Staff Perspective: Through SPC Jones’ Eyes - How Stigma Disrupts Mental Health Support for Service Members
Mental health stigma remains one of the most persistent barriers to care for service members. It operates at multiple levels—internally, socially, and institutionally—limiting help-seeking behavior and impacting readiness and relationships.
This four-part fictional vignette follows a day in the life of a junior enlisted soldier. After each act, we explore how different forms of stigma shape the individual’s behavior, relationships, and access to care.
As you read, consider: How might you recognize and respond to stigma in your work with service members?
Act I: The Couch
Specialist Sean Jones sits up abruptly, gasping for air. He realizes he's not at the field exercise—he’s just awakened from a vivid nightmare, drenched in sweat. A junior enlisted soldier recently returned from training, Sean witnessed a serious accident during the exercise that resulted in the likely medical discharge of a close friend. His wife, Stacey, groggily rolls over and asks if he’s okay.
“I’m fine,” he snaps, grabbing his pillow and heading to the couch.
Alone and restless, he tosses and turns, ruminating about the upcoming training. He worries that his nightmares, jumpiness, and unexpected urges to cry are signs of weakness. He fears this “weakness” will result in his failing the next training exercise. In reality, he feels like he doesn't deserve to be in the Army. And that makes him feel guilty because he’s still in and his friend’s career is over. After tossing and turning for hours, Sean gets up the next morning, tired and irritable, and leaves for work without speaking to Stacey. He wants to apologize but that means he’ll have to talk about what was going on with him and he “just can’t do it.” So instead he starts his day feeling exhausted, ashamed, and alone.
Analysis: Self-Stigma
Self-stigma refers to the internalization of negative beliefs about mental health, leading individuals to view their own distress as weakness or failure (Thornicroft, et. al., 2022).
SPC Jones interprets his trauma responses as personal flaws rather than normal reactions to a disturbing event. These beliefs erode his confidence, contribute to anticipatory anxiety about his performance, and inhibit emotional connection with his partner.
Self-stigma is associated with reduced help-seeking, impaired self-esteem, and social withdrawal, all of which are visible in this interaction (Corrigan & Rao, 2012).
Act II: The Break Room
At work, Sean is distracted and struggling to get work done. His colleague Forsyth notices and asks him what’s going on. He opens up enough to admit he is having trouble sleeping. Forsyth suggests going to Behavioral Health, noting that the clinic really helped him manage his sleep issues and post-deployment stress.
Sean hesitates thinking, Forsyth deployed—his problems are "real." I’m messed up because of an accident that happened during training…and I wasn’t even the one in the accident! His own distress feels unjustified in comparison. Still, he makes a call to Behavioral Health during a break, hoping for an after-hours appointment that won’t interfere with duty hours.
No such luck—the only available times are during duty hours. As he’s on hold, his NCO walks by, loudly complaining:
“If one more soldier tells me they’re unavailable because of a ‘behavioral health appointment'— I'm going to go ballistic on them! These punks are a bunch of selfish wusses who don’t have what it takes to be real soldiers!”
Spotting Sean, the NCO comes over and claps him on the shoulder.
“But not SPC Jones here! Jones got what it takes and knows how to get the job done. He’s always mission-first!”
SPC Jones abruptly ends the call, discreetly putting his phone back in his pocket. He acknowledges his NCO and heads back to work without making an appointment.
Analysis: Public and Organizational Stigma
Public stigma involves negative stereotypes or prejudice from others—often peers, leaders, or society at large towards those with mental health conditions (Thornicroft, et. al., 2022). The NCO’s remarks reinforce the idea that seeking help is selfish or weak, which discourages soldiers from pursuing care—even when they need it.
Organizational stigma refers to structural barriers, such as limited availability of care during off-duty hours or command climates that discourage medical appointments (Thornicroft, et. al., 2022). In this case, both forms of stigma intersect to shut down Sean’s attempt to access care.
