You are here

  • Home
  • Archive
  • Volume 12, Issue 3
  • Worker and manager perceptions of the utility of work-related mental health literacy programmes delivered by community organisations: a qualitative study based on the theory of planned behaviour

Article Text

Article menu
Mental health
Original research
Worker and manager perceptions of the utility of work-related mental health literacy programmes delivered by community organisations: a qualitative study based on the theory of planned behaviour
  1. Corina Crisan1,
  2. Pieter Andrew Van Dijk2,
  3. Jennie Oxley3,
  4. Andrea De Silva4
  1. 1Monash Sustainable Development Institute, BehaviourWorks Australia, Monash University, Melbourne, Victoria, Australia
  2. 2Monash Business School, Monash University, Melbourne, Victoria, Australia
  3. 3Monash University Accident Research Centre, Monash University, Melbourne, Victoria, Australia
  4. 4School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Corina Crisan; corina.crisan{at}monash.edu

Abstract

Objectives Reluctance to seek help is a leading contributor to escalating mental injury rates in Australian workplaces. We explored the benefit of using community organisations to deliver mental health literacy programmes to overcome workplace barriers to help-seeking behaviours.

Design This study used a qualitative application of the theory of planned behaviour to examine underlying beliefs that may influence worker’s intentions to participate in mental health literacy programmes delivered by community organisations and manager support for them.

Setting This study took place within three large white-collar organisations in the Australian state of Victoria.

Participants Eighteen workers and 11 managers (n=29) were interviewed to explore perspectives of the benefits of such an approach.

Results Community organisations have six attributes that make them suitable as an alternative mental health literacy programme provider including empathy, safety, relatability, trustworthiness, social support and inclusivity. Behavioural beliefs included accessibility, understanding and objectivity. The lack of suitability and legitimacy due to poor governance and leadership was disadvantages. Normative beliefs were that family and friends would most likely approve, while line managers and colleagues were viewed as most likely to disapprove. Control beliefs indicated that endorsements from relevant bodies were facilitators of participation. Distance/time constraints and the lack of skills, training and lived experiences of coordinators/facilitators were seen as barriers.

Conclusions Identifying workers’ beliefs and perceptions of community organisations has significant implication for the development of effective community-based strategies to improve worker mental health literacy and help seeking. Organisations with formal governance structures, allied with government, peak bodies and work-related mental health organisations would be most suitable. Approaches should focus on lived experience and be delivered by qualified facilitators. Promoting supervisor and colleague support could improve participation. Models to guide cross-sector collaborations to equip community organisations to deliver work-related mental health literacy programmes need to be explored.

  • mental health
  • health policy
  • health & safety

Data availability statement

No data are available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-056472

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Strengths and limitations of this study

    • This is the first study that used a qualitative framework to explore worker and manager perceptions of the benefit of using community organisations to deliver mental health literacy programmes to support the prevention of, and recovery from work-related mental injury.

    • Understanding the underlying beliefs influencing workers’ participation in mental health literacy programmes delivered by community organisations using a psychological theory-based decision-making model (theory of planned behaviour) is critical for the development of effective strategies to improve engagement rates.

    • The small sample size may limit the transferability of findings.

    Introduction

    Reluctance to seek help is a leading contributor for escalating mental injury rates in Australian workplaces.1–3 The financial cost of work-related mental injuries to Australian workplaces is significant, estimated to be more than AUD $12 billion per year in lost productivity.4 Work-related mental injuries are associated with work-related factors such as job demand and pressure, harassment, bullying, exposure to violence or traumatic events and interpersonal conflict.5–7 Many workers are reluctant to use the mental health programmes and support mechanisms provided by their workplace.8 9 Attitudinal barriers to help seeking include stigma, unrecognised need for help, preference for self-reliance and belief that treatment would be ineffective.10 11 Workplace barriers include mistrust of embedded programmes such as employee assistant programmes, fear of discrimination or repercussion on their career, limited confidence in managers’ capabilities surrounding disclosure and unsupportive organisational cultural norms.12–15 Furthermore, structural barriers such as the unavailability of service providers outside working hours can also affect access to care.11

    The escalating work-related mental injury rates4 warrant exploration of alternative ways to reach workers who may be unwilling, or unable, to access organisational and public health support before their mental health concerns reach unhealthy levels. Currently, underexplored is the utility of community organisations (COs) to deliver work-related mental health literacy programmes designed to address barriers to help-seeking behaviours. These organisations are non-governmental, not-for-profit, that operate for social purposes,16 are accessible and trusted sources of support, and have reach into many sections of the community.17 COs, such as sporting clubs, Men’s Sheds and Neighbourhood Houses, currently provide support for people within the community for a broad range of mental health problems through literacy training and guest speaker events that are designed to destigmatise mental illness and encourage help seeking but do not directly address work-related mental health and worker-specific needs.17–19 A community-based approach using COs to deliver mental health literacy programmes could conceivably be more appealing and effective than organisational initiatives.

    Mental health literacy refers to knowledge about mental illness and the skills required to recognise, manage and/or prevent it.20 The lack of mental health literacy is a key barrier to help seeking of workers.21 22 Building workers’ capacity/capability to recognise the symptoms of mental injury and access professional support is critical for addressing workplace-induced mental ill-health.11 23 24 Many programmes such as such as mental health first aid (MHFA)25 promote prevention, self-management and help seeking for mental ill-health. These interventions often use people with a lived experience of mental injury26 27 and can take a variety of forms ranging from general awareness events (R U OK?Day)18 through to structured programmes, training modules and information sessions21 over the course of multiple hours or days. MHFA training has been effective in reducing mental health stigma and improving participants’ knowledge, attitudes, skills and confidence to seek professional help.10 20 25 28–32 Building on evidence of their effectiveness, many employers have implemented mental health literacy programmes8 21 30 33 34 and use these initiatives to promote pathways and referrals to professional services offered by workplaces or public health practitioners.35 Though these efforts have increased literacy levels of workers,24 36 evidence suggests that this has not resulted in supportive attitudes or behaviours in the workplace37 and, therefore, low disclosure rates in workplaces are still a problem in addressing work-related mental injuries.9 38

    Previous studies have demonstrated that supportive social referents can be beneficial in the help-seeking process.8 39 An encouraging environment will facilitate workers’ confidence, and the development of tools required to seek timely access to mental health treatment.37 A supportive workplace management culture exhibiting positive attitudes towards mental health can facilitate workers’ willingness to disclose mental health problems.40 Evidence suggests, however, that support in many workplaces is insufficient to overcome worker reluctance to seek help. For example, a study has shown that perceptions of bias, role conflict and hierarchical relationships between the help provider and recipient significantly impact disclosure rates.41 Importantly, a perceived lack of genuine care and support can contribute to a worker’s exclusion, leaving them feeling isolated.37 42 43 The limitations of current approaches point to the need to explore solutions that can provide the level of support required to encourage workers’ help-seeking behaviours.

