Military culture & its Effects on mental health

by Makayla House, University of Kentucky BSW Practicum Student
Military culture can affect the way military members and their families perceive mental health. This also influences how they go about getting mental health care. In this blog, we will cover what the basics of military culture are, some of the barriers to military members receiving mental health care, and how we can help.

What is Military Culture?

Defining a culture, let alone military culture, can be complicated. There is a broad range of cultures and ideas inside the military, its different branches, and its people (Abraham et al., 2015 & Westphal & Convoy, 2015). The military is also a diverse population, bringing in multiple ethnicities, languages, religions, and more (Abraham et al, 2015 & Westphal & Convoy, 2015). Military culture can affect how service members and their families use healthcare services and utilize mental healthcare practices (Abraham et al., 2015 & Westphal & Convoy, 2015).
One key piece of military culture that can affect military mental health is the military code of ethics (Westphal & Convoy, 2015). While there are different codes of ethics for each military branch, the United States Army code combines the ideas of them all into one: loyalty, duty, respect, selfless service, honor, integrity,  and personal courage (The U.S. Army, n.d.). These codes can make it seem like military service members need to be heroic, so when interacting with civilians, military members can feel like they are not living up to the expectations of the civilians they serve (Westphal & Convoy, 2015). This idea of military members being heroic can cause others to miss the aspects of what military culture truly is and how it affects those involved (Westphal & Convoy, 2015).
Barriers to Receiving Care
Since healthcare professionals work with the general population as a whole, they can be one of the biggest barriers to military members receiving care (Westphal & Convoy, 2015). One barrier that military members have when it comes to healthcare professionals is that, when explaining their concerns, the military member may not realize all of the stressors that are building up on top of each other causing their health concerns (Westphal & Convoy, 2015). The healthcare professional may not realize the patient does not know this because they are not personally involved in military culture (Westphal & Convoy, 2015). There is both a knowledge and confidence gap when it comes to healthcare professionals assessing and treating military members (Westphal & Convoy, 2015). This gap has been explained by military members who have received quality care, but stated that the care they received was not relevant to their experience or that the provider did not understand the stressors of the military experience (Westphal & Convoy, 2015). This can create more barriers to getting care and help-seeking (Westphal & Convoy, 2015).
There have also been studies that show that military members may not receive care due to the mental health stigma in the military (cheney et al, 2018). Some worry about being judged by their fellow military members (Cheney et al, 2018). They also do not receive care due to the difficulty of receiving mental health care from the Veterans Administration, including but not limited to (Cheney et al, 2018):

• Slow clinic responses
  
• Scheduling problems
• Inconsistency in providers
• Large amounts of paperwork
• Lack of knowledge of where to go for mental health services
• Problems getting service-connected disability resources

How We Can Help
One way we can help is by increasing healthcare professionals’ cultural knowledge when it comes to the aspects of military culture and how it affects patients’ illnesses and reaction to treatments (Westphal & Convoy, 2015). This involves increasing awareness of exposure injury, defined as the distressing aftermath of exposure to an event, which can help healthcare professionals explain to patients why they are experiencing a disorder from the same experience that someone else came out fine from (Norman & Maguen, 2018 & Westphal & Convoy, 2015). Healthcare professionals need to understand the close-knit bond of combat service members and the impact that the loss of a military comrade can have on a military service member (Westphal & Convoy, 2015). Military members also need to work on the de-stigmatisation of mental health among themselves, which is critical in whether help for a mental illness is sought after (Abraham et al, 2015).

Conclusion

Military mental health is complicated, considering all the aspects going into it through both the civilian and military world. With the work of healthcare professionals and military members across the country, we can work towards making mental health resources more available for our country’s military members on all levels. One step is de-stigmatizing mental health in military culture, which will take the work of everyone involved and how it can impact help-seeking behaviors of patients coming from the military.

Resources
Abraham, T., Cheney, A.M., & Curran, G.M. ( 2015, July 29). A bourdieusian analysis of U.S. Military culture ground in the mental help-seeking literature. American Journal of Men’s     
Health. https://doi.org/10.1177/1557988315596037
Cheney, A.M., et al. (2018). Veteran-centered barrier to VA mental healthcare services use. BMC Health Services Research, 18(591). https://doi.org/10.1186/s12913-018-3346-9
Norman, S.B. & Maguen, S. (2020, May 19). Moral injury. National Center for PTSD. Retrieved March 8, 2021, from https://ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp
The U.S. Army (n.d.). The army values. Retrieved February 15, 2021, from https://www.army.mil/values/index.html
Westphal, R. & Convoy, S. (2015). Military culture implications for mental health and nursing care. OJIN: The Online Journal of Issues in Nursing, 20(1), M. 4. https://doi.org/10.3912/ 
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