policy analysis writing sample_walkerb

RUNNING HEAD: MILITARY MENTAL HEALTH STIGMA 1

Mental Health Stigma in the Military: Unemployment Rates among OEF/OIF Veterans

Brian E. Walker

SCWK8851, Prof. Allison Bauer

Policy Analysis & Research for Social Reform

Boston College Graduate School of Social Work


Problem Definition: Unemployment rates among OEF/OIF Veterans tied to mental health

stigma

Since 2001, approximately 1.64 million U.S. service members have deployed in support

of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) of which roughly 26% of the

returning Veterans have been positively diagnosed with a mental health condition such as

posttraumatic stress disorder (PTSD), anxiety disorders, or depression (Tanielian & Jaycox,

2008). Multiple and longer deployments in support of OEF/OIF have resulted in increased

prevalence rates of mental health problems among U.S. service members. Additionally, the

average adjustment period between deployments has lessened; thus, U.S. service members are

unable to adequately process and cope mentally, physically, and emotionally to the consequences

of deployment-related experiences. Subsequently, mental health symptomatology is often

exacerbated.

So if nearly one out of three OEF/OIF Veterans have received a mental health diagnosis,

how is this impacting military retention rates? A study conducted by Hoge, Auchterlone, &

Milliken (2006) revealed that 44,349 OEF/OIF Army and Marine service members who

deployed between May 1, 2003 and April 30, 2004 were discharged due to a mental health risk.

Of those discharged, 10,674 (24.0%) had been in military service for less than three years with a

majority having served less than a year. The average length of an initial commitment to military

service (e.g., enlistment) is four years; therefore, nearly one quarter of U.S. service members are

being prematurely discharged. Once discharged due to mental health related problems, the

Veteran often feels as though s/he is a failure because commitment to duty and service is highly

valued. Their mental health conditions have a greater tendency to worsen due to the abrupt end

to their military career as many may feel completely blindsided.


Veterans diagnosed with mental health problems have a greater probability of

experiencing interpersonal & employment-related issues, where approximately 18% of returning

Veterans have had difficulty maintaining stable employment (Adler et al., 2011; Sayer et al.,

2011; Tanielian & Jaycox, 2008). In a sample of 797 OEF/OIF Veterans, 50% of Veterans who

were unemployed were in the 18-29 year old category (n=162) (Adler et al., 2011). Younger

Veterans entering the civilian workforce have a much more difficult chance to successfully

reintegrate back into society. Savych, Klerman, & Loughran (2008) explained that young

Veterans tend to enter the civilian labor market for the first time at a later age on average than

their nonveteran peers. Additionally, the high rates of mental and physical disabilities resulting

from deployment related experiences, especially among 18-24 year olds, has resulted in

unemployment rates almost double the general population (Frain, Bethel, & Bishop, 2010).

In 2010, the average unemployment rate among all Americans in the United States was

9.4% and among Gulf War Era II Veterans (e.g., OEF/OIF), the unemployment rate was 11.5%

(Syracuse University, 2013). Although the unemployment rates dropped slightly for both groups

in 2012, OEF/OIF Veterans still had a higher percentage of Veterans unemployment with 9.9%

compared to 7.8% from the average national population (Syracuse University, 2013). In the state

of Massachusetts, the unemployment rate among OEF/OIF Veterans is a staggering 23.4%

compared to the national average of 9.9% and the unemployment rate among non-veterans in

Massachusetts is 6.3% (Syracuse University, 2013). Why are the unemployment rates among

OEF/OIF Veterans significantly higher in Massachusetts than the national average? Are the

employment-related and reintegration/rehabilitation services offered to Veterans in

Massachusetts truly effective? What are the preventative measures in place to prevent

recidivism rates of unemployment among OEF/OIF Veterans?


Due to mental health stigma, returning Veterans often experience difficulty gaining and

maintaining employment. According to a 2010 Society of Human Resource Management

survey, 46% of employers said that PTSD and other mental health issues were challenges in

hiring employees with military service. Furthermore, Veterans were seen as "less favorable"

when considering war-related psychological disorders (TODAY Health, 2012). High-profile

news about violence at the hands of Veterans and the possible links to PTSD exacerbates and

promotes mental health stigma. And though organizations such as the VA have increased the

level of mental health support for returning Veterans, more civilian employers know that

Veterans are at greater risk for mental health diagnoses such as PTSD (TODAY Health, 2012).

