39 2 TREATMENT SEEKING IN THE MILITARY - A QUALITATIVE STUDY was only mentioned by MH professionals and the preference for MH professionals who are familiar with the military context, was not mentioned by the MH professionals themselves. DISCUSSION Although barriers and facilitators for help seeking were discussed in stakeholder groups with 3 different perspectives, the findings yielded striking resemblances rather than differences. The main barriers and facilitators were recognized by all three perspectives (soldiers with and without MHC/SA and MH professionals), with only minor differences. The results showed that treatment is a complex decision, as has also been found in previous research (16). There is fear for negative career consequences and social rejection, and concerns surrounding confidentiality, the ‘strong worker’ workplace culture and practical barriers. On the other hand, social support, accessible care and having internal military mental health care help soldiers in seeking treatment. The majority of barriers to treatment seeking were related to different types of stigma. The fear for negative career consequences is related to structural discrimination, the fear of social rejection is related to public stigma, and the ‘strong worker’ workplace culture is related to self-stigma. Previous research showed mixed findings for the relationship between stigma and treatment seeking, where some find a negative relationship (11, 23), some find no relationship (3, 17), and others even find a positive relationship (24). For the fear of negative career consequences, existing research, both quantitative and qualitative, has mainly focused on fear of differential treatment and lack of career advancement opportunities (3, 11, 25). However, fear of losing a job has received far less attention (26), while it is recognized by all stakeholders in the current study, especially for substance abuse. Additionally, interventions that have been implemented in other countries have largely ignored this concern (26, 27). Fear of social rejection, the workplace culture, confidentiality concerns and practical barriers have all received attention in existing literature, both quantitative and qualitative (3, 10, 26, 28, 29). In the current study social support, both from family and the work environment, was found to be facilitating for treatment seeking, which has also been found by other researchers (29, 30). The importance of social support from the work environment (peers and supervisors) is directly related to the fear of social rejection being a barrier for treatment seeking. The importance of social support in the decision to seek treatment is not surprising, as the military is known for high social cohesion (30). Accessible care (including knowledge of where to find help) and preference for health care within the military have been recognized by existing literature (11, 31).
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