WASHINGTON — The Army staff sergeant knew something was seriously wrong when he still couldn’t sleep weeks after returning from Afghanistan. But he never considered going to Army psychiatrists.
"There’s still too much of a stigma in the military with seeing a therapist," said the solider, who asked to remain anonymous. "People are going to call you psycho. Even if people just see you going into the mental health offices, they’re going to think you’re crazy."
The sergeant did get help, but through the non-profit counseling organization Give an Hour. He’s been seeing a psychiatrist for nearly two years now, after duty hours and without his colleagues’ knowledge.
Military officials have redoubled efforts over the last year to encourage troops like that solider to seek therapy for a range of post-combat mental health issues, before they grow into destructive habits or criminal behavior. But most of those efforts have focused on ways to pull troops into military counseling programs, and outside groups say those official programs still lack the compassionate, trustworthy approach needed to appeal to those suffering from psychological trauma.
"Whether it’s real or perceived, there’s still the idea that seeking help is going to hurt your career," said Barbara Van Dahlen, founder of Give an Hour. "Families, too. If the military knows that you’re having problems, or if someone in the family is struggling, that’s not something troops want their superiors or peers to know."
Pentagon leaders, including Defense Secretary Robert Gates and Joint Chiefs Chairman Adm. Mike Mullen, are making efforts to eliminate the stigma of receiving treatment for the "invisible wounds of war," outside groups acknowledge.
Resiliency training, public service announcements and battle-buddy briefings on signs of suicidal thoughts have become standard throughout the ranks. Defense officials have changed security clearance applications to minimize questions about mental health services. Top officials, including Army Gen. Carter Ham, have publicly shared their own experiences with combat stress.
But last week, at a joint Defense Department and Veterans Affairs conference on military suicides, Mullen told service experts that "we’re not breaking through quickly enough" and that the services need "a much broader network of anonymous help that is effective."
That anonymity can’t be found within the military system, according to Carter Andrews, chairman of the mental health counseling nonprofit Not Alone. Troops he hears from would rather vent online anonymously than schedule sessions with their military counselors, even if they promise confidentiality.
"Their commanders are the people who put them in this position, in the troops’ eyes," he said. "Military leaders talk about getting rid of the stigma of those who need to get help, but when bad things happen, those troops lose that ability to trust. They don’t want to talk to the Defense Department or Veterans Affairs."
Andrews said the typical path for servicemembers and their families seeking his group’s services starts with anonymous posts on their message boards, followed by counselors reaching out with general advice and encouragement.
Eventually, as trust is built up, the mental health experts persuade posters to come into online chat sessions, then face-to-face group therapy. Sometimes they even find their way into formal counseling within the military or Veterans Affairs.
"Forget confidentiality, these guys need anonymity when they start off," he said. "Eventually we want them to feel comfortable enough to end up in a more structured DOD or VA program, but most can’t start off there."
Still, the military’s latest effort to draw in servicemembers suffering quietly from lingering mental health issues involves face-to-face counseling for all troops returning from overseas combat zones. Congress mandated the change late last year, and Pentagon officials are working to implement the sessions.
Iraq and Afghanistan Veterans of America was one of the veterans groups lobbying for that counseling, but group legislative associate Tom Tarantino acknowledges its success will depend on the details of the program.
"It’s all well and good for the senior leadership to speak about eliminating stigmas, but if that idea isn’t getting down to the E-5 then it’s not working," he said. "They’ve made great strides in the last four, five years, but they’re still playing catch-up."
For example, soldiers seeking psychological counseling with Army specialists are still required to sign confidentiality waivers during their appointments, acknowledging that some information may be discussed outside of sessions.
Army officials say that only pertains to things like reports of child abuse or threats of suicide, ordinary legal requirements which non-military counselors must also abide by.
But the standard Army waiver notes that "health records are the property of the U.S. government" and "your chain of command may have limited access to information in your medical file."
Van Dahlen said the waivers, while practical, don’t take into account the fear in the minds of individuals seeking counseling within the organization that employs them.
"In a civilian setting it’s something we’d take care of sometimes formally, sometimes informally, but in a way that helps build a relationship," she said. "A soldier could read that and say ‘This may protect me, but it’s also going to screw me.’"
Moreover, "if there’s a perceived sense of betrayal it’s hard to form a therapeutic relationship with the VA or DOD," according to Charles Marmer, head of the Department of Psychiatry at New York University’s medical center and former director of the PTSD research program for the VA.
Army officials have not decided whether the forms will be used for the new post-deployment counseling sessions. But regardless of whether higher-ups have access to the counseling records, many troops will still be scared away from any on-post help.
"I was always less concerned that my chain of command would find out than I was about my fellow soldiers finding out," said Brian McGough, a former soldier who was injured in a roadside bomb attack in Iraq in 2003.
"I was sitting in Walter Reed — everyone there was getting treatment for PTSD — but I still resisted going and speaking to someone about it."
McGough, now the legislative director for VoteVets.org, said military efforts to reduce the stigma of seeking help have made only small steps in recent years. The sergeant getting counseling through Give an Hour said even if his commanders didn’t pass judgment on his psychiatric visits, he thinks his peers would.
"This way, it’s on my terms," he said. "I didn’t really want anyone else discussing my business. But I knew I needed to talk to someone."
Reporter Megan McCloskey contributed to this report.