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Patient Educ Couns. 2014 Feb;94(2):238-42. doi: 10.1016/j.pec.2013.10.008. Epub 2013 Nov 5.

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

Author information

  • 1King's College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK.
  • 2King's College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK. Electronic address:



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.


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).


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.


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


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

Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.


Decision support techniques; Disclosure; Employment; Mental health

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