The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment

Abstract

Background: It is often claimed that military veterans are reticent to seek help for mental disorders, even though delayed treatment may impair recovery and impact the wellbeing of those close to the veteran. Objective: This paper aims to explore the barriers and facilitators to accessing professional mental health support for three groups of veterans who met criteria for a probable mental health disorder and: (1) do not recognize a probable mental disorder; (2) recognize they are affected by a mental disorder but are not seeking professional support; or (3) are currently seeking professional mental health support. Method: Qualitative telephone interviews were conducted with 62 UK military veterans. Thematic analysis identified core themes along an illustrative journey towards professional mental health support. Results: Distinct barriers and facilitators to care were discussed by each group of veterans depicting changes as veterans moved towards accessing professional mental health support. In contrast to much of the literature, stigma was not a commonly reported barrier to care; instead care-seeking decisions centred on a perceived need for treatment, waiting until a crisis event occurred. Whilst the recognition of treatment need represented a pivotal moment, our data identified numerous key steps which had to be surmounted prior to care-seeking. Conclusion: As care-seeking decisions within this sample appeared to centre on a perceived need for treatment future efforts designed to encourage help-seeking in UK military veterans may be best spent targeting the early identification and management of mental health disorders to encourage veterans to seek support before reaching a crisis event.

Barriers and facilitators for treatment-seeking for mental health conditions and substance misuse: multi-perspective focus group study within the military

“…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 healthcare all help soldiers in seeking treatment.…”

“…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. Nonetheless, 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.…”

“… 11 Although research, both quantitative and qualitative, has been conducted on barriers and facilitators of treatment, 9 it remains a complex phenomenon and more research is needed. 3 , 16 Existing research has focused on the perspectives of soldiers with mental health conditions and substance misuse, largely ignoring perspectives of soldiers without these conditions and military mental health professionals, 7 – 9 although they play a significant role in the decision to seek treatment. First, soldiers without mental health conditions and substance misuse problems potentially hold negative views (public stigma) and influence others in deciding to seek treatment.…”

Prevalence of common mental health disorders in military veterans: using primary healthcare data

“…10 It may take reaching crisis point to seek help, leading to higher rates of PTSD. 11 Research indicates that only 8% of the veteran population are correctly registered; resulting in a potential lack of support for their specialised MH needs. 12 The Royal College of General Practitioners (RCGP) launched…”

How Can We Actually Change Help-Seeking Behaviour for Mental Health Problems among the General Public? Development of the ‘PLACES’ Model

“…How individuals view their mental health problems is key, and low perceived need is another very common barrier [ 10 , 11 , 12 ]. Recent work conducted in a military population found that the perceived need for treatment (and not stigma) was the most prominent barrier to care [ 13 ]. Self-reliance is often found to be the preferred way of coping, particularly among young people [ 14 ].…”