Beyond the Uniform: Stigma as Inclusion Deficit, Physician Gateways to Care, and Short‐Run Over‐Performance Among U.S. Veterans

1. Introduction

Behavioral health workplace stigma remains a significant challenge for military veterans transitioning into civilian work environments. These stigmas deter veterans from seeking necessary mental health care, exacerbate challenges in job performance, and perpetuate workplace exclusion. Research highlights pervasive barriers, including self-stigma, public stigma, and career-related fears, which prevent veterans from accessing timely support [1,2]. Moreover, economic disparities such as reduced earnings and higher unemployment rates among veterans reflect systemic inequalities driven by stigma and low mental health literacy [3].

The World Health Organization [4] estimates that one in four individuals globally grapples with mental illness, yet mental health literacy remains limited in most workplaces. Veterans, in particular, encounter unique stigma stemming from perceptions of strength and resilience associated with military culture. Workplace stigma manifests in absenteeism, presenteeism, and turnover, resulting in substantial economic losses across sectors [5].

Despite growing recognition of workplace mental health challenges, gaps remain in understanding how stigma interacts with mental health literacy to affect veterans’ job performance. Existing studies have examined barriers to mental health service utilization [1] and the economic implications of workplace stigma [5], but few address the moderating roles of organizational level, professional experience, or age. Furthermore, research on interventions tailored to improve mental health literacy among veterans is scarce.

The primary goal of this study is to examine the interplay between workplace stigma, mental health literacy, and job performance among military veterans. Specific objectives include identifying the effects of stigma on veterans’ engagement with mental health support systems, exploring the role of mental health literacy in mitigating stigma and improving performance, and investigating how organizational level, professional experience, and age moderate these relationships.

1.1. Literature Review and Theoretical Framework

1.1.1. Synthesis of Supporting Literature into the Study’s Context

The findings of supporting literature complement the study by providing deeper insights into the multifaceted challenges faced by veterans and the potential pathways for intervention. Richards et al. [1] highlight how stigma reduces veterans’ willingness to seek healthcare and suggest strategies for reducing these barriers, aligning with the study’s emphasis on the adverse impact of workplace stigma on mental health engagement and job performance. This literature reinforces the study’s recommendation for stigma-reduction initiatives to foster a more supportive workplace environment.

Brown and Bruce [2] extend this understanding by differentiating between self-stigma, public stigma, and career worry, identifying career worry as the most significant barrier to seeking treatment. This insight supports the study’s focus on organizational interventions that mitigate stigma and career-related fears, which can enhance veterans’ mental health literacy and willingness to engage with support systems.

Roscoe [6] examines how veterans with PTSD employ communication strategies to manage stigma. This aligns with the study’s finding that workplace stigma impedes engagement and suggests that enhancing veterans’ communication skills and resilience could be a valuable addition to mental health literacy initiatives.

Garcia et al. [5] explore burnout among mental health providers in veteran-focused clinics, revealing how organizational factors such as workload and bureaucracy contribute to burnout. This literature underscores the study’s recommendation for organizations to create supportive environments, not only for veterans but also for those providing mental health services, ensuring effective care delivery.

Lastly, Harding [3] focuses on self-stigma within veteran culture, emphasizing the need for culturally sensitive mental health interventions. This aligns with the study’s emphasis on tailoring support strategies to address the unique needs of veterans, particularly by fostering understanding and acceptance of mental health issues within organizational cultures.

1.1.2. Implications for the Study

Incorporating these insights into the study strengthens the argument for targeted, multi-dimensional interventions addressing workplace stigma, career concerns, and organizational dynamics. It supports the call for culturally sensitive, communication-based approaches and highlights the importance of addressing both individual and systemic barriers to improve mental health engagement and job performance among veterans.

1.1.3. Addressing Stigma and Career Concerns

Richards et al. [1] and Brown and Bruce [2] both emphasize the detrimental effects of stigma on veterans’ mental health engagement. While “Beyond the Uniform” identifies workplace stigma as a significant barrier to mental health engagement and job performance, Richards et al. [1] suggest that tailored stigma-reduction strategies, such as normalizing mental health conversations and enhancing confidentiality protocols, can mitigate these barriers. Brown and Bruce [2] further point out that career worry—fear of professional repercussions—has a stronger impact than stigma alone. This insight supports the recommendation for organizations to implement policies that explicitly protect veterans’ career trajectories when seeking mental health support, creating a safer and more accepting workplace environment.

