Veterans Health Affairs, Social and Behavioral Health, Anchorage, TX 99504, USA.
Psychology Department, Our Lady of the Lake University, San Antonio, TX 78207, USA.
Int J Environ Res Public Health. 2019 Nov 4;16(21):4274. doi: 10.3390/ijerph16214274.
In response to the Air Force Surgeon General, Lieutenant General Mark Ediger's call for medical services to be guided by service members' values, preferences, and experiences within the medical system, we conducted an interpretive phenomenological analysis of transcripts in which service members shared their experiences of military mental health policy and practices after being identified as suicidal. Themes of their experiences underscore nuances as it relates to intersectionality of policy when faced with unique military contextual factors and power differentials; both of which were missing in available research literature. Their experiences also illuminate further the innate "Catch 22" which happens when accessing help. Catch 22 basically means if you know you need help than you are rational; but if you actually seek help, then you are crazy and not trustworthy to do your job. Themes presented center on the lack of confidentiality of Service Members in the Workplace, effects of Unit Members' Surveillance and Command Directed Evaluations, and experiences of Military Mental Health Services. Critical discussions of policy and taken for granted assumptions that often drive narrow responses to suicide, treatment, prevention, and stigma are presented. Particular attention is given to the lived experiences of service members when placed under the demands of circumstances created by policy that may inadvertently lead in some cases to further suffering. The paper closes with recommendations from participants and the authors for policy makers and future directions in research.
针对空军军医处处长马克·埃迪格尔（Mark Ediger）少将呼吁医疗服务以医疗系统内服务成员的价值观、偏好和经验为指导，我们对服务成员在被认定为自杀后分享他们的军事心理健康政策和实践经验的记录进行了解释性现象学分析。他们的经验主题强调了政策的交叉性，以及在面临独特的军事背景因素和权力差异时的细微差别；这些都是现有研究文献中所缺乏的。他们的经验还进一步阐明了在寻求帮助时固有的“两难处境”。“两难处境”基本上是指，如果你知道自己需要帮助，那么你是理智的；但如果你真的寻求帮助，那么你就是疯狂的，不值得信赖，无法胜任工作。提出的主题集中在工作场所中服务成员的机密性缺失、单位成员的监视和指挥定向评估，以及军事心理健康服务的经验。对政策进行了批判性讨论，并对那些常常导致对自杀、治疗、预防和耻辱感的狭隘反应的想当然的假设进行了探讨。特别关注了在政策所造成的情况下，服务成员的生活经历，这些情况在某些情况下可能会导致进一步的痛苦。本文最后提出了参与者和作者对政策制定者的建议，以及未来研究的方向。
