Stigma and poor mental health literacy as barriers to service use among unemployed people with mental illness

• Applicant: Professor Dr. Nicolas Rüsch
• Subject Area: Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
• Term: from 2014 to 2018
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 252345792

People with mental illness often choose not to use mental health services and therefore do not benefit from available psychopharmacological and psychosocial therapies. The resulting treatment gap has harmful consequences for individuals, their families and society, such as poor clinical outcomes, unemployment and productivity losses. Because individuals outside the healthcare system are a hard-to-reach population, barriers to use mental health services are poorly understood. Two factors likely reduce service use: (i) to avoid being stigmatised by others as mentally ill due to help-seeking (public stigma) and to internalise negative stereotypes and give up life goals (self-stigma); (ii) poor knowledge about mental illnesses and available treatments (mental health literacy).The aim of this study is to examine stigma- and knowledge-related facilitators and barriers to service use. Since it is not efficient to address the treatment gap and its consequences in the general population, we chose a more targeted approach. We will focus on a group in which untreated mental illness impairs vocational functioning, with significant socioeconomic and public health impact: unemployed individuals with high rates of mental illness and unmet mental healthcare needs that prolong unemployment.In a first qualitative phase, we will collect information on facilitators and barriers to service use. In the subsequent quantitative study, participants will be recruited using a screening followed by face-to-face interviews. We prospectively assess predictors of service use at baseline with standardised self-report measures, focussing on stigma and mental health literacy. In line with recent health behaviour models, we complement this approach with indirect measures of implicit attitudes to treatment (Brief Implicit Association Test) and with shame and anxiety as emotional barriers to service use. At six-month follow-up, mental health service use after baseline will be assessed.This study will fill the knowledge gap regarding barriers to service use and thus provide the empirical basis for subsequent development and randomised trials of interventions that aim to increase mental health service use. Furthermore, our study will provide insights into effective recruitment strategies for people with mental illness outside the healthcare system that can later be used to access such hard-to-reach individuals. Therefore this project is a vital step towards addressing the treatment gap and its harmful impact on individuals and society.

• DFG Programme: Research Grants
• International Connection: Switzerland