Stigma can be a barrier to a service member seeking support for their mental health. Recognizing mental health as part of overall health and changing attitudes are keys to addressing it.

“A significant challenge to seeking help for mental health is stigma,” said Dr. Nancy Skopp, research and clinical psychologist with the Defense Health Agency’s Psychological Health Center of Excellence.

Cultural biases, a lack of trust with the system, and even feeling shame and embarrassment are some of the reasons many do not seek out mental health care services, according to Skopp.

Skopp acknowledged that within the military, some service members view seeking help as a sign of “weakness, social inferiority, and/or a lack of resourcefulness. These feelings may be attributable to the culture within individual military units.”

“For example, warrior ethos emphasizes discipline, mental toughness, and self-sufficiency, and foremost attention to successful mission execution,” she added.

Skopp emphasized the importance of normalizing conversations around mental health, which makes it easier to take the first step to reach out and seek help.

How Stigma is Evolving

The office of the Deputy Secretary of Defense recently issued a document recommending the Department of Defense begin a review of policies to eliminate stigmatizing language related to mental health.

“I think the military, in regard to mental health, has done a great job to address some of the concerns of stigma,” said U.S. Navy Lt. Cmdr. Nick Guzman, mental health department head, Naval Medical Center Portsmouth.

“Military service members are subjected to all sorts of stressors unique to the traditional U.S. population such as having to relocate every two to three years, possibly overseas, adjust to a new assignment and uproot family that can bring upon career and financial challenges. These factors give rise to stress and anxiety in effort to quickly adapt to new sense of normalcy,” said Guzman.

Guzman explained many younger service members are more open to seeking help and talking about mental health. Mental health is now a large part of military entry programs and talked about more openly.

He mentioned the services now introduce mental health education and resilience training in their introductory programs. The U.S. Navy, for example, has employed a human performance curriculum during bootcamp training designed to strengthen a sailor’s mental, physical, and spiritual capacity to strive towards optimal performance.

Older generations of service members are less likely to talk about or seek help for mental health conditions, he added.

“If they believe it could potentially have a negative impact on their career, or affect their security clearance, or put them out of commission for a bit, they are more hesitant,” said Guzman.

According to the Defense Counterintelligence and Security Agency, out of more than 2.3 million security clearance reviews between 2012-2018, only 12 individuals (0.005% of all cases) had their clearance denied or revoked due to psychological health concerns.

Guzman also noted that service members with specialty duties or assignments may be more hesitant to seek help.

“They may see it as a negative reflection on themselves, like a deficiency or character default or defect, or a fear that others may judge them for seeking help,” Guzman said. “A bit of that does exist, but I do see stigma on the decline.”

He noted the recent COVID-19 pandemic helped lessen stigma as there was an increase in service members and their families seeking mental health assistance, taking into consideration the degree of isolation and unpredictability created by the pandemic.

“Mental health in general is not viewed as negatively as it once was, in part due to the perceived benefits from those that sought help proactively and who remain mission ready,” said Guzman.

Skopp said changing this stigma begins at the top with leadership.

“It will take time and sustained effort at all military levels,” said Skopp. “Leaders are uniquely positioned to influence desired cultural changes. It is critical for military leaders to fight aspects of military culture that promote negative beliefs about seeking care and continue efforts to reduce stigma.”

Changing the Language Used to Discuss Mental Health

Changing language used when working with a service member seeking help, or in promotional materials, is one effort the Military Health System is using to reduce stigma.

“Avoiding negative language is important,” said Skopp. “Language can open discussion of mental health issues and stigma. Mental health providers can use language in useful ways to start talking about stigma with their patients.”

The Psychological Health Center of Excellence has suggestions for how alternative language can be used when discussing mental health.

Alternatives to stigmatizing language can include:

• Avoiding language that defines someone by their condition or assumes that condition can’t be managed or overcome
• Avoiding language that makes judgments or assumes intention
• Describing without downplaying or becoming overly graphic
• Using updated, accurate terminology

Testimonials are another tool to help normalize talking about mental health care, especially from senior leaders, suggested Guzman.

“I think putting stories out there from leaders who are open about seeking help is beneficial,” said Guzman. “If someone was willing to put themselves out there to share their story—this is good.”

Guzman believes the military needs to rethink what mental health is, and “think about it in a different capacity.”

“Mental health is important to stay healthy, because it includes various levels of functioning, or various aspects of our normal daily functioning,” said Guzman. “It's linked to our physical health, and our social, interpersonal health, our emotional well-being, as well as our ability to perform complicated tasks and under stress.”

The MHS offers many resources and information regarding mental health, including the Real Warriors campaign.