Attitude and Help-Seeking Behavior of Gen Z towards Mental

Health: An Assessment

Jelcy Mae G. Vejano, Hannah Irish S. Ibarondo, Patricia Kyle M. Diaz &
Angelica Joyce S. Barcos
University of Makati, Makati City
jvejano.a61815948@umak.edu.ph

Abstract

Approximately 800,000 people are dying due to suicide and it is known as the
third leading cause of death in people ages 15 to 19 years old (WHO, 2019).
In line with this, this study aimed to explore the attitude and help-seeking
behavior of 150 students aged sixteen (16) to eighteen (18), who belong to
Generation Z regarding mental health. Research design utilized was mixed
methods, specifically, explanatory sequential. Results have shown that
respondents somewhat accept authoritarianism, moderately accept
benevolence, fairly accept social restrictiveness and moderately accept
community mental health ideology. Respondents have high intention to seek
help in terms of Psychological Concerns and Interpersonal Concerns, Academic
Problems, Drug/Alcohol Problems, and Weight Control. The attitude of the
respondents does not differ in age, sex, religion, grade level, people living with,
and ordinal position. The help-seeking behavior of Gen Z towards mental
health differs on sex in terms of Psychological Concerns and Interpersonal
Concerns, and Academic Problems. The result of the study shows that there is
a relationship between attitude and help-seeking behavior towards mental
health; however, it is classified as a very weak correlation. Establishing a
proper belief and practice towards mental health holistically is important. The
eidetic insight derived from the themes is “Holistic Reinforcement- Self as a
Present,” which is the basis of the mental health promotion program designed
for senior high school students.

Keywords: Mental Health, Generation Z, Attitude towards mental illness,

Intention to seek help

1.0 Introduction

Mental disorder is complex and can manifest in different forms. Mental

disorders influence human liberties, major social, and well-being in each
nation of the world (World Health Organization [WHO], 2019). Mental
health problems can interfere with our way of thinking, decision making,
activities of daily living, and social relationships which can bring harm
to one's life.

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The estimated data of people who go through mental health

disorder prevalence is 792 million, or out of ten individuals can be more
than one around the world (Our World in Data, 2017). Depression is one
of the leading and common mental health disorders throughout the
world, ranging from mild to moderate then severe (WHO 2020).
Globally, an estimation was made in 2017 that 264 million individuals
might experience depression. It is estimated that there are 284 million
individuals who are affected by an anxiety disorder, making it the most
common mental health disorder (Our World in Data, 2017).

According to the Department of Health (DOH), the WHO Global

School-Based Health Survey in 2011 presents that 16% of students
aged 13 to 15 have thought of attempting suicide while another 13%
have tried taking their own life several times over the past years. Suicide
occurs at any age. It is the third leading cause of death among people
ages 15 to 19 years old. Approximately 800,000 people are dying due
to suicide (WHO, 2019). In the Philippines, it has been reported that in
2011, there is 835 suicide deaths among ages 5 – 24 years old (WHO,
2017). WHO perceives stigma and taboo as a challenge in suicide
prevention. Stigma towards mental health disorders and suicide restrain
people from seeking help.

Promotion, value, and protection of mental health are secured

with the Mental Health Act; however, the budget for National Mental
Health Programs in the Philippines is not sufficient. According to DOH
(as cited in CNN Philippines, 2020), the budget for mental health
programs in the Philippines is ₱615 million. Every Filipino will receive
₱5.69 for mental health. With this lack of financial budget, incertitude
in quality implementation of mental health care may be apparent.

Mental health is usually perceived with a negative attitude.

Negative attitudes in people with mental health problems in the
Philippines were seen as standard. Filipinos describe people with a
mental health problem as “dangerous, blameworthy, incompetent and
weak.” This negative attitude influenced them to take unjust actions
such as avoidance, infliction of a penalty, and using force or threat
against them (Tuliao et al., 2018).

