Skip to main content
Top
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Barriers and facilitators of help-seeking among unemployed persons with mental health problems: a qualitative study

Authors: Tobias Staiger, Tamara Waldmann, Nicolas Rüsch, Silvia Krumm

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

Unemployed 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.

Methods

Fifteen 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.

Results

Participants 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.

Conclusions

Unemployed 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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Olesen SC, Butterworth P, Leach LS, Kelaher M, Pirkis J. Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study. BMC Psychiatry. 2013;13:144.CrossRefPubMedPubMedCentral Olesen SC, Butterworth P, Leach LS, Kelaher M, Pirkis J. Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study. BMC Psychiatry. 2013;13:144.CrossRefPubMedPubMedCentral
2.
go back to reference Baumeister H, Härter M. Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol. 2007;42:537–46.CrossRefPubMed Baumeister H, Härter M. Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol. 2007;42:537–46.CrossRefPubMed
3.
go back to reference Honkonen T, Virtanen M, Ahola K, Kivimaki M, Pirkola S, Isometsa E, Aromaa A, Lonnqvist J. Employment status, mental disorders and service use in the working age population. Scand J Work Environ Health. 2007;33:29–36.CrossRefPubMed Honkonen T, Virtanen M, Ahola K, Kivimaki M, Pirkola S, Isometsa E, Aromaa A, Lonnqvist J. Employment status, mental disorders and service use in the working age population. Scand J Work Environ Health. 2007;33:29–36.CrossRefPubMed
5.
go back to reference Jahoda M, Lazarsfeld PF, Zeisel H. The sociography of an unemployed community, Marienthal. Chicago: Aldine; 1971. first published in German in 1933. Jahoda M, Lazarsfeld PF, Zeisel H. The sociography of an unemployed community, Marienthal. Chicago: Aldine; 1971. first published in German in 1933.
6.
go back to reference Drydakis N. The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: A longitudinal study before and during the financial crisis. Soc Sci Med. 2014;128:43–51.CrossRefPubMed Drydakis N. The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: A longitudinal study before and during the financial crisis. Soc Sci Med. 2014;128:43–51.CrossRefPubMed
7.
go back to reference Åhs AM, Burell G, Westerling R. Care or not care – that is the question: Predictors of healthcare utilisation in relation to employment status. Int J Behav Med. 2011;19:29–38.CrossRef Åhs AM, Burell G, Westerling R. Care or not care – that is the question: Predictors of healthcare utilisation in relation to employment status. Int J Behav Med. 2011;19:29–38.CrossRef
8.
go back to reference Andrews G, Issakidis C, Sanderson K, Corry J, Lapsley H. Utilising survey data to inform public policy: Comparison of the cost-effectiveness of treatment of ten mental disorders. Br J Psychiatry. 2004;184:526–33.CrossRefPubMed Andrews G, Issakidis C, Sanderson K, Corry J, Lapsley H. Utilising survey data to inform public policy: Comparison of the cost-effectiveness of treatment of ten mental disorders. Br J Psychiatry. 2004;184:526–33.CrossRefPubMed
9.
go back to reference London School of Economics and Political Science. Centre for Economic Performance. Mental Health Policy Group. The depression report: a new deal for depression and anxiety disorders, London. In: LSE Research Online. 2006. http://eprints.lse.ac.uk/archive/00000818. Accessed 19 July 2016. London School of Economics and Political Science. Centre for Economic Performance. Mental Health Policy Group. The depression report: a new deal for depression and anxiety disorders, London. In: LSE Research Online. 2006. http://​eprints.​lse.​ac.​uk/​archive/​00000818. Accessed 19 July 2016.
11.
go back to reference Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, Docherty JP. Assessment of adherence problems in patients with serious and persistent mental illness: recommendations from the Expert Consensus Guidelines. J Psychiatr Pract. 2010;16:34–45.CrossRefPubMed Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, Docherty JP. Assessment of adherence problems in patients with serious and persistent mental illness: recommendations from the Expert Consensus Guidelines. J Psychiatr Pract. 2010;16:34–45.CrossRefPubMed
