This doctoral research investigates the mental health experiences and help-seeking behaviours of currently serving personnel within the Irish Defence Forces. Against a backdrop of limited empirical evidence in the Irish military context, this study aims to fill a critical gap by exploring how soldiers navigate mental health challenges and what factors influence their decisions to seek or avoid professional support. The study adopts a sequential explanatory mixed-methods design, integrating quantitative survey data from 687 participants across the Army, Navy, and Air Corps with qualitative data from 6 semi-structured interviews conducted with key Defence Forces stakeholders involved in mental health service provision. This dual-phase approach allowed for a deeper, more contextualised understanding of both the prevalence of psychological distress and the barriers impeding formal help-seeking within the organisation.

The quantitative strand revealed concerning levels of self-reported mental health difficulties, including symptoms of anxiety, depression, Post Traumatic Stress Disorder, alcohol use, self-harm, suicidal ideation, and suicide attempts. Notably, the prevalence rates identified in this study are higher than previously reported in Irish Defence Forces research and are broadly consistent with findings from comparable international military populations. Despite these elevated levels of distress, formal help-seeking remains low. Over 90% of participants indicated that disclosing a mental health issue to a military medical officer would negatively impact their careers, and a significant proportion expressed concerns about confidentiality, stigma, and being perceived as unfit for duty. Instead, many participants expressed a preference for peer support and external civilian services, particularly those perceived as offering greater discretion and psychological safety.

The qualitative findings supported these patterns, with key stakeholders acknowledging the existence of a culture in which seeking mental health support is often viewed as incompatible with military identity. Several participants in this phase were surprised by the scale of avoidance revealed in the survey, and many expressed concerns about the absence of a formal, Defence Forces-wide mental health policy. Interviewees highlighted that, although peer-led mental health providers were the most utilised sources, they are not adequately equipped to deal with serious mental health issues. The findings also underscore the need for structural reform, including the development of a holistic standalone mental health service, stronger protections for confidentiality through independent control of medical records and GDPR-compliant data management, and clearer safeguards to ensure patient autonomy, meaning that personnel retain genuine choice in how they disclose and access care rather than having decisions imposed by command-linked grading systems.

This research is grounded in Scott's (1990) Hidden Transcripts Theory, which provides a theoretical lens for understanding how military personnel may resist institutional norms by concealing distress and avoiding formal mental health pathways. Within this framework, acts of non-disclosure and avoidance are interpreted as strategic responses to perceived coercion and surveillance within hierarchical systems. These behaviours are not necessarily signs of disengagement but reflect an internal negotiation between self-preservation and professional identity. The theory also illuminates the discrepancy between outward conformity and private dissent within the Defence Forces, where compliance with institutional expectations often masks unresolved psychological struggles.

Key recommendations emerging from the study include the immediate development of an inclusive and research-informed Defence Forces mental health policy, the establishment of a multidisciplinary mental health unit incorporating both military and civilian expertise, and investment in research-informed educational campaigns to reduce stigma. A revised medical grading system that reflects the complexity of mental health recovery, along with the expansion of confidential external services, is also proposed. This study makes an original contribution to the understanding of military mental health in an Irish context by exposing the complex interplay of organisational culture, structural limitations, and individual psychological coping strategies. The findings highlight the urgent need for systemic reform to ensure that help-seeking is supported, stigma is dismantled, and the mental health and wellbeing of Irish Defence Forces personnel is safeguarded. Without such action, the continued underutilisation of support services poses risks not only to individual soldiers but also to the operational readiness and ethical integrity of the institution.

P.48 2.7 Alcohol Misuse in the Military The Healthy Ireland Survey 2023 reported that 70% of people aged 15+ consumed alcohol in the past year, a decline from 75% in 2018, with weekly drinking remaining stable at 38%. Men continue to drink more frequently than women (43% versus 34%), while binge drinking is especially concentrated among younger adults, with 36% of those aged 15- 24 engaging in this behaviour compared to only 7% of those aged 75+ (Department of Health, 2023). Ireland remains one of the higher consumers of alcohol internationally. According to the OECD Health at a Glance 2023 report, per-capita alcohol consumption in Ireland was 9.5 litres of pure alcohol per adult (15+), compared with an OECD average of 8.6 litres (OECD, 2023). Alcohol-related harm continues to place a significant burden on the healthcare system. In 2023, there were 17,507 hospital discharges with an alcohol-related diagnosis, with a similar figure recorded in 2022 (17,512) (Health Research Board, 2024). In 2021, alcohol-related diagnoses accounted for 177,230 bed days in Irish acute public hospitals (Alcohol Action Ireland, 2023). Treatment demand for alcohol problems also remains high. The National Drug Treatment Reporting System recorded 11,651 treatment cases in 2024 where alcohol was reported as a main or additional problem, indicating that hazardous use continues to affect a substantial proportion of the population (Health Research Board, 2024). Collectively, these findings highlight both the cultural acceptance of alcohol use and the enduring public health challenge it represents in Ireland, a backdrop of particular relevance when examining alcohol misuse within the Defence Forces...