Why active duty GIs seek health and mental health services in the civilian sector

Objectives: 1) To clarify the experiences of active duty GIs seeking civilian health and mental health services. 2) To assess civilian-sector services as an alternative to address limitations of military-sector services. Methods: Two researchers independently conducted thematic analyses of qualitative data collected during intake and follow-up interviews with 27 clients randomly selected from 292 consecutive GIs referred to the Civilian Medical Resources Network. Analyses were reconciled and refined through an iterative process. Results: Several key themes emerged: Mistrust of command – Clients reported that they did not trust the military command's ability to meet their needs effectively. Deception in recruitment – GIs emphasized deception by military recruiters during enlistment; examples of deception included job descriptions, expected bonuses and benefits, and services to be provided for family members and dependents. Double agency – GIs' individual needs conflicted with military priorities that military professionals considered; clients reported that military professionals tended to ignore or to downplay the severity of an individual's healthcare needs in order to maintain the military unit's strength and effectiveness. Family/household issues – Clients indicated that family members' health, social, and financial needs were addressed inadequately; becoming Absent Without Leave (AWOL) could result from perceived unmet needs for services. Economic problems – GIs described financial hardship as a cause for undue stress and/or inability to find adequate health care and social services. Geographic isolation – During deployment or at rural bases, clients perceived mental or medical health services as unavailable or inadequate. Reason for using civilian services – Clients turned to the civilian sector due to overwhelming situations with limited options for seeking help. We found no tendency toward ethnic/racial differences in reporting the themes of mistrust, double agency, economic problems, or lack of services. White and Hispanic clients tended to report more family/household issues than did African Americans. However, African Americans reported greater impact of geographic isolation. Conclusion: GIs who sought services in the civilian sector reported major social contextual problems that created difficulties in receiving suitable services from military professionals. Concerns deriving from social class and financial conditions appeared more prominent than concerns related to race/ethnicity. The findings indicated the importance of developing opportunities for civilian services to meet the needs of active duty GIs. Inherent contradictions and barriers to care within the military sector require more explicate attention in developing suitable policies to address the current public health crisis affecting military personnel.