# Relational influences on help-seeking for mental health and substance use problems among people experiencing social marginalisation: a scoping review

## TL;DR

This review explores how social relationships affect whether marginalized people seek help for mental health or substance use issues.

## Contribution

The paper provides a scoping review of how social capital theory and network analysis explain help-seeking behaviors in marginalized populations.

## Key findings

- Social capital and network culture can both deter and facilitate help-seeking among marginalized individuals.
- Quantitative social network analysis is underutilized in this area despite its potential.
- Fear of losing social capital and trust in service providers are key relational influences on help-seeking.

## Abstract

Understand the relational influences on help-seeking for mental health and substance use problems among people experiencing social marginalisation, with a focus on research applying social capital theory and social network analysis methods.

Scoping review.

EMBASE, Web of Science, Criminal Justice Abstracts and SocINDEX were searched up to June 2023, and Web of Science email alerts were used to capture any further publications up to June 2024.

English-language, peer-reviewed publications that (1) focused on/discussed help-seeking for mental health or substance use problems; (2) included adults experiencing social marginalisation beyond sociodemographic factors; and (3) applied social capital theory or social network analysis methods.

We extracted and charted data pertinent to review objectives and narratively synthesised results.

Twenty-seven papers were included. Most (n=19) focused on the experiences of people who used drugs. Five specifically focused on help-seeking, four of which applied quantitative social network analysis, one was framed by network theories of social capital and one referred to social capital in interpreting findings. The remaining 22 papers discussed help-seeking while focused on different phenomena. Seven of these framed their approach with social capital, but none explicitly applied social capital to help-seeking. Eight papers used social network analysis, with four focused on help-seeking and seven using personal networks. Social/relational influences identified included: fear of losing social capital, the risks of high bonding capital, service providers as social capital, selective help-seeking, trust and network culture. Social capital, interconnected with the tight-knit bonds within marginalised groups, could deter help-seeking. Knowledge and attitudes towards help and help-seeking, shaped by past experiences and network cultures, influenced help-seeking and contributed to a cautious and selective approach.

Theoretical elaboration and empirical research are required to better appreciate the relational influences on help-seeking for mental health and substance use problems among people experiencing social marginalisation. Social capital may provide a useful theoretical approach. While social network analysis methods have been applied, they are under-utilised.