mental health care include:
Barriers related to treatment
Factors that may impede service members from obtaining the treatment they need, or may contribute to treatment drop out include:
Personal negative attitudes about mental health
Lack of confidence in treatment effectiveness (e.g., “friends and family may be more effective in helping”)
Lack of trust in mental health providers and the mental health care system
Fear of psychotropic medication side effects
Structural Barriers [ Reference 2 ]
Scheduling issues (e.g., inconvenient clinic hours)
No time off work
Lack of knowledge on mental health service locations
Institutional barriers are displayed in the intended and unintended discrimination toward people with a mental health diagnoses that manifests in a range of DoD and service-specific policies [ Reference 3 ]. In the 2014 report titled, “Mental Health Stigma in the Military,” RAND Corporation identified ways that DoD policies can potentially increase barriers to care, including mental health care stigma, in the military [ Reference 3 ] [ Reference 5 ]:
Uses negative terminology (e.g., describes behaviors of people with mental health disorders as “childish outbursts”)
Prohibits actions or implies incompetence
Has non-mental health professionals determining fitness
Reduces people with a mental health diagnoses to a label (e.g., “mentally ill person”, “a psychotic,” or “a schizophrenic”)
Mental health care stigma in the military context is unique due to the military’s emphasis on certain qualities in service members (e.g., stoicism, strength, and independence). Service members sometimes believe that seeking mental health care can hinder their ability to embody these qualities.
Mental health stigma is a dynamic process by which service members internalize a marked identity about themselves and people with mental health disorders [ Reference 3 ]. While research indicates that mental health care stigma remains a significant concern for service members, particularly those in need of mental health treatment, there are mixed findings about how it impacts treatment-seeking behavior or mental health service use [ Reference 3 ] [ Reference 4 ]. Rates of perceived stigma among service members have consistently been problematic. In response, DoD promotes efforts to reduce mental health stigma. These efforts include initiatives such as the Real Warriors campaign, programs, and tools to combat mental health stigma, such as Writing About Mental Health in the Military and Talking About Mental Health in the Military: A Guide for Leaders [ Reference 3 ].
Mental Health Stigma in Key Contexts
Mental health stigma has been linked to four key interrelated contexts:
Figure 1: According to RAND Corporation (2014), stigma exists in interrelated contexts. The institutional and public contexts make up the military context.
Forms of Perceived Stigma Resulting from Key Contexts
The stigma created within the key contexts can take many forms [ Reference 3 ]:
Type of Stigma
- Public stigma
- Structural stigma
Impact of Stigma on service members
Mental health care stigma can have short-term and long-term impacts on service members [ Reference 3 ]:
- Seeking help to address early symptoms
- Intention to seek treatment
- Beliefs and attitudes about treatment
- Quality of life
These downloadable resources describe barriers to care in more detail.
Military personnel with mental health symptoms do not seek care for a variety of reasons from logistical, to confidentiality and stigma concerns. This infographic describes the types of barriers to care, forms of mental health stigma, and how barriers to care impact service members.
Survey research suggests that up to 35 percent of service members believe receiving mental health treatment can negatively impact their careers. This resource describes career concerns that keep some service members from seeking mental health care.
Only a few mental health conditions or medications affect deployability. This infographic addresses mental health concerns and deployment.
This resource that explains guidelines for confidentiality of mental health information in the military and how patients can work with their providers to help protect their information.
Barriers to Care: Security Clearance – Mental Health Section Endorsement and Treatment-Seeking Concerns
It is extremely rare to have a security clearance denied or revoked solely on the basis of reporting mental health conditions or treatment. This resource addresses concerns about mental health and security clearances and explains how seeking treatment may contribute favorably to eligibility decisions.