    Such an opportunity may exist in adopting a more socially inclusive approach at a community level.44 45 A strength of a community-based approach is the practical advice provided by peers with lived experience with no perceived inequality in the power relationship. This has been found to significantly improve participants’ recognition of emotional problems, confidence and coping skills.46–48 In the context of work-related mental injury, this could involve providing work-focused programmes tailored to worker needs delivered outside of workplace settings. As COs have a large reach and are an integral part of the Australian social fabric, they are well-placed to be a vehicle to reach disadvantaged and isolated workers by providing tailored opportunities to access mental health literacy programmes to overcome barriers to help seeking.49 What needs to be determined is if such an approach has any appeal or perceived benefit.

    Theory of planned behaviour

    To address the identified gaps in the literature, this study applied the theory of planned behaviour (TPB), a theory-based and robust decision-making model that is the most applied framework to better understand decision-making and behaviour change.50–54 The TPB posits that intention to perform a behaviour is primarily guided by three constructs. These are attitude (overall evaluation of participation), subjective norms (perceived social pressure associated with participation) and perceived behavioural control (the perceived degree of ease or difficulty to participate). Each of these constructs are influenced by the associated underlying beliefs, including behavioural beliefs (advantages and disadvantages of participation), normative beliefs (key referents who approve or disapprove of such participation) and control beliefs (barriers or facilitators to participation). The TPB is used in this study as an evidence-based framework for examining key beliefs influencing worker attitudes and intentions towards making use of the proposed CO delivery of mental health literacy programmes. A key strength of the TPB is that it facilitates identification of beliefs that differentiate users and non-users,55 which can help in the development of targeted strategies to facilitate decision-making/behaviour change.53

    The current study

    The objective of this study is to determine the potential utility of using COs to deliver work-related mental health literacy programmes to help overcome workplace barriers to help seeking. The two aims associated with this objective are (1) to explore attributes of COs that make them suitable to deliver work-related mental health literacy programmes from the perspective of workers (as a potential user) and managers (as an important social referent) and (2) to examine the motivations that influence worker intentions to potentially participate in such programmes, including how prior or current associations with COs may influence these motivations.

    To the authors’ knowledge, no previous studies have used the TPB to explore the factors influencing workers’ potential participation in CO-delivered mental health literacy programmes or to explore perceptions of a key social referent group (managers) towards such an approach. It is anticipated that the results of this study will inform opportunities for cross-sector collaborations to promote and enhance worker participation in mental health literacy programmes delivered by COs for the prevention of, and recovery from work-related mental injury.

    Methods

    Guidelines developed by O’Brien et al were followed to ensure the transparency of reporting on research design and methods of data collection and analysis.56

    Procedure

    Chief Executive Officers (CEOs) or Human Resources/Occupational Health and Safety (HR/OHS) managers from 27 large organisations (with 200+ workers) in the Australian state of Victoria with comprehensive mental health programmes in place were contacted by email with an invitation to participate in the study. The information included that the purpose of the interviews was to explore perceptions of workers and managers within the organisation about the potential utility of mental health literacy programmes delivered by COs to address barriers to help seeking for work-related mental injury. The invitation established that no mental health assessment would be conducted, participation was anonymous, voluntary and information collected would be confidential. No reimbursements were provided. Out of 27 organisations, nine initially responded (33%), however, only three workplaces finally participated (11%) due to challenges related to COVID-19. The information flyer and consent form were distributed through formal organisational communication channels. Selection criteria for workers included any full or part-time staff in a permanent or contracted role and who had been employed with the organisation for at least 6 months. Managers were invited based on their level of seniority within the organisation (executive or senior managers) and/or expertise in HR/OHS (convenience sample). The first author contacted respondents who expressed interest to confirm their eligibility. Informed consent was obtained from all participants prior to data collection.

    The interviews were conducted via video platforms (Zoom/Microsoft Teams) due to COVID-19 physical distancing restrictions at the time of data collection.57 The purpose of the research was explained, and demographic information was collected. Participants were informed that they could withdraw from the study at any time. Established interview protocols and techniques were followed to minimise interviewer and response bias.58 Twenty-nine interviews were conducted over a 4-month period between January and April 2020. Interviews were audio-recorded (average duration 46 min). Field notes were made following each interview to document the interviewer’s impressions and ensure reflexivity.58 Data collection ceased at the point of data saturation.59 The transcriptions were stored on a password-protected computer to which only the first two authors had access.

    Materials

    At the beginning of each interview, participants were provided with a definition of mental health literacy. We described current CO initiatives that provide mental health literacy programmes addressing general mental health awareness. In addition to general questions exploring managers’ and workers’ views of, and workers’ prior or current associations with COs, a belief elicitation interview protocol was used to explore workers’ underlying beliefs about using mental health literacy programmes delivered by COs (see online supplemental material A). Interviews included open-ended questions and a conversational style to allow in-depth examination of participants’ perceptions and experiences.58 To explore underlying behavioural beliefs, workers were asked about advantages and disadvantages of attending these programmes if the need arose. Normative beliefs were identified through questions about the role of significant people within their social and work networks in their decision to participate in these programmes. Control beliefs were explored through questions focusing on what made it easier or more difficult for workers to participate, and what encouraged or prevented them from using such opportunities. Probing questions were used when needed to clarify the responses, gain further insights and overcome researcher bias.48 Managers with HR/OHS experience were interviewed to understand how mental health literacy programmes delivered by COs might be perceived and supported in workplaces. Particularly, to understand whether they believed such approaches would complement existing workplace-based programmes and/or overcome some of the perceived access barriers associated with these programmes (see online supplemental material B). The interview protocols were piloted with three workers and two managers from the research team’s professional network and subsequently refined prior to commencing data collection. These data were excluded from the analysis.

    Participants

    Participants (n=29; 16 women, 13 men) of which 18 workers and 11 managers were aged 29–64 years. Eighteen participants worked in the public sector and 11 in the private sector. Nineteen participants were employed in an ongoing role, with the remainder in a contracting role. Participants were also classified as ‘with associations’ (A) or ‘without associations’ (WA) depending on whether they had prior or current associations with COs or not. Table 1 shows the key demographic details of participants.

    View this table:
    Table 1

    Demographic characteristics of study participants

    Patient and public involvement

    This study involved no patients, only members of the public who were in active employment. No patients or public were involved in the design, recruitment to or conduct of this study. The results have not been disseminated to the study participants. However, each participant was provided with an information sheet containing the Monash University website that will publish the findings of the study and the research team’s contact details, should they wish to be directly informed of the study’s results.

