Eliminating stigma: A leadership responsibility

  • Published
  • By Lt. Col. Chris Karns
  • Secretary of the Air Force Public Affairs
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.

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.