Ask the Question: Stigma & Discrimination

Transcript of video:

In his 2nd Inaugural address in 1865, President Abraham Lincoln called upon congress 
“to care for him who shall have borne the battle and for his widow and his orphan”
This quote was later adopted as the motto for the Veterans Administration 

When the civil war broke out in 1861, the nation had about 80,000 war veterans. 
By the end of the war in 1865, another 1.9 million veterans had been added to the rolls. 
At the time, this included only veterans of union forces. 
The General Pension Act of 1862 provided disability payments based on rank and degree of disability, and initiated benefits for widows, children, and dependent relatives. 
The law covered military service in times of peace and war.  
The inclination and moral imperative to care for those who have “borne the battle”, or served, as well as their families, has existed longer than our nation.
But the federal system has always struggled to meet the ever changing and increasing demand. 
Communities have long filled the gaps, cared for their own, and embraced the moral imperative to serve those who have served and undoubtedly will continue to do so. 
But capacity and access aren’t the only barriers to veterans, service members and their families getting the care that they need. 
Stigma and discrimination play an overwhelming role in the disconnect between community-based care and the individuals that need it. 

What does stigma have to do with military veterans, service members, and their families? 
Well- in research nationwide, stigma has been identified as the #1 barrier to accessing health care for this population. 
More specifically, many veterans report feeling embarrassed or ashamed of their needs (we call this internalized stigma) 
as well as believing that providers will judge them negatively for having served or will simply not understand them or their needs (we call this external stigma). 
The perception that health care providers do not understand veterans stems from the fact that the vast majority of health care professionals have no military background 
and minimal exposure to military culture.  
With less than 1% of the US population having served in the military
and the largest portion of those who serve coming from lower middle income to working class families, 
the culture gap between health care professionals and those who serve is wide. 
As a result, many veterans and service members fear that the lack of understanding will result in stereotypes, 
pathologized interactions, misunderstandings, over-glorification, or negative judgements, 
about their identity and their experiences. 
Even the most well-meaning can find themselves entangled in stereotypical perceptions of military service. 
Stigma and discrimination are informed by the assumptions and perceptions we hold about   
the WHO and the WHY motivating military service. 
Who do we think chooses to serve in the military? 
Why do we think they choose to serve? 
What type of person do we think chooses the military? 
How do we think it affects them? 
You may think differently about a service member or veteran who enlisted immediately after the terrorist attacks on 9/11, than you do about a service member or veteran who enlisted during peacetime. 
What about those who were drafted? Do you celebrate their service? Do you feel bad for them? 
What do you make of those who go to a military academy or college first, versus those who sign on the line before they even graduate from high school? 
Understanding your perceptions and assumptions is the first step to combating stigma and decreasing the potential for discrimination. 
For many veterans, stigma exists within, in the form of shame and guilt over their needs and sometimes their deeds. 
But stigma is also imposed externally in the form of assumptions and misperceptions about who a person is based on the uniform. 
Education and exposure is the best defense. 

So, what can you do? Well- rapport begins at the front door. 

Here are some simple starting points to create a more validating environment for veterans, service members and their families:
Make sure your lobby has an American flag or the facility has one flying outside- or both! 
Even a simple handheld flag in a vase or jar on the front desk is a good start and sends a subtle but positive message. 
Encourage any staff members that have served, or who have a close family member that serves 
to wear some sort of identifier on their uniform or clothing. 
A yellow ribbon, a branch specific pin or flag pin, a lanyard that says Airforce Mom or US Army Retired. 
Remember, for many veterans, they might identify with their service branch the way others might identify with their university or college. 
Making that connection builds immediate rapport and rapport leads to improved communication and understanding in all settings, but especially in health care. 
A simple rule for main entry greeters, receptionists, and front desk staff is to acknowledge warmly and with gratitude, everyone entering in uniform, 
as well as those individuals who display service or military affiliation on a hat, shirt, or in some other clear and positive way. 
They might say:
Good morning, I noticed your hat- thank you for your service!
Or
Vietnam Veteran? Wow, let me just say, welcome home.
Consider engaging children accompanied by a parent who is wearing a symbol of service by making an exclamation such as “Wow! Your mom is a Marine? You must be very proud!”  
Please do not forget that women serve too, and they always have. 
Be sure to acknowledge the elderly woman wheeling her veteran husband into the lobby- ask her if she served too.  
If you served or have a personal connection to military service, don’t be afraid to say so. 
Just keep it light and positive and avoid telling stories about someone else’s experiences. 
Be sure you are willing to accept gratitude in return if the individual chooses to thank YOU for your service or your family connection.  
And finally, never insert or engage in political discussions or references when greeting or showing appreciation to someone who has served. 
If the individual brings it up, politely dodge or exit the conversation. 
Politics have no place in expressions of appreciation for service and are a mine field for assumptions and stereotypes on both sides. 

There are many more ways to build rapport, 
from a warm greeting at the front door to Asking the Question in the exam room. 
Rapport combats stigma and discrimination. 
The toolkit can help you find what strategies will work best for your facility, staff, and service industry.