Seeking Mental Health Care in The United States Air Force **TW: Self Harm**

30 December 2022

I also want to preface this by saying what I'm sharing is strictly MY experience and not the experience of anyone else. Nor do I have any agendas or goals other than just releasing and sharing this experience in my life.

Towards the tail end of 2020, I chose to seek counseling through military one source. The stress of the pandemic, several of the social justice cases, the election year, leading D&I conversations and other situations at work left me feeling overwhelmed. I participated in a virtual session with the first counselor I could find. She seemed nice, told me that I would have to choose one issue to work on, but after her personal phone rang while I was pouring out my feelings to her and she hung up with me to answer the call, then came late to our second session, I discontinued speaking to her.

By early 2021 I saw a different counselor through Employee Assistance Services (they are a counseling service through a partner organization I was connected to) to discuss my issues. We talked every two weeks over the phone and our sessions were extremely helpful. He told me, that the experiences over the past year have allowed me to become more aware of, "my blackness" and that I don't need to confront or get answers to everything at once, and that it is a PROCESS." I left my sessions with him feeling extremely secure in who I was, confident in the direction I was going and hopeful for the future.

By August of 2021, my world turned upside down when I learned some devastating things about my family. I told my Commander (CC) at the time, he referred me to some counseling services, and I immediately took advantage of it. The Air Force Group that I am a part of has what's called an "Airmen's Resiliency Team (ART)." This team is comprised of a medical doctor, Chaplain, Psychologist and medical technicians who assist. I first sought treatment with the Chaplain. He was helpful in acknowledging that the feelings I was feeling were totally valid and provided helpful insight on how I was in a situation where the foundation I once had was destroyed and that I will need to relearn how to trust.

I think it was around mid-September 2021 when I met with the Psychologist. He too validated my feelings and acknowledged that everything I was going through was a lot. We decided to work on my issues one at a time. He recommended that I “give the Air Force less” and even consider postponing our January wedding to possible later in the 2022 summer.

By December the Psychologist, recommended that Michael and I see a marriage counselor. By this point I thought I was getting better as I was functional and avoiding things that could trigger me but then he asked me, "what do you see for your career? Do you want to stay in the AF?" I felt very confused that he was even asking me this question. I had never seen my life where 20 years in the Air Force was not a part of my plan. He then told me that from what he'd seen and experienced, the culture in the Air Force is extremely "toxic."

By mid-December 2021 Michael and I started going to the Marriage and Family Life Counselor (MFLC). Although she was assigned to a maintenance unit (not my career-field), she agreed to see us. She was PHENOMENAL. Patient to Client match is VERY important and for Michael and I, she was it. We went to the states for our wedding in January, we were doing well when we returned, life was good.

By March 2022, the world turned upside down for me again. A combination of significant stressors at work + catching covid + family stuff, left me in one of the darkest places of my life. Being left in isolation as I was going through it didn't help either, and after feeling an insurmountable amount of mental and physical pain, I made a choice I had never before done in my life to hurt myself. My intent at that time was to simply (at least I thought) transfer the pain from my head to somewhere else. What I later learned was that I had opened a door to something that would be significantly darker and would be beyond my ability to control.

Two weeks later I confessed to Michael what I had done, and we immediately went to the MFLC. In those two weeks prior to my confession, I learned that the pain was not going to just go away. I told myself that I could either attempt to preserve the life/career I had by holding my pain in/suppressing it, or I could risk losing my career and the image I created of my life in order to save myself. I chose the latter, but it wasn’t easy. I had worked myself up to be respected and established in my career, I have a high security clearance, I was highly likely to promote; I didn't know what confessing this stuff-reporting myself would do to my career. The MFLC told me that I was walking a slippery slope, that I need to take myself more seriously and that I need to get medical care from mental health in order to get on anti-depressant medication.

This is where the experience became EXTREMELY frustrating for me.

I called the base mental health office, told them what I had done and that I needed to be seen and they said the next appt they had available was in two weeks. I told them repeatedly that I need something sooner and they kept asking me, "Are you going to kill yourself?" Initially I said no but after being more and more explicit about what I had done, the technician gave the phone to one of the providers and she saw me that day. The provider was black, a woman, a Captain, and very empathetic and understanding to what I was going through. I felt very safe with her. Unfortunately for me, she was starting her mid-tour and wouldn't be available for the next month. I couldn't wait a month for care, so she paired me up with another provider within the Mental Health department.

