Relational influences on help-seeking for mental health and substance use in justice involved people

Abstract Background Delayed access to adequate mental health (MH) and substance use (SU) services among justice-involved people contributes to high emergency service use, and MH/SU-related deaths. Help-seeking is essential for accessing services, and is influenced by social networks embedded in communities. Little is known about the relational influences help-seeking in justice-involved people, limiting public health intervention development. Methods We used mixed methods social network analysis to examine relational influences on help-seeking in 50 justice-involved people in Scotland. We measured perceived MH/SU stigma and perceived usefulness of MH/SU support, collected details about participants’ social networks, and qualitative data about help-seeking experiences. We developed a network typology using k-means cluster analysis, validated with qualitative and quantitative data, and explored relationships between network type and help-seeking, stigma and perceived usefulness of support. Results We identified five network types: entangled, close-knit, unsure, jaded and building. Participants with a close-knit network had the highest proportion of help-seekers (75%) and jaded had the lowest (33%). Participants in small, closed networks perceived higher levels of MH stigma compared to participants in larger multi-component networks (MD = 0.6[0.551-1.15], p = 0.0246). Qualitative and quantitative data revealed how network culture and perceived stigma could influence help-seeking, and how network structure and composition was deliberately shaped for self-protection but influence access to resources that influenced help-seeking. Conclusions Help-seeking is influenced by network types; members’ characteristics, attitudes, and beliefs; and norms and culture. Findings present the basis to develop and test individual, network, and community level interventions to encourage early help-seeking. Key messages • Relational factors are important in justice-involved peoples’ decisions to seek help. • Individual, network, and community level interventions need to be developed to leverage the relational influences on individuals for public health benefit.