Act III: The Lunch Table
Meanwhile, Stacey meets friends for lunch. Tired from last night’s interrupted sleep, she yawns repeatedly. Her friends ask about it, and she hesitantly mentions Sean waking abruptly and shouting during the night.
One friend jokes: “you better watch out—make sure he doesn’t snap and kill you in your sleep!” The group laughs. Stacey forces a chuckle, then changes the subject. The comment unsettles her. She isn’t afraid of Sean, but she suddenly feels unsure about opening up to friends—or about asking him what's going on.
Analysis: Stigma by Association
Stigma by association occurs when family members or partners experience social rejection, judgment, or discomfort due to their relationship with someone perceived to have a mental health issue (Thornicroft, et. al., 2022).
Although the comment was meant as a joke, it reflects a damaging stereotype—linking mental illness to violence—and reinforces Stacey’s reluctance to seek support or ask questions. Like many military spouses, she may feel isolated from both her partner and her social circle.
Act IV: The Search
That evening, still troubled, Sean decides to look for a civilian provider outside the military system. He feels a glimmer of hope—maybe he can get help without his command knowing.
But the process is overwhelming. Who should he call—a counselor, psychologist, psychiatrist, psychiatric nurse practitioner? After a quick text exchange with Forsyth, he decides to call clinics that can prescribe medication. He finds one with availability—then he hears the cost: $300 for the intake, $150–$200 for follow-ups.
“Never mind,” he says, and ends the call. That faint hope disappears. He feels more lost than ever. Hopeless thoughts begin to surface. Maybe everyone would be better off without me, he thinks.
Analysis: Structural Stigma and Access Barriers
Sean’s final attempt highlights ongoing structural barriers to care outside the military: unclear provider roles, high out-of-pocket costs, and confusing systems of access.
Even when service members are motivated to seek care privately, these factors often lead to frustration, avoidance, and worsening distress (Kim et al., 2011). This moment illustrates how logistical obstacles can reinforce despair and delay treatment.
Conclusion: What Can Providers Do?
Understanding how stigma functions at every level—internal, interpersonal, and systemic—is key to helping service members like Sean. As providers, we can make a profound difference by intentionally addressing these barriers.
- As providers, we can: Normalize trauma responses during education and intake
- Address self-stigma explicitly in therapy
- Collaborate with commands to reduce public and organizational stigma
- Support spouses and families affected by stigma by association
- Advocate for accessible care pathways both within and outside the military system
By identifying and dismantling stigma—internally, interpersonally, and systemically—we can strengthen the mental health, relationships, and mission readiness of our service members (World Health Organization, 2024).
Resources
Military Crisis Line: Dial 988 and press 1, or visit VeteransCrisisLine.net
InTransition Program: https://www.health.mil/inTransition – Free, confidential coaching for service members transitioning between mental health providers
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.
Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.
References
Corrigan, P.W. & Rao, D. (2012) On the self-stigma of mental illness: stages, disclosure, and
strategies for change. Canadian Journal of Psychiatry, 57(8):464–9
(https://doi.org/10.1177/070674371205700804).
Kim, P. Y., Britt, T. W., Klocko, R. P., Riviere, L. A., & Adler, A. B. (2011). Stigma, negative
attitudes about treatment, and utilization of mental health care among soldiers. Military
Psychology, 23(1), 65–81. (https://doi.org/10.1080/08995605.2011.534415).
Thornicroft G., Sunkel C., Aliev, A. A., Baker, S., Brohan, E., el Chammay, R., et al. (2022). The
Lancet Commission on Ending Stigma and Discrimination in Mental Health. Lancet,
400(10361):1438–80 (https://doi.org/10.1016/S0140-6736(22)01470-2).
World Health Organization (2024). Mosaic Toolkit to End Stigma and Discrimination in Mental
Health. Copenhagen: WHO Regional Office for Europe.
(https://www.who.int/europe/publications/i/item/9789289061384).
