Even though I have been a squadron commander for three years, I have been an Air Force mental health provider for more than 21 years. Ever since I came in, mental health professionals have been trying to figure out how to overcome the stigma of someone seeking help. Even though Air Force leaders have always generally been supportive of people going to Mental Health, the stigma persisted. Fortunately, in the past few years, seeking help has become much more acceptable and encouraged, and the stigma has diminished. People who might not have sought help in the past are now reaching out for assistance.
To be fair, 20 years ago, the military mental health community did a lot to perpetuate the stigma themselves. It was common for people seeking care to have some significant, often unreasonable, duty limitations put on them. Providers were much quicker to initiate a medical board or recommend administrative separation on patients. For those who needed help then, it basically came down to a decision between getting help and risking their military careers. Certainly, that is not the kind of decision anyone should have to make, and caused a problem the Air Force has tried to fix over the past several years.
To help, the Air Force took several steps to make mental health care safer and more private. Except in certain circumstances that are disclosed up front, communications with a mental health professional are considered confidential. Situations that might require information to be disclosed include family violence or criminal activity. Drug or alcohol abuse and significant suicidal or homicidal risk is disclosed in order to get the member the proper treatment.
Finally, if the member’s symptoms interfere with his/her ability to safely perform duties or significantly impacts the mission, the commander needs to be informed of the risk. Before any information is disclosed, the provider makes every effort to talk with the member about the need to disclose information and exactly what will be disclosed. Even then, only the minimum amount of information is disclosed in order to allow the commander to make mission related decisions.
There are extra protections for members facing legal problems or investigation. In these instances, the mental health provider has near complete confidentiality and can only release information with the member’s approval or on the order of a military judge.
Over the last couple years, Department of Defense leaders have made an even stronger push to get people who need care to seek it, and to make it safer for them to do so. Our nation continues to ask us to make tremendous sacrifices, which often include putting ourselves in harm’s way. Our people are selflessly defending our nation, and the military medical system is obligated to provide the best, most comprehensive care possible for our military members and their families.
Nowadays, military mental health providers are treating more depression, anxiety and post-traumatic stress disorder than ever before, usually with very successful outcomes. In fact, PTSD is one of the most crippling, yet one of our most treatable disorders with a nearly 80 percent success rate. Many veterans who have suffered for years from sychological injuries from the Vietnam and Korean wars are finally now seeking help for PTSD because the newly developed methods of treatment are so effective.
Military mental health providers also continue to help people struggling with adjustment problems, relationship issues, occupational problems, or difficulties with other stressors. Sometimes we see people who are doing well and just want to better themselves or simply need some advice.
Unfortunately, a survey conducted a couple years ago determined there were still two factors that worked to keep military members from seeking help: the fear that they will be treated differently by supervisors and coworkers, and that there will be unrealistic duty limitations imposed on them by the unit.
Certainly, there are times when someone is not functioning up to par, and duty limitations are needed for safety. But mental health providers and commanders are eager to get people back to work as quickly as possible, because they also understand the impact of duty limitations on a unit and the member.
In fact, a review conducted a few years ago of active duty patients who voluntarily sought care found that mental health providers recommended duty limitations in only 2 percent of the cases, and the vast majority of these were very short term. Duty limitations and any contact with a member’s unit was extremely rare and the exception rather than the rule. In the vast majority of cases, the only way a supervisor or commander knows a member is seeking help is if the member tells them or allows the provider to talk with the commander.
Another common deterrent to seeking care is the fear that doing so will cause a security clearance to be pulled. In 21 years, I have seen this happen on less than five occasions, and in each, the unit was already working to pull the clearance because of behavioral problems before I even made the recommendation. Of note, a 2008 change in policy now allows members to avoid disclosing a history of mental health treatment on a renewal application if the treatment was for issues related to service in a combat area. This is just one more way in which our leaders are committed to removing barriers to care.
The push for people to seek help is not just lip service by our leaders. They are using services themselves. I have personally treated active duty members from every rank, including a general officer, and several colonels, chiefs, commanders, first sergeants and other people in positions of leadership. The DOD has also spent a significant amount of money on the Military OneSource and Military Family Life Consultant programs. These programs are intended to provide assistance for relationship, parenting, occupational, reintegration and other adjustment issues. Both of these programs are outside the military medical system, and no information is relayed back about anyone seeking assistance to make it completely confidential and off the radar. The chaplains are another excellent source of assistance and offer confidentiality. Truly, our leaders are making a legitimate plea for people to get the help they need.
Seeking help when needed is a sign of strength, and the DOD has renewed its commitment to removing obstacles and making this easier for people to do. Leaders, supervisors, co-workers, and friends can help by being supportive of someone who is seeking care and encouraging those who are having problems to get help. If you need help, please get it. By doing so, we can help our heroes reduce the impact their service has on their future and families, and keep the military strong.