Filipinos do not seek medical assistance for their mental health

because they are afraid of being called ‘crazy’ and spoiling the reputation
of their families (Tuliao et al., 2018). This negative view towards mental
health pertains to the view of the generations that existed before the
young generation, which is Generation Z.

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Generation Z’s population is continuously growing and suicide is

crucially predominant among them. In line with this, the researchers
considered conducting a study with Generation Z regarding their
attitude and help-seeking behaviors. This study attempted to fill the gap
in research relevant to mental health focusing on the youngest
generation. The researchers wanted to know if stigma is still present
towards mental health and as well as the opinion of the younger
generation towards mental health.

This study aimed to describe the relationship of attitude and help-

seeking behavior of generation Z towards mental health. Specifically,
this research sought to answer the following:
1. What is the profile of the respondents in terms of:
a) Age,
b) Sex,
c) Religion,
d) Grade Level,
e) People living with, and
f) Ordinal position?

2. What is the attitude of generation Z towards mental health in terms

of:
a) Authoritarianism,
b) Benevolence,
c) Social Restrictiveness, and
d) Community Mental Health Ideology (CMHI)?

3. What is the help-seeking behavior of generation Z towards mental

health in terms of the intention to seek help if the following occurs:
a) Psychological Concerns and Interpersonal Concerns,
b) Academic Problems,
c) Drug/Alcohol Problems, and
d) Weight Control?

4. Is there a significant difference between the attitudes of generation

Z towards mental health grouped according to demographic profile?

5. Is there a significant difference between the help-seeking behavior of

generation Z towards mental health grouped according to demographic
profile?

6. Is there a significant relationship between attitude and help-seeking

behavior of generation Z towards mental health?

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7. What are the experiences of Gen Z regarding mental health issues?

8. What mental health promotion can be derived from the study?

2.0 Methodology

2.1 Design

This study utilized mixed methods research design specifically,

explanatory sequential to obtain broad information for the specific
problems and analysis of data to be collected.

2.2 Instrument

Community Attitudes Towards the Mentally Ill (CAMI)

Taylor & Dear developed the CAMI survey questionnaire in 1981 which
has been continuously utilized in different countries worldwide (as cited
in Frykman & Angbrant, 2018). CAMI is a 40-item, Likert-scale,
instrument that measures attitude towards mental illness on four
dimensions namely authoritarianism, benevolence, social
restrictiveness, and community mental health ideology. There are five
positive statements and another five negative statements, or 10
statements for each dimension. Students respond accordingly to a
Likert-type scale of 1-5 (e.g., 1 = Strongly Disagree, 5=Strongly
Agree)

Responses that favor the part describe their attitudes towards

mental health. Positive statements under authoritarianism,
benevolence, social restrictiveness, and community mental health
ideology in which responses are “agree and strongly agree” refers to
pro while negative statements in which responses are “agree and
strongly agree” refers to anti.

Intention to Seek Counseling Inventory (ISCI)

Cash, Begley, McCown, and Weise created ISCI; however, some

authors adapted ISCI survey questionnaires and created three-
subscales (see Kang, 2016, for further description). ISCI survey
questionnaire is a 17 item, Likert-scale, instrument that measures the
help seeking behavior towards mental health. Students respond
accordingly to a Likert-type scale of 1-4 (e.g., 1 = Very Unlikely,
4=Very Likely).

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2.3 Participants

For the quantitative aspect of the study, a total of 150 University of

Makati students, aged 16 to 18 and selected using quota sampling,
participated in the study. Table 1 summarizes the profile of the
participants.

From the 150 participants, the study selected 10 using snowball

sampling and after securing their permission, proceeded to interview
the 10 key informants and gathered data to have a more in-depth
understanding of the data collected from the quantitative aspect of the
study.

