Stigma and Treatment Seeking by Service Members and Veterans

To the Editor: I read with interest the September article by Dr. Interian and colleagues (1) about returning National Guard soldiers with posttraumatic stress disorder (PTSD). The authors’ major points with regard to treatment seeking are certainly consistent with my own observations during a career of more than ten years as a mental health clinician with the Department of Veterans Affairs (VA). The increasing vigilance of frontline practitioners, combined with VA’s implementation of performance measures, helps keep assessments for targeted maladies—PTSD, depression, hypertension, and tardive dyskinesia, to name a few—in the forefront of our practice.

An additional factor in the recognition of mental illnesses among veterans may be the growing presence of primary care mental health clinics, which have been implemented systemwide by the VA. (The White River Junction VA Medical Center in Vermont was awarded a Gold Achievement Award from the American Psychiatric Association in 2005 for its effective use of this model of care [2].) Primary care mental health clinics are housed within or very near VA primary care clinics and lend themselves to a seamless and less stigmatizing experience. In addition, these clinics place mental health professionals within easy reach of primary care providers and do away with the need for requests for consultations, which for outpatients may not be completed for 14 days or more.

Absent from Dr. Interian and colleagues’ discussion of treatment seeking by returning soldiers is the continued presence of stigma associated with psychiatric illness and the accompanying fear that any future military promotions will be jeopardized by receiving treatment. Although stigma has lessened in recent years, I am often struck by the fact that many service members and veterans do not seek care more quickly—and those that do are very concerned about the confidentiality of their records.

It is my hope that research projects such as the one described by Dr. Interian and colleagues continue to assess treatment utilization and that replication studies will also measure the perception of stigma by service members. All of our returning warriors deserve our prompt and courteous attention. We need to be there when they are ready to open up.