66 3 CHAPTER 3 DISCUSSION This study aimed to examine attitudes, beliefs, needs, and factors associated with treatment-seeking intentions in military personnel with and without mental illness. Overall, a large majority believed that treatment was effective, but personnel also preferred to solve their own problems. There were stigma-related concerns, and high importance was attached to others’ advice about seeking treatment. Most personnel with mental illness sought treatment because their symptoms were too severe to deal with by themselves. As for needs, most weight was given to having a clear indication of where to go to for help, the availability of mental health professionals with military experience, and a discrete location to seek treatment. Overall, a higher preference for self-management and having earlier experience with seeking treatment by one’s self or having seen others’ experiences were associated with decisions and intentions to not seek treatment. For personnel with mental illness, negative associations with the importance given to others’ advice were negatively associated with decisions to not seek treatment. For personnel without mental illness, lower unit cohesion, lower belief that treatment is effective, less desire to be an example to others, higher denial of symptoms, and higher stigma-related concerns were associated with intentions to not seek treatment. Belief in treatment effectiveness and preference for self-management A large majority of personnel believed that mental health treatment is effective (91.6%). Even though a lower belief that the treatments work was associated with an intention not to seek treatment, more than three-quarters of personnel who had no intentions to seek treatment, believed treatment is effective, which is in line with previous research about the Dutch military (6). Hence, interventions aimed at overcoming the treatment gap should not focus on promoting the effectiveness of treatments. While personnel believed treatment is effective, most still prefer to solve their own problems. This was illustrated by the finding that most personnel with mental illness reported seeking treatment only once symptoms were severe, and that they had no other choice. Preference for self-management was found to be a barrier to seeking treatment in previous research, both in personnel with and without mental illness and among (Dutch) civilians (6, 11, 25, 26). Given the reported importance of selfmanagement, more self-help applications or personal recovery programmes could facilitate seeking treatment and give them the feeling that they are managing their own problems. There are currently different pilots with such applications and ongoing programmes, for example, with wellness recovery action planning (WRAP) (27). These applications and programmes should, however, also encourage seeking treatment from professionals, especially for more severe symptoms. Additionally, future research should
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