154 7 CHAPTER 7 GENERAL CONCLUSIONS AND DISCUSSION This thesis focused on mental health stigma in the military and the influence this has on health-related decision-making (treatment-seeking and disclosure) and ultimately on sustainable employment and well-being at work. Specifically, the three main aims of this thesis were to gain insight into 1) the decision of whether or not to seek treatment for mental health issues and illnesses (MHI) within the Dutch military, and to what extent stigma plays a role in this decision, 2) the decision of whether or not to disclose MHI to a supervisor in the Dutch military, and to what extent stigma plays a role in this decision, and 3) the association between actual disclosure decisions and disclosure experiences and subsequent sustainable employment and well-being at work in the Dutch military. First, the problem of mental health stigma in the Dutch military will be discussed, followed by the main findings per aim of this thesis. In addition, implications for practice, policy, and future research will be discussed along with strengths and limitations. Finally, this chapter ends with overall conclusions. Mental health stigma in the Dutch military The current thesis showed that both anticipated and experienced mental health stigma exist in the Dutch military. The qualitative studies (chapters 2 and 4) of this thesis showed that there was anticipated stigma related to treatment-seeking and disclosure of MHI to a supervisor. For example, there was fear of negative career consequences and fear of social rejection. This was not only perceived by military personnel with MHI, but also perceived by military personnel without MHI and mental health professionals. The quantitative studies of this thesis (chapters 3 and 5) confirmed the existence of both anticipated and experienced mental health stigma in the military. Approximately no less than one-third of military personnel with MHI feared that seeking treatment or disclosing their MHI would lead to social rejection (public stigma), others treating them differently (discrimination) and negative career consequences (discrimination), indicating that there was anticipated stigma. There was also experienced stigma. For example, onethird of military personnel with MHI who disclosed to their supervisor indicated that there was gossip about them, and approximately one in six indicated that they were discriminated against, socially rejected, and had negative career consequences (chapter 6). Finally, of the military personnel with MHI, half indicated that they saw themselves as weak due to their MHI (self-stigma) and that they felt ashamed of their MHI (chapters 3 and 5). The findings of the current thesis thus showed that mental health stigma exists in the Dutch military. Previous research suggests that mental health stigma forms a barrier to sustainable employment and well-being at work through four problem areas (figure 1) (1). The current thesis focused on two of these problem areas, namely the disclosure
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