Offenders' lack of trust in medical professionals means many may not seek help when they are experiencing mental distress, says a new BMJ study.

Men who have been incarcerated have significantly higher rates of mental illness and suicide and under-utilise mental health services compared to the general population. Previous research suggests that a positive prior encounter with a health professional may predict the likelihood of seeking help in the future.

Researchers from Exeter undertook a qualitative study, involving face to face in-depth interviews with 35 male offenders, a quarter of whom had been identified as at risk of self-harm. Nineteen of the participants were then interviewed after their release.

All were asked whether they had ever been formally diagnosed with a mental health problem and whether or not they felt they had a mental health problem (regardless of diagnosis). Several reported a formal mental health diagnosis, while many said that they personally felt they may have a mental health problem. Of the 35 interviewed, the majority (21) said that they would not consider attending a GP on account of mental health problems. Of those who were followed-up none had contacted a medical professional in the time between release and follow-up interview.

The researchers found that three factors which appeared to influence whether or not the participants would seek medical help. These were a chaotic upbringing, a fear of diagnosis and distrust of the system. Overall, lack of trust emerged as the most prominent factor. Many of the participants did not feel that health professionals genuinely cared about them or had the ability to help with mental health problems. Others were reluctant to seek helped because they feared a formal diagnosis of mental illness. Some of these individuals feared the stigma that such a diagnosis would bring, while others feared that a diagnosis would mean having to confront the problem.