164 7 CHAPTER 7 they had substance use related MHI, which is a very sensitive topic in the military, we believe that participants felt safe enough to guarantee honest answers. Implications for practice Based on the results of the current thesis, several recommendations can be made for practice and future interventions which can facilitate the decision to seek treatment for MHI and to disclose MHI to a supervisor in a safe environment, thus improving sustainable employment and well-being at work. First, this thesis highlights the barrier that mental health stigma forms for treatmentseeking and disclosure, and ultimately for sustainable employment and well-being at work. Therefore, if the Dutch military wants to improve the sustainable employment and well-being at work of their employees, it is important to implement interventions targeting this stigma. Public stigma and self-stigma can be targeted through interventions, and structural stigma can be targeted through culture and policy change. Public stigma: the results of the current thesis showed that military personnel feared social rejection as a consequence of treatment-seeking and disclosure. Additionally, approximately one out of six of those who had disclosed their MHI, indicated that they had experienced actual social rejection (chapter 6). This suggests that there are stigmatizing attitudes held by the general military personnel (public stigma). To address this public stigma, it is important to evaluate existing destigmatizing interventions for their effectiveness within the Dutch military. Previous research on destigmatizing interventions showed that interventions targeting public stigma that include both education about MHI and that promote contact between people with and without MHI (in the right context, e.g. no power differences, in the context of collaboration and legitimized by the supervisors) have positive effects on reducing stigma (46). Worldwide, interventions targeting public stigma in the military have only focused on education, or only focused on promoting contact (46). Future research into interventions could examine the effectiveness of combining these methods into a new intervention to reduce public stigma in the military. Self-stigma: the findings of the current thesis showed that over half of the military personnel with MHI, saw themselves as weak due to their MHI (chapter 3), highlighting the importance of reducing self-stigma in the military. Previous research shows that support with the disclosure decision can help people in dealing with different types of stigma, including self-stigma (47-50). Therefore, it would be important to assess and implement disclosure decision aids within the Dutch military context. For example, the Honest, Open, and Proud (HOP) program could be a useful intervention, which should first be tested within the Dutch military context. HOP is a peer-led group program to support people
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