Pentagon Scrubbing All Policies of Language That Stigmatizes Mental Health Conditions

An effort is underway in the Pentagon to remove language from Defense Department policies, regulations and instruction that stigmatizes mental health conditions and discourages service members from seeking help.

Deputy Secretary of Defense Kathleen Hicks issued guidance earlier this month to DoD leadership instructing them to "scour through all documents" to ensure they do not contribute to negative perceptions of mental health conditions or serve as barriers to care.

Hicks said Tuesday the department wants to ensure that it is not inadvertently adding to the stigma associated with mental health, treatment or care.

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"I put out guidance ... to remove language that stigmatizes ... language that was very normal in those issuances maybe 20 years ago but are not reflective of where the behavioral health community is today," Hicks said during a forum on military health hosted by The Washington Post.

"Issuances" include all policies, procedures, regulations and instructions. Under the guidance, those that don't adhere to current medical practice or use negative adjectives to describe mental health conditions, behavior or symptoms would be candidates for change, as would any policy that "implies incompetence in persons with mental or behavioral health disorders."

Policies that prohibit actions such as promotions or restricting the use of firearms solely because a service member has a mental health diagnosis also will be reviewed, as would any that allow a non-mental health professional to make a mental fitness assessment of a member.

Regarding language, some of the words that would be struck include terms such as "substance abuse," which would be changed to "substance misuse"; "mental institution," in favor of "psychiatric treatment facility"; and "irrational behavior" for something more specific or clinical -- "unusual," "impulsive" or "uncharacteristic" behavior.

"Policies should be precise in language in order to maximize clarity and minimize confusion. In general, broad or umbrella terms, such as 'mental,' should be used consistently across policies to avoid confusion or misunderstandings around the word's meaning," the guidance states.

According to the 2018 DoD Health of the Force study, roughly 16% of all military medical appointments, or 1.8 million outpatient visits, were for behavioral health. Diagnoses of mental health conditions among troops have remained fairly steady, at about 8% of the total force diagnosed in 2018.

A 2014 study conducted by Rand Corp, a Washington, D.C.-based think tank, found 203 DoD policies that may contribute to stigma; for example, an Army policy that required soldiers have no "mental instability to be eligible for recruiting duty." The policy failed to state what constitutes instability, or whether a troop whose health condition was managed would be eligible for recruiting duty.

"Without clarifications and updates to policies, DOD will be hampered in meeting its policy goal of reducing stigma," noted the Government Accountability Office in commenting on the Rand findings.

A review of policies published in 2021 by the Defense Health Agency's Psychological Health Center of Excellence found that of 285 DoD policies on mental health and substance misuse, 67% contained language that could potentially be stigmatizing.

The review noted, however, that DoD had reviewed its mental health-related policies and changed to 59% to adopt updated or neutral language.

Hicks did not specify a time frame for the work to be completed. A Pentagon spokesman said Tuesday, however, that the library is "vast" and the review is ongoing.

The scrutiny comes at a time when the Pentagon has come under fire from conservative politicians and advocacy groups for introducing policies and language aimed at expanding diversity and inclusion in the ranks -- efforts critics call a "woke agenda" they say is undermining combat capability.

But medical experts say that words matter, at least when it comes to mental health stigma and language.

In a paper published last year in the journal Neuropsychopharmacology, National Institutes of Health leaders said negative perceptions of mental health conditions and treatment can serve as barriers to care and prevent effective treatment.

But efforts to reduce stigma, through careful language, can reduce negative thoughts and biases toward mental health, not only among patients but the general population.

"This kind of shift in mindset is crucial for mobilizing needed resources toward the provision of quality mental health and addiction services and eroding the prejudices that keep people who need those services from seeking or receiving them. It is also crucial to help educate the wider public about conditions that have long been, and continue to be, greatly misunderstood," wrote Dr. Nora Volkow, director of the National Institute on Drug Abuse, and others.

Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime

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