Promoting Hope, Preventing Suicide

Research and advice on preventing teen and adult suicide

Don't Ask Don't Tell for Mental Health?

How do we hinder honesty about mental health?

Last week, I proposed that the military has created a new "don't ask, don't tell." I wasn't being entirely truthful - military personnel are asked about their struggles with mental health issues, such as depression or post-traumatic stress disorder. And, some of them do tell, disclosing symptoms, experiences, and fears. But, the study I wrote about last week found that more military personnel disclose their needs when their responses are anonymous - a crucial detail.

I wanted to write more about this issue, as I think there are so many layers, including:

  • What role does anonymity play in someone disclosing symptoms that may lead to a changed impression of that person?
  • How might some of the interventions we use - like screening for depression - not work in the ways we'd hope, because of stigma?
  • What are we not doing because we stick with using interventions that don't take into consideration very human responses, like shame, that make screening challenging?

Luckily, some readers shared thoughts that show that I'm not the only one thinking about these questions:

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"All you have to do is see one "homeless crazy person" in the city to get it in the back of your mind that admitting to any mental health issue is going to wind you up homeless because nobody's going to want you as an employee. It's a vicious cycle. It may not be based in 100% fact, but I also think it's foolish to believe that seeking help for a mental health problem definitely won't potentially affect your career - in the military or anywhere. Private or not, people talk. I think if you did an anonymous survey of employers... Many would likely admit they'd LOVE access to an employee's or potential employee's medical record, and they would certainly, if allowed, screen out anyone who's ever had any medical problems, and especially mental health problems. People know that the stigma is real, and the fear is genuine. Until the stigma lifts more, the fear should not be dismissed as unreasonable."

"Every year on depression screening day, my college sets up a table on the sidewalk by the psychology department where you are supposed to stop and take a test. And it's next to a busy restaurant. If you were depressed, would you want to be seen taking a test where your peers or colleagues might see you?? Given by people who might already know (of) you and will certainly know your results??"

"I have often thought if a doctor even had a painted "distress" button on his/her desk may help - the person would just put their hand on it and the doctor would then know to ask the questions - because the patient does not know how to express themselves when trying to broach the subject."

Do you have responses to any of these comments or other thoughts on this issue?

Copyright 2011 Elana Premack Sandler, All Rights Reserved

Elana Premack Sandler, L.C.S.W., M.P.H., is a public health social worker specializing in violence and injury prevention and adolescent health promotion.

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