Table 1. Demographic Profile of Respondents

Demographic Profile Frequency Percentage

1. Age (16-18) 16 7 4.7%
17 30 24.7%
18 106 70.7%
2. Sex (Male & Female 108 72.9%
Female) Male 42 28.0%
3. Religion Adventist 1 0.7%
Aglipayan 1 0.7%
Agnostic 4 2.7%
Apostolic 1 0.7%
Baptist 1 0.7%
Born Again 2 1.3%
Catholic 126 84.0%
Christian 8 5.3%
Iglesia ni Cristo 4 2.7%
Seventh-Day Adventist 1 0.7%
The Church of Jesus Christ 1 0.7%
of Latter-Day Saints
4. Grade Level (11 11th 22 14.7%
& 12) 12th 128 85.3%
5. People Living Alone 1 0.7%
With Father 3 2.0%
Grandparents 11 7.3%
Mother 3 2.0%
Parents 65 43.3%
Parents and Siblings 57 38.0%
Relatives 9 6.0%
Siblings 1 0.7%
6. Ordinal Position First child 52 34.7%
Second child 44 29.3%
Third child 27 18.0%
Fourth child 17 11.3%

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Fifth child 4 2.7%

Sixth child 1 0.7%
Seventh Child 1 0.7%
Youngest 1 0.7%
Total (N) 150 100.0%

2.4 Data Analysis

Quantitative data collected were processed using frequency and
percentage to come up with a demographic profile of the participants,
weighted mean and standard deviation for the Likert-scale responses
and t-test and ANOVA to test for difference. Pearson r was used to
determine whether there is a relationship between attitude and help-
seeking behavior of Gen Z.

Qualitative data were analyzed using Van Manen’s method.

Thematization process was utilized to determine the experiences. From
co-researcher’s experiences: individual themes, composite themes
arising, interlaced themes on common ground and obtaining eidetic
insight of the theme and as well as the symbolic representation of the
core theme or eidetic insight were derived.

Informed consent from the respondents was obtained and

confidentiality of survey and interview responses was maintained.

3.0 Result & Discussion

3.1 Profile of the respondent

The respondents were mostly at 12th grade aged 18 years old female,
mostly Catholic, living with their parents and first child. It is identified
that most of the population in the Philippines was composed of
individuals with ages 15-64 years old (O’Neill, 2021). According to
Macha et al. (2018), senior high school students are usually between 16
to 18 years old; and in Asia, the Philippines is known to be the country
with a large number of Christians. In the Philippines, 58.72% females
were enrolled in public and private Senior High Schools school year
2016-2017 to 2018-2019 while 44.21% in males (PSA, 2020).

3.2 Attitude of generation Z towards mental health

Table 2. Attitude of the Gen Z towards Mental Health

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Categories M SD Interpretation

Positive Authoritarianism 3.06 0.68 Somewhat Pro

Authoritarianism

Negative 2.46 0.66 Moderately Anti

Authoritarianism Authoritarianism

Positive Benevolence 2.31 0.76 Moderately Pro

Benevolence

Negative Benevolence 3.76 0.79 Fairly Anti Benevolence

Positive Social 3.79 0.79 Fairly Pro Social

Restrictiveness Restrictiveness

Negative Social 2.47 0.68 Moderately Anti Social

Restrictiveness Restrictiveness

Positive CMHI 2.12 0.75 Moderately Pro CMHI

Negative CMHI 3.33 0.79 Somewhat Anti CMHI

In terms of positive authoritarianism, respondents somewhat accept

that there should be a controlling perception and treatment towards
mental health disorders and people with mental illness. In terms of
negative authoritarianism, the respondents moderately accept that
controlling perception and treatment towards mental health disorders
and people with mental illness should not be shown.

In terms of positive benevolence, the respondents moderately

accept that there should be a sense of responsibility, a humanistic and
sympathetic view of a person towards people with mental health illness.
In terms of negative benevolence, the respondents fairly accept that
there shouldn’t be a sense of responsibility, a humanistic and
sympathetic view of a person towards people with mental health illness.

In terms of positive social restrictiveness, respondents fairly

accept that an individual must have a controlling apprehension towards
people with mental illness living in the society or neighborhood. In
terms of negative social restrictiveness, respondents moderately accept
that an individual shouldn’t have a controlling apprehension towards
people with mental illness living in the society or neighborhood.

