Barriers and facilitators of help seeking among morally injured Canadian Armed Forces Veterans and service members: A qualitative analysis

Introduction: Since the mission to Afghanistan (2001-2014), help seeking for mental health has improved among Canadian Armed Forces (CAF) personnel. However, little is known about help seeking among those experiencing distress after high-stakes morally transgressive acts by themselves or others ( i.e., moral injury; MI). MI is characterized by intense shame, guilt, and anger, loss of trust in oneself and others, and social withdrawal, which may impede individuals' willingness to seek help for problems. This study's aim was to identify potential barriers to and facilitators of help seeking among those experiencing MI. Methods: CAF service members (n = 6) and Veterans (n = 7) exposed to potentially morally injurious events (PMIEs) were recruited from specialized clinics in Ottawa, Canada. Participants completed semi-structured interviews about their mental health experiences, including factors associated with help seeking. Results: Time until help seeking ranged from immediately after the PMIE to more than 20 years later. Thematic analysis identified four main barriers (stigma, denial, no knowledge of problem or MI, negative perceptions of the military health system) and five main facilitators (sense of shared experience, screening, encouragement from others to seek help, purpose as motivation, alternatives to formal mental health care) to seeking professional help for psychological distress after a PMIE. Discussion: Findings suggest that PMIE-exposed CAF members and Veterans experience similar educational, systemic, and cultural barriers to help seeking found in previous studies but that specific education regarding MI may aid in promoting help seeking among PMIE-exposed service members and Veterans.