Journal of Occupational Rehabilitation

, Volume 25, Issue 2, pp 403–411 | Cite as

How Does a Decision Aid Help People Decide Whether to Disclose a Mental Health Problem to Employers? Qualitative Interview Study

  • F. Lassman
  • R. Claire HendersonEmail author
  • L. Dockery
  • S. Clement
  • J. Murray
  • O. Bonnington
  • S. Farrelly
  • G. Thornicroft


Background Decisions about whether to disclose mental health problems to employers are complex, with potential personal, employment and legal implications. Decision aids are evidence based tools, designed to help individuals make specific choices between treatment options. We previously developed a decision aid—Conceal Or ReveAL (CORAL)—to assist service users with decisions about disclosure to employers. As part of a mixed methods exploratory RCT, which demonstrated that the CORAL decision aid was effective in reducing decisional conflict, we aimed to explore its mechanism of action and to optimise the intervention for a future full scale trial. Methods In depth interviews were conducted with individuals receiving vocational support from a mental health trust and participating in the intervention arm of the pilot trial. Thematic analysis was conducted to identify the main themes relating to participants’ perceptions of the CORAL decision aid. Results Thirteen participants were interviewed and five main themes were identified: sense of self and values; sense of control; anticipation of disclosure; experience of disclosure; and mechanism of action of the decision aid. Conclusions Data from our 13 participants suggest that the CORAL decision aid acts on several dimensions of decisional conflict: clarifying the pros and cons of different choices; increasing knowledge; structuring the decision making process; and clarifying needs and values. The current study indicated that it would be most effective when delivered by a professional well versed in employment and mental health matters such as a vocational adviser. The need for employers and policymakers to reduce the negative impact of disclosure is also highlighted.


Decision aid Disclosure Mental health Employment Qualitative 



This publication is independent research funded by the National Institute for Health Research under its Programme Grants for Applied Research scheme (Improving Mental Health Outcomes by Reducing Stigma and Discrimination: RP-PG-0606-1053). The views expressed in this presentation are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. GT is also funded through a NIHR Specialist Mental Health Biomedical Research Centre at the Institute of Psychiatry, King’s College London and the South London and Maudsley NHS Foundation Trust. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Conflict of interest


Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • F. Lassman
    • 1
  • R. Claire Henderson
    • 1
    Email author
  • L. Dockery
    • 1
  • S. Clement
    • 1
  • J. Murray
    • 1
  • O. Bonnington
    • 1
  • S. Farrelly
    • 1
  • G. Thornicroft
    • 1
  1. 1.Health Service and Population Research Department P029, David Goldberg Centre, Institute of PsychiatryKing’s College LondonLondonUK

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