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Mental Health Stigma in the Military

Mental Health Stigma in the Military

Joie D. Acosta
Amariah Becker
Jennifer L. Cerully
Michael P. Fisher
Laurie T. Martin
Raffaele Vardavas
Mary Ellen Slaughter
Terry L. Schell
Copyright Date: 2014
Published by: RAND Corporation
Pages: 330
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  • Book Info
    Mental Health Stigma in the Military
    Book Description:

    This report assesses the U.S. military’s approach to reducing stigma for mental health disorders and their treatment, how well it is working, and how it might be improved. It presents priorities for program and policy development and research and evaluation to get service members the treatment they need as efficiently and effectively as possible.

    eISBN: 978-0-8330-8999-1
    Subjects: History, Psychology

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xii)
  6. Summary
    (pp. xiii-xxiv)
  7. Acknowledgments
    (pp. xxv-xxvi)
  8. Abbreviations
    (pp. xxvii-xxxii)
  9. CHAPTER ONE Introduction
    (pp. 1-6)

    Despite the efforts of both the U.S. Department of Defense (DoD) and the Veterans Health Administration to enhance mental health services, many service members are not regularly seeking needed care when they have mental health symptoms or disorders. Without appropriate treatment, these mental health symptoms or disorders can have wide-ranging and negative impacts on the quality of life and the social, emotional, and cognitive functioning of affected service members.

    Both the DoD Task Force on Mental Health (2007) and the DoD Task Force on the Prevention of Suicide Among Members of the Armed Forces (2010) identified the stigma of mental...

  10. CHAPTER TWO Defining Stigma in the Military Context
    (pp. 7-16)

    This chapter describes the process that we used to derive a definition and conceptual model of mental health stigma in the military context and summarizes key theoretical approaches to understanding stigma. We derived these through the literature review and consultation with our expert panel. The purpose of the definition and conceptual model is to guide the identification of promising intervention strategies and to provide a foundation for our assessment of DoD’s current approach to reducing stigma.

    The variations in definition are very important because the way in whichstigmais defined dictates the types of stigma-reduction strategies that are pursued....

  11. CHAPTER THREE Prevalence of Mental Health Stigma in the Military
    (pp. 17-28)

    Given the important and unique impact that military culture may have on stigma, our intent in this chapter is to answer a set of key questions useful to DoD. These questions include “How does the prevalence of stigma in the military compare to that in the general population?” “Is stigma declining in the military?” “Is stigma more prevalent in certain branches of the military or among certain ranks of service members?” and “Are there data available that can be used for longitudinal tracking of stigma prevalence and to evaluate stigma-reduction programs?” As noted in Chapter Two, there are multiple definitions...

  12. CHAPTER FOUR Societal Costs of Mental Health Stigma in the Military
    (pp. 29-54)

    Given the prevalence of mental health stigma in the military, what are its medical and societal costs? In this chapter, we present a microsimulation model developed to estimate the costs resulting from mental health stigma.¹ We based our model on an existing one that estimates the costs of untreated mental health symptoms or disorders among service members deployed as part of OEF or OIF and developed by Kilmer et al. (2011) as part of the RAND Invisible Wounds project (Tanielian and Jaycox, 2008). To adapt the model to include mental health stigma, we started by reviewing scientific literature to get...

  13. CHAPTER FIVE Promising Programmatic and Policy Approaches to Reducing Stigma
    (pp. 55-66)

    Given the conceptual model described in Chapter Two, what are the most-promising programmatic and policy approaches to reducing stigma? This chapter presents a review of the literature on evidence-based programs and policies to reduce stigma. We review the factors associated with mental health stigma that can be changed through intervention. To help distinguish factors, we organize them by each of the four key contexts that might be targeted through intervention (i.e., public, institutional, social, and individual) as specified in the conceptual model in Chapter Two. Within each context, we first review the literature, paying particular attention to the strength of...

  14. CHAPTER SIX U.S. Department of Defense Programs to Reduce Mental Health Stigma
    (pp. 67-78)

    Despite the availability of a wide range of evidence-based treatments for MHDs, the proportion of service members who seek needed treatment remains low. In response, DoD and individual branches of service have made a concerted effort to promote treatment-seeking through specific programs to reduce stigma, as well as through a widespread culture shift in which mental health is discussed in the context of readiness and resilience and in which help-seeking is redefined as a sign of strength. These approaches are generally aligned with the promising approaches described in Chapter Five and may have contributed, at least in part, to the...

  15. CHAPTER SEVEN U.S. Department of Defense Policies Related to Stigma
    (pp. 79-92)

    In this chapter, we aim to explore the DoD policy landscape as it pertains to mental health stigma. To identify the institutional policies that might either contribute to or reduce stigma toward service members with mental health challenges or toward those seeking treatment, we conducted a systematic assessment of policies in DoD and the services using a prospective policy-analysis methodology. We first describe the methods of the analysis, followed by a discussion of an important policy tension that emerged from our analysis—the tension between the need for commanders to assess the fitness of service members under their command and...

  16. CHAPTER EIGHT Key Findings and Priorities for Improving the U.S. Department of Defense’s Approach to Stigma Reduction
    (pp. 93-104)

    In this chapter, we summarize key study findings, outline priorities for improving DoD’s approach to stigma reduction, and include both short-term (in the next one to two years) and long-term (in the next three to five years) steps DoD can take to achieve these priorities. These priorities are ranked according to the findings described in this report and have been further refined and vetted through an expert panel. Appendix I contains more details on the expert-panel process used to finalize these priorities. In this chapter, we organize priorities into three categories: enhancing or improving stigma-reduction intervention, policies, and research and...

  17. APPENDIX A Methods for Literature Review
    (pp. 105-114)
  18. APPENDIX B Definitions of Mental Health Stigma
    (pp. 115-132)
  19. APPENDIX C Prevalence of Stigma in the General U.S. Population
    (pp. 133-136)
  20. APPENDIX D Detailed Methods for the Modeling Approach
    (pp. 137-164)
  21. APPENDIX E Program Descriptions and Analysis
    (pp. 165-180)
  22. APPENDIX F Policy-Analysis Methods
    (pp. 181-186)
  23. APPENDIX G Policies with Implications for Stigma
    (pp. 187-220)
  24. APPENDIX H Policies That Contain Negative Terminology with Implications for Stigma
    (pp. 221-224)
  25. APPENDIX I Methods Used to Conduct the Expert Panel to Refine and Vet Priorities for Mental Health Stigma Reduction in the U.S. Department of Defense
    (pp. 225-230)
  26. Bibliography
    (pp. 231-296)