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

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.

Triumph Over Adversity

Like other chapters, the author takes the reader on a journey of a combat social worker beginning in his childhood as the son of a Vietnam veteran with severe PTSD. With the valuable lessons learned from his father’s mental health treatment journey with the help of the early 1980s Vet Centers. The author shares his life experiences and lessons gleaned from a career as a trauma therapist and finally a 16-year career as an Army social worker, including lessons from Iraq combat tour and the Army’s comprehensive soldier fitness program. Research-based theories, books, and interventions are described critical to healing PTSD and empowering the holistic well-being of today’s service members. The author, currently an Army lieutenant colonel behavioral health officer concludes with a call for reinforcements due to increasing attrition of combat social workers, and the corresponding traits and mindset required for this dynamic career opportunity in today’s military mental health community.