Stigma-related factors that prevent service members from seeking mental health care include:

Individual Factors

The lack of perceived need for mental health treatment and the preference for self-management (i.e., use of other stress-coping strategies) among service members may contribute to underutilization of mental health services. In the 2015 Health Related Behaviors Survey of Active Duty Military Personnel, 36.1 percent of respondents reported a perceived need for mental health treatment and no mental health service use in the past year. These respondents were asked to report the reasons they did not seek treatment. The most common reason was that service members wanted to handle the problem on their own.

Social Factors

Service members have reported that their social networks significantly impact their decisions to seek mental health care. They may have concern about being labeled and being socially isolated; fear of public disclosure and negative reactions to mental health problems and treatment-seeking; and apprehension of being viewed as a burden by their family and friends.

Institutional and Treatment Factors

Some DOD and service-specific policies may manifest discrimination toward people with mental health diagnoses. The 2014 RAND Corporation report “Mental Health Stigma in the Military” identified ways that DOD policies can potentially increase barriers to care, including mental health care stigma, in the military. It reported that sometimes policies:

• Use negative terminology (e.g., describes behaviors of people with mental health disorders as “childish outbursts”)
• Prohibit actions or implies incompetence
• Limit privacy
• Has non-mental health professionals determining mental health fitness
• Reduce people with a mental health diagnoses to a label (e.g., “mentally ill person”, “a psychotic,” or “a schizophrenic”)

Treatment System

The treatment system can also impede service members from obtaining the treatment they need or contribute to treatment drop out. These include:

Medical mistrust

• Personal negative attitudes about mental health
• Lack of confidence in treatment effectiveness
• Lack of trust in mental health providers and the mental health care system
• Fear of psychotropic medication side effects

Structural barriers

• Scheduling issues (e.g., inconvenient clinic hours)
• No time off work
• Transportation issues
• Cost concerns
• Lack of knowledge about mental health service locations

Public Factors

For service members, public factors involve perceived military norms and military culture. In the 2015 Health Related Behaviors Survey of Active Duty Military Personnel, in which respondents were asked to report the reasons they did not seek mental health treatment, two of the four most common reasons cited were related to the military. Service members reported the fear of being treated differently and of being viewed negatively by military leaders and unit members adversely impacted their decision to seek mental health care: “It would have harmed my career” and “I was afraid my supervisor/unit leadership would have a negative opinion of me.”