Barriers Military Spouses Face in Getting Mental Health Help
I can’t get counseling.
Everyone will know.
My active duty spouse’s career will be negatively impacted.
My deployed spouse will worry about me.
My spouse will not be proud of me because I am not as resilient as I am supposed to be.
Counselors won’t understand the unique nuances of the military lifestyle.
I don’t know where to find a counselor.
I don’t have time.
It’s too expensive.
Service members can perceive stigma related to seeking mental health help because they believe seeking help could negatively impact their career, they could be viewed differently, and feel negatively about themselves because they are in therapy (1, 2, 3).
Confidentiality, or lack thereof, is a big contributor to stigma.
In the civilian world, someone can go to therapy without anybody knowing a single thing about it, but military families do not tend to have that same confidence.
Military installations are micro communities, so there is this feeling that everybody knows everyone else’s business. The impact on the family that military operations can take sometimes requires teamwork to support service members in their work and home life. Boundaries can become a little blurry.
Case in point: I think the whole squadron knew when I was ovulating so my husband could be home at the right time. How’s that for confidentiality!
When it comes to confidentiality, military spouses can even feel like they don’t even want their spouse to know they are going to counseling.
One study found that spouses wanted to shelter their service member spouse from having to worry about home life or possible career consequences that could unfurl if anyone found out a family member had mental health problems (4).
This same study also identified that military spouses internalized a value to be self-reliant, not needing help from anyone else.
This was definitely part of my experience.
I (mistakenly) perceived that my husband would think less of me if he knew I was struggling the way I was. He didn’t have those struggles, he made resilience look as easy as breathing. I figured it must be easy for those other spouses who were handling things just fine. I believed something was wrong with me because I was struggling. This belief only fed into my little personal narrative of being “less-than”, and made me strive harder to look like I had it together.
Stigma, concerns for confidentiality, and an expectation of self-reliance represent internal barriers to seeking mental health help.
There are some external barriers that military spouses experience, too.
Research identified external barriers of time, effort, and logistics, such as childcare, transportation, and scheduling (4).
This research article is old, and it had a very small sample size. I think some of these factors are highly dependent on rank and type of job within the military, but it makes sense to me that time is a big factor.
I wrote previously about how this lifestyle often keeps us in a state of transition, without the certainty of knowing how long we will be anywhere. It takes time to feel settled enough to think about therapy, and by the time you get around to scheduling therapy you might find out you are moving. It can be hard to start therapy knowing that you’ll have to start all over again at the next duty station.
The demands of a service member’s job can bring an atmosphere of unpredictability to the home.
Spouses with children may be struggling to juggle time to schedule the routine things in life, much less fit in a weekly therapy session.
Another, much larger study echoed these external barriers and also found that military spouses valued a therapist who understood military culture and did not know where to find a therapist they could trust. These spouses were also worried that information would not be kept confidential (5).
Anecdotally, I can share that everyone in the country seems to be facing the barrier or availability. Many therapists have long waiting lists, and those that don’t are usually the ones who don’t take insurance so affordability also becomes an issue.
So, how can we address some of these barriers?
Some of these barriers are systemic, with much bigger fixes than we can completely tackle on our own. It is encouraging that the DoD is working on systemic changes. A 2017 article highlighted the fact that the DoD is working to modify the ideal of a warrior to be someone who seeks help. They noted that the DoD is designing policy to encourage utilization of mental health services (6). The DoD’s recent special report by the Suicide Prevention and Response Independent Review Committee (7) highlighted a number of practical, specific changes aimed at reducing suicide numbers. Many of these changes focus on improving family well-being. One example that directly benefits us as military spouses is a recommendation to improve availability of affordable childcare so military spouses have one less barrier to meaningful employment. This would help military spouses be able to get to therapy, too!
I remember the first time a senior leader spouse encouraged me not to suffer in silence.
Her words were life-giving to me, and very different from what I had heard from other military spouses along the way.
It is my hope that the more we all start normalizing mental health struggles and getting healthy ourselves, we can create a ripple effect of safety and resilience.
Practically speaking, there are some considerations to therapy options that military spouses may not be aware of. I am not sure there is a perfect solution that addresses every barrier perfectly, but you can decide which barriers are most concerning to you and hopefully find some options.
Telehealth
To address confidentiality, accessibility and maybe even childcare (if you schedule during naptime), thanks to COVID, most therapists will do telehealth appointments now. You could schedule therapy in your own home and nobody needs to even know you are going to therapy.
Military and Family Life Counselor
If your installation has a Military and Family Life Counselor (MFLC), active duty service members and dependents can see an MFLC for confidential help with some of the more preventative issues and non-medical mental health help. These are things that insurance may not reimburse for, such as managing stress, dealing with deployment or relocation transitions, relational help, grief, or work stress. It is so confidential that they do not even keep records. In some cases, MFLC’s are assigned to installations for short terms, so if you want longer-term help you might be in the position of getting started and then having to change therapists.
Using an MFLC addresses the barrier of confidentiality, accessibility and affordability, as well as provides the peace of mind of working with someone who understands military culture.
Using Insurance to See an Outpatient Mental Health Provider
Seeing someone outside your military installation can address the confidentiality concern that someone might see that you are going to counseling. Using your insurance benefits can address the barrier of affordability.
