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

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.