Mental Barriers Research Articles

Mental health care-seeking and barriers: a cross-sectional study of an urban Latinx community

BackgroundThe Latinx community faces an increasing amount of mental health challenges and disparities in care. While the contributing factors are complex, there are likely potential barriers related to connecting with mental health support and accessing care that can be addressed.MethodsTo investigate barriers in connecting to mental health care, we conducted a cross-sectional survey of mental health service use and barriers in an urban community with a primarily Hispanic/Latinx ethnicity using a modified random walk approach for door-to-door data collection with a two-cluster sampling frame. Survey included questions on socio-demographic, mental health status, desire and attempt to seek care, and the Barriers to Access to Care Evaluation. Shapley additive explanation (SHAP) identified impactful barriers and demographic characteristics. Our primary outcome was the number of respondents who saw a professional in the past 12 months and the key determinants that enabled their successful connection. Secondary outcomes were people with poor mental health who had wanted or tried to seek any source of mental health support.ResultsOf the 1004 respondents enrolled, 70.5% were foreign born; 63.4% were women. In the past 12 months, 23.8% of respondents wanted to connect with mental health care; 15.5% tried to connect, and only 11.7% successfully connected to mental health services. The two most cited barriers had the highest SHAP values: concerns about treatments available (65%) and financial costs (62.7%). Additional barriers with high SHAP values: being seen as weak and having no one to help them find care. Of demographic characteristics, age had the highest SHAP values.ConclusionIn a community with a high density of Latinx immigrants, just under half of respondents wanting mental health care successfully connected. Perceived informational, financial, and stigma-related barriers impacted the likelihood to connect with mental health care. These factors should be considered when designing programs and interventions to improve mental health care access and services in the Latinx community.

Access to University Mental Health Services: Understanding the Student Experience: L'accès aux services universitaires de santé mentale : comprendre l'expérience des étudiants.

To describe student access to university mental health services and barriers and gaps in support. This multiple cohort study used self-report data from 4,138 undergraduate students who completed the U-Flourish Well-Being Survey at the start and completion of first year from 2018 to 2023. The survey incorporated validated measures of mental health symptoms, barriers to care, and open-text questions about the mental health care experience and perceived gaps. Quantitative analyses summarized utilization patterns and barriers. An interpretive qualitative analysis identified common themes about support services and opportunities for improvement from the student perspective. At university entry, 43% of students screened positive for anxiety and/or depression, 30% reported a lifetime mental disorder and 23% a lifetime history of self-harm. Over first year, 15% of students surveyed accessed university mental health services. Access was more likely in students identifying as older, gender diverse, female, having a prior mental disorder and those who screened positive for anxiety or depression. Common attitudinal and practical barriers reported included thinking problems would resolve (74%), being uncomfortable sharing (73%), and not knowing how to get help (50%). Common stigma barriers included concerns about what family or friends might think. Students expressed that both campus-based well-being and mental health care offered during flexible hours and accessible through online booking were important. Student-tailored mental health literacy may be a sustainable approach to address the attitudinal and practical barriers identified. If such barriers are reduced, an increased service demand would be expected and improved efficiencies needed. A clear Statement of Services, an online singular point of access with embedded triage to signpost students to indicated levels of care, and clearly worked-out care pathways including to community-based services would better align with a stepped care model, improve efficiency and access, and foster realistic expectations around university mental health support.

Recognising mental health challenges and barriers to treatment among veterans in the UK

Ahead of Remembrance Day, Samuel Thompson outlines the incidence of mental health issues among veterans, the barriers they encounter when accessing care and routes to receiving treatment.

Prevalence of Mental health and Receipt of Services in Latino Immigrants Living in Philadelphia

