Less than one third of individuals who experience psychological distress seek help from a mental health professional.
What are the roadblocks individuals face when contemplating counseling?
Access to mental health care can improve lives and communities. It can dramatically improve mental and physical health problems, and reduce the risk of family conflict, employment issues, substance abuse, and suicide.
To increase the use of mental health counseling and treatment services, we must first understand the avoidance factors that prevent people from seeking professional help.
The perceived social stigma associated with mental health treatment is a significant deterrent to those seeking therapy. Social stigma is the fear that others will judge you negatively or reject you, if you seek help for a problem. In general, the public tends to assign negative descriptions to individuals who experience mental illness. Individuals are viewed as unable to control their emotions and described as weak or crazy. This discouraging peer assessment only serves to increase an individual’s anxiety regarding their mental health concerns and decrease their desire to get help.
Apprehension arising from the adverse expectations some individuals have when seeking mental health services are called treatment fears. Concerns for how a mental health professional will treat them, worries about what the therapist will think of them and their problems, and fear that the counselor will pressure them to do something they don’t want to do, keep many people from professional counseling.
Fear of Emotion
Researchers have identified a fear of discussing painful emotions as another reason that some individuals avoid seeking counseling. People who have experienced trauma or distressing and deeply painful events often struggle to express their emotions for fear of reliving their pain. This anticipated risk of further emotional suffering prevents these individuals from participating in or endorsing mental health treatment.
Anticipated Utility and Risk
Calculating the anticipated utility and anticipated risk of seeking professional help can be a major influence on an individual’s decision to see a counselor. Anticipated utility refers to the perceived usefulness or lack thereof of therapy. Anticipated risk is the individual’s perception of the potential dangers of discussing their feelings with a mental health professional. For some, the risk of being misunderstood, judged, or even ignored by a therapist outweighs any potential benefits of treatment.
In order to be helped, a person must choose to reveal to a counselor their private feelings, thoughts, and actions. An individual’s comfort in self-disclosing or concealing personal information is related to their past help-seeking experiences and their current help-seeking intentions. The severity of a problem typically increases an individual’s willingness to self-disclose.
The attitudes and opinions of family members, friends and other members of an individual’s social network play an influential role in how that person defines and acts upon mental health symptoms. An individual’s fear of judgment and loss of social standing among their peers is a powerful deterrent to mental health counseling. However, if the individual believes that the important people in their lives would support and encourage mental health counseling, they are more likely to seek help. Individuals are also more likely to try therapy if they know others who have sought counseling and had a positive experience.
The fear of embarrassment and feelings of inferiority or incompetence have been linked to help-seeking decisions. To some, seeking help from another means admitting that they cannot deal with their problems on their own and as such, they are acknowledging their own inadequacy. To maintain a positive self-image, a person will decide not to seek professional help.
Barriers to counseling are not static, they can change in intensity and importance depending on the characteristics of the problem, the setting, the individual’s gender, age, and education level, as well as social and cultural influences. Different types of mental health concerns elicit different avoidance reactions, and the influence of avoidance factors can change depending on the type of treatment that is being considered. Avoidance factors are also thought to become stronger as one moves toward the decision to seek professional help.
DEMOGRAPHIC AND SITUATIONAL INFLUENCES
Sex and Gender
Biological sex or more specifically gender roles can play an important role in help-seeking decisions. Women tend to have more positive attitudes than men regarding counseling, at least for less severe diagnoses. The traditional male gender role, with its emphasis on being independent and in control, may increase the perceived risks associated with seeking help for emotional issues. If a man feels they need to ask for help, they may have increased feelings of insecurity and failure. Men are also more likely to avoid mental health treatment for less severe issues because of social stigma and accepted social norms.
Race and Ethnicity
The role race and ethnicity have in influencing help-seeking avoidance is significant. An individual’s cultural values, beliefs, and norms can create a significant barrier to using professional mental health services. In some cultures, seeking help for personal or emotional problems is considered taboo. Many believe that the best way to deal with personal challenges is to avoid thinking about them, or to seek guidance from family or friends. Seeking help from strangers is regarded as a source of shame or loss of face.
Setting and Problem Type
The social stigma associated with seeking help can vary depending on the mental health setting. People may see talking to a medical doctor as less stressful or embarrassing than a mental health professional because medical issues are not their fault. The perceived appropriateness of seeking help has also been found to be different depending on the type of problem. The seriousness of an individual’s mental health problem and the assistance they require, can increase or decrease the level of stigma.
Certain demographic factors can have an escalating or diminishing effect on avoidance factors. Individuals in their 20s and 30s tend to have a more positive attitude toward professional help, than adolescents and seniors. Perceptions of social stigma and social norms are important avoidance factors to these groups. Some adolescents can be particularly reluctant to seek counseling because of the threat to their developing self-esteem. People over 65 typically have more negative perceptions of therapy due to the perceived utility of mental health counseling. Many seniors discount mental health issues believing their distress is related to physical problems and preferring to manage these problems on their own with medication.
Understanding the effects of the different avoidance factors, and the demographic and situational influences on help-seeking decisions, is the first step in eliminating the barriers to counseling.
If you or a loved one is reluctant to seeking professional mental health counseling, understand that there is no shame in asking for help. We all struggle with feelings of fear, anxiety, and depression at some point in our lives. Speak to your family doctor for a recommendation or visit the Ontario Society of Psychotherapists website www.psychotherapyontario.org to find a therapist near you.