Armed Forces personnel are routinely exposed to occupational hazards that put them at risk of developing mental health problems (e.g. Hoge et al
Hotopf et al
Sareen et al
) which can adversely affect functioning in the workplace and operational effectiveness as well as being a major cause of personal distress. For these reasons, military organizations often invest substantial effort to encourage personnel with mental health problems to come forward and receive effective treatment. However, in both military and civilian populations, only a minority of those with mental illness seek care (e.g. Hoge et al
). Evidence from both military4
settings has shown that problems with the recognition of need represents by far the most prevalent barrier to receiving care. Fikretoglu et al
have shown that 80–96% of those who might benefit from care do not seek care having failed to recognize their own treatment needs; such individuals acknowledge clear-cut symptoms of mental disorders but deny any need for care. Individuals with mental health problems who do recognize a need for care often face a number of potential barriers to care, including problems with availability, accessibility and acceptability.5
Furthermore, differences in culture, policies, programmes and the structure of health services may affect the ability of individuals to access care and their experiences of stigma, for example, approaches to mental health screening differ between the US and UK.
Much has been made of the barriers to care that service members may have to deal with, particularly the stigmatization of mental health problems and/or the seeking of mental health care.6,7
A qualitative review of attitudes about post-traumatic stress disorder (PTSD) in the Canadian Forces found that soldiers felt stigmatized and abandoned after seeking help and many had not sought help for fear of being ostracized and ‘shown the door’.8
Hoge et al
investigated help-seeking and perceived barriers to care among United States soldiers and marines after deployment to Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom). This study revealed that of those who scored above the cut-off on mental health screening measures, only 38–45% indicated an interest in receiving help and only 23–40% had sought mental health care. The three most common perceived barriers to care were: (1) being perceived as weak; (2) being treated differently by unit leadership; and (3) members of their unit having less confidence in them. The problems with stigma may also follow personnel who leave the services. For example, a large-scale survey of ex-service personnel in the UK found that only approximately half of those with mental health problems had sought help; both stigma and embarrassment were found to be frequently cited barriers.9
However, although there are international data to show that stigmatizing beliefs are prevalent within military organizations, no attempt has been made to examine whether nations differ in terms of stigma and barriers to care. Using data from the military forces of five nations, this study aimed to identify: (1) how frequently stigma and barriers to care were reported by military personnel; (2) whether or not there was a differential reporting pattern, in terms of stigma and barriers to care, between those personnel with mental health problems and those without; and (3) if there were any differential patterns in the way stigma and barriers to care were reported by the individual nations.