United States (U.S.) military personnel express concerns about the potential impact of seeking mental health care on their careers. To date, there is a lack of empirical data on the association between mental health treatment utilization at a military treatment facility and career-related outcomes. This study examined short- and long-term military career outcomes among U.S. Air Force (USAF) personnel receiving outpatient mental health care. Phase 1 involved a retrospective chart review (N = 370) across nine USAF mental health outpatient clinics. Phase 2 involved a prospective case control comparison of the career-trajectories of USAF personnel who sought mental health treatment (n = 332) versus those who did not (n = 1147) after matching for military rank, time in grade, and occupational code. Overall, nearly a third of service members received career-affecting recommendations from their mental health treatment provider. Commander-directed service members were more likely to receive career-affecting recommendations than those self-referred or superior-encouraged. Younger age, higher rank, superior-encouraged referral, greater self-reported distress during first contact, and history of psychiatric inpatient care were predictors of receiving career-affecting recommendations. Service members receiving outpatient mental health care, compared to those without a military history of mental health care, were three times more likely to experience a medical board evaluation and nearly twice as likely to receive a discharge. Proactive, early self-referral for mental health treatment is one strategy for sustaining a military career. Department of Defense stigma reduction campaigns should provide empirically derived information about mental health treatment utilization and military career-related outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved)