Staiger Tobias, Waldmann Tamara, Rüsch Nicolas, Krumm Silvia
Department of Psychiatry II, Ulm University and BKH Günzburg, Parkstraße 11, 89073, Ulm, Germany.
BMC Health Serv Res. 2017 Jan 17;17(1):39. doi: 10.1186/s12913-017-1997-6.
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.
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.
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.
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.
有心理健康问题的失业者往往不使用心理健康服务，因此无法从现有的治疗方法中受益。由于医疗系统之外的失业人员是难以接触到的群体，人们对心理健康服务使用的障碍和促进因素了解甚少。本研究的目的是根据有心理健康问题的失业者的经历，确定寻求帮助和使用服务的障碍及促进因素。
对报告有心理健康问题的失业者进行了15次定性半结构化个人访谈。访谈主题包括寻求帮助和使用心理健康服务的个人经历，重点是障碍和促进因素。使用定性内容分析法对访谈记录进行分析，并确定主要主题。
参与者报告称，由于他们的心理健康问题，他们在社会环境以及医疗保健专业人员眼中被视为“异类”，这导致他们缺乏自尊并避免寻求帮助。受访者将无助和软弱等负面特质与寻求帮助联系在一起。他们将精神科药物等同于非法药物，并担心成瘾风险。然而，另一方面，社会支持和改变的愿望增加了寻求帮助的动力。寻求心理健康服务的个人大多认为就业机构工作人员给予了支持。
有心理健康问题的失业者在寻求帮助时在三个不同层面面临障碍和促进因素：（1）心理健康素养；（2）污名化和歧视；（3）医疗保健的结构和条件。应提高医疗保健专业人员对心理健康问题的认识和态度。在医疗保健环境中应减少对精神疾病患者的污名化。建议对就业机构工作人员进行有关心理健康问题和服务的培训。
