Development and preliminary evaluation of a decision aid for disclosure of mental illness to employers

Objective: Many mental health service users delay disclosing to employers or never do so due to previous experience of, or anticipation of discrimination. However, non-disclosure precludes requesting 'reasonable workplace adjustments'. Service users may experience conflicting needs and values in deciding whether to disclose. No evidence-based interventions exist to support this decision.

Methods: A decision aid (CORAL, or COnceal or ReveAL) to support mental health service users in reaching disclosure decisions was developed and subjected to preliminary evaluation (n=15).

Results: The majority found the decision aid quick (60%) and relevant (60%) and would recommend it (80%). Eighty percent reported that they would definitely or probably use it in making disclosure decisions. Forty percent each were positive or neutral on its ease of use. Semi-structured interviews revealed a demand for more information on the legal implications of disclosure. The mean level of 'decisional conflict' regarding disclosure reduced from 52.0 to 35.5 and mean Stage of Decision-making Scale score from 4.6 to 4.3.

Conclusion: The results suggest that the CORAL decision aid is feasible, relevant and valuable in supporting decisions about disclosing a mental illness to an employer.

Practice implications: The decision aid could be deployed in routine care without significant resource implications.