Pathways to mental health care in active military populations across the Five-Eyes nations: An integrated perspective

Deniz Fikretoglu*, Marie Louise Sharp, Amy B. Adler, Stéphanie Bélanger, Helen Benassi, Clare Bennett, Richard Bryant, Walter Busuttil, Heidi Cramm, Nicola Fear, Neil Greenberg, Alexandra Heber, Fardous Hosseiny, Charles W. Hoge, Rakesh Jetly, Alexander McFarlane, Joshua Morganstein, Dominic Murphy, Meaghan O'Donnell, Andrea PhelpsDon J. Richardson, Nicole Sadler, Paula P. Schnurr, Patrick Smith, Robert Ursano, Miranda Van Hooff, Simon Wessely, David Forbes, David Pedlar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.

Original languageEnglish
Article number102100
JournalClinical Psychology Review
Early online date11 Nov 2021
Publication statusPublished - Feb 2022


  • Help-seeking
  • Military
  • Service member
  • Service use
  • Treatment engagement


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