Helpseeking among prison inmates : a test of the theory of planned behaviour : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Psychology at Massey University

Abstract

Prison inmates are more likely than those in the general population to experience psychiatric disorders and related problems such as suicidal thinking, but are less likely to have contact with mental health services. The current study examined factors that could facilitate professional helpseeking in New Zealand prison inmates. Two versions of the Theory of Planned Behaviour (TPB) formed the theoretical basis for the study. The first was the standard TPB with attitudes, subjective norms and perceived behavioural control as determinants of helpseeking intentions, and behaviour. An extended version of the TPB included these variables and also the effects of inmates' prior contact with a psychologist, and their current emotional distress on helpseeking intentions and behaviour. A TPB helpseeking questionnaire was developed and trialled with a sample (n = 52) of male New Zealand prison inmates from one prison. Inmates at six other prisons (n = 515) then completed the final questionnaire, which assessed attitudes, subjective norms, perceived behavioural control and intentions to seek help from a prison psychologist. Participants' helpseeking was monitored over the following year through Corrections Psychological Service databases. Of the 419 inmates who were followed up, 88 were referred to a prison psychologist, which provided a proxy measure of helpseeking behaviour. The standard TPB explained up to 44% of the variance in prison inmate intentions to seek help for a "personal-emotional problem", and up to 33% of the variance for intentions to seek help for "suicidal feelings". Helpseeking attitudes and subjective norms were consistent and strong determinants of helpseeking intentions, whereas perceptions of behavioural control with respect to seeing a psychologist had a weak relationship with helpseeking intentions. There was some support for the extended version of the TPB model. The explained variance in helpseeking intentions increased slightly with the addition of prior contact and emotional distress to the model. Prior contact and emotional distress were associated with higher intentions to seek help, although the strength of these relationships varied according to which version of the TPB was tested. The standard and extended versions of the TPB had low predictive capacity for actual helpseeking as reflected in referral to a prison psychologist. General attitude (in one regression equation), age and prior contact with a psychologist were the only independent predictors of helpseeking behaviour. Inmates who sought help tended to have more favourable helpseeking attitudes. Prior contact with a psychologist was an approach factor for seeking help for a personal-emotional problem and for helpseeking for suicidal feelings. Age was the strongest predictor of helpseeking behaviour, in that older inmates were more likely than others to actually seek referral to a prison psychologist. The most striking finding for the current study was that contrary to the TPB model, intentions to seek help did not predict helpseeking behaviour for either emotional or suicidal problems. Recommendations are made regarding future TPB-based helpseeking research. Interview responses from the pilot study indicated that male-role characteristics, therapist gender and psychologists' cultural knowledge may influence inmates' willingness to seek psychological help. It may be fruitful for future TPB-based helpseeking studies to incorporate these aspects of helpseeking. It is also suggested that future helpseeking studies within a TPB framework further develop the subjective norm construct to include possible stigma concerns that inmates experience. The current study used an indirect measure of helpseeking behaviour, and suggestions are made to improve the prediction of helpseeking behaviour from the TPB. Specifically, the behaviour measure could incorporate other sources of help approached by inmates when they experience significant personal problems, and could detail the type of problems that prompt actual helpseeking. Finally, recommendations are made regarding prison-based interventions to improve inmate helpseeking.