Retired U.S. Army Gen. Peter Chiarelli li is currently chief executive officer of One Mind for Research. (Craig Barritt / Getty Images)
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Air Force leaders want airmen to get help when they need it, but there's more to consider than one's state of mind. Sometimes it's a choice that can have lasting effects on an airman's career.
Whether it's counseling for alcoholism, marital problems or combat-related stress or injuries, there's a fine balance between treating airmen who need help and keeping those same airmen and their co-workers safe in their jobs.
Much of what happens after getting help may depend on an airman's specialty, said Lt. Col. David Dickey, psychologist and chief of deployment mental health for the Air Force Medical Support Agency. The service has dozens of career fields for which a trip to mental health could trigger a talk with your commander.
"We get a lot of questions about confidentiality," Dickey said.
And there aren't any easy answers.
Mental health providers may not recommend a security clearance if something revealed to them causes concern. They also have a duty to report information to commanders that could affect the mission, Dickey said.
"The clearance for working with nuclear weapons is pretty different from getting a secret clearance, which pretty much everybody in the Air Force has," he said. "There's a whole different protocol if you're going to get a top-secret clearance, or if you're going to get put on flight status.
"We have a duty to the patients that we see, but there is also a duty to the mission of the organization ... that has to be considered," Dickey said. "Essentially everybody gets that. You don't want to just let anybody into handling nuclear weapons. You don't want to let just anybody be in charge of a multi-million-dollar aircraft."
Air Force leaders, alarmed by the high number of suicides this year — 79 by mid-September — are urging airmen to look for signs that they or their co-workers are suffering and address the problem before it becomes overwhelming.
"Let's not mistake this fact of suicide," Chief Master Sergeant of the Air Force James Roy said Sept. 19. "It tells us that there's a lot going on in our force today. … Why does somebody go to that extreme measure to work through a very difficult situation in their own mind? It may be not difficult to you, but in their own mind it's very difficult. So there are challenges within our force [that leadership must address]."
But some airmen say admitting depression or suicidal thoughts to someone who might have to report it to their boss would put their careers on the line.
An Air Force captain and flight commander said she has witnessed multiple pilots become anxious and angry after deployments. They worry that asking for mental health support, even for minor issues, will change their status to Duty Not Including Flying — and that can affect their ability to get promoted, the captain wrote in an email.
"Many of these people just need or wish to talk to someone (unbiased and professional) without jeopardizing their careers," the captain wrote. "Flyers, instead, are often bottling up their frustrations and becoming unintentionally (though often inevitably) distracted from the mission, discouraged (decreasing unitwide morale), self-medicated, and/or struggling to maintain healthy relationships (at home, work and elsewhere)," the captain wrote.
Another airman wrote in an email that assurances from top leaders aren't enough.
"Instead of spending millions of dollars on suicide prevention, which is not working, let's provide truly private treatment options without the stigma or fear of losing careers," the airman wrote. "Additionally, the shame and embarrassment, real or imagined, of facing co-workers, friends and family in an environment where we are told to be tough and not let our emotions interfere with our ability to accomplish the mission are in conflict with our needs."
Dickey said the service is now targeting some of its stigma-reduction efforts at peer-to-peer interactions. Anecdotally, it seems to be working, he said, thanks to leadership buy-in.
He points to a 2011 Community Assessment Survey of 63,290 airmen that shows 81 percent believe they can seek mental health care without a negative effect on their careers. Yet when it comes to concern about how co-workers and supervisors will view them if they seek counseling, more than half of airmen across all ranks still said they were either somewhat likely or very likely to be stigmatized.
Knocking down barriers
Removing that stigma has been a mission for Roy, who retires as the Air Force's top enlisted airman in January.
But he's not alone. With rising suicide rates across the services, top military leaders say they want to help service members understand that they can — and should — seek help.
Among them is retired Army Gen. Peter Chiarelli, the former Army vice chief of staff who is CEO of One Mind For Research, a nonprofit that is working to cure brain disorders.
Chiarelli said the entire chain of command must support treating invisible wounds, such as post-traumatic stress and traumatic brain injury, just as other wounds would be treated.
"The fact of the matter is they're real, and there is nothing shameful about it," he said in an Oct. 4 phone interview. "Only through education and talking about it can you get people to accept that they're real and get the help they need to take care of these wounds."
Chiarelli said that military leaders must continue to communicate that it is OK to get help, but they also must work to remove the barriers that make it hard to access help and stay in uniform.
"As long as there is stigma associated with these [issues], you're always going to have those incidents where people are penalized," he said. "It's just the nature of anything where there is stigma associated. People need to understand that the rules have changed, and when those cases [involving penalty] occur, senior leadership needs to take action to eliminate them."
Service members should not fear losing their jobs, he said.
"If it's a person in an MOS who requires a higher level [of security], the good organization would find a way to reclassify that person and put them in another MOS," he said.
Roy said at a warrior resiliency conference held in Washington, D.C., in March that Air Force leaders are looking for more ways to help airmen tend to their mental health and keep their careers on track. He said if maintaining security clearances and personnel reliability programs for airmen in high-security careers, such as nuclear operations, are barriers to seeking mental health services, then the Air Force should find ways to remove those barriers.
He also expressed concern that when airmen do seek help — particularly for post-combat stress — that they aren't given the same respect as other troops.
"In certain situations, we've had airmen come back from the area of responsibility who went to behavioral health where they were told, ‘There's no possible way that could have happened to you, because you are an airman,'" he said. "That's a problem."
Mental health technicians are increasingly "down into the shop level," Roy said, pointing out that Dover Mortuary Affairs in Delaware has a behavioral health specialist available to provide access at a moment's notice. Chaplains at other bases are reaching out to groups in dormitories that ordinarily may be prevented by peer pressure from speaking up about their problems, he said.
Ultimately, it's a balancing act. But Dickey said cases of airmen who have experienced a negative impact on theirs career are few.
"I would make the argument that of the people that it does adversely affect, in a sense, that's not a bad thing," Dickey said.
Staff writer firstname.lastname@example.org?subject=Question from AirForceTimes.com reader">Kristin Davis contributed to this report.