“I’m Not Sure I Trust the System Yet”: Lesbian Service Member Experiences With Mental Health Care Sarah D. Mount University of Nevada, Las Vegas Sarah M. Steelman Virginia Polytechnic Institute and State University Katherine M. Hertlein University of Nevada, Las Vegas The purpose of this research was to understand lesbian service member experiences with mental health care. Individual and organizational factors were explored, including the influence of military policy (e.g., “Don’t Ask, Don’t Tell”) on service member utilization of mental health services. Thirty-seven participants responded to a survey containing 16 open-ended items regarding the impact of “Don’t Ask, Don’t Tell” on one’s professional life, relational life, identity, and willingness to access mental health services. Data were analyzed through an open- and axial- coding and constant comparative method. The findings indicated a lesbian service woman’s likelihood of accessing mental health services was impacted by confi- dentiality concerns, fear of repercussions, and a sense that military culture lags behind policy changes. Recommendations for therapists included renewed focus on safety through affirmative practices, need for competency in military and lesbian/ gay culture, and sensitivity to the effects of systemic oppression on self-esteem. Implications and future research are discussed. Keywords: lesbian, service members, military, DADT, mental health The repeal of “Don’t Ask, Don’t Tell” (DADT) gave impetus to a new era within the ranks of the U.S. military. The landmark de- cision, signed into law on September 20, 2011, marked the end of over 100 years of antigay policy in the military and allowed lesbian and gay (LG) service members to serve openly for the first time in American history. In the years preceding repeal, re- search assessing the impact of DADT on LG service member mental health consistently uncovered feelings of rejection, depression, anxiety, increased substance use, and stigma- tization and victimization (Burks, 2011; Es- trada & Laurence, 2009; Estrada, Probst, Brown, & Graso, 2011; Moradi, 2009). The psychological effects of concealing one’s sex- ual orientation to avoid stigmatization are well documented in the general population ( Bolton & Sareen, 2011; Hatzenbuehler, 2009; Hatzenbuehler et al., 2010; Pachankis, 2007). Specifically, concealment often re- sulted in experiences of hypervigilance, pre- occupation, anxiety, depression, guilt, shame, social avoidance, isolation, increased effort in impression management, and an increased re- liance on feedback (Pachankis, 2007). Other effects noted in the general population in- cluded mood disorders such as depression, anxiety, increased substance usage, increased risk of suicide, and internalized heterosexism ( Bolton & Sareen, 2011; Hatzenbuehler, 2009; Hatzenbuehler et al., 2010). Wilder and Wilder (2012) found similar subjective and Sarah D. Mount, Marriage and Family Therapy, Univer- sity of Nevada, Las Vegas; Sarah M. Steelman, Marriage and Family Therapy, Virginia Polytechnic Institute and State University; Katherine M. Hertlein, Marriage and Fam- ily Therapy, University of Nevada, Las Vegas. Sarah D. Mount is now at Desert Parkway Behavioral Healthcare Hospital, Las Vegas, Nevada. The authors gratefully acknowledge the contributions and mentorship of Dr. Markie L. C. Blumer in the early devel- opment of this project. Correspondence concerning this article should be ad- dressed to Sarah D. Mount, Desert Parkway Behavioral Healthcare Hospital, 3247 S. Maryland Parkway, Las Ve- gas, NV 89109. E-mail: mounts@unlv.nevada.edu This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Military Psychology © 2015 American Psychological Association 2015, Vol. 27, No. 2, 115–127 0899-5605/15/$12.00 http://dx.doi.org/10.1037/mil0000071 115