Mental Health and The No-Fail Emergency Room

Disclaimer: I am not a mental health professional.  This is a field that unfortunately appears to have few “right” answers.  But as an observer of and leader in an organization with a seemingly intractable problem, it seems like maybe examining a new idea or two couldn’t hurt.

Imagine a local hospital advertising that 97% of their trauma-related emergency room patients survive and are released within 24 hours with minimal recovery.  It would sound to good to be true, right?  Well, imagine that upon further investigation you discover that the hospital achieves this 97% success rate by turning away any case that appears to be actually life-threatening.  Suddenly that 97% success rate doesn’t seem to reflect well on the overall system.

The military mental health system attempts to dispel the stigma and fear of actually seeking mental health services by advertising that 97% of patients are seen and treated with no adverse impact to their careers.  However, they are also very clear that anyone expressing “suicidal ideations” is going to be immediately placed under supervision, chain of command will be alerted, and so on.  Expressing a truly serious problem is going to bring about a radical and abrupt life change.

Obviously, there is a good reason for securing the safety of an individual in these circumstances.

However, I can’t shake the notion that much like the ER that turns away critical cases, the military’s own advertisement of its mental health system actively discourages the individuals who would benefit from it most.  Somehow I suspect that this contributes to the “inexplicable” trend of military suicides among individuals who never expressed any troubles at all.  Further, I suspect that this policy also discourages people who are using mental health services from being honest about the extent of their problems.

Clearly there are ethical issues that would be in play if the military mental health system instituted a 100% confidentiality policy instead of a policy that forces providers to disclose suicidal ideations to leadership and law enforcement.  I’m not suggesting it’s the right idea, or even a good idea.  But the fact that our own attempts to destigmatize the military mental health system seem to exacerbate the problem seems worth addressing.


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