Decisions on Disclosure in the Employment Setting (DECIDES)

Finding and keeping paid employment is more difficult for people with mental health problems compared to those without mental health problems. One barrier to paid employment is the stigma attached to mental health problems. This study focuses on the health, well-being and job seeking activities of unemployed people with mental health problems who receive social benefits from Dutch municipalities. This clustered RCT evaluates whether use of the Dutch version of the decision aid ‘Conceal or Reveal’ (CORAL), developed originally in the UK, about disclosure of mental health problems is more cost-effective in finding and keeping paid employment compared to a control group. Research questions are: (1) Is the intervention in the municipal practice cost-effective, even when costs other than vocational reintegration are included (such as healthcare costs)? (2) Does the intervention lead more often to finding and retaining paid work for unemployed people with mental health problems, compared to usual guidance in municipal practice? And (3) For whom, under which circumstances and in what way does the decision aid work best, or less well, and why? Subjects are recruited by 72 job coaches working at Dutch municipalities or organizations working on behalf of municipalities, of which 35 job coaches receive training in using the decision aid. In addition, to establish cost-effectiveness these results are combined with personal income data from the registration administration of Dutch municipalities and Statistics Netherlands.

The research questions of this study are:
1. Does the intervention lead more often to finding and retaining paid work for unemployed people with mental health problems, compared to usual guidance in municipal practice?
2. Is the intervention in the municipal practice cost-effective, even if costs other than vocational reintegration are included (such as healthcare costs)?
3. For whom, under which circumstances and in what way does the decision aid work best, or less well, and why?

Participants who participate in the study, will fill out questionnaires at baseline (T0), and at 3 months (T1), 6 months (T2) and 12 months (T3) post baseline. All primary and secondary outcomes are measured at each measurement.

The intervention includes a training for employment specialists about disclosure of mental health problems and using a decision aid about disclosure of mental health problems. This decision aid was originally developed in the UK and is designed for people with mental health problems. In a separate project, the decision aid was adapted to the Dutch context. One of the findings of that project was that the decision aid may be too much text for people with limited reading or concentration skills which is why two short versions of the decision aid were developed. Participants in the intervention group will receive the decision aid from the researchers after completing the first questionnaire and employment specialists are encouraged to use the decision aid in their contact with their clients. Furthermore, employment specialists give care as usual. Participants in the control group will receive the usual guidance by their employment specialist.