Creating accessible crisis services

An organisation can have very good support services but in the case of mental health, the belief that “if you build it, they will come” does not apply. It is estimated that as many as 80 percent of people with mental health issues don’t seek treatment or crisis services. Research shows that it’s often the people that most need the help that find it hardest to access it. This lack of engagement is probably reflected on the Return on Investment figures on workplace mental health interventions. ROI ranges between 0.4:1 and 9:1 with the smallest gains at the reactive end and the greatest gains coming from proactive measures. Quite often, organisations have paid a considerable amount of money for a service that is not being used. This can even leave them unaware of problems within their workforce as they assume everyone is okay!

Without doubt, for some people, “talking therapies” are very helpful. Organisations often serve this group well with access to peer listeners or counselling through an employee assistance programme.

A one size fits all approach doesn’t consider unique individual needs, yet the offer is often “counselling or nothing.” This then excludes the many people who cannot engage with this approach.

Crisis workers who go into an organisation for critical incident support face a familiar scenario: the organiser informs those affected by the incident that “a counsellor” is available onsite, yet that counsellor ends up sitting in a room twiddling their thumbs. Very few people will usually avail of the service.

There are many reasons for this including:

• Personal Identity – “I don’t need it,” “I’m the person who looks after everyone else”
• Not realising there is a problem, ignoring or misattributing symptoms
• A preference to be independent
• Lack of trust in the privacy or effectiveness of support.

The stigma around accessing therapy often means many people, particularly in traditionally demanding or “macho” industries, delay or avoid accessing support. This can lead to problems escalating or becoming chronic.

There are other barriers to people engaging with support such as:

• Lack of trust in mental health professionals
• Not knowing where, when or how to get help
• Practical problems such as time or transport required to attend appointments or financial constraints
• Concerns about impact on career, insurance, social standing
• Lack of confidence in the effectiveness of treatment

Where possible, mental health services need to address these barriers and educate potential service users about what is available, treatment efficacy and de-mystify the whole process of therapy.

Marketing messages can also be off-putting. Are potential barriers to care being addressed in your communications? For example,
Do people know what to expect if they contact a service?
Do words such as “help” and “support” turn off independent people?
Are messages clear about what the solution involves and how to know that it is the right one?
What is the evidence that services are effective and will be worth accessing?
Ensure routes to access services are very clear with phone numbers/emails etc.

People may be unwilling to attend if they don’t have answers to questions such as:

• Can they attend during working hours, or does it have to be in their own time?
• What to do if they do shift work?
• Who will have access to their confidential information?

In cases of trauma and crisis, it is not unusual for individuals to receive counselling support despite it not being evidence-based as effective. Recovery is then often long and slow and in worst cases, may even re-traumatise people. Individuals are likely to stay “in counselling” for a long time, with the organisation not being aware of what is going on and feeling disempowered or frustrated

Where evidence-based treatment, such as psycho-education, is provided the standard can vary hugely.

A lack of qualified trauma therapists can mean people are off work for several weeks before receiving support

There can be many sources of mental health support on offer but the providers can be working in little pockets of isolation. Having a host of one-stop solutions can be equally confusing for the person trying to decide where to go for help and advice. Clear pathways and a continuum of care that triage greater need to higher levels of care is essential.

Employees may know that there is “something in place” but they do not have a clue what it is, who is delivering it, and/or how to access it.

Time spent drawing up a strategy and having a joined-up, comprehensive approach will maximise the use of limited resources and facilitate individuals in getting the right kind of support that they need.

For more informative resources on strategies for creating resilient organisations, please see the following link.