Abstract
It is positive that preliminary findings from the 2007 National Survey of Mental Health and Wellbeing suggest that more Australians than in 1997 are seeking help for common mental disorders. The 2007 Survey, however, also suggested that two in three Australians who had common forms of mental disorder and 41% of those with serious thoughts of suicide during the last year did not seek or engage in professional help for their condition [1]. Even more concerning are the preliminary results suggesting that 86% of those who did not seek help for their common mental disorders thought that they did not need any type of mental health care [2].
Although we do not know why people with mental problems do not want help, the 2007 Survey raises the possibility that low service use is explained by a lack of perceived need for treatment or incomplete mental health literacy [1]. Another possibility is that the gap between service need and use is partially explained by the help-negation process.
Help negation refers to the help avoidance or refusal that has been found in patients with clinical and subclinical levels of suicidal ideation [3,4] and depression [5]. Consistent with several large US studies, Australian studies have repeatedly found that those with higher symptom levels are also those with higher intentions to seek help from no one and lower intentions to seek help from health-care professionals, family and friends [3–5].
Although the determinants of help negation are not yet known and require further research, studies so far have found that the process is not fully explained as a function of hopelessness, lack of prior help [3], the perception of poor-quality prior help-seeking experiences [4], or cooccurring psychological symptoms [5]. Beliefs about mental health treatment and the need to solve one's problems alone have been associated with help negation, but the role of these cognitions is still unclear [4,5].
Findings of help negation suggest that aspects of at least some types of psychological symptoms impede help-seeking. These findings also raise important implications for our future prevention initiatives and policies that rely on proactively seeking and accessing help. How successful can we expect future initiatives to be if a consequence of experiencing psychological distress, even in its very early stages of development, is a tendency to withdraw from specific helping opportunities or avoid help altogether? In the future, consideration might be well placed on both identifying the determinants of help negation and better understanding the role of social and cognitive variables such as mental health literacy and beliefs about treatment and autonomy, in strengthening and maintaining the help-negation process. Improving what we know about help negation might provide further clarification about why large proportions of Australians with mental disorders neither perceive their need for mental health care nor access mental health services.