1.1.4. Enhancing Mental Health Literacy

The study emphasizes the importance of mental health literacy (MHL) in reducing stigma and improving veterans’ engagement. Roscoe [6] deepens this perspective by highlighting how veterans with PTSD employ communication strategies to navigate stigma. Integrating this into the study’s context suggests that MHL programs should incorporate training on effective self-advocacy and stigma management communication. Additionally, Harding [3] notes the role of cultural values in shaping veterans’ perceptions of mental health, indicating that MHL efforts must be culturally tailored to address unique aspects of military identity, such as perceptions of strength and resilience, which may hinder help-seeking behaviors.

1.1.5. Supporting Organizational Change

Garcia et al. [5] provide an organizational lens by demonstrating that factors like excessive workload, bureaucracy, and lack of autonomy contribute to burnout among mental health providers. This aligns with the study’s focus on the role of organizational resources in mitigating stigma and enhancing job performance. Organizations could adopt a dual-focus approach by fostering supportive environments for both veterans and mental health providers. Initiatives such as mental health-friendly policies, access to evidence-based treatments, and regular wellness check-ins can reduce burnout and improve engagement across all stakeholders.

1.1.6. Broader Implications

The integration of these supporting works enhances the study’s theoretical framework and practical applications, aligning with the Job Demand-Resource (JD-R) model. By addressing both systemic barriers (e.g., organizational stigma, career concerns) and individual factors (e.g., communication strategies, cultural identity), the study provides a holistic roadmap for fostering veteran well-being and productivity.

Studies like those from Richards et al. [1] highlight that many veterans face significant barriers to seeking mental health support, with stigma being a leading factor. Public stigma (workplace), self-stigma (mental illness), and fears of career consequences often lead to underutilization of healthcare services.

Research by Brown and Bruce [2] notes that up to 50% of veterans experiencing mental health challenges such as PTSD or depression refrain from seeking help due to stigma or fear of career consequences. These barriers are compounded by low mental health literacy, which limits their ability to recognize and address mental health symptoms.

Harding [3] emphasizes that self-stigma, influenced by cultural norms around strength and resilience in military culture, exacerbates these challenges, leading to increased morbidity and lower engagement with support systems.

Workplace-specific studies, such as Garcia et al. [5], indicate that stigma in workplace environments can result in higher absenteeism and turnover, though exact prevalence rates vary across studies and industries.

1.1.7. Stigma in the Workplace

Stigma in the workplace encompasses prejudicial attitudes and discriminatory behaviors toward individuals with mental health conditions. For veterans, stigma often originates from stereotypes about their military service, such as assumptions of instability or aggression [1]. Studies by Vogt et al. [7] and Harding [3] reveal that stigma acts as a significant barrier to treatment, deterring veterans from seeking help due to fears of judgment.

1.1.8. Job Demand-Resource (JD-R) Model

The JD-R model serves as the theoretical framework for this study, positing that job demands (e.g., stigma, emotional labor) and resources (e.g., mental health literacy, organizational support) influence employee well-being and performance [8]. For veterans, stigma represents a job demand that increases stress and hinders engagement. Conversely, mental health literacy functions as a resource, enabling veterans to seek support and manage workplace challenges effectively.

1.1.9. Research Gaps

Despite growing recognition of workplace mental health challenges, gaps remain in understanding how stigma interacts with mental health literacy to affect veterans’ job performance. Existing studies have examined barriers to mental health service utilization [1] and the economic implications of workplace stigma [5], but few address the moderating roles of organizational level, professional experience, or age. Furthermore, research on interventions tailored to improve mental health literacy among veterans is scarce. Existing literature highlights the detrimental effects of stigma and low mental health literacy, but it remains unclear how these factors interact to influence job performance. There is also limited empirical evidence on how organizational and individual factors moderate these relationships.

2. Materials and Methods

2.1. Design and Sample

We analyzed a cross-sectional pilot survey of post-service Veterans employed in civilian organizations. Quality controls excluded preview and incomplete responses and enforced attention checks.

2.2. Measures

Individual Work Performance (IWP) was assessed with the 17-item IWPQ; counterproductive work behavior items were reverse-coded so higher values indicate better performance [9]. Workplace mental-illness stigma was measured with the Mental Illness Stigma Scale (MISS) with subdomains (e.g., Interpersonal Anxiety, Relationship Disruption, Poor Hygiene, Visibility, Treatability/Recovery/Professional Efficacy) [10]. Formal help-seeking was operationalized via the highest-loading observed indicator: likelihood of seeking help from a doctor/physician.

