title: Seeking help in times of economic hardship: access, experiences of services and unmet need.
abstract: Economic recessions are often accompanied by increased levels of psychological distress and suicidal behaviour in affected populations. Little is known about the experiences of people seeking help for employment, financial and benefit-related difficulties during recessions. We investigated the experiences of people struggling financially in the aftermath of the Great Recession (2008-9) - including some who had self-harmed - and of the frontline support staff providing assistance.
  
  
  
  Interviews were conducted with three groups of people in two cities: i) people who had self-harmed due to employment, financial or benefit concerns (n = 19) ('self-harm'); ii) people who were struggling financially drawn from the community (n = 22), including one focus group) ('community'); iii) and frontline staff from voluntary and statutory sector organisations (e.g., Job Centres, Debt Advice and counselling agencies) providing support services to the groups (n = 25, including 2 focus groups) ('service providers'). Data were analysed using the constant comparison method.
  
  
  
  Service provision was described by people as confusing and difficult to access. The community sample reported considerably more knowledge and access to debt advice than the participants who had self-harmed - although both groups sought similar types of help. The self-harm group exhibited greater expectation that they should be self-reliant and also reported lower levels of informal networks and support from friends and relatives. They had also experienced more difficult circumstances such as benefit sanctions, and most had pre-existing mental health problems. Both self-harm and community groups indicated that practical help for debt and benefit issues would be the most useful - a view supported by service providers - and would have particularly helped those who self-harmed.
  
  
  
  Interventions to identify those in need and aid them to access practical, reliable and free advice from support agencies could help mitigate the impact on mental health of benefit, debt and employment difficulties for vulnerable sections of society.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK. maria.barnes@bristol.ac.uk.
authors.forename: M C
authors.initials: MC
authors.lastname: Barnes
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
authors.forename: J L
authors.initials: JL
authors.lastname: Donovan
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
authors.forename: C
authors.initials: C
authors.lastname: Wilson
authors.affiliation: University of Salford, Salford, UK.
authors.forename: J
authors.initials: J
authors.lastname: Chatwin
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
authors.forename: R
authors.initials: R
authors.lastname: Davies
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
authors.forename: J
authors.initials: J
authors.lastname: Potokar
authors.affiliation: Centre for Suicide Prevention, University of Manchester, Manchester, UK.
authors.forename: N
authors.initials: N
authors.lastname: Kapur
authors.affiliation: Centre for Suicide Research, University of Oxford, Oxford, UK.
authors.forename: K
authors.initials: K
authors.lastname: Hawton
authors.affiliation: Suicidal Behaviour Research Laboratory, University of Glasgow, Glasgow, UK.
authors.forename: R
authors.initials: R
authors.lastname: O'Connor
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
authors.forename: D
authors.initials: D
authors.lastname: Gunnell
mesh_terms: D000328:Adult; D003376:Counseling; D057172:Economic Recession / Q000639:trends; D004651:Employment / Q000191:economics / Q000639:trends; D004739:England / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand / Q000191:economics* / Q000639:trends; D006801:Humans; D008297:Male; D008603:Mental Health / Q000191:economics* / Q000639:trends; D008605:Mental Health Services / Q000191:economics* / Q000639:trends; D008875:Middle Aged; D011203:Poverty / Q000191:economics / Q000523:psychology / Q000639:trends; D016728:Self-Injurious Behavior / Q000523:psychology; D055815:Young Adult
keywords: Experiences; Help-seeking; Mental health; Need; Qualitative; Recession; Self-harm; Services