    Data analysis

    All interview responses were transcribed verbatim by the first author, then confirmed for accuracy by the second author and imported into NVivo V.12 software.60 Each interview transcript was deidentified and assigned a unique code (W-worker, M-manager). Braun & Clarke’s six-stage thematic approach (familiarisation with the data, coding, searching for themes from the codes, reviewing themes, defining and naming themes and writing up the themes)61 was used to identify and interpret patterns within data. Data analysis was both inductively and deductively compared with the TPB framework.62

    The first author coded responses of a subset of interview transcripts (n=5) using the TPB framework and constructs (behavioural beliefs, normative beliefs and control beliefs). Field notes that were written following each interview were subsequently used in data analysis discussions among research team members to overcome any potential biases.58 The initial codes were checked for emerging patterns and grouped into a draft framework of themes that were semantically close to the participants’ wording.63 Where applicable, themes were further split into subthemes. The validity of these themes and subthemes was checked by the second and third authors who have expertise in qualitative methods. It was determined that they were relevant to the research questions and representative of the data.61 The framework was then applied to the remaining transcripts, while allowing for emergent themes until no new themes could be determined.64

    As the fieldwork and data analysis progressed, transcripts were reviewed systematically by the team’s qualitative experts, and themes were refined iteratively based on recurrence and their relationship to each other. Any differences of opinion were discussed until consensus was reached among the research team. Once themes and subthemes were confirmed, data were explored to identify common themes and understand the relationship between them.61 Inter-rater reliability reached 90% agreement.64

    Results

    Table 2 summarises workers’ and managers’ views about the attributes of COs that make them suitable for providing work-related mental health literacy programmes with supporting quotes. Empathy, safety, relatability, trustworthiness, social support and inclusivity were reported as appealing attributes of COs. Table 3 summarises the findings by the TPB belief categories. These are further divided by workers with associations with COs and those without, with supporting quotes. For the behavioural beliefs, the most reported advantages of participation in programmes delivered by COs included accessibility (acceptability and approachability), understanding (hearing peers’ lived experiences of work-related mental injury and sharing of lived experience with peers) and objectivity (unbiased by organisational goals and independent from workplaces). None of the workers without associations reported sharing of lived experience with peers and being independent from workplaces as advantages. The lack of legitimacy (leadership and governance) and lack of suitability were reported as disadvantages. No worker without associations mentioned issues surrounding leadership. For the normative beliefs, family and friends were reported as the social referents most likely to approve, while line managers and coworkers were viewed as most likely to disapprove of such participation. For the control beliefs, third-party endorsement was the most reported facilitator. Affiliations with peak organisations or those with work-related mental health expertise were reported by workers with prior or current associations with COs. Those without associations reported endorsement by government bodies. Limited access (distance and time constraints), the lack of skills, training and lived experiences of coordinators/facilitators (unqualified, celebrity) were the commonly reported barriers.

    View this table:
    Table 2

    Attributes of community organisations

    View this table:
    Table 3

    Summary of workers’ underlying beliefs

    Discussion

    The aims of the current study were to explore the potential benefit of COs to deliver work-related mental health literacy programmes from worker and manager perspectives and to identify worker motivations that might influence intentions to participate in such programmes.53 65 Overall, managers and workers believed that COs had the potential to be a viable, and appealing, alternative to workplace-based programmes. Prior or current associations with COs had an impact on workers’ perceptions of the advantages and challenges of such an approach. First, findings are discussed in relation to the features of COs as suitable providers of programmes, followed by each of the TPB underlying belief categories of workers (behavioural, normative and control).

    Attributes of COs

    Workers and managers believed that using COs to provide mental health literacy programmes could potentially overcome some of the barriers to accessing mental health support within workplaces. Empathy (n=13) was the most reported attribute, which entailed two subthemes being person-centred (n=8) and caring (n=5). Personalised affective responses to individuals’ experiences, feelings and situations66 have been shown to increase their willingness to seek help.67 Next was safety (n=12) in terms of being outside of workplace setting (n=6), confidential (n=5) and positive (n=1), which could help to overcome some workplace barriers such as fear of discrimination or repercussion on career.12 15 Relatability (n=12) was reported next. This referred to COs being a non-clinical and less stigmatising setting (n=8) and including people to which participants could relate (n=4). This implies COs provide psychologically safe, judgement free and less intimidating environments that could facilitate worker engagement and help seeking.68 Trustworthiness (n=11) was the fourth attribute reported as COs are independent from workplaces (n=5) and are unbiased by organisational goals (n=6). This feature may overcome concerns about discrimination and marginalisation associated with help seeking at work12 15 34 and supports prior research findings relating to COs’ position of trust in the community.17 Social support (n=9), reflected in social connection (n=5), sharing experiences (n=3) and companionship (n=1), and inclusivity (n=9), divided into value-based (n=4), interest-based (n=3) and overcoming isolation (n=2), were reported as positive attributes of COs. These results suggest that workers and managers perceive that COs possess a range of attributes that position them favourably to support community efforts to improve the mental health literacy of workers. Next, we explore the underlying motivations of workers to use such opportunities.

    The TPB

    Behavioural beliefs

    Accessibility to programmes is seen as a key advantage by both worker categories (n=13). This supports prior research findings into the role of community-centred approaches in improving access and use of health-related services.69 70 Two subthemes, consistent with Levesque’s dimensions of service accessibility,71 were acceptability (n=7) and approachability (n=6). Acceptability is the extent to which workers considered programmes delivered by COs to be appropriate to their needs.72 Approachability indicates that workers identified that such a service can be reached and could have a positive impact on their mental health literacy.71 These two dimensions are critical success factors for initiatives designed to provide health-related services such as work-related mental health literacy programmes.71 73 74

    The next advantage of the proposed programmes reported was understanding (n=8). Understanding had two subthemes, which were hearing peers’ lived experiences of work-related mental injury (5) and sharing of lived experiences with peers (n=3). Hearing the experiences of peers and being able to share experiences with them serves to provide hope,75 76 alleviate stress and uncertainty,77 destigmatise mental injury,78 reduce fear and feelings of isolation79 and is an important step in encouraging disclosure and help seeking.80 None of the workers without previous or current associations reported the sharing of lived experience as an advantage. This suggests that they are not familiar with some of the peer-to-peer benefits of COs and by extension programmes offered by them. Strategies emphasising the benefits of engaging with peers that have similar experiences through these programmes may improve workers’ awareness and motivation to participate.

    The third advantage reported was objectivity (n=5), understood in terms of unbiased advice (n=3), and an independent perspective (n=2). Unbiased and independent advice and information serve to alleviate some of the barriers associated with workplace-based programmes and contexts, such as concerns about fear, stigmatisation, judgement and privacy that have been linked to worker reluctance to use workplace counselling services.81–84 None of the workers without associations with COs identified an independent perspective as an advantage. Communication promoting this as well as the unbiased nature of programmes delivered by COs may enhance participation.