Spouses and family members may or may not need a referral from your primary care provider. If the therapist is in network with Tricare, they usually do not need a referral, but if they are considered Out of Network (which is different from just not taking Tricare) or a Non-Network Provider you may need a referral and you may need to pay a co-pay. The best thing to do if you want to use insurance is to ask the therapist you want to see whether you need a referral, and then call Tricare as well to make sure everything checks out on their end.
You can use Tricare’s website to see who they contract with in your area (https://tricare.mil/networkproviders). I have also had luck with the therapist directory on Psychology Today (www.psychologytoday.com). On that directory, you can filter by insurance so only therapists who take Tricare will come up. In reality, therapists can be a little lazy about keeping this updated, so you will still need to call that therapist and check with them.
NOT Using Insurance to See an Outpatient Mental Health Provider
Why would anyone not want to use their insurance benefits?
Right now it is really hard to find therapists with availability who take Tricare. In addition, spouses who are concerned about confidentiality issues may want to avoid getting an insurance company involved with their care. Especially a military spouse who doesn’t even want her service member spouse to know she is getting mental health care (I am not recommending hiding this information from your spouse, but if the only way you’ll go to therapy is to do so without telling your spouse, then hey, it’s a start. In cases where domestic violence is an issue, it can be outright dangerous to tell a spouse you are getting therapy).
There are some things that insurance does not reimburse for, which would generally be the same things that MFLCs will work with. For example, if you want some kind of preventative care or couples counseling. It is possible to get couples counseling reimbursed by insurance but somebody will to have a reimbursable diagnosis to do so. If you are going to counseling for preventative care and do not need a diagnosis, you may not want one attached to your medical record forever.
It might be that you want to work with a specialist, and you may or may not be able to find one with Tricare. In my practice, many women seek me out because I offer Christian Counseling, and I also offer EMDR Therapy as specialty areas. I have lived experience as a military spouse and a passion for working with this population. You can find people who take insurance and offer those services, but they may not have availability for new clients.
The downside to private pay therapists is of course, you are paying out of pocket, which can get expensive.
Other Helpers
Additional options for care can include lay counselors in churches, Chaplains and church leaders, as well as life coaches. Currently there are no regulations on the type of mental health training these types of helpers receive, which can impact the type of help they provide as well as their requirements for confidentiality.
There are really highly-trained, ethical professionals and lay counselors working in these categories, but it will take some work on your part to determine if they have the training to meet your needs.
If you need help figuring out how to get mental health help while you are at Carlisle Barracks, please feel free to reach out. Yes, of course I am posting this article to let people know I am an option, but this is part of my greater passion to encourage military spouses to get help from someone, whether it’s me or someone else. I know I am not the best fit for everyone, but I am willing to have a free phone conversation (717-219-4339) to help point you in the right direction.
Don’t suffer in silence!
There are ways to move past these barriers and get the help you deserve to be able to live your life with authenticity and satisfaction.
References
(1) Britt, T. W., Jennings, K. S., Cheung, J. H., Pury, C. S., & Zinzow, H. M. (2015). The role of different stigma perceptions in treatment seeking and dropout among active duty military personnel. Psychiatric Rehabilitation Journal, 38(2), 142-149. https://doi.org/10.1037/prj0000120
(2) Cornish, M. A., Thys, A., Vogel, D. L., & Wade, N. G. (2014). Post-deployment difficulties and help seeking barriers among military veterans: Insights and intervention strategies. Professional Psychology: Research and Practice, 45, 405–409. https://doi.org/10.1037/a0037986
(3) Valenstein, M., Gorman, L., Blow, A. J., Ganoczy, D., Walters, H., Kees, M., & ... Dalack, G. W. (2014). Reported barriers to mental health care in three samples of U.S. Army National Guard soldiers at three time points. Journal of Traumatic Stress, 27(4), 406-414. https://doi.org/10.1002/jts.21942
(4) Becker, S. J., Swenson, R. R., Esposito-Smythers, C., Cataldo, A. M., & Spirito, A. (2014). Barriers to seeking mental health services among adolescents in military families. Professional Psychology: Research and Practice, 45(6), 504-513. https://doi.org/10.1037/a0036120
(5) Lewy, C. S., Oliver, C. M., & McFarland, B. H. (2014). Barriers to mental health treatment for military wives. Psychiatric Services, 65(9), 1170-1173. https://doi.org/10.1176/appi.ps.201300325
(6) Morin, M. A. (2017). Department of Defense institutional responses to increase engagement in mental health services among active-duty men. Psychology of Men & Masculinity, 18(3), 251–255. https://doi.org/10.1037/men0000124
(7) Department of Defense (2023). Preventing suicide in the U.S. military: Recommendations from the Suicide Prevention and Response Independent Review Committee. Retrieved from https://media.defense.gov/2023/Feb/24/2003167430/-1/-1/0/SPRIRC-FINAL-REPORT.PDF
Jennie Sheffe is a National Certified Counselor ™ who helps women find freedom from anxiety and peace in their chaos. She sees clients virtually in the state of Pennsylvania, or in her Carlisle, PA office. She offers Christian counseling and EMDR Therapy.
