noun stig·ma \ˈstig-mə
A degrading and debasing attitude held by society that discredits a person or group because of an attribute (such as an illness, gender, gender identity, color, sexual orientation, nationality, religion, socioeconomic status, etc.). The resulting coping behavior of the affected person results in internalized stigma. Self or internalized stigma is equally destructive, whether or not actual discrimination occurs. Stigma often negatively affects a person’s dignity; marginalizes affected individuals; violates basic human rights; markedly diminishes the chances of a stigmatized person achieving their greatest potential; and impedes pursuit of happiness and contentment.
What does stigma have to do with military veterans, service members and their families?
Stigma was identified by NH Veterans as the #1 barrier to accessing healthcare. More specifically, NH Veterans identified feeling embarrassed or ashamed of their needs (internalized stigma) and feeling as though their providers do not understand them.
The perception that healthcare providers do not understand veterans stems from: 1) the fact that the vast majority of NH health care professionals have no military background and/or zero to minimal exposure to military culture 2) the veteran/service member’s fear/belief that a lack of understanding will result in stereotypes, pathologized interactions, misunderstandings, and over-glorification or negative judgments about their identity and experiences.
What does understanding military culture have to do with stigma?
When health care professionals and systems are responsive to their patients’ cultural backgrounds, patients are more likely to receive appropriate care, show up to appointments, follow through with treatment plans, disclose necessary treatment information, and pay their bills. It’s a win, win.
Fighting stigma in your practice:
Considerations for interacting with veterans, service members, or their family members…
A good start:
- Make eye contact
- You can never go wrong with “Thank you for your service”
- Or a hand shake
- She serves too
- No matter how old or young the veteran is, say “Welcome Home”
- Show you care by asking “How has it been going for you since you’ve been home?”
- Do ask, “Do you get any of your healthcare through the VA?”
- Remember that most NH Veterans do NOT get health care through the VA, and that’s ok.
- Accept their level of identification with their service, no matter how high or low
- Believe the stories. War is hell.
- Transitions are hard, whether the transition is from a deployment to home or from military service to civilian life.
Validate, Support, Accept, Refer
- Never insert politics into any conversation about someone’s service
- As well-meaning as you may be, don’t say “I’m glad you made it home [safe/okay/unharmed, etc]” or “Good thing you didn’t have to go over there!”
- “How many people did you kill?” Nope, NEVER. Just Do Not Ask.
- Don’t assume that one’s military service has involved a deployment or that a military deployment has involved combat. Listen and Ask.
- Don’t assume that one’s service is a factor in their presenting problem. Don’t assume that it isn’t. Listen and Ask.
Remember: The first step to fighting stigma is in knowing who you’re talking to. Ask the Question. Ask every patient you see, “Have you or a family member ever served in the military?”
– NH Legislative Commission on PTSD and TBI
Select your profession to see how:
By asking “Have you or a family member ever served in the military?” senior services professionals can:
- Help older veterans feel understood and respected for their military service
- Make effective referrals to Veteran-specific programs and resources
- Help military widows access survivor benefits
By asking “Have you or a family member ever served in the military?” children’s services professionals can:
- Help a student thrive when a parent is deployed
- Support families facing deployment and reintegration
- Improve peer sensitivity to military children
By asking “Have you or a family member ever served in the military?” employment and vocational services professionals can:
- Identify a warrior’s transferable skills
- Connect Veterans to military-friendly employers
- Help a returning Service Member access veteran job training programs
By asking “Have you or a family member ever served in the military?” faith-based professionals can:
- Identify families in need of extra help during deployment
- Motivate communities to come together on behalf of those who serve
- Connect military families to the supports and services they need
By asking “Have you or a family member ever served in the military?” healthcare and medical professionals can:
- Build critical rapport with a reluctant patient
- Understand the relationship between military experiences and medical symptoms
- Provide effective referrals and resources
By asking “Have you or a family member ever served in the military?” higher education professionals can:
- Help a warrior acclimate to a civilian learning environment
- Improve peer sensitivity to veteran classmates
- Effectively accommodate service-connected disabilities
By asking “Have you or a family member ever served in the military?” housing services professionals can:
- Identify families that qualify for Veteran-specific housing programs
- Address service-related barriers to stable housing
- Provide effective referrals and resources
By asking “Have you or a family member ever served in the military?” law enforcement professionals can:
- Keep veterans and their families safe
- Build trust and rapport in difficult situations
- Partner with providers who help Veterans in crisis
By asking “Have you or a family member ever served in the military?” legal services professionals can:
- Support justice-involved veterans
- Identify legal challenges related to military service
- Link to effective resources
By asking “Have you or a family member ever served in the military?” mental health professionals can:
- Build critical rapport with a reluctant client
- Understand the impact of military stressors on mental health and substance use
- Help a family understand the emotional effects of deployment on the whole family
By asking “Have you or a family member ever served in the military?” social services professionals can:
- Engage reluctant Veteran clients
- Meet a military family’s unique needs
- Coordinate services between veteran and civilian providers
By asking “Have you or a family member ever served in the military?” women’s services professionals can:
- Partner with veteran service providers in crisis situations
- Identify deployment-related triggers and risk factors
- Identify individuals affected by Military Sexual Trauma (MST)