B0038M1ADS EBOK (34 page)

This chapter covers essential information if you decide to receive assistance
from a mental health professional, and will probably be useful if you're
already in treatment. Topics covered in this chapter include the reasons
to consider getting professional help; why it's hard for warriors to ask for
help; the stigma and other barriers to receiving services; differences between
professional disciplines; what you can expect from treatment; the range of
options available; and the benefits and limitations of treatment. The goal of
this chapter is for you to acquire knowledge that will help you navigate the
mental health system and advocate for yourself (or your loved one).

Reasons to Seek Mental Health Treatment

Mental health professionals have a lot to offer a warrior who is struggling
with transition issues, most importantly support in alleviating distressing
symptoms, and a willing ear to facilitate the narration of the warrior's story
and expression of emotions associated with the story. It's truly a privilege, as
a helping professional, to listen to the stories that warriors and their family
members share and to assist them in their journeys. Assisting in the journey doesn't mean providing advice or answers, but rather helping individuals find the answers for themselves, so they can navigate their own course
toward greater meaning, purpose, and joy.

There are a number of reasons to consider seeking professional help.
Help is indicated if your transition and readjustment process isn't going
smoothly and you're experiencing high distress, or are having a lot of dif ficulty at work or with relationships involving loved ones or coworkers. If
you're experiencing high levels of PTSD symptoms according to the PTSD
checklist in chapter 1, or high anxiety levels, a persistently low mood,
you've lost interest in activities you used to enjoy, or you're flying off the
handle all the time, then these are reasons to seek help. Professional help
is indicated if you're experiencing significant problems with drinking or
drug use, as discussed in chapter 4, skill 5. If you're seriously contemplating suicide or homicide, then professional help is definitely warranted.

Before we discuss how to get help and the barriers to care, if you're
experiencing suicidal or homicidal intentions, or find yourself in an emotional crisis, then call the National Suicide Prevention Lifeline at 1-800273-TALK (8255), which is available to anyone (veteran or civilian) who
is in crisis or is concerned about someone in crisis. Counselors, who are
connected with a network of crisis centers, are available 24/7. The number
1-800-SUICIDE (2433) connects to the same line. You can also go to an
emergency room and be seen right away.

One question that may seem a bit confusing is why should you seek
help for PTSD if these reactions are normal expected responses to
deployment-related events? If the reactions are normal, why is it necessary to seek help? The answer has to do with the perspective in our society
that problems attributed to mental health are "disorders" or "illnesses,"
and you can only ask for help when something is "wrong" with you or
"broken." This perspective doesn't match reality, and we need to get used
to the idea that some normal emotional or physical responses can be devastating and life-changing, and that we always need a way to work through
these events. We need to start viewing mental health problems as part of
the normal human experience.

PTSD symptoms are normal responses to severe stress and trauma but
have a physiological basis, and like other medical illnesses, can clearly interfere in serious ways with a warrior's life after getting home. Seeking professional help may be the only path to integrating these experiences into who
you are. In other words, don't get stuck thinking that you can only seek help
if you view yourself as having something "wrong" with you. Although mental health professionals speak a different language, their primary goal is to ease the number and severity of the symptoms you experience, and help you
improve your ability to relate to people, to function at work, and to enjoy life.
This goal is consistent with your desire to feel better and integrate troubling
experiences so you can live a healthy and meaningful life.

STIGMA AND OTHER BARRIERS TO CARE

It's normal not to want help even when you need it most. Warriors are independent-minded and used to projecting strength and self-confidence, two
attributes that help them function in their jobs on the battlefield. They have
learned to "drive on" and deal with some of the most difficult circumstances
imaginable. They don't want to be seen as weak, and are concerned about
how they will be viewed or treated by others if they admit to having a problem that they can't deal with on their own. They have learned during one or
more tough deployments to keep personal problems to themselves and to
not allow these issues to interfere with their jobs-even when the problems
are overwhelming, like receiving a "Dear John" or "Dear Jane" letter/e-mail,
or witnessing the death of a friend. They have learned to put education,
career, and family goals on hold, and to function independently from their
partners. They have missed countless milestones in the lives of their children
and family members. They have missed births or left their children shortly
after delivery. They have dealt with difficult transitions before, during, and
after deployment. They have coped with and managed all of these situations,
and it can be very difficult to admit to anyone that they need help, much less
pick up the phone or walk into the office of a mental health professional.

