LAY SUMMARY This study examines challenges faced by Canadian Armed Forces (CAF) Veterans in seeking mental health support in general and following potentially morally injurious events (PMIEs) during their service and after release. Concerns arise that individuals with moral injury (MI) may avoid seeking mental health support due to the sensitive nature of their experiences. Qualitative interviews with 20 CAF Veterans identified 11 barriers to mental health support, including concerns about confidentiality, career implications, stigma, trust, legal considerations, relationship concerns, shame, guilt, and accessibility. This study emphasizes that MI-related barriers, like guilt and shame, are especially common in the context of MI. Effective communication and review of confidentiality assurances are recommended to reduce barriers and ensure adequate support for CAF members and Veterans in their mental health journeys.
Introduction: Military members often encounter high-stakes, morally challenging situations during their service (also known as potentially morally injurious events; PMIEs). Such experiences put military members at a higher risk of developing mental health concerns. Additionally, in response to PMIEs, some individuals may experience moral injury (MI)—profound and long-lasting psychosocial, spiritual, and functional impairments. There is concern that individuals with MI may be particularly hesitant to seek mental health services. This hesitancy may stem from the socially withdrawing nature of moral emotions and apprehensions about confidentiality during treatment seeking, as some PMIEs may be perceived as immoral, unethical, or illegal, depending on the context. Methods: Qualitative interviews (n = 20) were conducted to explore the barriers to mental health support-seeking experienced by Canadian Armed Forces Veterans, placing an emphasis on the nuanced challenges of MI, including perceived confidentiality concerns and whether PMIEs impact the decision to seek care. Results: Eleven barriers were found; concerns related to confidentiality, career, stigma, trust, legal, relationships, shame and guilt, and accessibility to and adequacy of support. Discussion: While numerous barriers to mental health support are common across various mental health issues, this study revealed that specific barriers, notably guilt, shame, and fear of reprimand, are uniquely pronounced in MI. There is a need to demarcate MI from other mental health challenges when considering treatment-seeking barriers. Effective communication and review of confidentiality assurances are recommended as viable approaches to reducing barriers to treatment and ensuring that Veterans are adequately supported in their mental health journeys.