Stigma and poor mental health literacy as barriers to service use among unemployed people with mental illness
Final Report Abstract
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 and to participate in job search activities are poorly understood. Two factors likely reduce service use and job search and contribute to long-term unemployment: (i) to avoid being stigmatised by others as mentally ill due to helpseeking (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). This study aimed to examine stigma- and knowledge-related facilitators and barriers to service use and job search in a hard-to-reach population: unemployed individuals with mental health problems. In a first qualitative subproject, we collected information on facilitators and barriers to service use by individual face-to-face interviews with 15 unemployed people with mental health problems. In the subsequent quantitative longitudinal study, 301 unemployed participants with mental health problems were recruited. We prospectively assessed predictors of service use, reemployment and other outcomes such as quality of life and recovery at baseline with standardised self-report measures, focusing on stigma variables and mental health literacy. At six-month followup, mental health service use, employment status as well as other outcomes were assessed. Our results can be summarized as follows: 1. Many participants found the decision difficult whether to disclose their mental health problem, and disclosure is a key reaction to stigma. Negative attitudes toward disclosing one’s mental health problem predicted reemployment, i.e. those participants who were more cautious to disclose to potential employers at baseline were more likely to be reemployed at six-month follow-up. At the same time, and independent of potential reemployment during the follow-up period, those who were more prone to disclosure among family and friends reported increased quality of life at follow-up. This means that outcomes of disclosure are complex and depend on the environment. These findings were independent of symptoms, length of unemployment and other potential confounders. 2. Better mental health literacy was associated with using mental health services. 3. Greater perception of public stigma and more negative reactions to stigma (e.g. selfstigma) predicted suicidality. 4. Attitudinal barriers to care, e.g. perceiving mental health care as unhelpful, predicted lack of help-seeking over time. Lack of service use at follow-up was strongly predicted by lack of service use at baseline, highlighting the need for interventions targeting those unemployed individuals outside the healthcare system. Based on the findings of this study, we designed a peer-led group program, that means led by people with own lived experience of mental health problems and unemployment. A pilot randomized-controlled trial provided initial evidence both for the difficulty to recruit this target group and for the program’s efficacy to improve depressive symptoms and recovery.
Publications
- (2019) Disclosure and Quality of Life Among Unemployed Individuals With Mental Health Problems: A Longitudinal Study. The Journal of nervous and mental disease 207 (3) 137–139
Rüsch, Nicolas; Malzer, Alexandra; Oexle, Nathalie; Waldmann, Tamara; Staiger, Tobias; Bahemann, Andreas; Wigand, Moritz E.; Becker, Thomas; Corrigan, Patrick W.
(See online at https://doi.org/10.1097/nmd.0000000000000914) - (2017) Arbeitslosigkeit und psychische Gesundheit – die AloHA-Studie. ASU Arbeitsmedizin Sozialmedizin Umweltmedizin 52:562-563
Rüsch N, Staiger T, Waldmann T, Becker T
- (2017). Barriers and facilitators of helpseeking among unemployed persons with mental health problems: a qualitative study. BMC Health Serv Res 17(1):39
Staiger T, Waldmann T, Rüsch N, Krumm S
(See online at https://doi.org/10.1186/s12913-017-1997-6) - (2018). Attitudes toward disclosing a mental health problem and reemployment: A longitudinal study. Journal of Nervous and Mental Disease 206(5):383-385
Rüsch N, Corrigan PW, Waldmann T, Staiger T, Bahemann A, Oexle N, Wigand M, Becker T
(See online at https://doi.org/10.1097/NMD.0000000000000810) - (2018). Intersections of discrimination due to unemployment and mental health problems: the role of double stigma for job- and help-seeking behaviors. Social Psychiatry and Psychiatric Epidemiology
Staiger T, Waldmann T, Oexle N, Wigand M, Rüsch N
(See online at https://doi.org/10.1007/s00127-018-1535-9) - (2018). Mental illness stigma and suicidality: the role of public and individual stigma. Epidemiology and Psychiatric Sciences 27(2):169-175
Oexle N, Waldmann T, Staiger T, Xu Z, Rüsch N
(See online at https://doi.org/10.1017/S2045796016000949)