Abstract Background and Purpose Research shows that Latino populations are less likely to seek formal mental health services, these attitudes combined with difficulty finding affordable services impact the ability to receive a mental health diagnosis. This project examines mental health symptoms, utilization of mental health services, and socio-ecological barriers to receive mental health services among Latino immigrants, including region of origin, health insurance, immigration status, and English proficiency. Methods Data was collected between 2021-2022 by Drexel University’s CRISOL lab using a cross-sectional respondent-driven sample survey of Latinos born outside the U.S. mainland and residing in Philadelphia. The final sample included 420 Latino/a/e immigrants. Descriptive statistics and bivariate associations using Chi-square analyses were computed. Outcomes The findings revealed that 29.1% of the surveyed individuals exhibited signs of Depression, 36.1% experienced symptoms of Anxiety, 8.7% showed signs of PTSD, and 43.4% possessed one or more mental health conditions. The findings show that country of origin (p<.01), health insurance (p<.05), immigration status (p<.01), and language proficiency (p<.001) are significantly associated with whether an individual has received mental health services in the past year or in their lifetime. Of the survey population, only 39.5% of individuals with one or more mental issues had received mental health services in their lifetime. Conclusions Interventions to increase access to mental health services for Latino communities are needed. Solutions addressing disparities in access to mental health services must address systemic, cultural, and language barriers. Key messages • Region of origin, health insurance, immigration status, and English proficiency impact the utilization of mental health services. • Immigrant populations face stressors that increase the risk for mental health disease and experience multiple barriers to access mental health services.

Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: A qualitative analysis.

Perinatal mental health disorders place a particularly high public health burden on South Africa (SA) via negative health outcomes for the birthing parent and adverse health outcomes for infants (e.g., low birth weight, preterm deliveries, malnourishment) as well as emotional and behavioral problems in children. Depression, posttraumatic stress disorder (PTSD), and other mental health disorders may also compromise engagement in HIV prevention behaviors during the perinatal period, when HIV acquisition risk increases. This is particularly important in SA, where almost a quarter of women between ages 15 to 49 have HIV. There is little research exploring the anticipated impacts mental health symptoms have on one's ability to emotionally connect or caregive after delivery; this critical information will enable providers to support women and their mental health during the transition from pregnancy to postpartum. HIV-negative pregnant persons were recruited from an antenatal clinic in Cape Town as a part of a larger study investigating mental health barriers to pre-exposure prophylaxis (PrEP) uptake during pregnancy. Participants qualified for an in-depth interview based on elevated symptoms of depression and/or PTSD. The interviews explored the likely impact of their mental health symptoms on their baby's wellbeing, their ability to bond with their baby, and their ability to meet their baby's needs. Following the principles of thematic analysis, we identified three main themes that described these relationships: (1) a strong perceived connection between maternal mental health and baby's wellbeing; (2) perceived strains on bonding with the baby; and (3) negative impact of mental health on likelihood of completing parenting tasks. This study will inform future mental health programming to prepare pregnant persons with mental health symptoms for a successful postpartum period with respect to bonding and caring for their infant.

Investigating the Level and Factors of Speaking Anxiety among High Performing School Students

English is mandatory for Malaysian students from standard one until form five. The subject per se has been one of the prerequisites to pass Sijil Pelajaran Malaysia (SPM) and to attain a high school certificate. Regardless of the long years formally learning and acquiring the language within the classroom walls especially, many still fail to speak fluently. Furthermore, the issue of low English proficiency among Malaysians has been one of the primal causes of unemployment in the country. In terms of an individual’s speaking performance, it is found that anxiety during speaking a particular language can cause mental barriers that will prevent learners from speaking fluently. This quantitative study examined the levels of speaking anxiety of Form 1 students towards the English language and the contributing factors towards English-speaking anxiety. 138 Form 1 students took part and completed an adapted 33-item English Language Classroom Anxiety Scale (ELCAS) questionnaire. The questionnaire was then analyzed using Statistical Package for the Social Sciences (SPSS) for the mean and frequency values. The results show that 56.5% of the Form 1 students have moderate levels of English-speaking anxiety. It is also found that the highest contributing factor towards the students’ speaking anxiety is Fear of Negative Evaluation (FNE) with a mean of 2.59. In conclusion, English proficiency level, and socioeconomic as well as geographical factors influence the level of speaking anxiety among ESL learners in Malaysia.

Investigating College Student Mental Health Needs and Barriers Using Natural Language Processing

College students’s mental health has been declining, despite efforts by universities to improve outreach and programming. Though a variety of resources are available, students, especially those who experience marginalization, often do not engage with them. LGBTQ+ students in Florida, in particular, may face unique challenges. To understand marginalized college students’s mental health experiences, we conducted ten focus group interviews (N = 65) with students with various marginalized identities. Using Natural Language Processing (NLP) techniques, we conducted sentiment analysis with respect to students’s responses on interview questions (e.g., mental health needs, how needs are met/not met) among LGBTQ+ and other minority groups. Overall, LGBTQ+ students yielded a more negative sentiment than the other groups, with a marginally significant (at 0.1 level) difference suggested by Wilcoxon rank sum test. This project presents a novel approach to leveraging traditional qualitative methods and AI, provides deeper understanding of the mental-health-related needs of marginalized college students, and practical implications for prevention and intervention efforts to promote college students’s mental health.