2.3. Modeling Approach

Structural paths reflected the revised conceptual model: stigma and hygiene predicting help-seeking; stigma, hygiene, and help-seeking predicting IWP. This specification aligns with pathway-to-care literature positioning primary care as a gateway to specialty mental health [11,12]. The research model is shown in Figure 1.

2.4. Data Collection Procedures

Data were collected through an anonymous online survey distributed via Qualtrics under the auspices of the University of New Orleans institutional review board (IRB) number: 05Apr24. The survey was rigorously pilot tested with 250 participants to ensure clarity and cultural sensitivity. Participants received a detailed explanation of the study’s objectives and provided electronic informed consent. Measures were taken to guarantee confidentiality and encourage candid responses, including anonymized survey links and encrypted data storage protocols [13].

2.5. Data Analysis

To empirically test the research model, we administered an online survey focused on veterans’ workplace stigma and work performance. The survey instrument was developed using scales adapted from existing literature. A panel of content validity experts, consisting of healthcare researchers and practitioners well-versed in the domain and experienced in quantitative research methods, was consulted to assess the content validity of all scales. All measures were assessed using a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Table 1 presents the measurement items and their sources. All latent constructs were measured using reflective items.

Participants in this study were veterans recruited through an American nonprofit organization that provides no-cost counseling through a network of volunteer mental health professionals. We received 275 responses and retained 209 (76%) after filtering out incomplete and invalid responses. The diverse profiles of veteran participants are summarized in Table 2.

To mitigate common method bias (CMB), we implemented procedural remedies during the survey design phase. Specifically, survey questions measuring exogenous constructs were separated from those measuring endogenous constructs to ensure they did not appear in a linear order [17]. In addition, we conducted Harman’s single-factor test to assess CMB. According to Podsakoff et al. [17], if common method bias is present, either a single factor will emerge from an unrotated exploratory factor analysis, or one general factor will account for the majority of the covariance among the measures.

2.6. Measurement Validation

The measurement model was assessed using multiple criteria: reliability, evaluated through composite reliability and Cronbach’s alpha; convergent validity, assessed using average variance extracted (AVE); and discriminant validity. Following established guidelines, indicator loadings were expected to exceed 0.70, while items with loadings between 0.40 and 0.70 were considered for removal only if their deletion resulted in an increase in composite reliability or AVE beyond the recommended threshold values [18].

2.7. Hypothesis Testing

To test the hypotheses, we estimated the sizes and the levels of significance of the path coefficients in the research model. Also, we evaluated the coefficients of determination (i.e., R² values) of the endogenous constructs, which measure the explained variances of the endogenous constructs and indicate the model’s predictive accuracy [18]. These values were estimated using the Covariance-based Structural Equation Modeling (SEM) with SPSS AMOS 28.

In addition, we applied PROCESS V5.0, an SPSS macro known for its capacity to assess complex mediation effects [19]. We used the latent variable scores of the constructs to run Model 4 in the macro, with a 95% confidence interval and 5,000 bootstrap samples to ensure the robustness of our results.

3. Results

3.1. Common Method Bias

Our results indicated that neither condition occurred in our data. Common method bias was not a significant concern in this study.

3.2. Measurement Validation

After removing a small number of items, the loadings of all remaining indicators exceeded the recommended threshold of 0.70, as shown in Table 1.

Furthermore, Table 3 presents an overview of the measurement model results, including the mean values, standard deviations, reliability, and validity metrics for each measurement item. The composite reliability and Cronbach’s alpha values for all constructs exceeded 0.70, indicating strong reliability. All AVE values were above 0.50, demonstrating robust convergent validity. Furthermore, for each construct, the square root of the AVE exceeded its highest correlation with any other construct, providing evidence of adequate discriminant validity.

3.3. Hypothesis Testing

The model demonstrates robust goodness-of-fit (χ² = 160.067, df = 85, χ²/df = 1.883, CFI = 0.954, TLI = 0.934, RMSEA = 0.065). It explains 25.9% of the variance (i.e., R²) in individual work performance, 4.7% in workplace stigma, and 6.6% in help-seeking from a doctor.

