BY , MSN, BSN, NE-BC, CCM, FAAN
One’s first reaction after reading this title may be negative, but that is not the intention. The intention is to highlight the sometimes “clandestine” acceptance and reverence of mental healthcare in certain sectors of our society. Another intention is to share my lived experiences from two sectors of society, but without the intent to generalize any anecdotes or familiarities. My inclusion in the two societal sectors is the military community and as an African American female minority group member. In both groups, and in my personal experiences, some members perceive mental healthcare as a value and an anathema simultaneously. Mental healthcare is needed, helpful, even life-saving, but societal pressures in these sectors sometimes produce denunciation, criticism and censure, resulting in a stigma that prevents the open, transparent embrace of mental healthcare.
The good news is that stigma was recognized and leaders implemented strategies to counter the stigma and facilitate mental health services. In the Air Force, the Surgeon General implemented programs and policies that embedded mental health providers within primary care clinics at every Air Force medical facility. If a mental health concern arose during the primary care visit, the physician or medical provider simply contacted the behavioral health specialist, who joined the patient during the current/active visit. If a follow-up appointment with the behavioral health specialist was needed, the patient scheduled the appointment within the primary care clinic. This strategy allowed the patient to avoid a mental health visit in a mental health clinic proper, thereby reducing the perceived stigma of mental healthcare. One of the concerns from some members of the military community was that mental healthcare affected a service member’s career. Some military leaders expressed concern about the perception of followers on their leadership if followers were aware of a mental health diagnosis or ongoing mental health services. To counter this stigma, the military implemented a policy that allowed for service members to seek mental healthcare outside of military medicine and without the requirement for a mental health referral or authorization. Service members were able to access mental healthcare free of charge for up to 10 visits. The strategy was effective, as mental health services were accessed more frequently and by more people than before the new policies. As a commander, I included mental health professionals in my organization’s team building, wellness and leadership development activities to afford easy and often discreet access to mental health professionals. I instituted a “mental health every day” ethos as a way to make mental health services as routine and expected as any other type of medical care.
My clinical teams were also providers of care, and I challenged team leaders to find innovative and creative ways to encourage utilization of mental health services. One team leader implemented holistic care for survivors of sexual assault. She developed a “one-stop shop” where several appointment types were bundled into one integrated encounter for weekly interventions that targeted physical, mental, spiritual, nutritional and wellness care. The team leader also contacted subject matter experts in male sexual assault recovery care and collaborated with the consultant to create “male circles” where victims of sexual assault were able to listen to the experiences of others without necessarily sharing their personal experiences in a group setting. Mental health providers provided cell phone access via text messaging to follow up with male sexual assault survivors in a non-military setting.
The military was successful in implementing many strategies to make access to mental healthcare easy and destigmatized. Part of the success was attributed to the utilization of mental healthcare in a way that subtly disguised or made mental healthcare appointments less obvious to others. At one point, the Air Force changed “Mental Health Services” to “Life Care Services,” again, in an attempt to eliminate the stigma associated with mental healthcare. “Life Care Services” eventually reverted back to Mental Health Services, but other initiatives evolved to emphasize the need for incorporating mental healthcare into the total lives of service members and their families. Senior leadership was committed to providing mental health services to service members but was challenged by the unwillingness of individuals to “risk their careers” or be stigmatized by public acknowledgment of a mental health diagnosis. In my opinion, the Air Force’s innovative strategies to “meet individuals where they were” led to more accessibility and more utilization.
As an African American woman with strong family ties and active involvement within my social, public, religious and educational communities, I have witnessed and experienced some of the resistance to mental healthcare. Like any other person who has experienced loss, trauma, mental illness or situational mental-health related conditions, the need for mental healthcare in the African American community is vital to a healthy life. Anecdotes from friends, family and colleagues are consistent with the perception that the African American family must be strong, resilient and spiritually grounded to combat (or offset) the need for mental healthcare. Values such as independence, potency, bravery, resilience and privacy make utilization of mental health services less desirable. However, mental health-like care in the context of church or clergy, social and affinity groups, themed retreats or workshops afford opportunities for mental health interventions that do not appear to be traditional mental healthcare. Some African American providers address the issue of stigma by utilizing home health or community-based services that allow for people to receive care in their homes or from a community liaison that the person trusts. Again, another example of creative strategies to “meet people where they are.” Trust is a critical consideration in healthcare for African Americans and especially for mental health services. There is also an element of fear as it relates to people with mental health illnesses resulting from generations of cultural beliefs around mysticism, healers and African tribal remedies. This fear must be addressed head-on by engaging in active listening and culturally respectful dialogues.
There are other factors that contribute to the underutilization of mental health services in both of the cohorts that I identify. But there has been demonstrable success with linking care to those who need intervention by developing creative ways to eliminate barriers such as stigma or culturally based resistance. There has been considerable progress toward the acceptance of mental healthcare and the benefits of utilizing mental health experts routinely as well as in crises. Leaders of both the military and African American communities are more open and public about the benefits of mental healthcare. African American celebrities, sports figures, social media influencers and community leaders are touting the benefits of mental healthcare, and this appears to have a positive effect via behavior modeling. Military leaders are “leading by example” as they share stories about their journeys of mental health and recovery. I have witnessed anecdotal progress, but this area is ripe for rigorous studies to substantiate (or not) the positive headway in access to mental health services. This issue of CMSA Today is filled with information from experts on mental healthcare. Be inspired personally and professionally to advance the body of knowledge in mental healthcare as a researcher, case manager or healthcare leader.
, MSN, BSN, NE-BC, CCM, FAAN
President of the Case Management Society of America
