Barriers to mental health support among Canadian Veterans: Complicating factors of confidentiality and moral injury.

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.