You “can’t get away from the social”: Individual, relational, and contextual influences on mental health and substance use-related help-seeking among people in contact with the criminal justice system

RATIONALE: People in contact with the criminal justice system outside institutional settings have high levels of mental health and substance use problems, contributing to adverse outcomes. Help-seeking behaviour is an important component of optimising access to effective treatment and support that is under-explored in this population. Empirical investigation into the influences on help-seeking for stigmatised health conditions is needed to inform efforts to facilitate help-seeking. AIM: This study established the individual, relational, and contextual influences on help-seeking for mental health and substance use problems among people in contact with the criminal justice system living in the community, and examined the applicability of existing models and frameworks for understanding help-seeking behaviour in this population. METHODS: We applied framework analysis to qualitative data from a mixed-methods social network analysis study. Our framework drew on help-seeking behaviour and healthcare access models to determine initial categories for help-seeking influences (desire, ability, and context). RESULTS: Help-seeking was confirmed to result from an interaction between 'desire to seek help', 'ability to seek help', and 'help-seeking context'. We show that help-seeking is not an individual behaviour, but strongly affected by relational influences that operate between individuals, across social networks, and via cultural norms. High levels of criminal justice involvement, and mental health and substance use problems in the social networks of people in contact with the criminal justice system shape these influences. CONCLUSIONS AND IMPLICATIONS: Optimising help-seeking for mental health and substance use problems among people in contact with the criminal justice system living in the community requires critical engagement with, and application of, existing models to ensure sufficient appreciation of relational and contextual influences. Research is needed to develop and test multi-level policy/practice interventions that go beyond individual factors.