When a Veteran experiences employment-related difficulties that may lead to unemployment due

to perceived mental health stigma, this greatly impedes and severely limits the ability of s/he to

successfully reintegrate back into society. The higher rates of unemployment among OEF/OIF

Veterans compared to their nonveteran counterparts, both nationally and locally here in

Massachusetts, are an indication that mental health stigma has truly become a pervasive and

socially debilitating issue.

Numerical Claim: Unemployment rates among OEF/OIF Veterans are significantly higher

than civilian counterparts both nationally and here in Massachusetts

“About 2.8 million Americans have served in uniform since 9/11, and an estimated 200,000 are

unemployed, according to government numbers…Those ages 18-24 had a jobless rate of 21.4%

in 2013 compared with 14.3% for their civilian counterparts.” – Gregg Zoroya, USA TODAY

A 2014 article in USA TODAY cited that approximately 200,000 Gulf War II Era

Veterans (e.g., those who served in support of the wars in Iraq & Afghanistan) were considered

unemployed of which 21.4% of Veterans ages 18-24 were unemployed in 2013 (Zoroya, 2014).

According to Zoroya (2014) the unemployment rates among Gulf War II Era Veterans was as


low as 6-7% from 2001-2008 as per the Bureau of Labor Statistics data. A 2014 US News

article entitled “Private Sector Tackles Veteran Joblessness” reported that an alliance known as

the 100,000 Jobs Mission has a goal of hiring at least 200,000 U.S. military veterans by the end

of 2014 which appears to match the aforementioned statistic (Peralta, 2014). Peralta (2014)

included a graph in the article with a source from the Bureau of Labor Statistics that reflected an

approximately 8% unemployment rate among Post 9/11 Veterans in January 2014 and was as

high as 12% two years prior. A 2011 report from the White House mentioned that more than

200,000 Post 9/11 Veterans were unemployed thus prompting an initiative known as the Veteran

Gold Card (www.whitehouse.gov, 2011). According to the 2011 White House report, the

approximate number of unemployed Gulf War II Era Veterans has remained relatively constant

for at least three years.

Upon further investigation, a 2015 news release from the Bureau of Labor Statistics, U.S.

Department of Labor reported that 182,000 Gulf War II Era Veterans nationwide were

unemployed in 2014 including 144,000 men and 37,000 women (Bureau of Labor Statistics,

2015). This equated to a 7.2% unemployment rate among all Gulf War II Era Veterans in 2014.

Comparatively, 205,000 Gulf War II Era Veterans were unemployed in 2013 with a respective

9.0% unemployment rate (Bureau of Labor Statistics, 2015. These numbers seem to be

consistent with those reported in the aforementioned news articles; however, the Bureau of Labor

Statistics also included statistics of those Gulf War II Era Veterans who were not in the labor

force which was 649,000 and 552,000 for 2014 and 2013 respectively (Bureau of Labor

Statistics, 2015). The statistic of unemployment rates among 18-24 year old Gulf War Era II

Veterans reported by Zoroya (2014) was also reported by the Chairman’s Office of Reintegration

(www.jcs.mil/CORe, 2014). Interestingly, however, the Bureau of Labor Statistics reported an


unemployment rate of 16.2% among 18-24 year old Gulf War II Era Veterans in 2014 (Bureau of

Labor Statistics, 2015). As with nationally reported unemployment rates, one may assume that

those rates are only based upon individuals who are actively collecting unemployment insurance.

Therefore, the unemployment rates reported by the news articles may not be an accurate

reflection of the number of Gulf War II Era Veterans who are not employed for various reasons

(e.g., disability-related, seeking further education, etc.).