A number of studies during OIF and OEF have shown that less than
half of service members and veterans with serious mental health problems
receive help. There are several reasons why warriors have a hard time asking for help. First, many warriors are afraid that when they start to talk
about their wartime experiences, it will open up a Pandora's box and
they'll lose control-they fear that they won't be able to keep it together at
work or at home. This fear is justified because wartime memories are connected with very strong emotions, some of the strongest that humans can
endure-emotions that have to be acknowledged and expressed as part of the process of integrating and living with these experiences. Treatment
isn't easy, even when (or especially when) it's needed the most.

Second, warriors are concerned that the therapist won't be able to
understand or relate to what they've experienced, or that they wi11 judge
them for things that happened. This fear is also justified because many
mental health professionals don't have sufficient understanding of the
military experience and have been trained to view problems within a psychological or medical framework, which labels war-related reactions as
"disorders" or "illnesses," without differentiating the range of what is normal under these circumstances.

Third, warriors worry that they will be perceived as weak or treated differently by others if they admit to having a problem. If they're still in the military, they also worry that mental health treatment could affect their careers.
This is also justified. When in combat, the warrior's life depends on his or
her "family" of unit members, where even the perception of weakness can
affect morale and cohesion, which in turn can contribute to mission failure.
Although the military and VA have been working actively to reduce stigma
through educational campaigns, many seasoned line leaders still consider
unit members who are receiving mental health treatment, particularly if they
are taking medication, as less dependable and more likely to break under
fire. This has operational ramifications when they decide whom to assign to
the more-difficult missions, which is unfortunate; warriors who are able to
admit to needing help may be more resilient.

The stigma of mental health treatment is also not unique to the military,
and continues as warriors transition out of the military and become civilians.
Although views of mental health problems are changing, there are still pervasive beliefs in the larger society that these problems reflect a personal failure
or weakness of character. This is particularly true in dangerous professions
like law enforcement and security, where receiving mental health treatment
is considered a sign of weakness or instability. It's also reflected in the disparity in insurance coverage for mental health vs. physical health problems.

The final reason that warriors hesitate to seek treatment is the many
other barriers besides stigma, such as finding the right professional, navigating complex insurance or reimbursement processes, and repeatedly having to miss work to receive a sufficient number of appointments for
treatment to be effective.

Table 2 shows results from a survey of soldiers and marines after
returning from deployment to Iraq and Afghanistan. These service members were asked to rate the concerns that "might affect your decision to
receive mental health counseling or services if you ever had a problem."
The table shows the percentage of warriors who agreed with each of the
statements. Nearly two-thirds (65 percent) of the warriors who had PTSD
or depression reported that they'd be concerned that they would be "seen
as weak," and 63 percent reported concerns that "unit leadership might
treat me differently" if they received services. Half or more reported concerns that their peers would have less confidence in them or that their
careers would be affected. Although percentages were lower among warriors from the same units who did not have mental health problems, many
of them had similar concerns, reflecting how pervasive these perceptions
are. The survey also identified important barriers to care, such as difficulty
getting an appointment or getting time off from work.

This survey, which has been repeated in numerous units before,
during, and after deployment, showed that perceived stigma and barriers remained elevated throughout the duration of the wars in Iraq and
Afghanistan. Massive education campaigns and an emphasis by military
leaders at the highest levels to reduce stigma haven't made a dent in the
problem. This doesn't indicate a failure of education campaigns so much
as the reality of how pervasive stigma is among warriors and in our society
at large. Part of the reason that stigma is so pervasive in the military is the
ratio of men to women, and the fact that men are much less willing than
women to acknowledge when they have problems or need help.

Another pertinent finding from this survey was that nearly 40 percent
of warriors who had serious mental health problems expressed distrust in
mental health professionals, and one-quarter indicated agreement with
the statement, "Mental health care doesn't work." This relates to the concern that warriors have that they won't be able to find a professional who
truly appreciates their problems or knows how to help them.