40 2 CHAPTER 2 For the comparison of views, there was high agreement across the three stakeholder groups for all main barriers and facilitators for treatment seeking. Existing research on this topic with similar findings only examined views of soldiers with MHC/SA (3, 7, 9). The high agreement across different perspectives implies that help seeking actually does pose a risk for negative career consequences and social rejection, and that a key to closing the treatment gap can be found in taking measures to overcome these adverse outcomes from occurring. As for differences between groups, two are noteworthy. First, supervisors’ attitude towards treatment and MHC/SA, both as barrier and facilitator, was not mentioned by soldiers with MHC/SA themselves. A possible explanation is that many soldiers with MHC/SA mentioned that they had sought treatment because they had no other choice – their symptoms were too severe. Previous qualitative research also showed that soldiers seek treatment at a ‘crisis point’ (16, 32). It could thus be that a supervisor plays an important role when someone is contemplating seeking treatment, however when symptoms become too severe, the supervisor’s role becomes negligible. However, existing research has shown that military leaders are influential for the decision to seek treatment (11), providing motive for further research into when and how military leaders influence the decision to seek treatment. Second, it is noteworthy that MH professionals did not mention failure to recognize need for treatment as a barrier. This has been recognized as a barrier in existing studies, but has to our knowledge never been found within a population of military MH professionals (33). This seems logical, as professionals will only see those who have recognized the need for treatment. However, better awareness of this can give guidance to MH professionals in how they provide care and how they approach new patients. Strengths and limitations The first strength of the present study was that multiple perspectives and types of MHC/ SA were included, creating a comprehensive and realistic view on the topic (29, 34, 35). Additionally, the sample included participants with an addiction, even though this is a sensitive topic within the military. Results showed that the fear of losing one’s job was especially present for substance abuse, making the inclusion of participants with addiction valuable. Second, this was, to the knowledge of the authors, the first study to examine barriers and facilitators for treatment seeking within the Dutch military. As most studies have been done in the United Kingdom, Canada and the United States (11), the current study is a valuable addition to existing studies. Third, measures were taken to ensure that participants would be able to speak freely about a relatively sensitive topic, which allowed for open and fruitful discussion. A safe and open environment was created in the current study by (1) using a diverse sample of soldiers from different armed forces to ensure participants were not familiar with each other, (2) asking participants to come in civilian clothes as to not emphasize different ranks, and (3) ensuring focus group leaders could not influence participants’ careers as they were not part of the military.
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