169 7 GENERAL CONCLUSIONS AND DISCUSSION and mental health literacy training in military basic training. This should also include training on how to communicate about MHI, as this was found to be hard for military personnel with and without MHI and supervisors (chapter 4). If MHI awareness and literacy and communication skills are generated in an early stage, and military personnel is taught how to support colleagues with MHI, this could also decrease the stigma and improve sustainable employment of military personnel. This is also important as the current thesis showed that half of the military personnel with MHI, denied their symptoms at first (chapter 3). Therefore, their peers could be important in signaling symptoms and facilitating early treatment-seeking. For example, unit training to increase support for military personnel with MHI has been shown to increase supportive behavior towards military personnel with MHI, and increase treatment-seeking for MHI (81). Furthermore, policymakers could also implement stigma awareness campaigns, as the majority of experts on this topic indicate that this is needed to tackle stigma (82) A final recommendation for the policymakers of the Dutch military is related to the zero-tolerance policy for substance use. The findings of the current thesis showed that the fear of negative career consequences formed a barrier to treatment-seeking, and this fear is likely to be even higher for substance use disorders, as the military has a strong zero-tolerance policy. Due to this zero-tolerance policy, we expect that military personnel might not be aware that treatment is available for substance use disorder within the military, and that when substance use is reported through a mental health professional, patient confidentiality is strictly adhered to, except for when there is an immediate danger for the patient and/or their surroundings. Therefore policymakers need to consider whether the possibilities of treatment for substance use disorder can be promoted more and whether the strong zero-tolerance policy should be made less strict. For the sustainable employment and well-being of personnel with MHI, including those with substance use disorder, it is important that they receive treatment (1). General conclusions The current thesis showed that mental health stigma exists in the Dutch military, and this was not only perceived by military personnel with MHI, but also by military personnel without MHI and mental health professionals. This mental health stigma formed a major barrier for both treatment-seeking and disclosure of MHI to a supervisor and can therefore potentially harm sustainable employment and well-being at work. Positive disclosure experiences were positively associated with multiple measures of sustainable employment and well-being at work, and these positive experiences were defined by higher supervisor support and lower stigma-related experiences. Furthermore, military personnel indicated a strong preference to solve their own problems and the supervisor played a key role in facilitating both treatment-seeking and disclosure. For the health, well-being, and sustainable employment of military personnel it is important that
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