Mental health stigma remains one of the most persistent barriers to care for service members. It operates at multiple levels—internally, socially, and institutionally—limiting help-seeking behavior and impacting readiness and relationships.
This four-part fictional vignette follows a day in the life of a junior enlisted soldier. After each act, we explore how different forms of stigma shape the individual’s behavior, relationships, and access to care.
As you read, consider: How might you recognize and respond to stigma in your work with service members?
Act I: The Couch
Specialist Sean Jones sits up abruptly, gasping for air. He realizes he's not at the field exercise—he’s just awakened from a vivid nightmare, drenched in sweat. A junior enlisted soldier recently returned from training, Sean witnessed a serious accident during the exercise that resulted in the likely medical discharge of a close friend. His wife, Stacey, groggily rolls over and asks if he’s okay.
“I’m fine,” he snaps, grabbing his pillow and heading to the couch.
Alone and restless, he tosses and turns, ruminating about the upcoming training. He worries that his nightmares, jumpiness, and unexpected urges to cry are signs of weakness. He fears this “weakness” will result in his failing the next training exercise. In reality, he feels like he doesn't deserve to be in the Army. And that makes him feel guilty because he’s still in and his friend’s career is over. After tossing and turning for hours, Sean gets up the next morning, tired and irritable, and leaves for work without speaking to Stacey. He wants to apologize but that means he’ll have to talk about what was going on with him and he “just can’t do it.” So instead he starts his day feeling exhausted, ashamed, and alone.
Analysis: Self-Stigma
Self-stigma refers to the internalization of negative beliefs about mental health, leading individuals to view their own distress as weakness or failure (Thornicroft, et. al., 2022).
SPC Jones interprets his trauma responses as personal flaws rather than normal reactions to a disturbing event. These beliefs erode his confidence, contribute to anticipatory anxiety about his performance, and inhibit emotional connection with his partner.
Self-stigma is associated with reduced help-seeking, impaired self-esteem, and social withdrawal, all of which are visible in this interaction (Corrigan & Rao, 2012).
Act II: The Break Room
At work, Sean is distracted and struggling to get work done. His colleague Forsyth notices and asks him what’s going on. He opens up enough to admit he is having trouble sleeping. Forsyth suggests going to Behavioral Health, noting that the clinic really helped him manage his sleep issues and post-deployment stress.
Sean hesitates thinking, Forsyth deployed—his problems are "real." I’m messed up because of an accident that happened during training…and I wasn’t even the one in the accident! His own distress feels unjustified in comparison. Still, he makes a call to Behavioral Health during a break, hoping for an after-hours appointment that won’t interfere with duty hours.
No such luck—the only available times are during duty hours. As he’s on hold, his NCO walks by, loudly complaining:
“If one more soldier tells me they’re unavailable because of a ‘behavioral health appointment'— I'm going to go ballistic on them! These punks are a bunch of selfish wusses who don’t have what it takes to be real soldiers!”
Spotting Sean, the NCO comes over and claps him on the shoulder.
“But not SPC Jones here! Jones got what it takes and knows how to get the job done. He’s always mission-first!”
SPC Jones abruptly ends the call, discreetly putting his phone back in his pocket. He acknowledges his NCO and heads back to work without making an appointment.
Public stigma involves negative stereotypes or prejudice from others—often peers, leaders, or society at large towards those with mental health conditions (Thornicroft, et. al., 2022). The NCO’s remarks reinforce the idea that seeking help is selfish or weak, which discourages soldiers from pursuing care—even when they need it.
Organizational stigma refers to structural barriers, such as limited availability of care during off-duty hours or command climates that discourage medical appointments (Thornicroft, et. al., 2022). In this case, both forms of stigma intersect to shut down Sean’s attempt to access care.
Act III: The Lunch Table
Meanwhile, Stacey meets friends for lunch. Tired from last night’s interrupted sleep, she yawns repeatedly. Her friends ask about it, and she hesitantly mentions Sean waking abruptly and shouting during the night.