As a comparison, analysis of the unemployment rate among Gulf War Era II Veterans in

Massachusetts is necessary. In the state of Massachusetts, the Bureau of Labor Statistics

reported an unemployment rate of 4.7% among Veterans 18 years and over according to 2014

annual averages (Bureau of Labor Statistics, 2015). However, these rates include all Veterans

regardless of era served. U.S. Congresswoman Carolyn B. Maloney reported that 11.9% of Post-

9/11 Veterans living in the state of Massachusetts were unemployed in 2014 compared to the

national average of 7.2% (Maloney, 2015). As per the Maloney (2015) report, 171,000 Veterans

in Massachusetts were in the labor force with an overall unemployment rate of 4.7% which is

consistent with the Bureau of Labor Statistics report. Specifically among Gulf War II Era

Veterans in Massachusetts, 5,000 were unemployed compared to 41,000 in the labor force which

equated to an 11.9% unemployment rate in Massachusetts (Maloney, 2015).

Based on these alarming statistics, both locally here in Massachusetts and on a national

level, along with the growing percentages of returning OEF/OIF Veterans seeking mental health

treatment, our returning Veterans are struggling to rehabilitate and reintegrate back into society.

I believe a major contributing factor behind this social epidemic is mental health stigma. One

way to address mental health stigma (and to subsequently reduce unemployment rates among

returning OEF/OIF Veterans) is via a frontend approach targeting ways in which the military can


help reduce mental health stigmatization and military discharge policies. Another way to address

mental health stigma is via a backend approach by focusing on stigmatization experienced post-

military discharge (e.g., from civilian employers, media attention, etc.) Ultimately the goal is to

increase the level of support for OEF/OIF Veterans and military service members who are

struggling with mental health related issues. For the purposes of the next section, I will focus on

three different approaches in addressing mental health stigma among our returning Veterans and

military service members. Analysis of each approach will be based on the following criteria:

1. Feasibility

2. Effectiveness/Efficacy (how well the policy alternative can and/or will function)

3. Cost (financially and/or otherwise)

4. Ethics/Values

Policy Alternative #1: Need for increased confidentiality measures

A study published in Epidemiologic Reviews showed that 60% of military personnel who

experience mental health problems do not seek help (Sharp, Fear, Rona, Wessely, Greenberg,

Jones, & Goodwin, 2015). This is an alarming statistic and mental health stigma is believed to

be at the center of it. The belief is that mental health stigma acts as a deterrent for military

service members discouraging them from seeking mental health diagnoses and treatment. The

study by Sharp et al., (2015) showed that 44% of personnel reported concerns that their

leadership would treat them differently and 42% reported that they feared that they would be

seen as weak. Perceived threat of harassment, judgment and criticism regarding mental illness as

well as seeking treatment becomes an often difficult hurdle to overcome in the military.

Refusing to seek mental health treatment, however, only perpetuates and exacerbates mental

health symptoms which can have a negative impact on the individual and their military unit.


Because the military is centered around mission readiness, the concept of “fitness of

duty” applies to the psychological health and well-being of service members themselves. In an

interview with Col. Rebecca I. Porter, chief of the Behavioral Health Division of the Office of

the Army’s Surgeon General, she discussed the responsibilities of Army leaders in managing

their troop’s mental health. She explained that the command is responsible for monitoring the

overall health and well-being of its soldiers; therefore, if a commander has reason for concern,

they have access to behavioral health providers for consultation or treatment (Nakashima, 2011).

A Commanding Officer does reserve the right to order an official mental health evaluation.

According to a 2006 study in Military Medicine, 39% of those who were required to participate

in a command-directed mental health evaluation experienced a negative career impact (NAMI,

2015). Therefore, if a service member has a chronic pattern of difficulty adjusting to stress or

change, then that may warrant cause for separation from the military (Nakashima, 2011). Those

who are then discharged from the military due to mental illness (many as a result of deployment

and combat-related experiences) are seen as being “unfit for duty.”

Although the Department of Defense is bound to rules mandated by HIPAA regarding

disclosure of PHI, there are exceptions for the U.S. military. According to Collier (2010),

military commanders are permitted to access health information when “such access is necessary

to accomplish the military mission …[including] drug testing, fitness for deployability, changes

in duty status due to medical conditions, medical conditions or treatments that are duty limiting,

and perceived threats to life or health” (p. E821). Those in favor of such access argue that

people surrender certain personal rights when joining the military and that the “mission of the

collective trumps the rights of the individual” (Collier, 2010, p. E821). Engel (2014) argued that

the issue in the military regarding mental health stigma is due to inadequate boundaries between


the workplace and the therapist’s office. Engel (2014) also stated that military chaplains, in stark

contrast, enjoy essentially absolute confidentiality. Conversations shared with military

chaplains, unlike with mental health providers, are not entered in official military health records.

