Saturday, November 10, 2012

Here is a partial thesis I made for a client with the initials L.L. who couldn't put together what he wanted in the paper and relied entirely on my judgement. 

The Stigma of Mental Health Counseling on
Active Duty U.S. Military Personnel


Alex Y. Lim


B         Introduction

            This paper explores the impact to stigma associated with having mental illness on active military personnel on their private and work lives. The social and psychological cost of suffering of the condition effectively places the combat-fatigued service member in double jeopardy as he or she suffers from the ailment while having to cope with a devalued place in society occasioned by the stigma society has cast on them (Corrigan & Watson, 2002).
            US Military service personnel have this fear that consulting a psychologist or a psychiatrist will push down their prospects for career advancement in the military. According to Navy Commander, Anthony Arita, PhD., this needless fear revolving around  their psychological or mental problems being exposed to their superiors have occasioned significant worry that it could compromise their security clearances, prospects for promotion and  even result in service dismissal (Dingfelder, 2009).  Dingfelder (2009) in said that Arita, the director of clearinghouse, outreach and advocacy at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury said: "There is the perception that if I do step forward there will be dire consequences" (Dingfelder, 2009, para. 4).     Such fears are unfounded according to military experts, but they nevertheless have fueled what amounts to a mental health crisis in the US military, where nearly a fifth of service members returning from recent regional conflicts and wars such as in Iraq and Afghanistan have been diagnosed with symptoms of major depression and post-traumatic stress disorder.  Only about half of the returning service members with such issues have sought treatment, according to a study by Rand Corp (2008).
            This is around 300,000 service members with combat-induced mental health issues, says Terri Tanielian, who had co-authored with psychologist Lisa Jayrox, PhD a study which estimated that apart from the human cost, the nation can expect military personnel with mental illness to cost nearly $6.2 billion in direct medical care and lost productivity within the first two years after a traumatic combat duty.  This reality has not escaped military leaders, who rightfully worry that such invisible war damages could diminish the competence of the nation’s fighting force already stretched thin.   
            Dingfelder (2009) observed that just about all the military agencies are now involved in their own wars fighting the stigma of seeking mental health services. For instance, the Defense Department recently revised its security clearance questionnaire so that people who seek mental health care for combat-related reasons do not have to report it. It is interesting to note that prior to this revision,  when soldiers filled out security-clearance questionnaires, they were almost always told to just reply "no" to the dreaded Question 21 which asked: “In the last seven years, have you consulted with a mental-health professional or consulted with another health-care provider about a mental health condition” (Arnews,  2008)  This is considered the appropriate answer when the soldier is receiving mental health counseling to deal with stress resulting from combat or to family and marriage issues.  A “no” should also be the answer if the mental health counseling was not ordered by any court as a result of violence.  This advice was contained in an All Army Activities (ALARACT) message guidance issued by Army G2 security division until an updates SF 82 questionnaire can be issued with a more appropriate working for question 21.
            It had to take two US Army generals who candidly share their post-traumatic stress disorder (PTSD) experiences in April 2009 for the Department of Defense (DoD) in the following month to launch a service-wide anti-stigma campaign to prompt ordinary military personnel to admit and recount their respective stories of seeking mental healthcare (Dingfelder, 2009).  It reportedly cost the military $2.7 million; but that is just a drop in the billion dollar budget of the armed forces.
            After all these decades of hiding behind the stigma, this can be considered a historic effort that could finally defang  the societal stigma associated with seeking psychiatric or mental health care in the American cultural landscape, according to  Mark Bates, PhD, interim director of the resilience and prevention directorate at the Defense Centers of Excellence (DCoE). He further stated that "what we are trying to do is bring home the message that physical health is just as important as mental health. We're creating mental health parity in the military" (Dingfelder, 2009, para. 9). 

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