Stigma and other barriers to care are very interesting, because we often think that stigma is the primary barrier to people seeking mental health care when in fact many studies over the past two decades, not only in the Canadian Forces but in other populations, show that the number one barrier to seeking mental health care is that the individual does not perceive they have a need for care. That was one of the reasons we developed the road to mental readiness program, which has the four-colour mental health continuum model, to increase mental health literacy and, hopefully, result in earlier recognition of distress and access to care.
We do know other barriers to care exist. Some of them are related to stigma: worrying about what others may think of me, how my leadership may perceive me and how others may treat me. For the most part, the data regarding those stigma-related barriers is fairly encouraging. The interesting part of that is we find that once people are impacted by a mental illness or a mental health injury, their perception of those barriers tends to increase significantly, and those barriers become much more important.
Some of the barriers are more structural, with people feeling they don't have time or may not know where to access help. We spend a fair amount of time in our education programs talking about how one might overcome or challenge some of those particular barriers to care.
The other aspect is negative attitudes toward care-seeking, which we also spend a fair amount of time in our education program talking about, specifically letting people know that mental health treatment is effective, that it's evidence-based and what mental health treatment might look like.