Fleet mental health: A discourse analysis of Navy leaders' attitudes about mental health problems.

摘要

Mental disorders are a significant source of medical and occupational morbidity for active duty military members. The majority of military personnel believe that using mental health services will cause career harm, and over 81% of those with mental health problems do not seek treatment. The literature suggests that stigma and fear of negative career impact are significant barriers to the use of mental health services. Military members have indicated that concern about leaders' attitudes is a barrier to seeking help. The attitude of military leaders is important because those leaders have authority over both subordinates' careers and their access to mental health services. Military culture and leaders' perceptions of mental illness are potential sources of organizational norms regarding mental health service use.; This study used semistructured interviews and military policies as data sources to analyze the language, knowledge, and attitudes of Navy surface fleet leaders about mental illness and mental health treatment using Foucault's concept of discourse analysis. A discourse is a system of knowledge that influences language, perceptions, values, and social practices. The data yielded by the study showed that fleet mental health, not mental illness stigma, was the dominant discourse of leaders' attitudes about mental illness and subordinates' use of mental health services. Leaders expressed frustration with accessing and using mental health resources to ensure that sailors are mentally combat ready. The source of the leaders' frustration is the fundamental difference between the Navy surface warfare community and the mental health community. Differences between the two communities are aggravated by inconsistent policies, separate organizational expectations, unique knowledge structures, and specialized language. This study provided an initial look at the attitudes that Navy surface warfare leaders have regarding mental illness and the use of mental health services. The study findings indicate that organizational differences may have a stronger influence on leaders' attitudes than does stigma. This study provides an elaborated view of mental health knowledge and power within a Navy community. That view can be used to identify practical and concrete implications for further research on stigma in the military and for improvements to fleet mental health services.