Content warning: self-harm and suicidal behaviours
About the study
Not all individuals who experience mental health problems seek support, even though it might be beneficial for them. The use of mental health services by serving personnel and veterans has received growing research attention over recent years, and promoting help-seeking is a key suicide prevention strategy. Yet, little is known about the experiences of UK Armed Forces veterans when seeking (or not seeking) help for self-harm and suicidal behaviours (i.e., suicidal thoughts and suicide attempts).
Help-seeking can involve formal support provided by medical professionals (e.g., clinical psychologist/general practitioner) or informal support typically received from social networks (e.g., friends/family). Help-seeking for self-harm and suicidal behaviours may involve different barriers than help-seeking for mental health problems due to the stigma associated with these behaviours, and therefore should be explored further. In particular, there are a lack of qualitative studies exploring this topic area.
The aim of this study was to qualitatively explore UK ex-serving personnel’s experiences of seeking help for self-harm, suicidal thoughts, and suicide attempts.
This work was conducted as part of a PhD being completed by Charlotte Williamson, investigating self-harm and suicidal behaviours in the UK Armed Forces and is nested within Phase 4 of the KCMHR Health and Wellbeing cohort study, a long-term study investigating the health and wellbeing of Iraq and Afghanistan era UK serving personnel and veterans.
Who took part in this study?
A sub-sample of veterans who participated in Phase 4 of the KCMHR cohort study, who reported experience of self-harm and/or suicidal behaviours, and agreed to further contact, were invited to take part in this qualitative study. Overall, 32 veterans were contacted and 15 completed interviews.
A range of participants were recruited including: men and women; ex-Regulars and ex-Reservists; those who served in the Naval Services, Army, and Royal Air Force; individuals who did and did not seek help for self-harm and suicidal behaviours; and those who sought help formally (e.g., in a clinical setting) or informally (e.g., friends and family).
What did we do?
Individual interviews were conducted by telephone or Microsoft Teams audio call, and were made up of three key sections: (1) military background; (2) reasons for engaging in self-harm and/or suicidal behaviours; and (3) experiences of seeking or not-seeking help for self-harm and/or suicidal behaviours.
This work examined data on help-seeking for self-harm and suicidal behaviours, including if they did or did not seek help, when and where they sought help, and the factors that make it easier (i.e., facilitators) or more challenging (i.e., barriers) to seek help for these behaviours. Interviews were audio-recorded, written up, and analysed using reflexive thematic analysis.
What did we find?
Participants’ decisions and experiences of seeking help for self-harm and suicidal behaviours were split into five distinct but related and interacting themes: 1) military mindset, 2) stigma, 3) fear of consequences, 4) access to and awareness of support, and 5) facilitators to help-seeking.
Overview of help-seeking themes and subthemes developed from participant interviews
Note. Dashed lines represent interaction between themes
The findings of this study were generally similar to existing research on help-seeking for mental health problems among military populations which identified barriers including stigma, military culture and masculine norms, lack of recognition of need for support, difficulties accessing support, and career concerns, and facilitators including social networks/social support.
However, this study extends understanding by outlining some barriers to help-seeking which might be specific to self-harm and suicidal behaviours which require attention:
1) Embarrassment and shame (as part of self-stigma) were discussed by those who did and did not seek help for self-harm and suicidal behaviours. Although embarrassment and shame are common across many mental health difficulties, these feelings may be enhanced for self-harm and suicidal behaviours due to societal views that these behaviours are unacceptable, feelings of worthless or failure, or feeling weak or unable to cope.
2) Societal hierarchy of health problems (i.e., the way certain health conditions are prioritised or viewed) is considered a broader societal view but appeared to be heightened in the military context. Participants described feeling less deserving of support than others, especially those with physical health problems (e.g., amputation injuries).
Conclusions
Continued efforts are required to challenge the ongoing mental health-related stigma that exists during and after military service and acts as a key barrier to help-seeking for self-harm and suicidal behaviours. This study highlighted the need to provide an environment where military serving personnel and veterans feel willing and able to seek help for self-harm and suicidal behaviours. By encouraging military personnel to access support (and in a timely manner) has the potential to reduce the impact on health and wellbeing and ultimately save lives.
Want to know more?
You can read the research article here:
Williamson C, Busuttil W, Simms A, Palmer L, Stevelink SAM & Sharp M-L (2025). ‘Man up and get on with it’: A qualitative exploration of UK ex-serving personnel’s experiences of seeking help for self-harm and suicidal behaviours. European Journal of Psychotraumatology.
[doi: 10.1080/20008066.2025.2480990].
For updates on this study and other work being conducted at KCMHR please follow @CF_Williamson and @kcmhr on X and take a look at our most recent blog posts.
To find out more about the findings from Phase 4 of the KCMHR cohort study, you can read this blog post.
Funding
Phase 4 of the KCMHR cohort study was funded by the Office for Veterans’ Affairs, UK Government, but was conducted by KCMHR which is a fully independent research group.
Need to access help and support?
Please see our Signposting Booklet detailing national and local support for the Armed Forces veteran community.
For immediate crisis help:
NHS 111 Online
Speak to health professionals for advice about mental and physical health. Open 24 hours a day, 365 days a year.
Tel: 111 Web: 111.nhs.uk
Samaritans
Someone to talk to 24 hours a day. Open 24 hours a day, 365 days a year.
Tel: 116 123 Email: jo@samaritans.org Web: samaritans.org
Combat Stress 24 Hour Helpline
Provides confidential help and advice on any mental health issues to the military community and their families. Open 24 hours a day, 365 days a year.
Helpline: 0800 138 1619 Email: helpline@combatstress.org.uk
Text: 07537 404719 (standard charges may apply)