12.
go back to reference Bonabi H, Müller M, Ajdacic-Gross V, Eisele J, Rodgers S, Seifritz E, Rössler W, Rüsch N. Mental health literacy, attitudes to help seeking, and perceived need as predictors of mental health service use: A longitudinal study. J Nerv Ment Dis. 2016;4:321–4.CrossRef Bonabi H, Müller M, Ajdacic-Gross V, Eisele J, Rodgers S, Seifritz E, Rössler W, Rüsch N. Mental health literacy, attitudes to help seeking, and perceived need as predictors of mental health service use: A longitudinal study. J Nerv Ment Dis. 2016;4:321–4.CrossRef
13.
14.
go back to reference Clement S, Schaumann O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JSL, Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45:11–27.CrossRefPubMed Clement S, Schaumann O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JSL, Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45:11–27.CrossRefPubMed
15.
go back to reference Jorm AF. Mental health literacy. Empowerment the community to take action for better mental health. Am Psychol. 2012;67:231–43.CrossRefPubMed Jorm AF. Mental health literacy. Empowerment the community to take action for better mental health. Am Psychol. 2012;67:231–43.CrossRefPubMed
16.
go back to reference Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005;20:529–39.CrossRefPubMed Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005;20:529–39.CrossRefPubMed
17.
go back to reference Angermeyer MC, Dietrich S. Public beliefs about and attitudes towards people with mental illness: A review of population studies. Acta Psychiatr Scand. 2006;113:163–79.CrossRefPubMed Angermeyer MC, Dietrich S. Public beliefs about and attitudes towards people with mental illness: A review of population studies. Acta Psychiatr Scand. 2006;113:163–79.CrossRefPubMed
18.
go back to reference Rüsch N, Corrigan PW, Wassel A, Michaels P, Larson JE, Olschewski M, Wilkniss S, Batia K. Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use. Br J Psychiatry. 2009;195:551–2.CrossRefPubMedPubMedCentral Rüsch N, Corrigan PW, Wassel A, Michaels P, Larson JE, Olschewski M, Wilkniss S, Batia K. Self-stigma, group identification, perceived legitimacy of discrimination and mental health service use. Br J Psychiatry. 2009;195:551–2.CrossRefPubMedPubMedCentral
19.
go back to reference Schomerus G, Angermeyer MC. Stigma and its impact on help-seeking for mental disorders: What do we know? Epidemiol Psichiatr Soc. 2008;17:31–7.CrossRefPubMed Schomerus G, Angermeyer MC. Stigma and its impact on help-seeking for mental disorders: What do we know? Epidemiol Psichiatr Soc. 2008;17:31–7.CrossRefPubMed
20.
go back to reference Corrigan PW, Larson JE, Rüsch N. Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry. 2009;8:75–81.CrossRefPubMedPubMedCentral Corrigan PW, Larson JE, Rüsch N. Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry. 2009;8:75–81.CrossRefPubMedPubMedCentral
21.
go back to reference Savage H, Murray J, Hatch SL, Hotopf M, Evans-Lacko S, Brown JSL. Exploring professional help-seeking for mental disorders. Qual Health Res. 2015;26:1–12. Savage H, Murray J, Hatch SL, Hotopf M, Evans-Lacko S, Brown JSL. Exploring professional help-seeking for mental disorders. Qual Health Res. 2015;26:1–12.
22.
go back to reference Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G. Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry. 2012;12:36.CrossRefPubMedPubMedCentral Clement S, Brohan E, Jeffery D, Henderson C, Hatch SL, Thornicroft G. Development and psychometric properties the Barriers to Access to Care Evaluation scale (BACE) related to people with mental ill health. BMC Psychiatry. 2012;12:36.CrossRefPubMedPubMedCentral
23.
go back to reference Ho G, Shih M, Walters DJ, Pittinsky TL. The Stigma of Unemployment: When joblessness leads to being jobless. In: UCLA: The Institute for Research on Labor and Employment. 2011. https://escholarship.org/uc/item/7nh039h1. Accessed 29 July 2016. Ho G, Shih M, Walters DJ, Pittinsky TL. The Stigma of Unemployment: When joblessness leads to being jobless. In: UCLA: The Institute for Research on Labor and Employment. 2011. https://​escholarship.​org/​uc/​item/​7nh039h1.​ Accessed 29 July 2016.
24.
