Army experts: Mixed messages can fuel stigma, prevent Soldiers from accessing behavioral healthcare

By V. Hauschild, MPH, U.S. Army Public Health CenterDecember 5, 2022

Army experts: Mixed messages can fuel stigma, prevent Soldiers from accessing behavioral healthcare
Just as a Soldier in physical pain has access to a healthcare professional, the Army ensures professionally trained personnel are available to help Soldiers experiencing a variety of behavioral health conditions and life stressors. Soldiers and leaders can reduce obstacles like stigma that prevent Soldiers from seeking care. (U.S. Army Public Health Center photo illustration by Graham Snodgrass) (Photo Credit: Graham Snodgrass) VIEW ORIGINAL

ABERDEEN PROVING GROUND, Md. – Military policies and testing requirements ensure Soldiers are physically trained and ready to fight the nation’s wars, while reducing injury risks through scientifically-supported methods. Examples include gradually increasing activity duration or intensity over time, and replacing “running-centric” training regimens with more varied exercise activities, like strength and agility training.

But many leaders across the Department of Defense say that improving Soldiers’ mental health is another vital component to increasing the strength of the fighting force.

“Much like the work done on improving physical readiness training protocols, the Army continues to research evidence-based practices for improving psychological health, wellness and resiliency” says Lt. Col. Jeffrey Bass, a clinical and forensic psychologist of the U.S. Army Public Health Center’s Division of Behavioral and Social Health Outcomes Practice.

The Army’s current approach to training Soldiers is reflected in its updated doctrine titled “Holistic Health and Fitness.” The H2F program emphasizes total wellness, not just physical fitness, and encourages Soldiers to take care of both their minds and their bodies.

“Today’s Army offers Soldiers and their families a variety of resources to improve their readiness and resiliency,” says Bass. “Just as a Soldier in physical pain has access to a healthcare professional, the Army ensures professionally trained personnel are available to help Soldiers experiencing a variety of behavioral health conditions and life stressors. Army leaders have increasingly provided information about behavioral health services and encouraged Soldiers to take advantage of the confidential and free help. However, just promoting available resources isn’t enough.”

Research in military populations – including studies by the APHC – have found that many Soldiers continue to avoid seeking behavioral health care because of stigma.

Stigma refers to negative attitudes and beliefs about people, places or things. Stigma can lead to labeling, stereotyping and discrimination against a group of people, such as those who seek care for mental or behavioral health issues. According to the Centers for Disease Control and Prevention, stigma is often associated with fear, a lack of knowledge and a need to blame someone. People may stigmatize themselves due to their own beliefs or perceptions.

Army behavioral health experts have found that Soldiers tend to bring their own personal biases, stereotypes and experiences regarding behavioral health with them into the Army. The Army’s culture of toughness, combined with social stigma, self-shame, and perceptions of negative career impacts, continues to prevent some Soldiers from seeking behavioral healthcare.

However, positive change is occurring.

In the BSHOP’s A Decade of Behavioral Health EPICON Findings, stigma is identified as an ongoing barrier that prevents Soldiers from seeking and continuing behavioral healthcare.

But the CDC reports that society has made some headway in reducing stigma around behavioral healthcare. Army leaders also report that stigma surrounding behavioral health and help-seeking has been greatly reduced in recent years.

The APHC has reported that anti-stigma campaigns are having a positive impact in combating the negative beliefs Soldiers bring with them to the Army.

Soldiers have stated that although they may have entered the Army with strong biases against seeking behavioral healthcare, Army anti-stigma messages have made them realize such services can be helpful – and even necessary.

Mixed messaging

APHC experts have found that although most Army leaders feel they adequately promote behavioral healthcare-seeking to their Soldiers, many Soldiers report receiving negative messages from their leaders about seeking behavioral healthcare.

This mixed messaging may not be intentional; in part, it reflects Army leaders’ interest in balancing the health and welfare of their Soldiers with critical mission needs. One example is a unit’s requirement to conduct a field exercise or combat deployment with a minimum number of Soldiers (i.e., 80 percent of personnel). In this case, Army leaders may inadvertently promote mission execution over personal care.

Unit leaders have acknowledged that messages they receive from their superiors emphasizing numbers and mission goals can overpower or even contradict positive messages promoting behavioral and mental wellness.

“The mixed messaging may lead to conflicting perceptions among Soldiers about behavioral health support, which can fuel stigma,” says Bass.

For example, if Soldiers are unavailable while attending to behavioral healthcare appointments, there may be fewer unit members to accomplish the day’s mission, which can lead to guilt by Soldiers seeking treatment, and distrust and resentment by fellow unit members. This outcome increases Soldiers’ future reluctance to seek appropriate care.

Soldiers who perceive their peers’ negative attitudes or career consequences associated with behavioral healthcare will likely not risk similar consequences for themselves. For example, while behavioral health help-seeking does not typically result in revocation of a security clearance, Soldiers continue to report clearance-related career concerns that impact their willingness to engage in treatment.

Additionally, some Soldiers indicate they are afraid to disclose their personal issues, including behavioral health symptoms, to their leadership due to fear of being viewed as less capable, being treated poorly, or suffering other consequences.

“Although behavioral health stigma in the Army is slowly but surely improving, particularly among our junior Soldiers who exercise excellent personal resilience by seeking professional care, other Soldiers report fears of being seen as weak or made fun of when engaged in behavioral healthcare," says Bass.

Sometimes such perceptions are based on personal observations of peers who spoke up about behavioral health issues and experienced negative treatment. In other cases the perceptions are, in fact, misperceptions. In either case, they are still Soldiers’ reality.

Next steps

Leaders, Soldiers and their families should recognize the value that behavioral healthcare can provide by strengthening the individual as well as the military and family unit.

Bass recommends some actions Army Leaders can take to help Soldiers:

  • Continue to communicate the benefits of behavioral health services to your Soldiers and be aware of social stigma and mixed messaging.
  • Support Soldiers who decide to seek care by finding ways to help them make appointments they are able to keep without subjecting them to negative consequences like longer work hours.
  • Ensure Soldiers’ privacy. Do not share personal behavioral health information that Soldiers have shared with you.
  • Maximize unit cohesiveness and ensure your unit understands the benefits of efforts to help ensure strong minds. Enforce a “zero tolerance policy” towards bullying, name-calling, or alienating those who need or seek behavioral health care.

Bass also recommends actions Soldiers can take to help themselves and others:

  • Remember that the Army doesn’t expect you to be bulletproof. You are provided equipment and resources to maintain and improve your capabilities and health.
  • Be smart. Recognize when you need help. If you are not comfortable talking about behavioral or mental health concerns with your chain of command or a behavioral health provider, consider starting with a trusted fellow Soldier, family member, or non-medical support personnel such as a Chaplain or Military and Family Life Counselor.
  • Work to eliminate stigma. Seek help if you need it for yourself, and encourage and support your battle buddies if they need help. Do not participate in bullying, name-calling, or alienating those who seek behavioral healthcare, and report these actions to your superiors if you see them.

To find local resources that can help you, check these out:

MilitaryOneSource - Mental Health

• Army Community Resource Guide

The U.S. Army Public Health Center focuses on promoting healthy people, communities, animals, and workplaces through the prevention of disease, injury, and disability of Soldiers, retirees, family members, veterans, Army civilian employees, and animals through population-based monitoring, investigations, and technical consultations.

NOTE: The mention of any non-federal entity and/or its products is for informational purposes only, and not to be construed or interpreted, in any manner, as federal endorsement of that non-federal entity or its products.