Abstract
BackgroundUnemployed people with mental health problems often do not use mental health services and therefore do not benefit from available therapies. As unemployed individuals outside the healthcare system are a hard-to-reach group, barriers to and facilitators of mental health service use are poorly understood. The purpose of this study was to identify barriers to and facilitators of help-seeking and service use based on experiences of unemployed people with mental health problems.MethodsFifteen qualitative semi-structured individual interviews were conducted with unemployed persons who reported mental health problems. Interview topics included individual experience with help-seeking and mental health service use with a focus on barriers and facilitators. Transcripts were analysed using qualitative content analysis and major themes were identified.ResultsParticipants reported being treated as “different” within their social environment as well as by health care professionals because of their mental health problems, which resulted in a lack of self-esteem and avoidance of help-seeking. Interviewees associated negative attributes with help-seeking such as helplessness and weakness. They equated psychiatric medication with illegal drugs and worried about the risk of addiction. However, social support and a desire for change on the other hand increased the motivation to search for help. Employment agency staff were mostly perceived as supportive by individuals seeking mental health services.ConclusionsUnemployed individuals with mental health problems faced barriers and facilitators when seeking help on three different levels: (1) mental health literacy; (2) stigma and discrimination; and (3) structures and conditions of health care. Awareness and attitudes of health care professionals concerning mental health issues should be improved. Stigmatisation of people with mental illnesses should be reduced in health care settings. Training for employment agency staff concerning mental health problems and services is recommended.
Highlights
Unemployed people with mental health problems often do not use mental health services and do not benefit from available therapies
Corrigan [13] reports that three factors influence help-seeking behaviours of people who might benefit from mental health treatment: public stigma (“all people with mental illness are dangerous”); self-stigma (“I have a mental illness, so I must be dangerous”) and structural stigma, which involves processes that represent macro level units rather than individuals, for example, waiting times for treatment as a consequence of limited funding for mental health services [13]
Instrument Based on the literature and informal discussions with service users and relatives, we developed a semistructured interview guide [25] with a series of questions on the following topics (Table 1): (i) dealing with unemployment and mental stress; (ii) stigma-related facilitators of and barriers to service use; (iii) knowledgerelated facilitators and barriers; (iv) any other potential barriers and facilitators; (v) recommendations for optimising mental health care services
Summary
Unemployed people with mental health problems often do not use mental health services and do not benefit from available therapies. Insight, accessibility and quality of services [10, 11], two additional factors influence the choice whether or not to seek help: knowledge about mental illness and available treatments [12] and stigma as a barrier to help-seeking [13, 14]. Both factors have the advantage of being potentially amenable to interventions. Others put off help-seeking because they felt stigmatised by being identified and labelled as mentally ill (illness-related stigma) [21, 22]
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