Drivers of dropout and enhancers of engagement for male military veterans in therapy: practitioner perspectives

Abstract

ABSTRACT Male veterans are vastly over-represented in suicide rates relative to non-veterans. A critical avenue for improving male veterans’ mental health outcomes is improving their engagement with mental health services. This study presents a qualitative investigation of mental health practitioners’ perspectives on enhancers of engagement in, and drivers of dropout from therapy among male veterans. Participants were 138 mental health practitioners across Australia, the USA, Canada, New Zealand and the UK (44.9% male; age M = 47.5 years, SD = 12 years). Participants responded to qualitative survey items inquiring about their perspectives on what works to engage male veterans in therapy, alongside common drivers of therapy dropout. Under an overarching theme contextualising the therapeutic alliance between veterans and mental health practitioners, interpretive description analyses led to eight distinct subthemes. Results highlight the range of areas in which mental health practitioners can thoughtfully adapt their practice to engage male veterans and align with military masculinities. In addition, findings underscore the range of barriers facing veterans when they seek help, which can precipitate dropout if not overcome by the right balance between practitioner engagement and veteran persistence.