Staff Perspective: Addressing Stigma and Encouraging Mental Health Care in the Military - A Double-Edged Sword?

Staff Perspective: Addressing Stigma and Encouraging Mental Health Care in the Military - A Double-Edged Sword?

Dr. Jenny Phillips

The 2014 RAND Report, Mental Health Stigma in the Military, presented a comprehensive picture of mental health stigma in the military as well as the ongoing efforts of the DoD to combat the issue. Researchers performed an extensive assessment based on literature reviews, interviews with program staff, policy analysis, and the input of experts in the field, and provided a series of recommendations to combat the ongoing stigma faced by Service members seeking mental health care.

One identified area for targeted interventions was the social context of Service members, including the opinions and actions of their unit. Given the cohesive culture of the military, the influence of a Service member’s unit often carries as much or more influence as that of their family and friends. A longitudinal study by Kelley and colleagues (2014) that explored the relationship between perceived organization support, stigma, and PTSD symptoms in a military population provided evidence for the importance of the relationship. Findings suggested that a supportive environment may create a climate of reduced mental health stigma for Service members. As a result of both theoretical and research-based support for this relationship, many stigma reduction interventions have expanded their focus beyond individual Service members to the unit and organizational level.

The findings of a new study have potentially introduced a new wrinkle to the field, presenting complicated findings on the relationship between unit support and mental health treatment-seeking behaviors in a military population. Russell, Russell, and Hill (2021) recently published the findings of a two-study series examining the relationship between service-induced mental health issues and utilization of professional mental health services. They also looked at whether perceived support from service members’ military units potentially moderates those relationships. Outcomes based on data from two different Army National Guard Units suggested that organizational support, specifically from military units, was often associated with a lower likelihood of seeking treatment for service-related mental health issues. The authors concluded that, contrary to traditional thinking, “greater organizational support from one’s unit may inadvertently reduce treatment seeking among those who exhibit the highest mental health symptoms” (Russell, Russell, & Hill, 2021).

The findings may seem surprising, but are not inconsistent with anecdotal evidence from providers who have worked with military populations. As one military psychologist shared, high levels of unit cohesion and support may contribute to a “We take care of our own” mentality that can impede both command- and self-directed referrals for mental health care from professionals. Russell and colleagues do not speculate much further on the nature or cause of the uncovered relationship, but do recommend additional research within the military and other high-risk occupations to examine the basis of the findings and whether they replicate in similar fields. These initial data suggest that there may be truth to concerns about “Too much of a good thing” and that too great an emphasis on social support may take away from a Service member’s perceived need for professional interventions. As the study authors describe it, the “double-edged sword” of unit support is clearly important; it also requires more nuanced research regarding how best to maintain mission-critical unit cohesion without taking away from the importance of professional mental health treatment, when needed.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Jenny Phillips, Ph.D., is the Assistant Director of Evaluation for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, MD.

Acosta, J. D., Becker, A., Cerully, J. L., Fisher, M. P., Martin, L. T., Vardavas, R., ... & Schell, T. L. (2014). Mental health stigma in the military. Rand National Defense Health Research Institute, Santa Monica, CA. Kelley, C. L., Britt, T. W., Adler, A. B., & Bliese, P. D. (2014). Perceived organizational support, posttraumatic stress disorder symptoms, and stigma in soldiers returning from combat. Psychological Services, 11(2), 229-234.
Russell, D. W., Russell, C. A., & Hill, R. P. (2021). Mental health service utilization after military missions: The double-edged consequences of unit-level organizational support. Psychological Services. Advanced online publication.