Content warning: self-harm and suicidal behaviours
Not all individuals who experience mental health problems seek support, even though it might be beneficial for them. The use of mental health services by serving personnel and veterans has received growing research attention over recent years, and promoting help-seeking is a key suicide prevention strategy.
Yet, little is known about the experiences of UK Armed Forces veterans when seeking (or not seeking) help for self-harm and suicidal behaviours (i.e., suicidal thoughts and suicide attempts).
Help-seeking can involve formal support provided by medical professionals or informal support typically received from social networks. Help-seeking for self-harm and suicidal behaviours may involve different barriers than help-seeking for mental health problems due to the stigma associated with these behaviours, and therefore should be explored further. In particular, there are a lack of qualitative studies exploring this topic area.
The aim of this study was to qualitatively explore UK ex-serving personnel’s experiences of seeking help for self-harm, suicidal thoughts, and suicide attempts.
This work was conducted as part of a PhD being completed by Charlotte Williamson, investigating self-harm and suicidal behaviours in the UK Armed Forces and is nested within Phase 4 of the KCMHR Health and Wellbeing cohort study, a long-term study investigating the health and wellbeing of Iraq and Afghanistan era UK serving personnel and veterans.
A sub-sample of veterans who participated in Phase 4 of the KCMHR cohort study, who reported experience of self-harm and/or suicidal behaviours, and agreed to further contact, were invited to take part in this qualitative study. Overall, 32 veterans were contacted and 15 completed interviews.
A range of participants were recruited including: men and women; ex-Regulars and ex-Reservists; those who served in the Naval Services, Army, and Royal Air Force; individuals who did and did not seek help for self-harm and suicidal behaviours; and those who sought help formally or informally.
Individual interviews were conducted by telephone or Microsoft Teams audio call, and were made up of three key sections: (1) military background; (2) reasons for engaging in self-harm and/or suicidal behaviours; and (3) experiences of seeking or not-seeking help for self-harm and/or suicidal behaviours.
This work examined data on help-seeking for self-harm and suicidal behaviours, including if they did or did not seek help, when and where they sought help, and the factors that make it easier (i.e., facilitators) or more challenging (i.e., barriers) to seek help for these behaviours. Interviews were audio-recorded, written up, and analysed using reflexive thematic analysis.
Participants’ decisions and experiences of seeking help for self-harm and suicidal behaviours were split into five distinct but related and interacting themes: 1) military mindset, 2) stigma, 3) fear of consequences, 4) access to and awareness of support, and 5) facilitators to help-seeking.
Conclusions
Continued efforts are required to challenge the ongoing mental health-related stigma that exists during and after military service and acts as a key barrier to help-seeking for self-harm and suicidal behaviours. This study highlighted the need to provide an environment where military serving personnel and veterans feel willing and able to seek help for self-harm and suicidal behaviours.
By encouraging military personnel to access support (and in a timely manner) has the potential to reduce the impact on health and wellbeing and ultimately save lives.
