title: Understanding help seeking behaviour among male offenders: qualitative interview study.
abstract: OBJECTIVE
  To explore the factors that influence help seeking for mental distress by offenders.
  
  
  METHODS
  Qualitative study based on in-depth interviews with prisoners before and after release.
  
  
  METHODS
  One category B local prison in southern England.
  
  
  METHODS
  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.
authors.affiliation: Primary Care Research Group, Peninsula Medical School, Exeter EX1 2LU.
authors.forename: Amanda
authors.initials: A
authors.lastname: Howerton
authors.forename: Richard
authors.initials: R
authors.lastname: Byng
authors.forename: John
authors.initials: J
authors.lastname: Campbell
authors.forename: David
authors.initials: D
authors.lastname: Hess
authors.forename: Christabel
authors.initials: C
authors.lastname: Owens
authors.forename: Peter
authors.initials: P
authors.lastname: Aitken
mesh_terms: D000293:Adolescent; D000328:Adult; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010817:Physician-Patient Relations; D011329:Prisoners; D013315:Stress, Psychological / Q000628:therapy*