As shown in Figure 2, the results indicate that veterans’ anxiety is positively and significantly associated with perceived workplace stigma (β = 0.232, p ≤ 0.01), providing support for H1. In contrast, anxiety does not have a significant effect on help-seeking from a doctor (β = −0.051, p = 0.618) or on veterans’ individual work performance (β = 0.042, p = 0.711). Workplace stigma, however, has a significant negative effect on help-seeking behavior (β = −0.155, p ≤ 0.05), thereby supporting H3a. Interestingly, workplace stigma also exhibits a significant positive association with veterans’ individual work performance (β = 0.351, p < 0.001). Moreover, hygiene is positively and significantly related to help-seeking from a doctor (β = 0.260, p ≤ 0.01), supporting H5a, whereas its effect on individual work performance is not statistically significant (β = 0.185, p = 0.110). Lastly, as predicted, help-seeking from a doctor has a significant negative effect on veterans’ individual work performance (β = −0.211, p ≤ 0.01), supporting H6.

3.4. Indirect Effects

The findings indicate that the indirect effects of veterans’ anxiety on both help-seeking behavior and individual work performance, mediated by workplace stigma, are statistically significant (help-seeking: estimate = -0.035, 95% CI = [-0.092, -0.002]; individual work performance: estimate = 0.057, 95% CI = [0.013, 0.114]), thereby providing support for H4a and H4b.

3.5. Control Variables

In terms of the control variables, demographic characteristics, including age, education, work experience, organizational level, and industry sector, do not exhibit significant effects on individual work performance.

4. Discussion

4.1. Roadmap-Informed Interpretation

The findings are best understood through a translational public-mental-health lens rather than as a purely clinical utilization problem. Give an Hour’s published approach organizes mental-health access around four linked actions—Listen, Lean In, Learn, and Lead—and emphasizes multimodal, evidence-based, consumer-informed support for people affected by human-made trauma [20]. This roadmap is highly congruent with the present study because the core empirical signal is not simply that Veterans do or do not seek care; it is that the available care journey is filtered through stigma, visible symptoms, and physician-based gateways. In this sense, the model identifies a design problem: workplace and community systems must be built so that Veterans encounter credible, low-friction, non-punitive pathways before crisis points emerge.

The first element of the roadmap, Listen, is reflected in Give an Hour’s use of journey mapping to identify critical mental-health touchpoints [20]. Our physician-gateway finding should be interpreted similarly: “doctor” is not merely a preferred provider category but a mapped touchpoint in a constrained access pathway. Many Veterans first understand distress through a medical frame, particularly when symptoms are visible, functional, or embodied. Yet the same pathway can delay care if the individual fears workplace stigma, anticipates career penalty, or cannot access timely specialty services. A workplace-informed journey map would therefore identify the points at which stigma, uncertainty, and access bottlenecks interrupt help-seeking and would intentionally place warm handoffs at those points.

The second element, Lean In, calls for informed and tailored responses aligned with customer needs and preferences [20]. For this manuscript, that means moving beyond one-size-fits-all advice to “seek help” and toward trusted, culturally attuned routes that match Veterans’ lived experience. The data suggest that hygiene and visible-symptom concerns may push Veterans toward formal care, but interpersonal anxiety and stigma can simultaneously keep distress private. Responsive design therefore requires multiple first doors—primary care, peer navigation, chaplaincy, employee assistance, Vet Centers, tele-mental health, and community partners—so help-seeking does not depend on a single clinical gateway.

The third element, Learn, focuses on continuous improvement through iterative engagement [20]. This principle provides a methodological bridge from the present pilot to the next research phase. The findings should be treated as early evidence for refining the model rather than as a closed causal account. Future waves should test whether physician-based help-seeking remains the highest-loading pathway, whether peer-navigation indicators emerge as stronger predictors when they are made visible to respondents, and whether interpersonal anxiety predicts later depletion or merely coincides with short-run over-performance. Continuous learning also requires transparent model diagnostics, including measurement reliability, structural invariance, sensitivity analyses, and preregistered longitudinal outcomes, rather than narrative interpretation alone.

The fourth element, Lead, emphasizes resilient communities and measurement that privileges customer voice and experience [20]. This shifts the practical implication of the study from “educate individual Veterans” to “build workplace and community ecosystems that make support normal, visible, and safe.” Give an Hour’s tools and training infrastructure also offer a practical vocabulary for this work: early identification, healthy self-care, the Five Signs, and the Silent 6 can help translate latent distress into observable, non-shaming language [21]. Of particular relevance is the “people pleasing/overextension” indicator, which maps directly onto the over-performance mechanism suggested by the study--the possibility that Veterans under stigma may work harder, take on more, and mask distress until the pattern becomes costly.