Why do instructors pass underperforming students? A Q-methodology study

BackgroundFormal evaluations are an integral part of a student's learning and encourage students to learn and help instructors identify students’ weaknesses. Over the past few decades there have been growing concerns that instructors and evaluators are passing students who do not meet expectations. This phenomenon, in which instructors pass students who do not meet expectations, has been referred to as “failure-to-fail”. In this study, we used Q-methodology to identify instructors’ justifications for failure-to-fail.MethodsA Q-methodology study was conducted to identify the major viewpoints of instructors at a Canadian university. A by-person factor analysis with principal component factor extraction and Varimax rotation was used. The analysis was conducted using the QFACTOR program in Stata. A Cohen’s effect size of 0.80 was used to identify distinguishing statements.ResultsFifty seven instructors participated in this study. Through a by-person factor analysis, three factors representing three viewpoints emerged: Intrinsically Motivated, Extrinsically Motivated, and Administratively & Emotionally Deterred. The Intrinsically Motivated group perceived mental barriers that prevented them from failing students. They strongly disagreed that they experienced pressure from either students or their schools to pass students. The Extrinsically Motivated believed that their higher-ups and the university encouraged them to pass all students. They perceived discomfort associated with defending their reasons for failing students and were concerned that failing students would damage their own career advancements. The Administratively & Emotionally Deterred group believed that the process of failing a student was stressful and exhausting. They disagreed that a failed student is a result of the instructor’s own inadequate guidance or mentorship.ConclusionsThis study identified three distinctive viewpoints that outline areas of consideration for addressing the failure-to-fail mechanism. More transparent discussions within schools, as well as identifying solutions, are required to create systems that ensure educational and professional standards are maintained. Further replication of this study in various disciplines may be used to determine whether these findings are consistent in different fields.

Empowering the periphery: regional planning perspective to left-behind places

Left-behind places, characterized by population decline, economic stagnation, and social decay, present complex challenges that demand regional and place-based plan- ning solutions. Distinguishing the importance of peripheral areas in this perspective is highly crucial, despite their absence from decision-makers’ political agendas as in the case of ne- glecting them due to physical or mental barriers prolongs these disparities. This exploration underlines the regional planning perspective aimed at empowering the periphery, focusing on possible strategies to revive left-behind areas and foster local development. Providing insights from urban planning and regional development, this work discusses the dynamics of decline in the regions and unfolds key principles and approaches for regional level intervention. By emphasizing place-based strategies, this exploration offers input for policymakers, planners, and practitioners seeking to address the spatial disparities and promote different perspec- tives on left-behind places. There are several strategies to employ local resources, and start transformative change, consequently expected to result in advancing the agenda of regional development. Planners must prioritize social infrastructure changes to address diverse needs and promote the well-being of communities within left-behind places, ensuring inclusive local development.

Qualitative Exploration of Experiences of Mental Illness and Stigma Management Strategies Among University Students in Lahore

Current literature on student mental health offers ample evidence of a worldwide increase in the prevalence of mental health issues among university students. However, there is limited literature from a social constructionist approach within Pakistan examining the student perception of mental illness, stigma, stigma management, and barriers to help-seeking. This study attempts to bridge the gap by conducting a descriptive qualitative study using the social constructionist framework to understand the perception of mental illness and its corresponding stigma in a fluid, non-canonical fashion. Semi-structured interviews with 11 university students reveal the personalized meanings given to the critical terms within the study. Intersectional dimensions of gender, class, and level of education are extensively explored, considering the student’s perceptions. The reflexive thematic analysis identifies perceived determinants of mental illnesses, the perceived relationship between mental illness and stigma, stigma management strategies employed by respondents, and perceived coping mechanisms. In Pakistan, where mental illness is not only prevalent but highly stigmatized, this research hopes to be a valuable addition to scholarly research on mental health and illness among young people in higher education institutes.

