178 CHAPTER 1 8 INTRODUCTION (CHAPTER 1) Mental health issues and illnesses (MHI), including substance use disorders, are very common. Globally, the lifetime prevalence of mental illness has been estimated to be 29%. A recent study in the Netherlands showed that the lifetime prevalence of mental illness has increased to 48%. At any given moment, approximately 20% of the workingage population experiences a mental illness. These numbers don’t even include stressrelated mental health issues, such as burnout, which are common in the work setting, and responsible for a large share of sick leave. When compared to workers without MHI, workers with these health problems have a significantly higher risk for sick leave, early retirement, exiting the workforce via disability benefits, or unemployment. However, people with MHI can benefit from the positive aspects of employment, such as daily structure, social connection, and inclusion. This, together with the current shortage of workers, highlights the importance of investing in sustainable employment and wellbeing at work of workers with MHI. Stigma as a barrier to sustainable employment and well-being at work Mental health stigma is an important barrier to sustainable employment and well-being for workers with MHI. Stigma refers to problems of knowledge (ignorance), attitudes (prejudice), and behavior (discrimination). Mental health stigma exists at different levels. 1) Public stigma: members of the general population endorse prejudice and discrimination against individuals with MHI, 2) Self-stigma: this occurs when individuals with MHI internalize these negative stereotypes and prejudices held by the general population, and 3) Structural stigma/discrimination: this refers to rules, regulations, and cultural attitudes and values that either intentionally or unintentionally disadvantage individuals with MHI. Mental health stigma in the military Military personnel operate in potentially hazardous, dangerous, and emotionally demanding situations. Being exposed to stressors at work can lead to an increased risk of developing MHI. Moreover, the mental health stigma can be expected to be even stronger in the military, compared to civilian populations as there is a general focus on being strong and tough in the military, which may enhance the negative opinions about those who have MHI. Mental health stigma can influence two important decisions that military personnel with MHI face, namely (1) the decision to seek treatment and (2) the decision to disclose MHI to a supervisor. As both these decisions can affect health, sustainable employment, and well-being at work, the current thesis focused on these two decisions within the military context.
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