Be-Me: Stigmatisation of mental health complaints as a barrier to sustainable employability

Introduction

For this project, the influence of stigmatisation of mental illness on the sustainable employability of military personnel is examined. Stigmatisation is thought to have a negative impact on two important decisions that a person with mental illness faces. This concerns (1) the decision to seek treatment for mental illness and (2) the decision to disclosure mental illness to a supervisor. The current project will therefor examine the influence of stigma, and other factors, on these two decisions. The results of this study will be used for theory development and for advising intervention studies concerning sustainable employability in the military.

Project overview

Objective:

To study the influence of stigmatisation of mental health complaints on the sustainable employability of Defence personnel.

Target population:

Military personnel in general with extra focus on military personnel with mental illness.

Timeframe:

The study started in September 2018. The expected duration is 5 years.

Results:

Barriers and facilitators for treatment-seeking for mental illness

The first paper was published in BJPsych Open in 2020. The paper focuses on the barriers and facilitators for treatment seeking for mental illness. This was studies using a multi-perspective qualitative focus group study. The perspectives included were military personnel with mental illness, military personnel without mental illness and mental health professionals.

Five barriers for treatment-seeking were identified: (1) fear of negative career consequences, (2) fear of social rejection, (3) confidentiality concerns, (4) the ‘strong worker’ workplace culture and (5) practical barriers. Three facilitators were identified: (1) social support, (2) accessibility and knowledge, and (3) healthcare within the military. The views of the different stakeholder groups were highly congruent.
 

Barriers for treatment-seeking were mostly stigma related (fear of career consequences, fear of social rejection and the ‘strong worker’ workplace culture) and this was widely recognised by all groups. Social support from family, peers, supervisors and professionals were identified as important facilitators. A decrease in the treatment gap for mental illness is needed and these findings provide direction for future research and destigmatising interventions.

Decision (not) to disclose mental illness in the work environment

The second paper was published in BMJ Open in 2021. This paper focusses on barriers and facilitators for the decision to disclosure mental illness to a supervisor in the military. This was also studied using a multi-perspective qualitative focus group study. The perspectives included were military personnel with mental illness, military personnel without mental illness and mental health professionals.

Five barriers for disclosure were identified: (1) fear of career consequences, (2) fear of social rejection, (3) lack of leadership support, (4) lack of skills to talk about mental illness, and (5) masculine workplace culture. Three facilitators were identified: (1) anticipated positive consequences of disclosure, (2) leadership support, and (3) work-related mental illness. Views of the stakeholder groups were highly congruent.

Almost all barriers (and facilitators) were related to fear for stigma and discrimination. This was acknowledged by all three perspectives, suggesting that stigma and discrimination are considerable barriers to sustainable employment and well-being. Supervisor knowledge, attitudes and behaviour were critical for disclosure, and supervisors thus have a key role in improving health, well-being and sustainable employment for soldiers with mental illness. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing mental illness.

Attitudes, beliefs and needs related to treatment seeking

The third paper was published in the Journal of Psychiatric Research in 2022. The paper examined military personnel's attitudes, beliefs, and needs around seeking treatment for mental illness. A cross-sectional questionnaire study of military personnel with (N = 324) and without (N = 554) mental illness was conducted.

The majority of the personnel believed treatment was effective (91.6%); however, most preferred to solve their own problems (66.0%). For personnel with mental illness, compared to those who sought treatment, those who did not had a higher preference for self-management and found advice from others less important. For those without mental illness, those with no intention to seek treatment indicated a higher preference for self-management, stigma-related concerns, denial of symptoms, lower belief in treatment effectiveness and found it less important to be an example, compared to those with treatment-seeking intentions. A clear indication of where to seek help was the most reported need (95.7%).

Regression analyses indicated that not seeking treatment was most strongly related to preference for self-management (OR(95%CI) = 4.36(2.02–9.39); no intention to seek treatment was most strongly related to a lower belief that treatment is effective (OR(95%CI) = .41(0.28–0.59) and with not having had positive earlier experiences with treatment seeking (OR(95%CI) = .34(0.22–0.52).

To facilitate (early) treatment seeking, interventions should align with a high preference for self-management, mental illness stigma should be targeted, and a clear indication of where to seek treatment is needed.