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Mental Health Stigma Is a Process

• Mental health stigma is a dynamic process by which a service member perceives or internalizes a brand or marked identity about himself or herself or people with mental health disorders. This process happens through an interaction between a service member and the key contexts in which he or she operates: public, institutional, social, and individual.
• Four immediate outcomes are empirically linked to stigma: coping mechanisms, interpersonal outcomes, attitudes toward treatment seeking, and intentions to seek treatment.
• The literature has theoretically linked four long-term outcomes to stigma: well-being, quality of life, treatment initiation, and treatment success. The authors could not empirically link these, however.

Current U.S. Department of Defense Stigma-Reduction Efforts Are Aligned with Best Practices and May Be Contributing to a Decline in Self-Reported Stigma

• DoD's approach is broader than stigma reduction and encompasses minimizing barriers to mental health care. This assessment shows that that approach is consistent with best practices and may have contributed to declines in self-reported perceptions of stigma in a subset of the military population.
• Most of the stigma-reduction programs currently implemented by DoD target stigma in the public context.
• Policy language barring service members with mental health disorders from career opportunities could create paths for discrimination. Tensions exist between the privacy of service members seeking mental health treatment and the need for commanders to assess unit fitness.
• Some policies support universal educational stigma-reduction programs but not more-targeted programs for those in mental health treatment.
• Few measures of self-stigma in the military exist, and no DoD-wide measures of military mental health stigma are currently being collected.