Dr. Trina Clayeux’s role as CEO of Give an Hour and her background in workforce development, mental health, trauma-informed workplaces, and military/veteran family experience make this roadmap especially relevant to the present organizational framing [22]. The study’s central contribution is therefore not only empirical but translational: it connects validated stigma and performance measures to an implementation model that can be acted on by employers, community partners, and Veteran-serving systems. By reframing stigma as an inclusion deficit, help-seeking as psychological agency, and mental-health literacy as psychological-safety infrastructure, the manuscript offers a bridge between evidence, workplace practice, and Veteran-centered support.

4.2. Limitations and Future Research

This manuscript remains a pilot analysis and should not be interpreted as causal proof. The cross-sectional design prevents temporal ordering, and the single observed physician help-seeking indicator is parsimonious but incomplete. Future studies should model help-seeking as a multidimensional construct that includes peer navigation, tele-mental health, chaplaincy, Vet Centers, employee assistance programs, and community-based organizations; measure mental-health literacy directly; test measurement invariance across Veteran subgroups; and examine whether over-performance predicts later depletion, burnout, absenteeism, or turnover. Longitudinal, preregistered, and implementation-focused designs are needed to distinguish short-run compensatory performance from sustainable functioning.

4.3. Recommendations

The findings support a set of upstream, culturally responsive recommendations designed to strengthen psychological safety, diversify access pathways, and protect both well-being and sustainable work performance. These recommendations should be interpreted as implementation priorities generated from a cross-sectional pilot, not as evidence that any single intervention has already been proven effective. Consistent with Give an Hour’s Listen, Lean In, Learn, and Lead roadmap, the central design principle is to move credible support closer to the points where Veterans experience stigma, uncertainty, and access friction, before distress becomes visible through impairment or crisis [20].

4.3.1. Employers and Supervisors

Employers should treat psychological safety as performance-protective infrastructure rather than as an optional wellness message. Operational policy should explicitly separate help-seeking from adverse career consequences, protect confidentiality, normalize the use of employee assistance, leave, peer, and community resources, and hold leaders accountable for the climate in which those resources are offered. Sustained, contact-based stigma-reduction practices and routine feedback loops are more likely to alter daily behavior than episodic awareness campaigns alone [23,24,25].

Supervisory and gatekeeper training should be calibrated to meaningful changes from an employee’s baseline, not only to visible decline. For some Veterans, increased work hours, reluctance to disengage, perfectionistic overextension, reduced use of personal leave, or unusually intense task absorption may represent compensatory effort rather than evidence that support is unnecessary. These patterns should prompt a private, non-diagnostic conversation about workload, functioning, and preferred resources, not punitive monitoring or an assumption of illness. Healthy drive and discipline remain valued; the relevant signal is an abrupt or sustained departure from the individual’s established pattern. Give an Hour’s Five Signs and Silent 6 provide non-shaming language for this approach, particularly the concepts of personality change and people pleasing/overextension [21,26,27].

4.3.2. Community Partners and Veteran-Serving Organizations

Community systems should implement a no-wrong-door, low-friction access architecture. Physician access remains important, but the physician-based indicator used in this pilot should not be treated as the only legitimate gateway. Peer navigators, chaplains, Vet Centers, tele-mental health, employee assistance programs, primary care, and community-based providers should be connected through warm handoffs, shared referral protocols, and clear escalation pathways [28,29,30,31]. Journey mapping should identify where career concerns, eligibility questions, timing, uncertainty, or lack of trust cause Veterans to disengage. Some Veterans may benefit from brief upstream support, while others will require clinical care; the system should accommodate both without requiring crisis-level impairment as proof of need.

Employers, community organizations, and Veteran-serving organizations should co-design these pathways with Veterans and review them as an integrated service journey rather than as disconnected programs. The practical test is whether a Veteran can enter through any trusted door, retain choice about the next step, and receive a timely handoff without repeated disclosure or avoidable delay. This approach operationalizes the Listen and Lean In elements of the Give an Hour roadmap by aligning support with lived experience rather than requiring Veterans to adapt to a single system entry point [20].