Understanding community-based mental health interventions among migrant workers in Singapore

BackgroundMigrants in Singapore face unique mental health risk factors and barriers to formal care. Within this context, the Migrant Writers of Singapore (an arts collective) has organised a community-based intervention to address mental health needs, the Mental Health Awareness and Well-Being Festival.AimTo understand migrants’ motivations for organising and participating in the Festival as a form of community-based mental health support, as well as their perspectives on the role and effectiveness of such interventions.MethodsThematic analysis of semi-structured interviews conducted in October and November 2023, with 10 members of MWS involved in the Festival.ResultsInterviewees were primarily motivated by personal experiences of giving or receiving peer support, or finding relief through MWS’s arts-based activities; and to a smaller extent by the need for greater mental health awareness among migrants. Interviewees saw the value of community-based interventions in: (i) easing loneliness, (ii) establishing solidarity, (iii) facilitating communication in help-seeking, and (iv) building longer-term social networks.ConclusionsFindings suggest that community-based interventions may be an enabler of peer support, and help address underlying mental health risk factors. Arts-based activities can enhance these interventions, though further research is required to evaluate concrete outcomes, and ascertain the wider applicability of these findings.

Providers’ perspectives of barriers and facilitators to scale-up of mental health care in the public health delivery system of Mozambique: a qualitative inquiry

BackgroundA central challenge to closing the mental health treatment gap in low- and middle-income countries (LMICs) is determining the most effective pathway for delivering evidence-based mental health services. We are conducting a cluster-randomized, Type 2 hybrid implementation-effectiveness trial across 20 districts of Mozambique called the Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs (PRIDE) program. Following training of nonspecialized providers in facilitation of evidence-based treatments for mental health and informed by the Consolidated Framework for Implementation Research (CFIR), we identified how PRIDE compares to care as usual and the perceived barriers and facilitators of implementation and modifications needed for widescale service delivery and scale-up.MethodsWe conducted rapid ethnographic assessment using freelisting among 34 providers, followed by four focus group discussions (n = 29 participants) with a subsample of psychiatric technicians and primary care providers from 14 districts in Nampula Province. We used Thematic Analysis to inductively apply open codes to transcripts and then deductively applied the CFIR domains and constructs to organize open codes.ResultsThe main Outer Setting constructs relevant to implementation were recognition that patient mental health needs were significant. Additionally, numerous community-level characteristics were identified as barriers, including distance between clinics; shortage of providers; and low awareness of mental health problems, stigma, and discrimination among community members towards those with mental health struggles. The PRIDE program was perceived to offer a relative advantage over usual care because of its use of task-sharing and treating mental illness in the community. PRIDE addressed Inner Setting barriers of having available resources and training and provider low self-efficacy and limited knowledge of mental illness. Providers recommended leadership engagement to give support for supervision of other task-shared professionals delivering mental healthcare.ConclusionsPrimary care providers and psychiatric technicians in Mozambique perceived the relative advantage of the PRIDE program to address mental health treatment access barriers and offered recommendations for successful sustainment and scale up of integrated mental health care.

Drug-Related Violence, Substance Abuse, and Mental Health Challenges in a Southeastern American Indian Tribe: A Qualitative Study

ABSTRACT Background Drug-related violence [DRV] and substance abuse impact the mental health of economically challenged minority community members. DRV challenges to mental health promotion are exacerbated in American Indian [AI] communities. Purpose To investigate psycho-social and environmental factors influencing DRV, substance abuse, and mental health challenges within the Lumbee, a southeastern American Indian Tribe. Methods In-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders were conducted. Results Findings align with existing research, revealing the influence of poor socioeconomic conditions, poor coping strategies, broken family structures, and failed federal policy. The substantial influence of local Christian churches on beliefs, attitudes, and practices of the Lumbee community vis-à-vis DRV and mental health was recognized. Discussion Findings indicated that social-environmental factors, seemingly independent of drug use/violence prevention and treatment, play important roles in the Lumbee community’s ability to recover from mental health consequences of DRV. Identifying barriers to, and facilitators of, prevention and treatment are critical to improving the welfare of tribal communities. Translation to Health Education Practice Major competencies associated with this research apply to Areas I & II, Assessment of Needs/Capacity and Planning. Identification of DRV and mental health education, prevention and treatment barriers are critical to quality-of-life improvement in tribal communities.