Service members, then, perceive that seeking treatment can potentially harm their career due to

mistrust over confidentiality. Though military commanders do have a responsibility of

effectively maintaining a cohesive and healthy unit, the question remains whether they have a

right to unrestricted access.

The Military Mental Health Empowerment Act (MMHEA), otherwise known as H.R.

1464, was formed in 2013 to require the provision of information to members of the armed

forces on availability of mental health services and related privacy rights. H.R. 1464 primarily

sought to address the extent to which information regarding a service member seeking and

receiving mental health services may be disclosed among promotion boards, commanding

officers, and other members of the Armed Forces. Additionally, H.R. 1464 sought to restrict any

adverse actions taken against a service member for seeking and receiving mental health services

including any negative personnel action resulting from a mental health diagnosis. H.R. 1464

also sought to increase awareness and availability of mental health services by informing and

educating all enlisted and officer recruits during their initial military training. This goal was

designed to help eliminate perceived stigma associated with seeking and receiving mental health

services as well as to clarify the extent to which information may be disclosed.

Policy Alternative #2: Increase mental health service utilization in military

In addition to increased attrition rates in the military due to mental health related issues,

Veterans suffering from mental health problems also battle stigmatization with utilizing mental

health services. A study conducted by Hoge et al., (2004) found that among service members


who screened positive for a mental disorder, 38-45% indicated an interest in receiving help and

between 23-40% reported having received professional help. Negative beliefs about mental

health care (particularly psychotherapy) and decreased perceptions of military unit support were

associated with a decreased likelihood of utilizing mental health counseling and medication

(Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009). These findings, in particular the

perceived lack of military unit support, are consistent with those of Hoge et al., (2006) regarding

military attrition rates due to mental health problems. Pietrzak et al., (2009) suggested that

increasing military unit support regarding mental health may help to decrease mental health

stigma and subsequently increase mental health service utilization among U.S. service members

and Veterans.

One way that the military, in particular the Army, is addressing mental health service

utilization is by embedding mental health teams within soldiers’ units. At Joint Base Lewis-

McChord (JBLM) and elsewhere, the Army has pushed counseling teams out of hospitals to

embed with troops. This has helped cut back the use of private psychiatric hospitals while

expanding intensive mental health programs at military facilities (Bernton & Ashton, 2015).

Bernton & Ashton (2015) explained that these reforms come at a time when the Army, despite a

dramatic reduction in troops headed to Iraq & Afghanistan, still faces serious challenges trying to

reach and treat soldiers suffering from PTSD and other mental health conditions. Across the

Army, patient contacts with mental health personnel reached 2 million in 2014 which was more

than double the numbers six years earlier when the Army had deployed many more soldiers in

ground combat in support of the wars in Iraq & Afghanistan.

According to Army data, soldiers resist care because many still feel that reaching out to a

mental health provider will be held against them by their peers and leaders, and could damage


their careers (Bernton & Ashton, 2015). The intent on embedding mental health providers

among soldiers’ units is to help reduce stigma and make it easier for soldiers to seek care from

psychiatrists, counselors and social workers. These specialists may now have offices within

walking distance from barracks versus in more distant medical centers off-post. Ease of access

has been shown to increase service utilization. Advocates for this initiative also explain that

doctors in regular contact with a single unit are best able to understand the pressures soldiers face

and their regular presence also gives them credibility with military leaders (Bernton & Ashton,

2015). However, the closeness of ties to the command also draws criticism, particularly for

those who see mental health providers such as psychologists and psychiatrists as proxies for

military leaders who may be seeking punitive action against them (Bernton & Ashton, 2015).

Either way, this alternative to addressing mental health stigma has proven to be effective in the

Army and may be equally beneficial across the military with similar implementations.

