BMJ  2007;334:303 (10 February), doi:10.1136/bmj.39059.594444.AE (published 12 January 2007)

Research

Understanding help seeking behaviour among male offenders: qualitative interview study

¹ Primary Care Research Group, Peninsula Medical School, Exeter EX1 2LU , ² Mental Health Research Group, Peninsula Medical School

Objective To explore the factors that influence help seeking for mental distress by offenders.

Design Qualitative study based on in-depth interviews with prisoners before and after release.

Setting One category B local prison in southern England.

Participants 35 male offenders aged 18-52, a quarter of whom had been flagged as being at risk of self harm.

Results Most respondents reported that they would not seek help from a general practitioner or other healthcare professional if experiencing mental distress. When followed up after release, none had sought medical help despite the fact that many had considerable emotional problems. Many participants were hesitant to seek help because they feared being given a formal diagnosis of mental illness. Some of these men feared the stigma that such a diagnosis would bring, whereas others feared that a diagnosis would mean having to confront the problem. Lack of trust emerged as the most prominent theme in prisoners' discourse about not seeking help from health professionals. Distrust towards the "system" and authority figures in general was linked to adverse childhood experiences. Distrust directed specifically at healthcare professionals was often expressed as specific negative beliefs: many perceived that health professionals (most often doctors) "just don't care," "just want to medicate," and treat patients "superficially." Those men who would consider going to a general practitioner reported positive previous experiences of being respected and listened to.

Conclusions Distrust is a major barrier to accessing health care among offenders. Like most people, the respondents in this study wanted to feel listened to, acknowledged, and treated as individuals by health professionals. By ensuring that a positive precedent is set, particularly for sceptical groups such as ex-prisoners, general practitioners and prison doctors may be able to encourage future help seeking. Information specifically designed for prisoners is needed to help to de-stigmatise mental illness, and preparation for release should include provision of information about access to health and social services. Awareness training for health professionals is recommended: trust might be fostered in this population by seemingly trivial gestures that indicate respect.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Articles

Young military veterans show similar help seeking behaviour

Lauren N van Staden, Nicola Fear, Amy Iversen, Claire French, Christopher Dandeker, and Simon Wessely
BMJ 2007 334: 382. [Extract] [Full Text] [PDF]

Improving the mental health of offenders in primary care

Gill Mezey
BMJ 2007 334: 267-268. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• van Staden, L. N, Fear, N., Iversen, A., French, C., Dandeker, C., Wessely, S. (2007). Young military veterans show similar help seeking behaviour. BMJ 334: 382-382 [Full text]  
• Mezey, G. (2007). Improving the mental health of offenders in primary care. BMJ 334: 267-268 [Full text]  

Rapid Responses:

Read all Rapid Responses

Understanding help seeking behaviour in male offenders; a challenge

Ademola A Bello
bmj.com, 2 Feb 2007 [Full text]

Prison Pay System is counterproductive

Andrew J Ashworth
bmj.com, 11 Feb 2007 [Full text]

More Psycho Social interventions required

Salman A Mushtaq
bmj.com, 13 Feb 2007 [Full text]

Help-seeking behaviours: similar findings in young military veterans

Lauren N van Staden, et al.
bmj.com, 13 Feb 2007 [Full text]

Offenders need to address their basic needs before they can focus on health

Paula J Whittaker, et al.
bmj.com, 20 Apr 2007 [Full text]