Help-seeking behavior

• TYPE OF PSYCHOLOGY: Social psychology
• Few people who experience significant psychological distress seek professional help. Research has identified a number of factors that contribute to help-seeking behavior. These include demographic factors, patients’ attitudes toward a service system that often neglects the special needs of racial and ethnic minorities, financial factors, and organizational factors. People most likely to be in need of help are least willing to seek it, and if they do seek help, they are least likely to benefit from it.

Introduction

The National Institute of Mental Health estimates that one in five Americans has a mental health condition, but most never seek treatment from mental health services. Many factors impact an individual's likeliness of seeking treatment, including age, socioeconomic status, childhood trauma, marital status, location, education level, and a lack of knowledge concerning where to seek help. Additionally, the stigma society places on mental health conditions is a deterrent for some people, while others are unaware they have a mental health condition.

Help-seeking provides a critical step between the onset of mental health problems and the provision of help. Help-seeking is the contact between individuals and healthcare providers prompted by the affected person’s efforts and their family and loved ones. Help-seeking is behavior designed to elicit assistance from others in response to a physical or emotional problem. There are three dimensions to help-seeking behavior—whether a person decides to seek help, at what time the person seeks help (delayed or prematurely), and the appropriateness of the help-seeking behavior. Societal attitudes and belief systems prevalent in any given group significantly impact help-seeking behavior. Understanding patterns of when and why people seek help is fundamental to devising effective responses.

Evolving attitudes concerning mental health and mental health conditions have been monitored by nationally representative surveys since the 1950s to study how people cope with and seek treatment for mental health conditions if they become symptomatic. The 2012 CDC national survey, Attitudes Toward Mental Illness, tracked levels of public perception regarding the effectiveness of mental health treatment as well as public attitudes toward mental illness (stigma). The survey concluded that while over 80 percent of responding individuals believed that treatment of mental health conditions was effective, just over 50 percent of respondents felt that society was sympathetic toward the mentally ill. Stigmatization of mental health conditions is often a reason for inaction or refusal to engage in help-seeking behavior. According to the CDC, in the 2020s, between 20 and 50 percent of adults diagnosed with a mental health condition saw a mental health provider. Historically, individuals from US states with a high per capita expenditure for mental health services are not only more likely to seek and receive mental health treatment but also report a belief that mental health treatment was effective. Stigma interferes with the willingness of many people, even those who have a serious mental illness, to seek help.

Barriers to Seeking Help

Many people with mental health conditions do not seek treatment. The barriers to treatment include demographic factors, people’s attitudes toward a service system that often neglects the special needs of racial and ethnic minorities, financial factors, and organizational factors.

Demographic factors also affect help-seeking behavior. African Americans, Latinos, and low-income women are less inclined than non-Latino White females to seek treatment. L. K. Sussman, L. N. Robins, and F. Earls, in a 1987 study of differences in help-seeking behavior between Black and White Americans, found that common patient attitudes deter people from seeking treatment. These attitudes include not having enough time, fear of being hospitalized, thinking that they can handle it alone, thinking that no one can help, cost of treatment, and stigma. Cost is a major factor that predisposes people against seeking treatment, even people with health insurance because of the inferior coverage of mental health as compared with healthcare in general. Finally, organizational barriers to help-seeking include the fragmentation of services and unavailability of services. Racial and ethnic minority groups often perceive that services offered by the existing system will not meet their needs because helpers will not take into account their cultural and linguistic practices.

Seeking treatment is a complex process that begins with the individual or individual's support system recognizing that thinking, mood, or behaviors are unusual and severe enough to require treatment; interpreting these symptoms as a medical or mental health problem; deciding whether or not to seek help and from whom; receiving care; and evaluating whether continuation of treatment is warranted.

A number of barriers deter racial and ethnic minority groups from seeking treatment. Many members of minority groups fear or feel ill at ease with the mental health system. Minority groups also may experience the system as a product of White European culture. Clinicians often represent a White, middle-class orientation with biases, misconceptions, and of other cultures.

Cultural heritages may also impart patterns of beliefs and practices that impact the willingness to seek help. Mental health issues may be viewed as spiritual concerns, and a number of ethnic groups, when faced with personal problems, therefore seek guidance from religious figures.

Asian Americans are less likely than White, Black, and Latino Americans to seek help. Amy Okamura, a professor at the School of Social Work at San Diego State University, concludes that for many Asians and Pacific Islanders, it is more culturally appropriate to go to a doctor with physical symptoms that are a manifestation of mental and emotional problems. Furthermore, Asians and Pacific Islanders may first try to change their diet or use herbal medicine, acupuncture, or the services of a healer.

Julia Mayo, chief of the Clinical Studies Department of Psychiatry at St. Vincent’s Hospital and Medical Center in New York, has found that often African Americans wait until they are in crisis and then go to emergency rooms for treatment rather than approach a White therapist. The practice of using the emergency room for routine care is generally attributed to a lack of insurance. Cost and lack of insurance have been found to be barriers to treatment in the past.

In addition, level of acculturation, as measured by language preference, has been identified as an obstacle to seeking help; that is, people who do not speak English are less able to access formal help sources. For example, Asian international students were found to indicate a significant relationship between levels of acculturation and attitudes toward seeking professional psychological help. The most acculturated students were most likely to have positive attitudes toward seeking professional help. Several hypotheses, most of which assume a conflict between the process and the values of traditional East Asian culture, are offered to explain this pattern of underutilization of mental health services. For example, attitudes and beliefs about mental health among Asians have been identified as influencing Asians’ underutilization of psychotherapy. Examples of these attitudes and beliefs include the belief that seeking outside help for psychological problems will bring shame on one’s family, that psychological problems are the result of bad thoughts and a lack of willpower, and that one must resolve problems of this type on one’s own.

Help-Seeking Patterns and Models

Many factors contribute to a person’s willingness to seek help, including age, gender, availability of social support, expectations about help-seeking outcomes, self-concealment tendencies, fear of psychological treatment, and type of psychological problem. Adults ask for help less often for problems that are perceived as stigmatizing, those that reflect personal inadequacy, and those related to intimacy. Help is sought more often for problems regarded as serious and when the cause of the problem is attributed to external causes. Help-seeking increases with age and women typically seek help more often than men. Understanding patterns of help-seeking aids professionals in devising effective interventions for people in need.

Generally, people seek help based on the problem factors, such as the perceived normality of the problem, the perceived preventability of the problem, and the perceived cause of the problem. The level of pain or impairment associated with the problem, the seriousness of the problem, and past positive history with help-seeking all contribute to one’s decision to seek help.

Help-seeking behavior can be characterized by the following principles: The need for help arises from the help-seeker’s situation; the decision to seek help is affected by many factors; people tend to seek help that is most accessible; people tend first to seek help or information from interpersonal sources, especially from people like themselves; help-seekers expect emotional support; and people follow habitual patterns in seeking help. Furthermore, people will go to anonymous sources of help if the personal cost of revealing a need is too much to go to an interpersonal source.

Several models have been proposed to qualify help-seeking behaviors. The Integrated Behavioral Model (IBM-HS) focuses on how personal beliefs about possible outcomes and social norms impact an individual’s decision to seek help, such as social support, mental health knowledge, and perceived need. The Health Belief Model concerns a person’s beliefs about the severity compared to the benefits of seeking help. Similarly, the Decision-Making Model focuses on the underlying cognitive processes that underlie the decision to seek help. Factors include perceived control and social costs.

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