The stigma of mental health problems and other barriers to care in the UK Armed Forces

Abstract

BackgroundAs with the general population, a proportion of military personnel with mental health problems do not seek help. As the military is a profession at high risk of occupational psychiatric injury, understanding barriers to help-seeking is a priority.MethodParticipants were drawn from a large UK military health study. Participants undertook a telephone interview including the Patient Health Questionnaire (PHQ); a short measure of PTSD (Primary Care PTSD, PC-PTSD); a series of questions about service utilisation; and barriers to care. The response rate was 76% (821 participants).ResultsThe most common barriers to care reported are those relating to the anticipated public stigma associated with consulting for a mental health problem. In addition, participants reported barriers in the practicalities of consulting such as scheduling an appointment and having time off for treatment. Barriers to care did not appear to be diminished after people leave the Armed Forces. Veterans report additional barriers to care of not knowing where to find help and a concern that their employer would blame them for their problems. Those with mental health problems, such as PTSD, report significantly more barriers to care than those who do not have a diagnosis of a mental disorder.ConclusionsDespite recent efforts to de-stigmatise mental disorders in the military, anticipated stigma and practical barriers to consulting stand in the way of access to care for some Service personnel. Further interventions to reduce stigma and ensuring that Service personnel have access to high quality confidential assessment and treatment remain priorities for the UK Armed Forces.

Pathways into mental health care for UK veterans: a qualitative study

“…There are around 2.8 million veterans living in the UK (The Royal British Legion, 2014) of which a significant minority experience mental health difficulties (Iversen et al, 2011). In the UK the National Health Service (NHS) is responsible for providing health care to veterans supported by a number of charitable and for-profit organizations.…”

“…Findings suggest that factors including stigma (Iversen et al, 2011), negative attitudes about mental health services (Kim, Britt, Klocko, Riviere, & Adler, 2011) and poor recognition of the need for treatment (Britt, Wright, & Moore, 2012) are barriers to help-seeking for veterans. Furthermore, practical barriers to accessing care are deemed important, including problems with the availability and accessibility of services (Brown, Creel, Engel, Herrell, & Hoge, 2011), waiting times (Damron-Rodriguez et al, 2004) and excessive paperwork (Westermeyer, Canive, Thuras, Chesness, & Thompson, 2002).…”

PTSD in the armed forces: What have we learned from the recent cohort studies of Iraq/Afghanistan?

“…The purpose of screening for PTSD would be to improve the prognosis of the condition by the use of efficacious treatment, but identification of PTSD may not be helpful if a large proportion of cases can improve without treatment (Rona et al, 2005). This issue is also complicated by what is known about help seeking and stigma and only a proportion of personnel with PTSD will actually seek help (Ben-Zeev et al, 2012;Iversen et al, 2011;Langston et al, 2010).…”

Conflicting Notions on Violence and PTSD in the Military: Institutional and Personal Narratives of Combat-Related Illness

“…In line with the chief findings of many psychological studies of military ''barriers to care'' (Hoge et al 2004;Kim et al 2010;Iversen et al 2011;Ben-Zeev et al 2012), these armed forces have focused on fighting self-images of weakness or fear of such views. Education programs are developed to deal with stigma, which emphasize, for instance, that seeking help is a sign of strength (Iversen et al 2011).…”