Two weeks later I met with the new provider. I asked to get medication (per the recommendation of the MFLC) and me being the patient and not knowing how all of this worked, he explained to me my options. He shared how he offers a weekly stress management course, how there is another diabolical therapy course, how there is the Psychiatrist available, but it could take some weeks to see him, or we could continue triage in order to determine what is the best course of care for me. I chose the last option with enrollment in the additional stress management course.

For the first couple of months this plan kept me functional. While I only was able to have a one-on-one appt with my provider every two-three week, the fact that he also led the weekly stress management course, helped me feel like I was receiving some semblance of continuity in care. My appointments also allowed me to get some reprieve from some of the environments that caused me pain, while the community I experienced during the stress management course helped me gain perspective and learn that I was not alone. This set-up worked.... until it didn't work.

By May to the end of June I started to feel extremely fatigued with work. Then because work fatigued me, that would create conflict when I was home. So I started to feel like there was no place mentally and emotionally "safe" for me. I didn't feel like there was anywhere where I could fall apart and that I always needed to be "on" or "okay" for someone else. This rapidly exhausted me. I started to notice that I could function but when something upset me, my thoughts became more and more extreme. It started to not take much for me to feel upset and even though I knew some of the causes for my feelings were ridiculous, I wasn’t able to stop the painful feelings that followed. To cope with the feelings, I started to hurt myself more. This then created more conflict in my marriage, when Michael would find out. I shared all of this with my therapist, and he would say, "You're still doing this?" I would show him my self-harm scars. "We are going to work on that," was his response.

By June I saw the Psychiatrist. He too wanted to see my self harm scars so I showed them to him. I was placed on a very low dosage of anti-depressants by the end of the month. I also continued to see the MFLC with Michael and she was extremely frustrated with my care at the mental health office. She wasn't happy that I had started seeing them the first month of April and didn’t receive my first round of medication until the end of June. She wasn’t happy that I was only being seen by a provider every three weeks and despite my communication of my self harm, there wasn’t a sense of urgency to elevate my care. As a patient unfamiliar with the mental health system, I didn’t know what to expect or what to do other than just tell the truth. I also was suffering mentally, emotionally, and mentally which limited my ability to repeatedly advocate for myself. She then asked me was I telling them everything I'm telling her. I told her yes. I sensed some doubt from her. She mentioned that the way I was composed, the way I say things suggested differently. I was confused. Michael and the MFLC provider both seemed frustrated. I felt like I was at fault or doing something wrong. “What else do I have to do for others to believe my pain?” I thought.

By mid-July after flagging on one of my questionnaires, my mental health provider pulled me aside and asked me do I feel like I need something more intensive. I said yes. I feel like I'm getting worst. He then got my leadership team involved for a treatment team meeting (TTM) and presented me with the option to go to a month-long Trauma Intensive Outpatient Therapy Program (IOP). I agreed to go.

At this point I had a new Squadron Commander and new first sergeant. Both were supportive of the therapy. My CC chatted with me one day and said that in the four days she has met me, I am always smiling and laughing. That it was hard for her to know that underneath all of that, that I was carrying so much pain. She then said to me that, "its okay to not be okay".

After that discussion I reflected. Is that what's taking so long for me to get the care that I need? Is it the way I am carrying myself that is causing other people to not take the pain that I am expressing and acting on seriously??? Is it really okay for me, an officer, a "high performer," a Black woman, to show my pain?

The last week of July is when everything fell apart. I was one week away from IOP and was looking forward to spending the month of August getting the elevated medical care that I really needed but took about a year for me to be presented with the option to go. I remember my last day at work, looking at my computer and not being able to read the words. It was like they were blurry to me because it was so difficult for me to concentrate. I told myself that after this I just had one more day and I just needed to hold on a little bit longer.

July 28th, I met with the counselor at Camp Humphreys, a U.S. Army base 30 minutes south of Osan AB. They told me that, "while the actions that occurred in August 2021 were very traumatic, they would be categorized as 'life altering' rather than 'life threatening'. I know you want to discuss what happened in August but you were enrolled in our trauma program because of your sexual assault in college. In order to proceed in the program this is the trauma you would need to work on." At that time, I did not see how this trauma was relevant to the issues I was experiencing in the present moment, neither had it been discussed at any depth in therapy, so I was FURIOUS. The next IOP therapy that was more suitable for my needs was 6 September. I was DEVASTATED. I couldn’t fathom the idea of having to carry and mask this pain for another month.

That night I couldn't stop the thoughts of DIE DIE DIE. I thought I'd be able to control it but I was in such a state of pain, fatigue, and depression that it was like something else took over.