go back to reference O’Donnell AT, Corrigan F, Gallagher S. The impact of anticipated stigma on psychological and physical health problems in the unemployment group. Front Psychol. 2015;6:1263.PubMedPubMedCentral O’Donnell AT, Corrigan F, Gallagher S. The impact of anticipated stigma on psychological and physical health problems in the unemployment group. Front Psychol. 2015;6:1263.PubMedPubMedCentral
25.
go back to reference Wengraf T. Qualitative research interviewing: biographic narratives and semi-structured methods. London: Sage; 2001.CrossRef Wengraf T. Qualitative research interviewing: biographic narratives and semi-structured methods. London: Sage; 2001.CrossRef
26.
go back to reference Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine; 1967. Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. Chicago: Aldine; 1967.
27.
go back to reference Mayring P. Qualitative content analysis. Forum: Qualitative Social Research. 2000;2:1–10. Mayring P. Qualitative content analysis. Forum: Qualitative Social Research. 2000;2:1–10.
28.
go back to reference Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 4th ed. London: Sage; 2009. Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 4th ed. London: Sage; 2009.
29.
go back to reference Economou M, Bergiannaki JD, Peppou LE, Karayanni I, Skalkotos G, Patelakis A, Souliotis K, Stefanis C. Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area. Int J Soc Psychiatry. 2016;62:243–51.CrossRefPubMed Economou M, Bergiannaki JD, Peppou LE, Karayanni I, Skalkotos G, Patelakis A, Souliotis K, Stefanis C. Attitudes towards depression, psychiatric medication and help-seeking intentions amid financial crisis: Findings from Athens area. Int J Soc Psychiatry. 2016;62:243–51.CrossRefPubMed
30.
go back to reference Eisenberg P, Lazarsfeld P. The psychological effects of unemployment. Psychol Bull. 1938;35:358–90.CrossRef Eisenberg P, Lazarsfeld P. The psychological effects of unemployment. Psychol Bull. 1938;35:358–90.CrossRef
31.
32.
go back to reference van der Sanden RL, Bos AE, Stutterheim SE, Pryor JB, Kok G. Experiences of stigma by association among family members of people with mental illness. Rehabilitation Psychology. 2013;58:73–80.CrossRefPubMed van der Sanden RL, Bos AE, Stutterheim SE, Pryor JB, Kok G. Experiences of stigma by association among family members of people with mental illness. Rehabilitation Psychology. 2013;58:73–80.CrossRefPubMed
33.
go back to reference Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry. 2014;1:467–82.CrossRefPubMed Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry. 2014;1:467–82.CrossRefPubMed
34.
go back to reference Vogel DL, Wade NG, Hackler AH. Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. J Couns Psychol. 2007;54:40–50.CrossRef Vogel DL, Wade NG, Hackler AH. Perceived public stigma and the willingness to seek counseling: The mediating roles of self-stigma and attitudes toward counseling. J Couns Psychol. 2007;54:40–50.CrossRef
35.
go back to reference van Os TW, van den Brink RH, Tiemens BG, Jenner JA, van der Meer K, Ormel J. Are effects of depression management training for general practitioners on patient outcomes mediated by improvements in the process of care? J Affect Disord. 2004;80:173–9.CrossRefPubMed van Os TW, van den Brink RH, Tiemens BG, Jenner JA, van der Meer K, Ormel J. Are effects of depression management training for general practitioners on patient outcomes mediated by improvements in the process of care? J Affect Disord. 2004;80:173–9.CrossRefPubMed
36.
go back to reference Huxley P. Mental illness in the community: The Goldberg-Huxley model of the pathway to psychiatric care. Nord J Psychiatry. 1996;50:47–53.CrossRef Huxley P. Mental illness in the community: The Goldberg-Huxley model of the pathway to psychiatric care. Nord J Psychiatry. 1996;50:47–53.CrossRef
37.
go back to reference Becker DR, Drake RE. A working life for people with severe mental illness. New York: Oxford Press; 2003.CrossRef Becker DR, Drake RE. A working life for people with severe mental illness. New York: Oxford Press; 2003.CrossRef
Metadata
Title
Barriers and facilitators of help-seeking among unemployed persons with mental health problems: a qualitative study
Authors
Tobias Staiger
Tamara Waldmann
Nicolas Rüsch
Silvia Krumm
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-1997-6

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue