Project completion year
beyondblue commissioned this literature review to identify and synthesise key resources that define the term ‘help-seeking behaviour’ in the context of mental health and wellbeing. There is currently no agreed and commonly used definition of help-seeking, and the purpose of the review is to support recommendations for development of a standardised definition of help-seeking behaviour applicable to the Australian mental health context.
A database search revealed a very high level of research activity in the field, and restriction to the terms ‘help’, ‘seek’ and ‘mental’ was required to generate a manageable review. This generated 316 articles, which were systematically reviewed. Almost half the publications originated from the USA, but second most common were Australian publications, which comprised 15 per cent. Publications dated back as far as 1971, but there has been a surge in interest since 2005.
The review confirmed that there is no commonly referred to definition of help-seeking and that most articles did not explicitly define the term but took its definition to be self-evident. Nevertheless, in the mental health context, help-seeking has been characterised primarily as an adaptive coping response to mental health problems that comprises a search for assistance from external sources.
There were no psychometrically sound measures of help-seeking that were routinely used in the literature. Most studies developed their own measures. The most commonly used standardised measures were the Attitudes Toward Seeking Professional Psychological Help Scale, which measures attitudes, and the General Help-Seeking Questionnaire, which measures past help-seeking experiences and intentions to seek future help.
There were few elements of help-seeking that were common across all definitions and population sub-groups, and no patterns were evident whereby particular elements were common to specific population sub-groups. The most common element was a focus on formal help-seeking sources, rather than informal sources, although studies did not assess a common set of professional sources - each study addressed an idiosyncratic range of formal sources.
Similarly, the studies considered help-seeking for a range of mental health problems and no consistent terminology was applied. The most common mental health problem investigated was depression, followed by use of generic terms such as mental health problem, psychological distress or emotional problem.
On the basis of the results of the review, it is evident that a simple definition of help-seeking is much needed, along with development of psychometrically valid measures. It is recommended that help-seeking be defined as:
In the mental health context, help-seeking is an adaptive coping process that is the attempt to obtain external assistance to deal with a mental health concern.
To enable consistency and the ability to compare study results, researchers need to be encouraged to consider and make explicit the following elements:
- Process (and respective timeframe) refers to the part of the process that is of interest: whether the focus is on a general orientation or attitudes toward obtaining assistance; future behavioural intentions; or observable behaviour (either in the past or prospectively in the future).
- Assistance is the source and type of assistance that is sought. Source of assistance needs to clearly distinguish:
a. professional health service providers with a specified role in delivery of mental health care (formal)
b. service providers and professionals that do not have a specified role in delivery of mental health care (semi-formal)
c. informal social supports (informal)
d. self-help resources (self-help)
- Concern refers to the type of mental health problem for which help is being sought. This needs to be clearly defined and made explicit.
Finally, to develop a psychometrically sound measure of help-seeking that could be commonly applied across a range of studies and that clearly addresses each of the elements referred to above, a research project needs to be undertaken. This would provide clear examples of valid and reliable ways to operationalise help-seeking. In the meantime, using the general definition presented here and encouraging researchers to consider the major conceptual elements described above will begin to provide a guide to standardised outcome measurement, program development and resource allocation and assist stakeholders to communicate in relation to this critical health care process.
Rickwood D, Thomas K, Bradford S. Review of help-seeking measures in mental health: an Evidence Check rapid review brokered by the Sax Institute (http://www.saxinstitute.org.au) for beyondblue 2012.