By Lt. Col. Chris Karns, Secretary of the Air Force Public
Affairs / Published September 02, 2014
WASHINGTON (AFNS) -- As a child, a close relative of mine
committed suicide. In those days, mental health was only discussed in hushed
tones and little support was available. I was shaped by this experience and in
my military career, I have tried to create an environment where people feel
comfortable discussing their problems and supported in their efforts to seek
professional help. In fact, I consider this to be leadership responsibility.
As a squadron commander, I felt part of leadership was
knowing the Airmen and creating an environment of trust and support. As an Air
War College student, I saw an opportunity to further research mental health and
the increased role leadership and communication needs to play in defeating
mental health stigma.
Recently, comic genius, renowned actor and USO veteran Robin
Williams committed suicide. While this event was tragic, there are lessons to
be learned. It helped people recognize that even some who seem to have it all
struggle from time to time and need professional help.
Immediately after Williams’ death, a dialogue started. The
related mental health dialogue needs to be sustained, especially in the
military.
Since 2001, suicide rates across the Department of Defense
have trended upward. Whether in the military or in society, there exists a need
to overcome any perceived stigma associated with mental health treatment. The
military culture celebrates and promotes strength and a warrior identity. To many,
seeking help erroneously implies vulnerability. While the Air Force promotes
help-seeking behavior, a perceived stigma associated with mental health
treatment still exists.
Interestingly, in a 2011 Air Force study, a high percentage
of Airmen responded that it would somewhat to absolutely impact their
willingness to seek care if co-workers would look down on them. This signals
there is still work to be done. Eliminating stigma requires dialogue, a
continual leadership emphasis, and positive examples of those benefiting from
treatment.
While September marks Suicide Prevention Month, attention
and discussion on this important subject needs to extend beyond a designated
month, especially in times of manpower reductions and when more is expected of
Airmen and families. Leaders have a responsibility to actively recognize the
stress being placed on Airmen and families and work to regularly understand and
educate them on help-seeking programs and encourage help-seeking behavior.
While improvement has occurred in overcoming stigma, several
studies still reflect concern over a perceived stigma associated with seeking
mental health treatment. Potential force reductions and career uncertainty run
the risk of deterring Airmen from seeking mental health services. Therefore,
Air Force behavioral health advocacy, communications and educational campaigns
implemented by leaders at all levels need to gain the necessary confidence of
Airmen to lessen the stigma associated with mental health services and
reinforce a culture of trust and support.
Statistically, mental health issues are more common than one
may think. According to Harvard Health Publications, a national survey reported
that “about 6 percent of employees experience symptoms of depression in any
given year.” Moreover, Harvard medical experts claim that “anxiety disorders
affect about 6 percent of the population at some point in life, but typically
go undiagnosed for five to 10 years.” Considering stressors faced by the
military, one can assume the percentage of service members suffering from
depression is greater than the civil sector.
The leader’s communication role
While emphasizing the individual’s personal role and
responsibility in resiliency is important, more needs to be done to develop an
interactive approach to overcome stigma. Therefore, it is incumbent upon the
leader to establish the right organizational culture and support to enable
dialogue to occur. A leadership narrative that normalizes mental health
treatment challenges needs to be developed.
According to congressional testimony, a large percentage of
Air Force suicides involve relationship problems of some kind. Since
relationships matter, leaders should strongly encourage family involvement in
commander’s calls and help them understand mission demands and the Air Force’s
support structure. Additional avenues of support can advance the discussion.
In an Air Force study, chaplains rated top marks from Airmen
as a trusted source. As such, partnering with the chaplaincy can help as well
as examples of Airmen and families overcoming a mental health issue. Stories
about mental health treatment benefits need to be told. Leaders at all levels
should take advantage of existing educational programs such as the Patriot
Support Program’s anti-stigma campaign to aid their education efforts and
efforts to defeat stigma.
Leadership messages
During times of uncertainty, mental health services should
be actively communicated and encouraged. In a RAND Corporation study, perceived
impact to career was listed as one of the top five barriers for neglecting to
seek mental health care. Overcoming the stigma and career impact perception is
the ultimate leadership challenge.
Peer group opinions and attitudes are another area requiring
leadership focus. To defeat stigma, peer-group education is required to enhance
acceptance and dispel myths. Multiple voices, especially by leadership, are
required to dispel myths concerning career impact. Leaders also need to check,
and if necessary, adjust their own attitudes toward Airmen seeking help.
Education
In addition to the Air Force’s holistic approach to
wellness, overcoming stigma should be a primary focus of commander’s calls and
in Air Force education efforts. Consistently promoting or normalizing mental
health services by commanders at all levels requires more than occasional
statements that getting help should be considered a sign of character strength
instead of a weakness. Stigma needs to be a stronger focus area as well as
creating erroneous stereotypes.
Advocacy and engagement
The Army achieved success when retired Gen. Peter Chiarelli
served as the vice chief of staff. For Chiarelli, the responsibility to defeat
stigma was not merely positional, but also personal. He led a 15-month study on
the subject and wrote a book on the issue. He provided an honest assessment of
culture and “the lost art of leadership” as central to the issue. Where
Chiarelli succeeded was in the number of soldiers willingly seeking care. He
made progress toward normalizing treatment. He generated regular public
dialogue on the subject. He made winning this battle personal. In turn, he was
effective.
Real people who share stories of hope and recovery are
required. Celebrate wounded warriors who may have benefitted from treatment.
Have them lead the effort to generate dialogue in order to reduce stigma.
Develop and brand mental health strength conditioning and performance
enhancement programs. Similar to sports psychology, discuss mental health in
the context of achieving one’s full potential. For instance, highly-selective organizations
such as Air Force Special Operations Command have recognized the merit,
permanently assigning psychologists within elite units to enhance the
performance of Airmen. The relationship between mental health and Airmen can be
more than crisis support.
Leaders can speak openly to Airmen and families through all
communication channels. Social media stimulates dialogue, enables connections
to be made, and helps those suffering understand they are not alone. People
need to feel connected. Establish a network and database of people available to
share stories and provide support. Focus on relationship issues, financial
advice and stigma-busting stories of hope. Increase public stories of real
Airman with real examples of discovery, recovery and success after receiving
treatment. Airmen and families need to see other institutions that value
strength seeking help. Discover what educational programs may exist within
police departments, fire departments or even professional sports. Develop
training specific to overcoming stigma, and ensure its integration at each
level of professional military education and also within the DOD dependent
school system. This will enhance Airman and family understanding, and reduce
stigma for future generations.
When a percentage of Airmen still believe a stigma is
attached to mental health services, seeking help becomes less of a choice and
more of a perceived risk. Ultimately, success rests with leadership’s ability
to expand communication, education, and ensures a culture of trust exists.
When people are comfortable, and they recognize the leader
understands and cares for them, then stigma will decline. The time to end the
mental health stigma is now. All leaders have a moral responsibility to get
this right. Lives depend on it.