Policy Alternative #3: Increase mental health awareness in the workplace

According to a poll conducted by the Disability Management Employer Coalition

(DMEC) in 2014, approximately one quarter of employers believed workplace stigma

surrounding diagnosed psychological or psychiatric disorders has increased. Additionally,

between 20% and 25% of employers polled in 2014 said they perceived a rise in workplace

stigma in 2014 surrounding the treatment of mental health and behavioral health conditions

despite all the tools, resources and information available to employers about mental illness and

behavioral health (Dunning, 2015). DMEC’s survey also found that although employers have

broadened the range of mental health services, education and training they provide to employees

and managers, the percentage of companies that have actually implemented many of those

programs has dropped dramatically to just 15% since 2010 (Dunning, 2015). Terri Rhodes,


DMEC’s executive director in San Francisco explained that little acknowledgment has been

made in society that working functional employees can have varying degrees of behavioral

health issues (Dunning, 2015). Therefore, improvements must be made in mental health training

for employees and employers alike.

Collins, Wong, Cerully, Schultz, & Eberhart (2012) suggested to initiate educational

approaches to reducing mental health stigma in the workplace by providing factual information

regarding mental illness and recovery to replace inaccurate stereotypes and subsequently

increase affirming attitudes. One of the strategies regarding mental health stigma education is

the emphasis that anyone can get a mental illness—particularly that mental illness affects large

portions of the population and that those with mental illnesses can recover and/or have decreased

mental health symptomology following treatment (Collins et al., 2012). Changing these beliefs

is likely to break down perceptions of “us” versus “them.” Some topics could include the causes

of mental illness, mental health treatment, and the experiences of people with mental health

problems (Collins et al., 2012). Evidence also suggests that fostering interactions with

individuals with mental illness can have an even greater impact on attitudinal changes than

educational strategies (Collins et al., 2012).

In Canada, many employers are required to attend a Mental Health in the Workplace

workshop where they can obtain a certificate by highlighting the importance of a mentally health

workplace. The cost of this certificate program is $1495 per person and involves an in-class

workshop session and online training modules (Shepell, 2015). Another training option would

be geared specifically for educating employers and employees about the military and Veteran

community—particularly those with mental illnesses. The National Alliance on Mental Illness

(NAMI) offers a free 6-session educational program called NAMI Homefront, which is led by


trained family members of service members/Veterans living with mental health conditions.

Although this is traditionally a course designed as a peer-to-peer model (e.g., Veterans and

service members with their family members as the targeted audience), a program such as NAMI

Homefront could be adapted to educating the civilian employment sector. Employers and

companies/organizations who decide to participate in mental health educational programs such

as these could be provided a federal tax break as a financial incentive which could potentially

offset any financial costs incurred associated with the training programs.

Analysis of Policy Alternative #1: Need for increased confidentiality measures

As a disabled Veteran with mental health problems who also experienced a negative

career impact due to such issues, I know firsthand how difficult it is to not have mental health

problems affect the overall mission of the military. I was found to be mentally unfit to hold a top

secret security clearance and subsequently was discharged from my unit in Germany and sent

back to the United States. Although I voluntarily sought mental health treatment, I received

pressure from my military command to do so. In the military a service member gives up certain

rights, freedoms, and privileges that to a civilian would otherwise be afforded. The mission of

the military, as Collier (2010) explained, is valued much greater than the needs, wants, and

desires of the individual.

Increased measures to ensure confidentiality in the military regarding mental health

records and mental health treatment may not be entirely feasible. Military commanders and

leaders do indeed have a responsibility to ensure the safety, health, and well-being of their

service members as well as fulfilling the overall mission and duty. When one enlists in the

military, they swear and pledge an oath to protect and serve the United States against all enemies

foreign and domestic. If a service member is suffering from mental health related issues that


may in fact interfere with his/her ability to perform their duty, their military leaders and

commanders will need to thoroughly evaluate. For example, let us assume that a service

member, who is suffering from PTSD, is on a routine patrol while on deployment and responds

to a perceived threat by discharging their weapon and in the process kills a fellow service

member. Additionally, this particular service member was diagnosed with severe PTSD prior to

their most recent deployment and had been confidentially seeking mental health treatment. In

this situation the military command was unaware of the mental health diagnosis and a potentially

unfit service member was deployed. What may result is a major investigation and the service

member’s leaders could also be held responsible.