    The lack of legitimacy (n=7) was the most reported disadvantage. This theme included leadership (n=4) and governance (n=3). Most workers who indicated these concerns had previous or current associations with COs, which may reflect some challenges associated with organisations that rely heavily on untrained volunteerism. Screening for organisations that are appropriately structured, led and governed to deliver these programmes is important as worker choices to participate may depend on the perceived quality of leadership and governance of COs. The lack of suitability (n=6) was another disadvantage. COs are highly diverse regarding reputation, mission, size, resources17 and, therefore, only organisations that are appropriately positioned should be selected to provide these programmes.

    Normative beliefs

    Family (n=7) and friends (n=5) were reported as the social referents (important others) most likely to approve participation in programmes offered by COs for both categories of workers. In contrast, line managers (n=6) and coworkers (n=5) were believed to likely disapprove, particularly by workers without associations (n=9). Research has shown that organisational culture and social norms strongly impact workers’ disclosure and help-seeking behaviours.38 39 85–87 This suggests that for workers without associations, direct managers continue to be important social referents while workers with prior or current associations were less influenced by the opinions of those within their workplace. Associations with COs present a strong social network, which may weaken the reliance on the approval of workplace referents when considering help seeking and strengthen their potential in delivering mental health literacy programmes to promote help seeking. Messages promoting supervisor and colleague support for CO-delivered mental health literacy programmes could potentially help in improving worker participation rates, particularly for those without previous associations with COs.

    Control beliefs

    Third-party endorsement (n=7) was reported as a key facilitator to participation, but the type of entity deemed appropriate to provide such endorsement differed between the categories of workers. Workers with associations with COs preferred recommendations from appropriately qualified organisations (n=2) and peak bodies (n=2), which suggests that they understood the benefit of such affiliations to enhance targeted outcomes. Peak bodies (ie, Neighbourhood Houses Victoria) have the trust, reputation, resources,88 reach17 and collaborative experience89 required to coordinate the implementation of such programmes and, therefore, could be useful in helping promote them more widely. Workers without associations referred to endorsement from government entities (n=3), which implies they were not aware of the benefit of affiliations and highlights the importance of having endorsements to fit audience expectations. What this does point to is the importance and potential of cross-sector collaborations with third parties such as government/statutory entities, organisations with work-related mental health expertise, peak bodies and COs, to promote, resource, facilitate and enhance worker participation.

    Limited access (n=10) encompassing time (n=6), and distance (n=4) constraints, was the most identified barrier for workers. Selecting and promoting COs that have the capacity to overcome these limitations through size, reach, delivery models (online and/or outside working hours) could potentially enhance worker participation rates. Another barrier identified was lack of skills, training and lived experiences of coordinators/facilitators (n=5). Workers preferred facilitators that were qualified through training or experience to address work-related mental health literacy (n=3). Just relying on the celebrity status of a facilitator, without appropriate skills or experiences, was identified as deterrent (n=2). Literature shows that formally trained facilitators and evidence-based content are critical to ensure programme effectiveness.21 28 34 None of the workers with associations with COs reported the celebrity status of a facilitator/speaker as a barrier. These workers may have been exposed to initiatives that have used people of note and, therefore, were not sceptical of their potential contribution. Research has shown that motivational talks given by notable speakers such as sportsmen have had a positive impact in the community in raising awareness of mental health, particularly on men’s intentions to seek help.90 Our findings indicate that the lived experience of work-related mental illness of a speaker could play a bigger role than their celebrity status in encouraging worker participation, particularly for those who did not have associations with COs. Promotion of programmes/events delivered by qualified (skills and experience) coordinators/facilitators may alleviate some of the participation barriers.

    Strengths and limitations

    This is the first TPB-based qualitative research that has explored the potential utility of CO-delivered mental health literacy programmes to overcome workplace barriers to help seeking for work-related mental injury. Our study identified a range of worker attitudes and beliefs that indicate that COs are potentially a viable and complementary alternative to workplace-based programmes for accessing mental health literacy programmes and peer support.

    The small convenience sample size of our study limits the transferability of findings. Response bias may be an issue due to participants being self-selecting and may be more motivated by goodwill than the average member of the population. Furthermore, respondents were white-collar workers from large organisations located in a metropolitan area and may have different perspectives than those from smaller blue-collar organisations, or those located in remote/regional settings. Finally, this study was conducted during a global pandemic, which may have affected respondents’ views surrounding mental health approaches within their workplace or wider community.

    Future research

    Future research needs to identify COs that are best suited to deliver work-related mental health literacy programmes based on the attributes, positioning and governance structures that workers find appealing and investigate their appetite, capacity and willingness to provide these programmes through cross-sector collaborations. Research needs to explore the benefit of affiliations with relevant, and well-established bodies (ie, peak bodies) and third-party endorsement of these initiatives via collaborative approaches for effective reach in the community. Future studies could replicate this study using a larger sample that is more representative of workers in general.

    Conclusion

    The current study used a well-founded psychological decision-making theory (TPB) to explore the motivation of workers to engage with mental health literacy programmes delivered by COs. Workers with and without current or previous associations with COs were compared. Results showed that COs can provide workers with an alternative to workplace settings to access mental health literacy programmes. COs are seen as being suitable as they are empathetic, safe, relatable, trustworthy, supportive and inclusive environments. Advantages of programmes delivered by COs were discussing shared experiences with peers and the opportunity to receive independent perspectives and unbiased advice. Workers without associations with COs were not as aware of these benefits. Family and friends were most likely to approve of participating in such programmes. Supervisors and colleagues were important social referents that might disapprove, therefore their support for these programmes should be encouraged and communicated. Workers with associations with COs reported the lack of suitability and the legitimacy of leadership and governance of COs as limiting factors. COs who are appropriately structured, led and governed should be identified to deliver these programmes. Workers without associations referred to endorsement by government bodies, whereas those with associations referred to endorsement by peak bodies and specialist organisations. Strategic alliances with appropriately positioned COs and third parties such as statutory entities, peak bodies and organisations with work-related mental health literacy expertise should be explored to inform the development of a framework for cross-sector collaboration to support and promote mental health literacy programmes delivered by COs.

    Data availability statement

    No data are available.

    Ethics statements

    Patient consent for publication

    Ethics approval

    This study involves human participants and was approved by Monash University Human Research Ethics Committee project ID: 20548. Participants gave informed consent to participate in the study before taking part.

