Characterising the factors of informal help-seeking for mental health by British adults in the workplace

Abstract

The prevalence and burden of poor mental health is high as the UK population emerges from the most socially restrictive phases of the COVID-19 pandemic. Very few adults seek help for mental health problems from formal help sources such as doctors, and in com[parson seek help from informal sources such as work related sources, family and friends. However, little is known about the relative rates of either type of help seeking, or about the attitudes that underpin help seeking with informal sources, especially in workplace settings. In order to better understand the factors of informal help-seeking for mental health by British adults in the workplace, five studies were carried out. The aims were to conduct two large studies of British adults, one cross-sectional and one longitudinal, to understand rates of formal and informal help seeking, and the attitudes associated with help seeking behaviour. Further aims included reviewing the literature to understand what is known about mental health interventions that target improvement of attitudes about mental health in the workplace. The final aims were to adapt, prototype, and test the efficacy and feasibility of a workplace intervention to improve attitudes toward mental health help seeking with informal sources. In a cross sectional study of 5,003 British adults it was found that informal help seeking for mental health from friends, family and work colleagues is more common than help seeking from formal sources such as doctors (23% versus 9% of the sample, respectively). It was further found in a series of logistic regression models that attitudes about help seeking contribute to actual help seeking over and above demographic and symptom variables. In a longitudinal study of 2,295 British adults it was found that over a three month period improvements in attitudes about comfort talking with informal sources of help, such as work-related sources and family, changed in association with increases in the types of people they seek help from (p=0.033, p=0.045 respectively) . However attitudes about comfort talking with formal sources of help were not associated with increases in the types of people they seek help from. Furthermore, improvements in stigma, mental health knowledge and perceived helpfulness of help seeking were not associated with increases in the types of people help seek from. A systematic review was carried out to understand what is known about how attitudes associated with help seeking in the workplace can be addressed with workplace interventions. Current research knowledge of randomised controlled trials of interventions conducted in workplace settings with outcomes that include attitudes towards help seeking was reviewed and intervention effect sizes were calculated. Most evidence found was of weak quality, studies lacked data to calculate effect sizes and those with data demonstrated a range of effect sizes from small to large. Studies with large effect sizes targeted helping others, not help seeking for oneself. Existing interventions target a narrow range of attitudes, chiefly stigma and confidence to help others, but not other attitudes known to be associated with help seeking. Furthermore, they do not measure or target improvement of attitudes in towards informal help sources in the workplace. A study was carried out to co-design adaptations to, adapt, and perform small scale prototype testing of a previously validated intervention to improve attitudes about mental health help-seeking from informal sources in a workplace setting. The study found that adaptations were recommended and the final technology-enabled prototype was acceptable. The feasibility and preliminary efficacy of this brief intervention was carried out during the COVID-19 pandemic in 2020 with 203 British adults. A two armed randomised controlled feasibility trial with pre- and post-intervention surveys found the intervention was acceptable to users and was effective at improving attitudes of comfort towards help seeking with work colleagues (mean difference between groups = 1.07, p<.001), work supervisors (mean difference between groups 0.98, p=0.002) and human resources (mean difference between groups =1.07, p<0.001), mental health knowledge (p=0.003) and stigma (p=0.024), with most gains in attitudes retained at a one year follow up. Effect sizes ranged from small to moderate. A borderline statistically significant difference was found between the control and experimental groups on the count of people who went from not help seeking with their work supervisor at baseline to help seeking with their work supervisor at T2. Twenty-three percent (7/31) of the experimental group increased their help seeking behaviour in this way, in comparison with 3% percent of the control group (1/29) (p=0.070). It was concluded that attitudes are associated with informal help seeking above and beyond symptoms and demographics, and are an important but understudied part of addressing poor mental health. Not only mental health knowledge, but also important attitudes such as comfort talking with help sources, perceived helpfulness of sources of support, and stigma are possible to improve in brief workplace interventions using a technology-enabled format. It is feasible for a brief workplace mental health intervention to include content that targets both helping oneself as well as others and to be adapted to different workplace settings, including hybrid teams that work both in offices and from home. Policymakers should leverage the current appetite among employers to address mental health as part of national strategies to reduce disability and economic burden.