Decision (not) to disclose mental health conditions or substance abuse in the work environment: a multiperspective focus group study within the military

Abstract

ObjectivesMany workers in high-risk occupations, such as soldiers, are exposed to stressors at work, increasing their risk of developing mental health conditions and substance abuse (MHC/SA). Disclosure can lead to both positive (eg, support) and negative (eg, discrimination) work outcomes, and therefore, both disclosure and non-disclosure can affect health, well-being and sustainable employment, making it a complex dilemma. The objective is to study barriers to and facilitators for disclosure in the military from multiple perspectives.DesignQualitative focus groups with soldiers with and without MHC/SA and military mental health professionals. Sessions were audiotaped and transcribed verbatim. Content analysis was done using a general inductive approach.SettingThe study took place within the Dutch military.ParticipantsIn total, 46 people participated in 8 homogeneous focus groups, including 3 perspectives: soldiers with MHC/SA (N=20), soldiers without MHC/SA (N=10) and military mental health professionals (N=16).ResultsFive barriers for disclosure were identified (fear of career consequences, fear of social rejection, lack of leadership support, lack of skills to talk about MHC/SA, masculine workplace culture) and three facilitators (anticipated positive consequences of disclosure, leadership support, work-related MHC/SA). Views of the stakeholder groups were highly congruent.ConclusionsAlmost 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 MHC/SA. Furthermore, adjustments could be made by the military on a policy level, to take away some of the fears that soldiers have when disclosing MHC/SA.

Expectations of Mental Illness Disclosure Outcomes in the Work Context: A Cross-Sectional Study Among Dutch Workers

“…This is important, as 27% of Dutch workers does not disclose mental illness in the work environment, and therefore by definition also misses out on workplace support and accommodations that may be important to stay at work. Finally, the findings add to the growing literature that a safe workplace atmosphere, where workers with health problems are supported rather than excluded, is not only highly important for disclosure, but ultimately also for workers’ sustainable employment, health and well-being [ 1 , 19 , 49 , 51 ]…”

“…Future studies should also focus on actual outcomes of workplace disclosure. Nevertheless, perceptions are important predictors of actual behavior [ 48 ], and many workers fear that disclosure will lead to discrimination (e.g., job loss, no contract renewal, lower wages) [ 1 , 30 , 49 ]. Whether or not these perceptions are true, they can influence workers’ disclosure behavior (non-disclosure).…”

Workplace Mental Health Disclosure, Sustainable Employability and Well-Being at Work: A Cross-Sectional Study Among Military Personnel with Mental Illness

“…However, a longitudinal study among unemployed people showed that those who were more reluctant to disclose their MI to (potential new) employers, were more likely to have found a job after six months [23]. Additionally, disclosure to a supervisor can lead to stigma and discrimination [24][25][26]. For example, of those who reported a negative disclosure experience in a study among Dutch workers, a quarter reported that they had been treated differently due to their disclosure [27].…”

“…It is plausible that the decision to disclose or not is an even more prominent dilemma in high-risk occupations, such as the military. People in military professions are expected to be strong, and not to show weakness, possibly making disclosure harder [21,24,32]. For example, in a study in the German military, a soldier indicated "If I hear that this battalion commander is mentally ill … as a subordinate, honestly, I'd say 'What kind of guy is that?'…”

“…[33]. Additionally, previous research on disclosure in the military has also shown that military personnel fear that disclosure will lead to them not being considered fit for high-risk occupations, and there is a fear of negative career consequences such as loss of employment, not being able to advance in your career, or not being able to what you like best about your work [24]. Also, research suggests that disclosure might lead to more negative consequences in these types of occupations [22].…”