4.3.3. Clinicians and Behavioral Health Providers

Clinical assessment should examine functioning alongside impairment and should include explicit inquiry about over-functioning. Intake and follow-up protocols can assess changes in work intensity, inability to disengage, perfectionism, people pleasing, and role overextension alongside traditional symptoms and functional losses. Cultural competence is essential to distinguish military-derived discipline, mission focus, and resilience from compensatory overwork used to contain or conceal distress. A change from baseline should trigger contextual assessment rather than automatic pathologizing, and care plans should include stepped options and warm handoffs that do not depend exclusively on a physician gateway [3,6].

The negative association between physician help-seeking and individual work performance in this cross-sectional sample should not be interpreted as evidence that care reduces performance. Temporal order is unknown, and one plausible explanation is that formal help-seeking occurs only after distress has already become costly. Clinicians and organizational partners can address this possibility by reducing delay, offering earlier and less stigmatized points of contact, and making navigation support available before a Veteran must self-identify as impaired [12].

4.3.4. Researchers and Implementation Partners

The next research phase should move beyond single-moment associations to longitudinal and intervention designs that establish temporal order. Help-seeking should be measured as a multimodal construct that includes physicians, peers, chaplains, tele-mental health, Vet Centers, employee assistance programs, crisis services, and community organizations, with attention to timing, sequence, and intensity of use. Mental-health literacy should also be operationalized directly as a multidimensional construct rather than inferred from a single help-seeking item. Repeated-measures studies should test whether apparent over-performance is transient, whether it predicts later depletion, burnout, absenteeism, or turnover, and whether these pathways differ across Veteran subgroups and employment settings.

Research partnerships with Give an Hour and other Veteran-serving organizations should be designed as continuous learning systems. Veteran advisory input, preregistered outcomes, measurement invariance testing, sensitivity analyses, and implementation metrics should accompany tests of effectiveness. Frameworks such as the Consolidated Framework for Implementation Research and RE-AIM can help determine not only whether an intervention works, but for whom, under what conditions, with what reach, and whether it can be sustained [32,33]. Each research wave should return actionable findings to employers, clinicians, community partners, and Veterans while the model is refined in practice.

4.3.5. Policymakers and System Leaders

Policy should treat stigma as heterogeneous and as an inclusion deficit rather than as a single awareness problem. The measured dimensions in this study did not behave uniformly: interpersonal anxiety was associated with workplace stigma, hygiene concerns were associated with physician help-seeking, workplace stigma was associated with lower help-seeking, and workplace stigma was also associated with higher self-reported work performance. A single educational campaign is unlikely to address these distinct mechanisms. Policy levers should therefore be matched to the barrier, including enforceable confidentiality and career protections, contact-based education, funding for peer and navigation services, reimbursement and contracting arrangements that support warm handoffs, and evaluation standards that capture trust, pathway choice, time to first contact, and sustained functioning rather than utilization volume alone [31,34,35].

5. Conclusions

This study demonstrates that Veteran workplace mental health cannot be reduced to an individual’s willingness to seek care. Workplace stigma, physician-based help-seeking, and reported performance are embedded in systems of access, identity, work norms, and trust. Workplace stigma was associated with lower formal help-seeking and higher individual work performance, while hygiene concerns were associated with greater physician help-seeking. These findings complicate the assumption that distress will first appear as diminished output. A plausible interpretation is compensatory over-performance, in which some Veterans maintain or intensify work effort while concealing strain. Because the design is cross-sectional, this remains a testable working theory rather than a causal conclusion. Likewise, the negative association between physician help-seeking and performance cannot establish that care harms performance or determine which condition occurred first.

The Give an Hour roadmap provides a coherent structure for translation: Listen to Veterans’ care journeys and changes from baseline; Lean In with culturally matched, no-wrong-door supports; Learn through longitudinal measurement and implementation feedback; and Lead by making psychological safety operational across workplaces and communities [20]. This framework connects employer, community, clinical, research, and policy action around a shared objective: creating early, credible, non-punitive pathways to support and recognizing that both under-functioning and over-functioning may warrant careful inquiry.

The study’s contribution is both scholarly and practical. It reframes workplace stigma as an inclusion deficit, mental-health literacy as psychological-safety infrastructure, and help-seeking as an expression of agency. These reframes move the field upstream from crisis response after harm has accumulated toward trusted, community-grounded systems that protect dignity, choice, and sustainable participation in civilian employment. The central implication is not that high performance is pathological; it is that performance alone is an insufficient indicator of well-being. Systems that respond to meaningful changes from baseline while preserving Veterans’ autonomy are better positioned to protect health, workforce readiness, and long-term performance.