    References

    1. ↵
      1. Potter R,
      2. O'Keeffe V,
      3. Leka S, et al
      . Analytical review of the Australian policy context for work-related psychological health and psychosocial risks. Saf Sci 2019;111:37–48.doi:10.1016/j.ssci.2018.09.012
      OpenUrl
    2. ↵
      1. Cocker F,
      2. Sanderson K,
      3. LaMontagne AD
      . Estimating the economic benefits of eliminating job strain as a risk factor for depression. J Occup Environ Med 2017;59:12–17.doi:10.1097/JOM.0000000000000908pmid:http://www.ncbi.nlm.nih.gov/pubmed/28045792
      OpenUrlPubMed
    3. ↵
      1. Harvey SB,
      2. Deady M,
      3. Wang M-J, et al
      . Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001-2014. Med J Aust 2017;206:490–3.doi:10.5694/mja16.00295pmid:http://www.ncbi.nlm.nih.gov/pubmed/28918719
      OpenUrlPubMed
    4. ↵
      1. Productivity Commission
      . Mental health. Report No. 95. Canberra, Australia, 2020. Available: https://www.pc.gov.au/inquiries/completed/mental-health/report/mental-health.pdf
    5. ↵
      1. Safe Work Australia
      . Bullying & Harassment in Australian Workplaces: Results from the Australian Workplace Barometer Project 2014/2015. Canberra, Australia 2016.
    6. ↵
      1. LaMontagne AD,
      2. Keegel T,
      3. Vallance D, et al
      . Job strain - attributable depression in a sample of working Australians: assessing the contribution to health inequalities. BMC Public Health 2008;8:181.doi:10.1186/1471-2458-8-181pmid:http://www.ncbi.nlm.nih.gov/pubmed/18505559
      OpenUrlCrossRefPubMed
    7. ↵
      1. Harvey SB,
      2. Modini M,
      3. Joyce S, et al
      . Can work make you mentally ill? A systematic meta-review of work-related risk factors for common mental health problems. Occup Environ Med 2017;74:301–10.doi:10.1136/oemed-2016-104015pmid:http://www.ncbi.nlm.nih.gov/pubmed/28108676
      OpenUrlAbstract/FREE Full Text
    8. ↵
      1. Glozier N
      . Review of evidence of interventions to reduce mental ill-health in the workplace. Canberra, Australia, 2017.
    9. ↵
    10. ↵
      1. Hanisch SE,
      2. Twomey CD,
      3. Szeto ACH, et al
      . The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review. BMC Psychiatry 2016;16:1–11.doi:10.1186/s12888-015-0706-4pmid:http://www.ncbi.nlm.nih.gov/pubmed/26739960
      OpenUrlCrossRefPubMed
    11. ↵
      1. Dewa CS,
      2. Hoch JS
      . Barriers to mental health service use among workers with depression and work productivity. J Occup Environ Med 2015;57:726–31.doi:10.1097/JOM.0000000000000472pmid:http://www.ncbi.nlm.nih.gov/pubmed/26147540
      OpenUrlPubMed
    12. ↵
      1. Dewa CS,
      2. van Weeghel J,
      3. Joosen MCW, et al
      . Workers' decisions to disclose a mental health issue to managers and the consequences. Front Psychiatry 2021;12:631032.doi:10.3389/fpsyt.2021.631032pmid:http://www.ncbi.nlm.nih.gov/pubmed/33841203
      OpenUrlPubMed
    13. ↵
      1. LaMontagne AD,
      2. Milner AJ,
      3. Allisey AF, et al
      . An integrated workplace mental health intervention in a policing context: protocol for a cluster randomised control trial. BMC Psychiatry 2016;16:49.doi:10.1186/s12888-016-0741-9pmid:http://www.ncbi.nlm.nih.gov/pubmed/26920745
      OpenUrlPubMed
    14. ↵
      1. Tynan RJ,
      2. Considine R,
      3. Rich JL, et al
      . Help-Seeking for mental health problems by employees in the Australian mining industry. BMC Health Serv Res 2016;16:498.doi:10.1186/s12913-016-1755-1pmid:http://www.ncbi.nlm.nih.gov/pubmed/27654943
      OpenUrlPubMed
    15. ↵
      1. Ammendolia C,
      2. Côté P,
      3. Cancelliere C, et al
      . Healthy and productive workers: using intervention mapping to design a workplace health promotion and wellness program to improve presenteeism. BMC Public Health 2016;16:1190.doi:10.1186/s12889-016-3843-xpmid:http://www.ncbi.nlm.nih.gov/pubmed/27884132
      OpenUrlPubMed
    16. ↵
      1. Productivity Commission
      . Contribution of the not-for-profit sector. research report. Canberra, Australia, 2010. Available: https://www.pc.gov.au/inquiries/completed/not-for-profit/report/not-for-profit-report.pdf
    17. ↵
      1. Lyons A,
      2. Fletcher G,
      3. Farmer J, et al
      . Participation in rural community groups and links with psychological well-being and resilience: a cross-sectional community-based study. BMC Psychol 2016;4:16.doi:10.1186/s40359-016-0121-8pmid:http://www.ncbi.nlm.nih.gov/pubmed/27059602
      OpenUrlPubMed
    18. ↵
      1. Ross AM,
      2. Bassilios B
      . Australian R U OK?Day campaign: improving helping beliefs, intentions and behaviours. Int J Ment Health Syst 2019;13:61.doi:10.1186/s13033-019-0317-4pmid:http://www.ncbi.nlm.nih.gov/pubmed/31534474
      OpenUrlPubMed
    19. ↵
      1. Wilson NJ,
      2. Cordier R
      . A narrative review of Men’s Sheds literature: reducing social isolation and promoting men’s health and well-being. Health Soc Care Community 2013;21:451–63.doi:10.1111/hsc.12019
      OpenUrlCrossRefPubMedWeb of Science
    20. ↵
      1. Jorm AF,
      2. Korten AE,
      3. Jacomb PA, et al
      . "Mental health literacy": a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Med J Aust 1997;166:182–6.doi:10.5694/j.1326-5377.1997.tb140071.xpmid:http://www.ncbi.nlm.nih.gov/pubmed/9066546
      OpenUrlPubMedWeb of Science
    21. ↵
      1. Moll SE,
      2. Patten S,
      3. Stuart H, et al
      . Beyond silence: a randomized, parallel-group trial exploring the impact of workplace mental health literacy training with healthcare employees. Can J Psychiatry 2018;63:826–33.doi:10.1177/0706743718766051pmid:http://www.ncbi.nlm.nih.gov/pubmed/29673271
      OpenUrlPubMed
    22. ↵
      1. Szeto ACH,
      2. Dobson KS
      . Reducing the stigma of mental disorders at work: a review of current workplace anti-stigma intervention programs. Applied and Preventive Psychology 2010;14:41–56.doi:10.1016/j.appsy.2011.11.002
      OpenUrl
    23. ↵
      1. Compton R-L,
      2. McManus JG
      . Employee assistance programs in Australia: evaluating success. J Workplace Behav Health 2015;30:32–45.doi:10.1080/15555240.2015.998971
