155 7 GENERAL CONCLUSIONS AND DISCUSSION decision and the decision to seek treatment for MHI. These decisions, including the role mental health stigma plays in these decisions, will now be discussed in more detail. Figure 1. Four key problem areas of stigma for sustainable employment of people with mental health issues and illnesses (1). The decision of whether or not to seek treatment for mental health issues and illnesses Previous research suggests that stigma forms a problem for sustainable employment and well-being at work of military personnel as it can form a barrier to treatment-seeking (figure 1). Therefore, the first aim of this thesis was to gain insight into the decision of whether or not to seek treatment for MHI within the Dutch military, and to what extent stigma plays a role in this decision. For this purpose, both qualitative and quantitative studies were conducted. The qualitative study was used to explore the topic, and the quantitative study was used to confirm and expand the qualitative findings. The qualitative study (chapter 2) consisted of eight focus groups, with a total of 46 participants, including three perspectives (military personnel with MHI, military personnel without MHI, and mental health professionals). Five barriers to treatment-seeking were identified, most of which were stigma-related: fear of negative career consequences, fear of social rejection, confidentiality concerns, the ‘strong worker’ workplace culture and practical barriers. Additionally, three facilitators were identified: social support from family, supervisors and peers, accessibility of health care and knowledge of where to seek treatment, and healthcare organized within the military. The three perspectives were highly congruent.
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