The military structure is very duty and mission orientated that the potential cost of the

safety and security of those actively serving would be far too great. The tradeoff of increased

confidentiality of mental health records and mental health treatment requires far too much risk

that military commanders may be willing to accept. In April 2014, Army Specialist Ivan Lopez,

who had a history of mental health issues, opened fire at Fort Hood, TX killing three people and

wounded 16 others before taking his own life. Spc. Lopez had recently transferred to Fort Hood

from Fort Bliss where he was stationed at for four years; however, his commanders at Fort Hood

were not privy to Lopez’s mental health history (Wong, 2014). A new software program called

“Commander’s Risk Reduction Dashboard,” developed by Army officials, allows commanders

to consolidate information from multiple Army databases to track soldiers with at-risk behaviors;

however, the accepted culture in the military conflicts with this as service members are given a

fresh start with every permanent change in duty station (Wong, 2014). Therefore, is ensuring the

privacy of the individual worth pursuing at the potential cost of others’ safety? Certainly

situations such as the 2014 Fort Hood shooting are unfortunate and may not be representative of


the larger body of service members who struggle with mental health related issues; however,

military leaders and commanders would argue that these occurrences are more preventable with

measures limiting confidentiality of mental health records.

This, then, brings me to the next criteria of ethics/values. As mentioned previously, the

military greatly values duty and mission. The military is not individualistic but rather group and

mission-orientated. Therefore, personal needs of confidentiality may conflict with the needs of

the military to ensure the safety and security of everyone. To reiterate a point mentioned earlier

in this section, service in the military requires one to give up certain rights, freedoms, and

privileges otherwise experienced in the civilian world. Increased confidentiality measures may

jeopardize the military’s overall mission. It is indeed unfortunate the increased rates of mental

health diagnoses in the military and subsequent military discharges due to said conditions;

however, if one is unable to adequately and safely perform his/her duties in the military,

reevaluation must be implemented by military leaders and commanders which may include

discharge from the military or relocation/reassignment. If measures were put in place to ensure

increased individual confidentiality similar to those experienced in the civilian sector, it would

be met with great opposition. As a result, I believe that this would increase mental health stigma

in the military instead of lowering it and thus would not be effective.

Analysis of Policy Alternative #2: Increase mental health service utilization in military

Due to the success the Army has had in increasing mental health service utilization by

embedding mental health providers among troops, this policy alternative is very feasible to be

implemented across all military branches for both the active and reserve/National Guard

components. This could even be implemented at major military installations that are forward

deployed in war zones such as Iraq and Afghanistan; however, this would require mental health


service providers to deploy with the military units and civilian mental health providers may not

be willing to do so. Instead, the military could enlist the help of mental health providers who are

already currently serving in the military. An exception to the feasibility of embedding mental

health service providers with deployed service members may be the Navy. With the exception of

Navy aircraft carriers, most Navy vessels (including submarines) have limited available

resources and capabilities of providing mental health services to deployed Navy service

members. Most Navy vessels do have a Chaplain onboard; however, Chaplains are not trained to

be licensed mental health providers who can provide both diagnoses and treatment. Therefore,

embedding mental health service providers with service members may be limited to military

installations (e.g., military bases) primarily. With respect to cost, the military already has trained

service members and civilian providers, therefore, costs would be very negligible aside from

building facilities if necessary.

Embedding mental health service providers with service members and thus increasing

accessibility to mental health treatment services would indeed help reduce barriers to treatment

seeking. Ouimette et al., (2011) examined the perceived barriers to care for Veterans seeking

treatment at the VA hospitals and found that factors such as perceived lack of skill and

sensitivity among hospital staff were among those that decreased mental health treatment service

utilization. As Bernton & Ashton (2015) explained, embedding mental health service providers

among military installations where the service members are at versus at scattered sites such as

remote military hospitals increases credibility and gives the service providers a greater

perspective of military life. This, then, would greatly improve rapport and could foster greater

therapeutic relationships that would subsequently have a positive effect on mental health service

utilization. Due to the increase in credibility and improved therapeutic relationships, mental


health stigma would be lowered. Unity and military support are highly valued among service

members. If military leaders and commanders could see the positive effect a policy alternative

such as this would have on their service members, this would greatly reduce the stigma behind

mental health service use. Such treatment may be viewed no differently than routine physical

training to maintain good physical fitness—and now service members can receive assistance in

establishing and maintaining good mental fitness especially since the military is a very stressful

and demanding profession.

