Mitigating Stigma and Other Barriers to Care Through Mental Health Service Delivery in Primary Care Settings
Published in: Care of Military Service Members, Veterans, and Their Families / Edited by Stephen J. Cozza, Matthew N. Goldenberg, Robert J. Ursano, M.D. (Washington, D.C.: American Psychiatric Association, 2014), Chapter 11, p. 203-221
Mental health disorders and associated psychosocial problems are endemic among civilian and active duty military and veteran populations in the United States (Kessler et al. 2005a, 2005b) and worldwide (WHO International Consortium in Psychiatric Epidemiology 2000; World Health Organization 2001). There is a growing evidence base, however, suggesting that common mental health disorders respond to both pharmacological and psychotherapeutic interventions. Curiously, a large proportion of individuals with mental health disorders who would likely benefit from such interventions neither seek out nor receive treatment. In these high-risk active duty military and veteran populations, current research indicates that between 23% and 57% of psychiatric needs go unmet (Chermack et al. 2008; Fikretoglu et al. 2008; Hankin et al. 1999; Hoge et al. 2004, 2006; Seal et al. 2010; Taniellan and Jaycox 2008). Moreover, when care is received, it is frequently suboptimal as a result of treatment dropout and/or nonadherence to medication regimens (Seal et al. 2010; Taniellan and Jaycox 2008). This is particularly concerning when one considers that active duty service members and military veterans with mental health disorders have access to some of the nation's most comprehensive health care. This striking gap between needs and services has led to calls for changes in health service delivery systems and reform of current models of health care delivery (Burnam et al. 2009). In this chapter, we draw attention to the link between barriers to care (particularly stigma associated with mental health care) and suppressed treatment seeking and service delivery rates. We discuss the emerging rubric of collaborative care health service models and argue that such models offer a promising solution to fill the gap between needs and services by directly addressing actual and perceived barriers to care. Finally, we present specific case studies of collaborative care implementation in both active duty military and U.S. Department of Veterans Affairs (VA) settings illustrating the effectiveness of health systems innovation that expands the reach of service delivery without compromising treatment efficacy.