      OpenUrl
    24. ↵
      1. Brouwers EPM,
      2. Joosen MCW,
      3. van Zelst C, et al
      . To disclose or not to disclose: a Multi-stakeholder focus group study on mental health issues in the work environment. J Occup Rehabil 2020;30:84–92.doi:10.1007/s10926-019-09848-zpmid:http://www.ncbi.nlm.nih.gov/pubmed/31410722
      OpenUrlPubMed
    25. ↵
      1. Hadlaczky G,
      2. Hökby S,
      3. Mkrtchian A, et al
      . Mental health first aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: a meta-analysis. Int Rev Psychiatry 2014;26:467–75.doi:10.3109/09540261.2014.924910pmid:http://www.ncbi.nlm.nih.gov/pubmed/25137113
      OpenUrlCrossRefPubMed
    26. ↵
      1. Moll S,
      2. Patten SB,
      3. Stuart H, et al
      . Beyond silence: protocol for a randomized parallel-group trial comparing two approaches to workplace mental health education for healthcare employees. BMC Med Educ 2015;15:78.doi:10.1186/s12909-015-0363-9pmid:http://www.ncbi.nlm.nih.gov/pubmed/25880303
      OpenUrlPubMed
    27. ↵
      1. Kelly CM,
      2. Jorm AF,
      3. Wright A
      . Improving mental health literacy as a strategy to facilitate early intervention for mental disorders. Med J Aust 2007;187:S26–30.doi:10.5694/j.1326-5377.2007.tb01332.xpmid:http://www.ncbi.nlm.nih.gov/pubmed/17908021
      OpenUrlPubMedWeb of Science
    28. ↵
      1. Brijnath B,
      2. Protheroe J,
      3. Mahtani KR, et al
      . Do web-based mental health literacy interventions improve the mental health literacy of adult consumers? results from a systematic review. J Med Internet Res 2016;18:e165.doi:10.2196/jmir.5463pmid:http://www.ncbi.nlm.nih.gov/pubmed/27323907
      OpenUrlPubMed
    29. ↵
      1. Jorm AF,
      2. Christensen H,
      3. Griffiths KM
      . The impact of beyondblue: the National depression initiative on the Australian public's recognition of depression and beliefs about treatments. Aust N Z J Psychiatry 2005;39:248–54.doi:10.1080/j.1440-1614.2005.01561.xpmid:http://www.ncbi.nlm.nih.gov/pubmed/15777361
      OpenUrlCrossRefPubMedWeb of Science
    30. ↵
      1. Bovopoulos N,
      2. Jorm AF,
      3. Bond KS, et al
      . Providing mental health first aid in the workplace: a Delphi consensus study. BMC Psychol 2016;4:1–10.doi:10.1186/s40359-016-0148-x
      OpenUrlPubMed
    31. ↵
      1. Gulliver A,
      2. Griffiths KM,
      3. Christensen H, et al
      . A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry 2012;12:81.doi:10.1186/1471-244X-12-81pmid:http://www.ncbi.nlm.nih.gov/pubmed/22799879
      OpenUrlCrossRefPubMed
    32. ↵
      1. Kitchener BA,
      2. Jorm AF
      . Mental health first aid training: review of evaluation studies. Aust N Z J Psychiatry 2006;40:6–8.doi:10.1080/j.1440-1614.2006.01735.xpmid:http://www.ncbi.nlm.nih.gov/pubmed/16403032
      OpenUrlCrossRefPubMedWeb of Science
    33. ↵
      1. Gayed A,
      2. Milligan-Saville JS,
      3. Nicholas J, et al
      . Effectiveness of training workplace managers to understand and support the mental health needs of employees: a systematic review and meta-analysis. Occup Environ Med 2018;75:462–70.doi:10.1136/oemed-2017-104789pmid:http://www.ncbi.nlm.nih.gov/pubmed/29563195
      OpenUrlAbstract/FREE Full Text
    34. ↵
      1. LaMontagne AD,
      2. Martin A,
      3. Page KM, et al
      . Workplace mental health: developing an integrated intervention approach. BMC Psychiatry 2014;14:131.doi:10.1186/1471-244X-14-131pmid:http://www.ncbi.nlm.nih.gov/pubmed/24884425
      OpenUrlCrossRefPubMed
    35. ↵
      1. Reupert A
      . Enhancing workforce capacity in mental health promotion, prevention and early intervention. Adv Ment Health 2018;16:1–4.doi:10.1080/18387357.2018.1429196
      OpenUrl
    36. ↵
      1. Reavley NJ,
      2. Morgan AJ,
      3. Jorm AF
      . Predictors of experiences of discrimination and positive treatment in people with mental health problems: findings from an Australian national survey. Soc Psychiatry Psychiatr Epidemiol 2017;52:269–77.doi:10.1007/s00127-016-1301-9pmid:http://www.ncbi.nlm.nih.gov/pubmed/27803976
      OpenUrlPubMed
    37. ↵
      1. Moll SE
      . The web of silence: a qualitative case study of early intervention and support for healthcare workers with mental ill-health. BMC Public Health 2014;14:138.doi:10.1186/1471-2458-14-138pmid:http://www.ncbi.nlm.nih.gov/pubmed/24507543
      OpenUrlPubMed
    38. ↵
      1. Brohan E,
      2. Evans-Lacko S,
      3. Henderson C, et al
      . Disclosure of a mental health problem in the employment context: qualitative study of beliefs and experiences. Epidemiol Psychiatr Sci 2014;23:289–300.doi:10.1017/S2045796013000310pmid:http://www.ncbi.nlm.nih.gov/pubmed/23919992
      OpenUrlPubMed
    39. ↵
      1. Stratton E,
      2. Einboden R,
      3. Ryan R, et al
      . Deciding to disclose a mental health condition in male dominated workplaces; a focus-group study. Front Psychiatry 2018;9:1–10.doi:10.3389/fpsyt.2018.00684
      OpenUrlCrossRef
    40. ↵
      1. Harvey SB,
      2. Joyce S,
      3. Tan L
      . Developing a mentally healthy workplace: a review of the literature, 2014. Available: https://www.headsup.org.au/docs/default-source/resources/developing-a-mentally-healthy-workplace_final-november-2014.pdf?sfvrsn=8
    41. ↵
      1. Bovopoulos N,
      2. Lamontagne AD,
      3. Martin A
      . Exploring the role of mental health first aid officers in workplaces. A qualitative study using case study methodology. Int J Work Heal Manag 2018;11:366–81.
      OpenUrl
    42. ↵
      1. Laverack G
      . Health activism. Health Promot Int 2012;27:429–34.doi:10.1093/heapro/das044pmid:http://www.ncbi.nlm.nih.gov/pubmed/22923451
      OpenUrlCrossRefPubMedWeb of Science
    43. ↵
      1. Rossetto A,
      2. Potts LC,
      3. Reavley NJ
      . Perceptions of positive treatment and discrimination toward people with mental health problems: findings from the 2017 and 2019 attitudes to mental illness surveys. Stigma Heal 2019;273:141–8.
      OpenUrl
    44. ↵
      1. Gardner A,
      2. Cotton SM,
      3. Allott K, et al
