title: Rural Women Veterans' Use and Perception of Mental Health Services.
abstract: While the total number of veterans in the U.S. is decreasing overall, the number of women veterans is significantly increasing. There are numerous barriers which keep women veterans from accessing mental health care. One barrier which can impact receiving care is living in a rural area. Veterans in rural areas have access to fewer mental health services than do urban residing veterans, and women veterans in general have less access to mental health care than do their male colleagues. Little is known about rural women veterans and their mental health service needs. Women, who have served in the military, have unique problems related to their service compared to their male colleagues including higher rates of post-traumatic stress disorder (PTSD) and military sexual trauma (MST). This qualitative study investigated use of and barriers to receiving mental health care for rural women veterans. In-depth interviews were conducted with ten women veterans who have reported experiencing problems with either MST, PTSD, or combat trauma. All ten women had utilized mental health services during active-duty military service, and post service, in Veterans Administration (VA) community based-outpatient clinics. Several recurring themes in the women's experience were identified. For all of the women interviewed, a sentinel precipitating event led to seeking mental health services. These precipitating events included episodes of chronic sexual harassment and ridicule, traumatic sexual assaults, and difficult combat experiences. Efforts to report mistreatment were unsuccessful or met with punishment. All the women interviewed reported that they would not have sought services without the help of a supportive peer who encouraged seeking care. Barriers to seeking care included feeling like they were not really a combat veteran (in spite of serving in a combat unit in Iraq); feeling stigmatized by providers and other military personnel, being treated as crazy; and a lack of interest from those providing care in hearing their stories. This study may generate positive social change by helping providers approach women veterans in a way that is sympathetic to their experiences.
authors.affiliation: University of Nevada Reno, Orvis School of Nursing. Electronic address: kingelse@unr.edu.
authors.forename: Kathy
authors.initials: K
authors.lastname: Ingelse
authors.affiliation: Oregon Health & Science University, College of Nursing.
authors.forename: Deborah
authors.initials: D
authors.lastname: Messecar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D036301:Qualitative Research; D012424:Rural Population; D012742:Sex Offenses / Q000523:psychology; D057545:Social Stigma; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D014481:United States; D014728:Veterans / Q000523:psychology*