Pharmacy barriers for transgender and gender diverse young adults

BackgroundTransgender and gender diverse (TGD) individuals face substantial physical and mental health care barriers. Community pharmacies are one of the most accessible health care settings; however, concern for discrimination at the pharmacy has been reported. It is important to gain a better understanding of TGD individual’s perspectives and experiences at the pharmacy to ensure optimal and inclusive care. ObjectiveTo identify TGD individual experiences and barriers at the pharmacy. MethodsThis institutional review board−approved qualitative study recruited TGD young adults in the United States between ages 18 and 29 years for semi-structured focus group discussions. Questions focused on barriers to obtaining medications at the pharmacy and negative or positive experiences with pharmacists. Interviews were recorded, transcribed, and transcripts were analyzed for common themes amongst participants. ResultsNine 1.5- to 2-hour focus groups were conducted and included 30 participants (2–6 participants in each group). All participants reported having been prescribed medications by a physician or mental health provider. Participants self-reported issues at pharmacies and with pharmacy personnel. Major themes included issues accessing medications and supplies (needles, syringes), questioning of prescription validity and patient identity, and lack of education or understanding of TGD individuals by pharmacy staff. ConclusionTGD individuals experience barriers at the pharmacy and concerning issues with pharmacy staff. Education, structural competency, and improvements in gender-related data management are necessary for pharmacists and pharmacy staff to provide equitable and inclusive care for TGD individuals.

Value of Engagement in Digital Health Technology Research: Evidence Across 6 Unique Cohort Studies.

Wearable digital health technologies and mobile apps (personal digital health technologies [DHTs]) hold great promise for transforming health research and care. However, engagement in personal DHT research is poor. The objective of this paper is to describe how participant engagement techniques and different study designs affect participant adherence, retention, and overall engagement in research involving personal DHTs. Quantitative and qualitative analysis of engagement factors are reported across 6 unique personal DHT research studies that adopted aspects of a participant-centric design. Study populations included (1) frontline health care workers; (2) a conception, pregnant, and postpartum population; (3) individuals with Crohn disease; (4) individuals with pancreatic cancer; (5) individuals with central nervous system tumors; and (6) families with a Li-Fraumeni syndrome affected member. All included studies involved the use of a study smartphone app that collected both daily and intermittent passive and active tasks, as well as using multiple wearable devices including smartwatches, smart rings, and smart scales. All studies included a variety of participant-centric engagement strategies centered on working with participants as co-designers and regular check-in phone calls to provide support over study participation. Overall retention, probability of staying in the study, and median adherence to study activities are reported. The median proportion of participants retained in the study across the 6 studies was 77.2% (IQR 72.6%-88%). The probability of staying in the study stayed above 80% for all studies during the first month of study participation and stayed above 50% for the entire active study period across all studies. Median adherence to study activities varied by study population. Severely ill cancer populations and postpartum mothers showed the lowest adherence to personal DHT research tasks, largely the result of physical, mental, and situational barriers. Except for the cancer and postpartum populations, median adherences for the Oura smart ring, Garmin, and Apple smartwatches were over 80% and 90%, respectively. Median adherence to the scheduled check-in calls was high across all but one cohort (50%, IQR 20%-75%: low-engagement cohort). Median adherence to study-related activities in this low-engagement cohort was lower than in all other included studies. Participant-centric engagement strategies aid in participant retention and maintain good adherence in some populations. Primary barriers to engagement were participant burden (task fatigue and inconvenience), physical, mental, and situational barriers (unable to complete tasks), and low perceived benefit (lack of understanding of the value of personal DHTs). More population-specific tailoring of personal DHT designs is needed so that these new tools can be perceived as personally valuable to the end user.

Vietnam, Women, and Science: Mental Barriers and Gender Gap

Considering the cultural context of Vietnamese society, this article explores the influence of mental barriers regarding the traditional role of women and its impact on their possibilities to participate in scientific activities. Vietnam is a country that has promoted scientific and technological activities and the strengthening of a national innovation system as a critical element on its path to development. These actions have made it possible to shore up economic growth that began with opening up and economic reform. In this way, Vietnam has achieved some critical achievements in the economic and social fields. However, reducing the gender gap in scientific activities is still a vital challenge, although the government has taken significant measures to overcome it. The article analyzes the relationship between women in science in Vietnam and the gender stereotype based on data collected through reports of international organizations, news reports, and other relevant data. The principal argument is that this situation results from the mental barriers of Vietnamese society that present strong stereotypes regarding the role of women. Therefore, to advance gender equality, changing the mental stereotypes still present in Vietnamese culture is necessary.

Adult perceptions of mental health access barriers facing youth in rural Washington State: A group concept mapping study.