      . Social inclusion and its interrelationships with social cognition and social functioning in first-episode psychosis. Early Interv Psychiatry 2019;13:477–87.doi:10.1111/eip.12507pmid:http://www.ncbi.nlm.nih.gov/pubmed/29076286
      OpenUrlPubMed
    45. ↵
      1. Filia KM,
      2. Jackson HJ,
      3. Cotton SM, et al
      . What is social inclusion? A thematic analysis of professional opinion. Psychiatr Rehabil J 2018;41:183–95.doi:10.1037/prj0000304pmid:http://www.ncbi.nlm.nih.gov/pubmed/29975085
      OpenUrlPubMed
    46. ↵
      1. Syzdek MR,
      2. Addis ME,
      3. Green JD, et al
      . A pilot trial of gender-based motivational interviewing for help-seeking and internalizing symptoms in men. Psychol Men Masc 2014;15:90–4.doi:10.1037/a0030950pmid:http://www.ncbi.nlm.nih.gov/pubmed/25484627
      OpenUrlPubMed
    47. ↵
      1. Couture S,
      2. Penn D
      . Interpersonal contact and the stigma of mental illness: a review of the literature. J Ment Health 2003;12:291–305.doi:10.1080/09638231000118276
      OpenUrlCrossRef
    48. ↵
      1. Mead S,
      2. Filson B
      . Mutuality and shared power as an alternative to coercion and force. MHSI 2017;21:144–52.doi:10.1108/MHSI-03-2017-0011
      OpenUrl
    49. ↵
      1. Whiteford GE,
      2. Pereira RB
      . Occupation, Inclusion and Participation. In: Whiteford G, Hocking C, eds. Occupational science: Society, inclusion, participation. Wiley Blackwell, 2012: 185–207.
    50. ↵
      1. Tomczyk S,
      2. Schomerus G,
      3. Stolzenburg S, et al
      . Ready, willing and able? an investigation of the theory of planned behaviour in help-seeking for a community sample with current untreated depressive symptoms. Prev Sci 2020;21:749–60.doi:10.1007/s11121-020-01099-2pmid:http://www.ncbi.nlm.nih.gov/pubmed/32140825
      OpenUrlPubMed
    51. ↵
      1. White MM,
      2. Clough BA,
      3. Casey LM
      . What do help-seeking measures assess? building a conceptualization framework for help-seeking intentions through a systematic review of measure content. Clin Psychol Rev 2018;59:61–77.doi:10.1016/j.cpr.2017.11.001pmid:http://www.ncbi.nlm.nih.gov/pubmed/29153743
      OpenUrlPubMed
    52. ↵
      1. Rickwood D,
      2. Thomas K
      . Conceptual measurement framework for help-seeking for mental health problems. Psychol Res Behav Manag 2012;5:173–83.doi:10.2147/PRBM.S38707pmid:http://www.ncbi.nlm.nih.gov/pubmed/23248576
      OpenUrlCrossRefPubMed
    53. ↵
      1. Fishbein M,
      2. Predicting AI
      . Predicting and changing behavior: the Reasoned action approach. 1st edn. NY: Psychology Press, 2009.
    54. ↵
      1. Ajzen I
      . The theory of planned behavior. Organ Behav Hum Decis Process 1991;50:179–211.doi:10.1016/0749-5978(91)90020-T
      OpenUrlCrossRefWeb of Science
    55. ↵
      1. Ajzen I,
      2. Fishbein M
      . Understanding Attitudes and Predicting Social Behavior. Englewood Cliffs, N.J.: Prentice-Hall, 1980.
    56. ↵
      1. O'Brien BC,
      2. Harris IB,
      3. Beckman TJ, et al
      . Standards for reporting qualitative research: a synthesis of recommendations. Acad Med 2014;89:1245–51.doi:10.1097/ACM.0000000000000388pmid:http://www.ncbi.nlm.nih.gov/pubmed/24979285
      OpenUrlCrossRefPubMed
    57. ↵
      1. O’Sullivan D,
      2. Rahamathulla M,
      3. Pawar M
      . The impact and implications of COVID-19: an Australian perspective. The International Journal of Community and Social Development 2020;2:134–51.doi:10.1177/2516602620937922
      OpenUrl
    58. ↵
      1. Patton MQ
      . Qualitative Research and Evaluation Methods: Integrating Theory and Practice. 4th ed. Thousand Oaks, US: SAGE Publications, 2015.
    59. ↵
      1. Saumure K,
      2. Given LM
      . Data Saturation. In: Given LM, ed. The SAGE encyclopedia of qualitative research methods. SAGE Publications Inc, 2008: 195–6.
    60. ↵
      1. QSR International Pty Ltd
      . NVivo qualitative data analysis software (released in March 2020), 2020. Available: https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home
    61. ↵
      1. Braun V,
      2. Clarke V
      . Using thematic analysis in psychology. Qual Res Psychol 2006;3:77–101.doi:10.1191/1478088706qp063oa
      OpenUrlCrossRef
    62. ↵
      1. Boyatzis RE
      . Transforming qualitative information: thematic analysis and code development. Thousand Oaks, CA: Sage Publications, 1998.
    63. ↵
      1. Nowell LS,
      2. Norris JM,
      3. White DE
      . Thematic analysis: Striving to meet the Trustworthiness criteria. Int J Qual Methods 2017;16.
    64. ↵
      1. Miles MB,
      2. Hubermana M
      . Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks, CA: Sage Publications, 1994.
    65. ↵
      1. Hardeman W,
      2. Johnston M,
      3. Johnston D, et al
      . Application of the theory of planned behaviour in behaviour change interventions: a systematic review. Psychol Health 2002;17:123–58.doi:10.1080/08870440290013644a
      OpenUrlCrossRefWeb of Science
    66. ↵
      1. Davis MH
      . Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol 1983;44:113–26.doi:10.1037/0022-3514.44.1.113
      OpenUrlCrossRefWeb of Science
    67. ↵
      1. Martinez AG
      . When “They” Become “I”: Ascribing Humanity to Mental Illness Influences Treatment-Seeking for Mental/Behavioral Health Conditions. J Soc Clin Psychol 2014;33:187–206.doi:10.1521/jscp.2014.33.2.187
      OpenUrl
    68. ↵
      1. O'donovan R,
      2. Mcauliffe E
      . A systematic review of factors that enable psychological safety in healthcare teams. Int J Qual Health Care 2020;32:240–50.doi:10.1093/intqhc/mzaa025pmid:http://www.ncbi.nlm.nih.gov/pubmed/32232323
      OpenUrlPubMed
    69. ↵
      1. South J,
      2. Bagnall A-M,
      3. Stansfield JA, et al
      . An evidence-based framework on community-centred approaches for health: England, UK. Health Promot Int 2019;34:356–66.doi:10.1093/heapro/dax083pmid:http://www.ncbi.nlm.nih.gov/pubmed/29206912
      OpenUrlPubMed
    70. ↵
      1. Newbigging K,
      2. Mohan J,
      3. Rees J, et al
      . Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study. BMJ Open 2017;7:e019238.doi:10.1136/bmjopen-2017-019238pmid:http://www.ncbi.nlm.nih.gov/pubmed/29122807
      OpenUrlAbstract/FREE Full Text
    71. ↵
      1. Levesque J-F,
      2. Harris MF,
      3. Russell G
      . Patient-Centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18.doi:10.1186/1475-9276-12-18pmid:http://www.ncbi.nlm.nih.gov/pubmed/23496984
      OpenUrlCrossRefPubMed
    72. ↵
      1. Sekhon M,
      2. Cartwright M,
      3. Francis JJ
      . Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res 2017;17:1–13.doi:10.1186/s12913-017-2031-8
      OpenUrlCrossRef
    73. ↵
      1. Saurman E
      . Improving access: modifying Penchansky and Thomas’s Theory of Access. J Health Serv Res Policy 2016;21:36–9.doi:10.1177/1355819615600001
      OpenUrlCrossRefPubMed
    74. ↵
      1. Shengelia B,
      2. Murry CJ,
      3. Adams OB
      . Utilization: Defining and Measuring Health System Coverage. In: Murray CJL, ed. Health systems performance assessment. debates, methods and empiricism. Geneva: World Health Organization, 2003: 221–34.
    75. ↵
      1. Leamy M,
      2. Bird V,
      3. Le Boutillier C, et al
      . Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry 2011;199:445–52.doi:10.1192/bjp.bp.110.083733pmid:http://www.ncbi.nlm.nih.gov/pubmed/22130746
      OpenUrlAbstract/FREE Full Text
    76. ↵
      1. Yeung WS,
      2. Hancock N,
      3. Honey A, et al
      . Igniting and maintaining hope: the voices of people living with mental illness. Community Ment Health J 2020;56:1044–52.doi:10.1007/s10597-020-00557-zpmid:http://www.ncbi.nlm.nih.gov/pubmed/31993841
      OpenUrlPubMed
    77. ↵
      1. Townsend SSM,
      2. Kim HS,
      3. Mesquita B
      . Are You Feeling What I’m Feeling? Emotional Similarity Buffers Stress. Soc Psychol Personal Sci 2014;5:526–33.doi:10.1177/1948550613511499
      OpenUrl
    78. ↵
      1. Peck CE,
      2. Lim MH,
      3. Purkiss M, et al
      . Development of a lived experience-based digital resource for a Digitally-Assisted peer support program for young people experiencing psychosis. Front Psychiatry 2020;11:635.doi:10.3389/fpsyt.2020.00635pmid:http://www.ncbi.nlm.nih.gov/pubmed/32714223
      OpenUrlPubMed
    79. ↵
      1. Honey A,
      2. Boydell KM,
      3. Coniglio F, et al
      . Lived experience research as a resource for recovery: a mixed methods study. BMC Psychiatry 2020;20:1–13. 2020 201.doi:10.1186/s12888-020-02861-0
      OpenUrlCrossRef
    80. ↵
      1. Taylor J,
      2. Jones RM,
      3. O'Reilly P, et al
      . The station community mental health centre Inc: nurturing and empowering. Rural Remote Health 2010;10:1–12.doi:10.22605/RRH1411pmid:http://www.ncbi.nlm.nih.gov/pubmed/20701415
      OpenUrlPubMed
    81. ↵
      1. Lingard H,
      2. Francis V
      . The work‐life experiences of office and site‐based employees in the Australian construction industry. Construction Management and Economics 2004;22:991–1002.doi:10.1080/0144619042000241444
      OpenUrlCrossRef
    82. ↵
      1. Azzone V,
      2. McCann B,
      3. Merrick EL, et al
      . Workplace stress, organizational factors and EAP utilization. J Workplace Behav Health 2009;24:344–56.doi:10.1080/15555240903188380pmid:http://www.ncbi.nlm.nih.gov/pubmed/24058322
      OpenUrlPubMed
    83. ↵
      1. Walton L
      . Exploration of the attitudes of employees towards the provision of counselling within a profit-making organisation. Counselling and Psychotherapy Research 2003;3:65–71.doi:10.1080/14733140312331384658
      OpenUrl
    84. ↵
      1. Deyo-Svendsen ME,
      2. Palmer KB,
      3. Albright JK, et al
      . Provider approachability: an All-Staff survey approach to creating a culture of safety. J Patient Saf 2019;15:e64–9.doi:10.1097/PTS.0000000000000409pmid:http://www.ncbi.nlm.nih.gov/pubmed/28820796
      OpenUrlPubMed
    85. ↵
      1. Peters E,
      2. Spanier K,
      3. Radoschewski FM, et al
      . Influence of social support among employees on mental health and work ability-a prospective cohort study in 2013-15. Eur J Public Health 2018;28:819–23.doi:10.1093/eurpub/cky067pmid:http://www.ncbi.nlm.nih.gov/pubmed/29668870
      OpenUrlPubMed
    86. ↵
      1. Jung H,
      2. von Sternberg K,
      3. Davis K
      . The impact of mental health literacy, stigma, and social support on attitudes toward mental health help-seeking. Int J Ment Health Promot 2017;19:252–67.doi:10.1080/14623730.2017.1345687
      OpenUrl
    87. ↵
      1. Joyce T,
      2. Hazelton M,
      3. McMillan M
      . Nurses with mental illness: their workplace experiences. Int J Ment Health Nurs 2007;16:373–80.doi:10.1111/j.1447-0349.2007.00492.xpmid:http://www.ncbi.nlm.nih.gov/pubmed/17995508
      OpenUrlCrossRefPubMed
    88. ↵
      1. Melville R R
      . The state and community sector peak bodies: theoretical and policy challenges. Third Sect Rev 1999;5:25–41.
      OpenUrl
    89. ↵
      1. Roberts R,
      2. Lockett H,
      3. Bagnall C, et al
      . Improving the physical health of people living with mental illness in Australia and New Zealand. Aust J Rural Health 2018;26:354–62.doi:10.1111/ajr.12457pmid:http://www.ncbi.nlm.nih.gov/pubmed/30303285
      OpenUrlPubMed
    90. ↵
      1. Harding C,
      2. Fox C
      . It's Not About "Freudian Couches and Personality Changing Drugs": An Investigation Into Men's Mental Health Help-Seeking Enablers. Am J Mens Health 2015;9:451–63.doi:10.1177/1557988314550194pmid:http://www.ncbi.nlm.nih.gov/pubmed/25237040
      OpenUrlCrossRefPubMed

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Contributors CC, PAVD, JO and ADS developed the study idea. CC developed the study design and interview protocol, with PAVD providing theoretical expertise and guidance. CC conducted and transcribed the interviews, and PAVD confirmed accuracy. CC analysed the data, and PAVD and JO provided qualitative methods expertise on data analysis and data interpretation. CC drafted the manuscript with regular input from PAVD and JO. PAVD and JO reviewed the draft manuscript. All authors critically reviewed and approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.