The next day I woke up, had a panic attack, refused to go to work, or back to my same therapist and by that Monday was hospitalized. My MFLC provider told me that our mental health system had failed me. I had been hurting for a very long time, and hopefully now I could get the help that I needed. She told me that the current diagnosis I had did not seem accurate and to make sure that while I was in the hospital, to insist that the Psychiatrist properly diagnoses me.

It wasn’t until after I was hospitalized and completed the IOP therapy where I started to feel some relief. I did have some experiences of concern while I was in IOP, as my Psychologist in the program told me, "The Air Force is an abusive system....The same thing that's been happening to your grandma, to your mom, is now happening to you [racism]. It’s not getting better anytime soon.... You're going to go through the month long IOP and not get better. I can counsel you 23 hours of the day, daily but the hour you return to work, it’s not going to fix the problem...we can start a Medical Evaluation Board package for medical retirement as soon as October 4th." While these comments definitely placed my guard way up and added a thick extra layer of pressure on me to make a decision about my career that I really wasn’t in the mental state to make, the experience in its totality was very good. The Acceptance Commitment Therapy (ACT), group and individual therapy sessions helped save my life (after I expressed that I just want to focus on my care and make a decision about my career at some point after the program). I've adopted the attitude of taking the meat and leaving the bones when it comes to IOP. Thankfully there were a lot more meat than bones.

Reflecting on all of this I can't help but have compassion for myself in going through this mental health system. I’ve learned that despite my actions, I really DIDN'T want to die. I was just SO EXHAUSTED and TIRED of being in so much mental, emotional, and physical pain. I think the thing about mental illness is that it can be very easy to not believe that you have it. I would formerly pride myself on my ability to push through issues. To "Overcome." I believed I belonged to an organization that celebrated excellence over mediocracy; our ability to multi-task, achieve outcomes, to be given more work with less resources; to drop personal boundaries as a sign of commitment or loyalty. At least that was MY initial understanding of "service before self". I no longer believe this anymore because this mentality, was KILLING me. Now that I am in a healthier state of mind, I can see just how mentally SICK I had become. And how being in that sick state for too long almost killed me. I once broke my leg in college and it turned black, purple, twisted and swelled up. I had to get surgery, 1 plate and seven screws put in, was on crutches and went through physical therapy for 6-9 months. There was no doubt of the legitimacy of my pain. This mental illness honestly is not much different only the pain and injury is within. It's invisible and more difficult to "prove".

I now am adopting a mentality of if I don't take care of me, I will be no good for anyone else. And if that just means I have a lower capacity of production or sphere of influence, than that's just what it is. Significance cannot be measured in size or output. And that’s my focus now. Significance.

One of the nurses in the hospital shared with me how there are only four Psychiatrist on the Korean peninsula because with this being a hardship tour, they expect people to be screened for mental health issues before they arrive, so care is limited. She also shared how the military doesn't place a lot of funding into mental health as a whole. I haven’t done any research to corroborate what she said but her comments did make me think. Mental health issues in the military are nothing new. In fact, I took an entire class in undergrad about the impact of combat stress on veterans. It seems like there is so much attention on treating veterans living with the effects of the stress but what initiatives are done for prevention? What actions are being done to support prioritization of an Airmen’s ability to develop and preserve both awareness of self, their environment and ultimately becoming more emotionally intelligent? The best thing for me was to GET OUT of the environment that was hurting me and place myself into a safe space with community and professionals who could teach me skills to identify, process, and healthily respond to the stressors I was experiencing. I needed to be in a supportive environment and to be placed in an environment where I could be rehabilitated in order to recover.

Over this year of treatment, I have had two therapists describe the Air Force as "toxic and abusive" and further encourage me to get out. I am still in a mindset that my overall experiences in the Air Force have been more positive than negative which is why, now that I am in a healthier state of mind, the decision to stay or move on is not an easy one; nor do I want to rush a decision.

I just wonder how many people holdback from seeking mental health services out of fear of the consequences. Or from shame, pride, disbelief or denial of how sick they are becoming, poor quality of care, or fear the stigma that may come with it? Or even worst, they seek help and are not believed. I went through all of this as a Senior Captain with very good verbal communication skills and a stellar performance record. What about others who don't have the rank, or skills or "career credibility"? What are they going through? What does it take for them to be believed or receive quality care?

Occasionally I do wonder if people really seized the care within the mental health system rather than internally battling on their own just surviving or in other cases, not surviving, would that inspire a shift in the culture to be one of more prevention of toxicity, of committing and clearly communicating clear priorities, and ultimately a healthier environment?