To explore adult community members' perspectives concerning barriers to mental health care that confront rural-dwelling youth. Group concept mapping, a participatory community-engaged research method, was used. Adult community members brainstormed and sorted statements describing barriers rural youth encounter in accessing mental health services. Point and cluster maps were created to visualize conceptual similarities between statements. Statements were rated according to their commonness and importance (1: low commonness/importance, 5: high commonness/importance). Thirty-five adults sorted and/or rated 71 barriers facing rural youth in accessing mental health services. Seven conceptual clusters were identified: system-level barriers, knowledge and communication, youth concerns, parent/guardian concerns, parent/guardian barriers, costs and convenience, and school-level barriers. Within youth concerns, community members also identified a subcluster focused on stigma. Common and important statements related to limited after-school programs and community mental health support initiatives. Group concept mapping methodology provides structure for conceptualizing challenges facing rural youth in accessing mental health services. Policies should be informed by rural community concerns and priorities. After-school and support programs may align with mental health needs identified by rural communities.

Patient Experience and Barriers to the Visual Field Test for Glaucoma.

There are significant mental, physical, and perceptual challenges in patients undergoing visual field testing, particularly in the elderly population with glaucoma. To quantitatively and qualitatively investigate patient experiences of undergoing visual field testing. This cross-sectional, mixed-methods study involves adult patients attending a private outpatient ophthalmology clinic in Brisbane, Australia. Participant experiences of visual field testing were assessed using a 100mm visual analog scale (VAS), followed by face-to-face semi-structured interviews. Outcome data comprised of VAS scores (1-100) and thematically analyzed verbatim notes. Out of the 152 participants (M:F 79 (52.0%):73 (48.0%)) the age group with the highest proportion of participants was 71-80 years 56 (36.8%), and most had a primary ocular diagnosis of glaucoma 107 (70.4%). The mean VAS score for visual field testing experience was (60.45 [SD=30.38]). The mean VAS score of participants with glaucoma was significantly lower than that of participants without glaucoma (55.34 [31.13] vs 72.67 [25.04]; P<0.05). Prevalent themes regarding participant experiences of visual field testing consisted of concentration difficulties, intra-test and peri-test anxiety, skepticism in the testing process, and physical discomfort. Age, gender and mean visual field index did not influence the participant's experience of visual field testing. Mental and physical barriers to visual field testing tolerability were identified in a predominantly elderly population with glaucoma. Our findings highlight the importance of addressing patient concerns and apprehensions regarding visual field testing and emphasize the value of patient-initiated breaks, particularly for individuals experiencing concentration difficulties and physical discomfort.

Characteristics of Youth Crisis App Users: Mental Health Service Access and Barriers and Perceptions of Helpfulness

Characteristics of Youth Crisis App Users: Mental Health Service Access and Barriers and Perceptions of Helpfulness

Mental health and employment outcomes in working-age US adults, 2010-2019.

Individuals with severe mental illness experience greater unemployment and barriers to workforce re-entry. However, less is known about additional indicators of employment stability for individuals across mental illness severity. This study aims to examine associations between mental illness severity, use and adequacy of mental health treatment, and indicators of employment stability. In this repeated cross-sectional study, 2010-2019 data from the U.S. National Survey of Drug Use and Health were used to construct multivariate logistic regression models predicting the odds of part-time employment, past-year work interruption, number of past-year employers, and past-month health-related work absence by mental illness severity and adequacy of mental health treatment. Compared to individuals with no mental illness, those with any and severe mental illness had significantly higher odds of part-time employment (adjusted odds ratios [AORs] = 1.51 and 2.16, 95% confidence intervals [CIs] 1.4-1.6 and 2.0-2.3), multiple past-year employers (AORs = 1.78 and 2.34, CIs 1.7-1.9 and 2.1-2.6), past-year work interruption (AORs = 1.69 and 2.20, CIs 1.6-1.8 and 2.1-2.4), and >7 days of past-month work absence (AORs = 2.51 and 3.82, CIs 2.3-2.8 and 3.3-4.5). Among respondents with mental illness, perceived inadequacy of mental treatment predicted higher odds of all adverse employment outcomes. Compared to those with no mental illness, individuals with mental illness of any severity have higher odds of employment instability. Policy and programmatic support aimed at addressing the needs of individuals with mental illness, including access to adequate mental health treatment, are needed to facilitate continued, competitive employment.