165 7 GENERAL CONCLUSIONS AND DISCUSSION with MHI in their disclosure decision and in coping with stigma (48). A pilot trial of HOP is currently being tested in the German armed forces (48). Another disclosure decision aid that could be tested within the Dutch military is the CORAL decision aid, which assists in the decision to disclose MHI to an employer (51). Finally, READY is an online decision-aid tool that could also be tested for effectiveness within the Dutch military. An advantage of this tool is that it is an online tool focused on the individual, unlike HOP which makes use of a peer-led group (52). The individual nature of this tool likely matches the high preference military personnel have to solve their own problems. For treatment-seeking, previous research has shown that an online help-seeking stigma-reduction intervention effectively targets self-stigma (53). This could also be tested in the Dutch military context to assist military personnel in reducing self-stigma. A key finding of this thesis was the importance of the supervisor. The findings showed that supervisors’ support, knowledge about MHI, and positive attitudes/non-stigmatizing attitudes towards MHI can facilitate both disclosure and treatment-seeking (Chapters 2 and 4). The results also showed that military personnel often delay treatment-seeking and disclosure, waiting until symptoms are severe (chapters 3 and 5). Additionally, previous research has shown that early disclosure (in a safe environment) and treatmentseeking are important for sustainable employment and well-being at work (1, 15, 17, 18, 54). Therefore, supervisors must be educated about MHI, positive attitudes should be enhanced, and they should receive training in how to better support workers with MHI. A systematic review and meta-analysis within civilian settings on training managers to understand and support the mental health needs of employees showed that training can have positive effects on managers’ mental health knowledge, non-stigmatizing attitudes towards mental health, and improved behavior in supporting employees with MHI (55). For example, a study among managers in Australian fire and rescue services showed that mental health training improved their confidence in communicating with their employees (56). Recently, a workshop for supervisors concerning these topics has been developed in the Dutch military, based on the findings of this thesis. Although this training is yet to be evaluated in a formal study, the first reactions to this workshop are positive. Future research needs to examine the effects of this workshop on the MHI knowledge and attitudes of supervisors, and ultimately on the sustainable employment and well-being at work of their employees. Finally, the findings of this thesis showed the high preference of military personnel to solve their own problems, and to ‘self-manage’. This preference was negatively associated with both treatment-seeking and disclosure (Chapters 3 and 5). Therefore, future interventions must take this preference for self-management into account. For example, Wellness Recovery Action Plan (WRAP) is a peer-support-led intervention that focuses on self-management of MHI and has been shown to reduce symptoms in civilian
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