179 8 SUMMARY The decision to seek treatment A recent systematic review showed that about 60% of military personnel who experienced MHI did not seek help, whereas many could benefit from professional treatment. Leaving MHI untreated poses a threat to sustainable employment through a higher risk of worsening of symptoms, leading to sick leave and unemployment. The international literature reports different factors that determine whether military personnel seek treatment or not. They are related to (1) stigma and discrimination, (2) sociodemographic factors, (3) characteristics of the healthcare environment, (4) treatment and MHI beliefs, and (5) social support. Although there is international literature on barriers and facilitators for treatmentseeking for MHI in the military, research on this topic was completely lacking within the Dutch military. To implement effective interventions to promote treatment-seeking, and subsequently sustainable employment and well-being at work, it was important to first examine the decision to seek treatment for MHI within the Dutch military context. The decision to disclose mental health issues and illnesses to a supervisor The decision to disclose MHI to a supervisor or not can potentially impact sustainable employment and well-being at work. Previous research has shown that disclosure to a supervisor can lead to work accommodations and supervisor support, which can prevent worsened symptoms and sick leave, and non-disclosure can lead to missed opportunities for this support. However, disclosure can also lead to being stigmatized and discriminated against, which can negatively affect sustainable employment and well-being at work. This makes the decision to disclose MHI to a supervisor or not, a true dilemma. Although research on disclosure to a supervisor was almost completely lacking within the military, there has been more research on the disclosure of MHI in civilian workplace settings. This research shows that stigma forms an important barrier to disclosure, and that supervisor support is an important facilitator. More research was needed into the (non-)disclosure decision in the military, as these insights could help to facilitate disclosure in a safe environment so that personnel can receive support that can prevent adverse occupational outcomes. Additionally, as disclosure can negatively and positively affect sustainable employment and well-being at work, more insight was needed into the direct association between disclosure and sustainable employment and well-being at work. Sustainable employment and well-being at work In the literature, there are different conceptualizations of sustainable employment, as it is a broad concept that is hard to grasp. Generally, sustainable employment refers to the ability of workers to participate in the labor market during their lifetime. Traditionally
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