PTSD, received “minimally adequate” treatment for these injuries (Tanielian and Jaycox, 2008). The authors of the report were unable to determine the percentage of veterans with a PTSD diagnosis who received high-quality care for PTSD, but their research strongly suggested that there was a large gap between the number of service members and veterans who had PTSD and the number who received high-quality care for it. That gap represents extensive human suffering and lost productivity. One possible reason for the gap between those who need care and those who are receiving high-quality care is the existence of barriers that prevent access to high-quality care.

BARRIERS TO CARE

Research on posttraumatic care for active-duty service members and veterans has identified a large number of possible barriers to and facilitators of care. Barriers to care exist at the patient, provider, and institutional levels. For example, patient barriers could include concern about the employment effects of seeking treatment for PTSD, a perception that mental health care is ineffective, a lack of information on resources for care, financial concerns, and logistical problems, such as travel distance (Hoge et al., 2004, 2006; Milliken et al., 2007; Warner et al., 2011). For providers, barriers could include lack of training, lack of time, and treatment location issues, such as transportation in the theater of war (MHAT VII, 2011a, b; Sayer et al., 2009b; Warner et al., 2011). At the organizational level, barriers could include rigid organizational requirements for screening and treatment and the competing demands of force readiness in the Department of Defense (DoD). Treatment programs requiring significant time commitments, such as the 3-week Functional and Occupational Rehabilitation Treatment program, are a challenge to receiving treatment because commanders may be hesitant to approve leave for such long periods of time.

Although such external barriers as logistics and financial pressures exist, barriers to care may also be internal and be related to a person’s attitudes and beliefs (Curry et al., 2011). Some internal barriers are closely related to the construct of stigma. Stigma has been defined as a negative and erroneous stereotype about a person (Corrigan and Penn, 1999). The stigma process has been further described as consisting of cues, prejudice, and discrimination (Corrigan, 2004) and may be categorized as public stigma or self-stigma. In public stigma, a naive public exhibits prejudice toward a stigmatized group; self-stigma occurs when members of a stigmatized group internalize public stigma (Corrigan and Watson, 2002). The stigma attached to having a mental illness and receiving a psychiatric diagnosis has been the subject of extensive study in military and in civilian contexts (Britt et al., 2007; Corrigan, 2004; Corrigan and Penn, 1999; Corrigan and Watson, 2002; Hoge et al., 2004; Warner et al., 2011).



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