Analysis of Policy Alternative #3: Increase mental health awareness in the workplace

In order to make any significant impact on the rising unemployment rates among

OEF/OIF Veterans, this policy alternative would need to require most (if not all) civilian

employers to participate in implementing training and education regarding mental health—

particularly among returning Veterans and the military community. Requiring civilian

employers to participate may have an opposite effect and could in fact foster resentment and

refusal to understand the mental health-related issues faced by the Veteran and military

community. Instead, adding an incentive in the form of a federal tax break may actually draw in

civilian employers to voluntarily implement such trainings in their organizations. Certainly this

may still not draw enough interest as some civilian employers may not feel this training is

applicable and/or relevant. Disclosing one’s prior military status is often voluntary and some

Veterans opt not to publicly disclose their prior military status for various reasons including: (1)

their job and/or area of specialty in the military was highly sensitive/classified; (2) shame or

embarrassment especially if they were discharged from the military due to less than honorable

conditions and/or mental health issues; (3) may want to fully separate themselves from their


military service and assimilate into civilian society. For many of these reasons, civilian

employers may not be aware if any of their employees are Veterans.

This policy alternative would be effective in reducing mental health stigma in the

workplace assuming the “us” versus “them” mentality is diminished. Training programs such as

those mentioned previously in this paper focus on normalizing mental health issues by having

those who are either dealing with mental health issues themselves or are a family member of

someone who is instruct and lead the trainings. This, I believe, is at the center core of mental

health stigma: the perception that those with mental illnesses are not able to be functioning

members of society. Furthermore, the media often portrays the extreme cases of mental illnesses

(e.g., the psychopathic serial killers, mentally ill homeless) when the reality is that mental illness

can (and often does) affect a large proportion of society—many of whom have symptoms that

are undetectable whether due to any combination of treatment, therapy, or medication. The key

to educational and training programs aimed at addressing mental health is to help raise awareness

and understanding thus to foster greater support and empathy.

Overall cost of implementing such programs could be mitigated and/or offset by federal

tax breaks. Obviously the Mental Health in the Workplace workshop in Canada would not be

supported by many employers due to the overwhelming financial cost. However, as previously

mentioned in this paper, NAMI offers free programs on a wide range of topics including LGBT,

Veterans & Active Duty and they have centers located throughout the country. Although many

of the training and educational programs offered by NAMI are targeted more towards mental

health service providers, the content could be adjusted to fit the specific needs of the

organization. In order to promote participation, employers could offer incentives to their

employees such as comped time, CEUs (or equivalent), small bonus, etc.


Policy Decision

Upon an in-depth analysis of each policy alternative, I would choose a combination of

alternatives #2 & #3. My focus would be on increasing accessibility of mental health treatment

services by embedding service providers among military installations as well as incorporating the

NAMI Homefront program in the trainings service members already receive. The military

already employs both civilian and military personnel as mental health service providers so costs

would be limited to just obtaining space to hold such services (whether already existing or not).

As research has demonstrated, increased military unit support has improved mental health

service utilization (Pietrzak et al., (2009)). Addressing the “us” versus “them” mentality and

emphasizing the fact that people with mental health related issues can indeed be functioning and

contributing members of society provided by adequate support, is crucial in reducing mental

health stigma. If service members are given improved mental health support they will be more

likely to seek mental health treatment upon discharge from the military. As previously

mentioned in this paper, untreated mental illnesses can and often exacerbate the symptomatology

and thus create greater issues. I do not believe anything can be successfully done to increase

confidentiality measures in the military as the overall mission of the military and safety and

security of all military personnel is paramount. By taking a front-end approach to mental health

stigma in the military, I strongly feel that returning Veterans will have the tools and resources

necessary for an easier transition to civilian life which would result in lower unemployment rates

and subsequent interpersonal & professional issues.


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