Ease the road to mental health care after military sexual trauma

Despite a decade of research on the issue, sexual assault and harassment in the military is still a pervasive problem. Recent estimates show that 6% of women in the military have been sexually assaulted in the past year. Another 24% experienced sexual harassment.

While efforts to eradicate this problem continue, there is also this: the effects of the trauma of these attacks can be permanent, especially after the period of active duty. So it is not only the military services, but also the veterans services that need to connect these women with appropriate mental health care.

Not enough progress has been made in this area.

Of course, women’s difficulties in getting treatment for sexual trauma are not unique to the military. But like so many other things, serving in the military is a complicating factor.

In surveys, focus groups and interviews, female military personnel have explained how they are filled with self-doubt and shame after a sexually traumatic experience. They felt they should have been able to prevent or stop it. They worried about what their colleagues or commanders would think. Or they didn’t think the trauma was “severe” enough to warrant care—perhaps especially if they compare their experience to that of a fight.

“It wasn’t violent for me. I froze,” a veteran told researchers at the University of New Mexico. So that’s another reason why I feel guilty because it’s like I didn’t fight. I just froze and put up with it, so I feel like, geez, it was my fault. … Somehow I am responsible for this.

Women should not feel that there is a trauma threshold to seek mental health care. That message must be conveyed clearly and repeatedly throughout a military career – from pre-deployment to post-deployment to transition from the military. As one female veteran said in another study of military sexual trauma during deployment, “You can’t just say it once and say, ‘Okay, this option is there if you need help.’ People don’t pick up on that, it just has to be drilled in and at some point you want the help.

Women who have been assaulted or harassed also report in large numbers that they lack confidence in military or veteran health systems or their healthcare providers. It could help to add more female psychiatrists, psychologists and other counselors. Research has shown that victims of sexual trauma who asked for female medical providers and were unable to obtain them were more likely to forego healthcare from the Department of Veterans Affairs.

In addition, the environment of military and veteran healthcare facilities can be unwelcoming, if not downright triggering. As one woman shared in a survey of VA health care perceptions: “There are so many men here. There are many, many men, and men who have mostly worn uniforms. And that was one of my biggest triggers, being around people in uniform.”

VA facilities could roll out more women-only spaces and clinics, or at least create enough distance between patients in waiting rooms. In addition, VA employees, including receptionists, could be trained in stigma-reducing communication skills.

Difficulty getting an appointment, getting time off from work, arranging childcare, and the cost — all of these factors kept women from seeking mental health treatment as well. And of course, standard mental health care requires multiple visits, so these hurdles keep coming up.

For military moms, programs like Children’s Waiting Room serve as promising models that can make it easier for them to get to medical appointments, especially given the evidence that women with children are less likely to stay in psychotherapy than women without children. Health systems may also offer weekend or evening appointments.

The Pentagon recently clarified that its recovery leave policy should be extended to victims of sexual assault so they have time to recover. It also made it clear that service members should be allowed time off from normal duty for medical or counseling appointments. But this policy does not appear to allow leave to receive treatment for other traumatic experiences, such as sexual harassment.

The Pentagon and VA must also continue their efforts to ensure victims receive quality mental health care in a safe and supportive environment — and that they don’t have to jump over hurdles to get it.

Julia Rollison is a senior policy researcher at the nonprofit, nonpartisan Rand Corp. Her research focuses on public health issues, access to and quality of health care, with an emphasis on reproductive health and the health care workforce.

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Ease the road to mental health care after military sexual trauma

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