Stigma and Help-seeking Behaviour
The experience of stigma affects the capacity and willingness of people with mental health difficulties to seek help, resulting in limited treatment efficacy or an increased risk of relapse in remitted individuals, which can in turn lead to an amplification of negative attitudes and discrimination (Sartorius 2007). Evans-Lacko et al. (2012a) explored the association between public views, self-stigma and help-seeking behaviour in individuals in 14 European countries (affiliated to the Global Alliance of Mental Illness Advocacy Networks [GAMIAN] study). The findings indicated that people with mental health difficulties living in countries with less-stigmatizing attitudes showed superior rates of help-seeking behaviours, increased utilization of treatment and more favourable perceptions about the accessibility of relevant information, in addition to comparatively low rates of self-stigma and perceived discrimination. Clement et al. (2015) conducted a recent systematic review investigating mental health-related stigma as a barrier to help-seeking. Of 144 studies included in the review, 99 had been carried out in the USA or Canada.
A further 20 had been conducted in Europe, 10 in Australia/New Zealand, 8 in Asia and only 1 study in South America. Overall, the findings indicated that stigma related to mental health difficulties is a significant impediment to people seeking help from services for these difficulties.
Although stigma is recognized as a universal phenomenon, it has been argued that it is a bigger barrier to accessing treatment in low-resource settings (Thornicroft et al. 2010). Ssebunnya et al. (2009), in research conducted in Uganda, found that self-stigma can delay help-seeking as well as elevated levels of rejection and shame. Reflecting on the situation in ‘developing countries,’ Mascayano et al. (2015) stated that mental health-related stigma constitutes ‘a major problem related to help-seeking in people with mental health difficulties’ (p. 1). However, there have been comparatively few studies conducted investigating mental health-related stigma in LMICs generally and fewer still that have investigated the impact this stigma has on help-seeking in LMICs in particular.