One friend jokes: “you better watch out—make sure he doesn’t snap and kill you in your sleep!” The group laughs. Stacey forces a chuckle, then changes the subject. The comment unsettles her. She isn’t afraid of Sean, but she suddenly feels unsure about opening up to friends—or about asking him what's going on.
Analysis: Stigma by Association
Stigma by association occurs when family members or partners experience social rejection, judgment, or discomfort due to their relationship with someone perceived to have a mental health issue (Thornicroft, et. al., 2022).
Although the comment was meant as a joke, it reflects a damaging stereotype—linking mental illness to violence—and reinforces Stacey’s reluctance to seek support or ask questions. Like many military spouses, she may feel isolated from both her partner and her social circle.
Act IV: The Search
That evening, still troubled, Sean decides to look for a civilian provider outside the military system. He feels a glimmer of hope—maybe he can get help without his command knowing.
But the process is overwhelming. Who should he call—a counselor, psychologist, psychiatrist, psychiatric nurse practitioner? After a quick text exchange with Forsyth, he decides to call clinics that can prescribe medication. He finds one with availability—then he hears the cost: $300 for the intake, $150–$200 for follow-ups.
“Never mind,” he says, and ends the call. That faint hope disappears. He feels more lost than ever. Hopeless thoughts begin to surface. Maybe everyone would be better off without me, he thinks.
Analysis: Structural Stigma and Access Barriers
Sean’s final attempt highlights ongoing structural barriers to care outside the military: unclear provider roles, high out-of-pocket costs, and confusing systems of access.
Even when service members are motivated to seek care privately, these factors often lead to frustration, avoidance, and worsening distress (Kim et al., 2011). This moment illustrates how logistical obstacles can reinforce despair and delay treatment.
Conclusion: What Can Providers Do?
Understanding how stigma functions at every level—internal, interpersonal, and systemic—is key to helping service members like Sean. As providers, we can make a profound difference by intentionally addressing these barriers.
- As providers, we can: Normalize trauma responses during education and intake
- Address self-stigma explicitly in therapy
- Collaborate with commands to reduce public and organizational stigma
- Support spouses and families affected by stigma by association
- Advocate for accessible care pathways both within and outside the military system
By identifying and dismantling stigma—internally, interpersonally, and systemically—we can strengthen the mental health, relationships, and mission readiness of our service members (World Health Organization, 2024).
Resources
Military Crisis Line: Dial 988 and press 1, or visit VeteransCrisisLine.net
InTransition Program: https://www.health.mil/inTransition – Free, confidential coaching for service members transitioning between mental health providers
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.
Adria Williams, Ph.D., is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) with the Uniformed Services University of the Health Sciences. Dr. Williams is a suicide prevention subject matter expert and trainer.
References
Corrigan, P.W. & Rao, D. (2012) On the self-stigma of mental illness: stages, disclosure, and
strategies for change. Canadian Journal of Psychiatry, 57(8):464–9
(https://doi.org/10.1177/070674371205700804).
Kim, P. Y., Britt, T. W., Klocko, R. P., Riviere, L. A., & Adler, A. B. (2011). Stigma, negative
attitudes about treatment, and utilization of mental health care among soldiers. Military
Psychology, 23(1), 65–81. (https://doi.org/10.1080/08995605.2011.534415).
Thornicroft G., Sunkel C., Aliev, A. A., Baker, S., Brohan, E., el Chammay, R., et al. (2022). The
Lancet Commission on Ending Stigma and Discrimination in Mental Health. Lancet,
400(10361):1438–80 (https://doi.org/10.1016/S0140-6736(22)01470-2).
World Health Organization (2024). Mosaic Toolkit to End Stigma and Discrimination in Mental
Health. Copenhagen: WHO Regional Office for Europe.
(https://www.who.int/europe/publications/i/item/9789289061384).