19 1 GENERAL INTRODUCTION In the Dutch military, all healthcare is organized internally. This includes mental health treatment. There are four mental healthcare treatment centers distributed across the Netherlands, which means that there is always treatment available relatively close to someone’s home. Military personnel can seek treatment for both MHI and substance use disorders, and the costs are covered by military health insurance. For ‘soft drugs’ (such as marijuana, hashish, and sleeping pills) and alcohol, treatment is provided within the military, for ‘hard drugs’ (such as heroin, cocaine, and amphetamine) military personnel is referred externally. Military personnel can also individually decide to seek treatment outside of the military; however, they should first gain permission from their health insurance to ensure these costs will be covered. Regarding the rules and legislation concerning substance use, there is a zero-tolerance policy for use of hard drugs within the military, with the sanction of unconditional discharge. The use of alcohol is only forbidden during training and deployment. The use of soft drugs results in an official warning from the military, with multiple warnings leading to discharge. However, when substance use is reported to a mental health professional, there are confidentiality agreements that ensure privacy, and treatment is possible. When military personnel seek treatment, their treatment and diagnosis are not reported to their supervisor. They can decide for themselves whether they tell the supervisor about their MHI, or substance use disorder. However, there is an exception if the patient forms a risk for their safety or the safety of their immediate surrounding, then the supervisor will be informed. Finally, it should be noted that the current thesis examines mental health issues and illnesses. This includes diagnosed mental health illnesses, but also self-reported (undiagnosed) mental health issues, such as stress-related issues. These mental health issues and illnesses also include substance use disorders. The present thesis This thesis has three main aims: 1. To gain insight into the decision of whether or not to seek treatment for MHI within the Dutch military, and to which extent stigma plays a role in this decision. 2. To gain insight into the decision of whether or not to disclose MHI to a supervisor in the Dutch military, and to which extent stigma plays a role in this decision. 3. To gain insight into the association between actual disclosure decisions and disclosure experiences, and subsequent sustainable employment and well-being at work in the Dutch military.
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