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Intervention

Disclosing a mental illness in employment-seeking contexts (CORAL)

Background:

Employment is one of the areas of life where mental health service users report most discrimination. In a US survey 61% (N=1,301) felt they had been turned down for a job for which they are qualified, when it was revealed that they are a mental health consumer (1). In the UK, 56% (N=411) believed that they had definitely or possibly been turned down for a job in the past because of their mental health problems (2). Similarly, in a recent international survey, 64% of participants(N=736) had stopped themselves from applying for work/training/education because of their diagnosis of mental illness (3).

Given this information, it is hardly surprising that the decision of whether or not to disclose a current diagnosis or previous history of a mental illness is a complex one. These decisions involve weighing the benefits, or necessity, of reasonable adjustments in the workplace against the prejudices that employers and colleagues may hold.

Research suggests that employers and colleagues exhibit a range of discriminatory behaviours such as: restricting opportunities for advancement; micro-management; over-attribution of mistakes to illness; gossip, and social exclusion. On the other side, reported positive benefits of disclosure include reasonable accommodations in the workplace, support from managers and colleagues and relief at being able to be open and honest about symptoms and mental health appointments. As a foundation for this research we carried out a systematic review of beliefs, behaviours and influencing factors associated with disclosure in the workplace (Brohan et al 2011)

Aims:

The aim of this study is to develop and test a decision aid tool to assist mental health service users in reaching disclosure decisions. 

Method:

The decision aid will be developed from the information obtained in a previous systematic review and qualitative study of disclosure decisions. Interviews will be conducted with mental health service users to evaluate and refine the tool. Other work will examine employers' views by means of a survey. Progress to date and future plans: A literature review on employers’ attitudes and hypothetical behaviours in hiring mental health service users was conducted. The systematic review on disclosure decisions (Brohan et al 2011) and the qualitative interviews with mental health service users have taken place. Two papers on employers' views have been published (Brohan et al 2010; Little et al 2010 ).

A Decision Aid Tool (DAT) was developed and tested on a group of 15 service users and demonstrated initial feasibility and acceptability. A pilot randomised control trial to evaluate the effectiveness of the DAT has been carried out with 80 participants (Henderson et al 2013).

Qualitative interviews have been conducted a subgroup of the participants taking part in the pilot trial to understand how the intervention worked. In response to participants testing CORAL who expressed a need for more legal information, some of the SAPPHIRE team are now working on a project funded by Guy's and St Thomas's Charity (EQUALS: PI Claire Henderson) to develop and test a computer system applying the Equality Act 2010 to mental health problems.

It has been developed through collaboration with computer scientists and a legal academic at King's College London, a write specialising in putting mental health information into plain English and Monad Solutions, a specialist policy automation company. It can inform a lay person, using his/her responses to questions, whether (a) s/he has a disability according to the Act, (b) his/her employer may be required to provide reasonable adjustments, and (c) the employer may have discriminated against them on grounds of disability. See summary for more information.  

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