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In terms of positive CMHI, respondents moderately accept a

positive approach towards mental health facilities and services in the
residential area. While in terms of negative CMHI, respondents
somewhat accept a negative approach towards mental health facilities
and services in the residential area.

According to Prensky (as cited in Törőcsik et al., 2014), Gen Z’s

exposure to the internet made them more distinct from other
generations, using advanced technology in their way of living formed
their behavior. Gen Z are more open in accepting mental health services
and individuals with mental illness since they can easily access
information online about mental health awareness campaigns. However,
it is also seen that there is a need of enlightenment regarding the nature
of mental illness to foster acceptance of people with mental illness
(Vijayalakshmi et al., 2013).

3.3 Help-seeking behavior of generation Z towards mental health

in terms of the intention to seek help

Table 3. Help-seeking behavior of Gen Z

Categories M SD Interpretation

Psychological Concerns and 2.83 9.60 High intention to

Interpersonal Concerns seek help

Academic Problems 2.97 3.82 High intention to

seek help

Drug/ Alcohol Problems 3.04 2.09 High intention to

seek help

Weight Control 2.88 0.91 High intention to

seek help

If respondents will experience psychological concerns and interpersonal

concerns; academic problems; drug and alcohol problems; and weight
control problem, they have a high intention to seek help. The following
problems that receive a high mean score are perceived as significant
issues (Pheko, et al., 2013). According to Evan (as cited in CHC, 2018),
gen Z have awareness if they need attention regarding their mental
health and if it is worse.

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3.4 Significant difference between the attitude of generation Z

towards mental health grouped according to demographic profile.

There was no significant difference between age and attitude of

respondents in terms of: authoritarianism, F (2, 147) = 0.23, p 0.80;
benevolence, F (2, 147) = 0.59, p 0.56; social restrictiveness, F (2, 147)
= 0.23, p 0.79; and community mental health ideology, F (2, 147) =
0.63, p 0.53.

There was no significant difference between sex and attitude of

respondents in terms of: authoritarianism, t (148) = -0.30, p 0.77;
benevolence, t (148) =-0.01, p 1.00; social restrictiveness, t (148) =
0.22, p .82; and community mental health ideology, t (148) = -0.90, p
0.37.

There was no significant evidence between religion and attitude of

respondents in terms of: authoritarianism, F (9, 140) = 1.08, p 0.38;
benevolence, F (9, 140) = 0.68, p = 0.73; social restrictiveness, F (9,
140) = 0.89, p 0.54; and community mental health ideology, F (9,140)
= 1.46, p 0.17.

There is no significant difference between year level and attitude

of respondents in terms of: authoritarianism, F (1, 148) = 0.09, p 0.77;
benevolence, F (1, 148) = 1.17, p 0.28; social restrictiveness, F (1, 148)
= 1.24, p 0.27; and community mental health ideology, F (1, 148) =
3.12, p 0.08.

There was no significant difference between people in which they

live with and attitude of respondents in terms of: authoritarianism, F (7,
142) = 0.77, p 0.61; benevolence, F (7, 142) = 0.53, p 0.81; social
restrictiveness, F (7, 142) = 0.86, p 0.54; and community mental health
ideology, F (7, 142) = 1.01, p 0.43.

There was no significant difference between ordinal position and

attitude of respondents in terms of: authoritarianism, F (5, 144) = 0.28,
p 0.92; benevolence, F (5, 144) = 1.21, p 0.31; social restrictiveness,
F (5, 144) =0.36, p 0.88; and community mental health ideology, F (5,
144) = 0.62, p 0.68.

3.5 Significant difference between help-seeking behavior of

generation Z towards mental health grouped according to
demographic profile.

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There was a significant difference between sex and the help-seeking

behavior of the respondents in terms of Psychological and Interpersonal
concerns, t (148) = 2.99, p 0.003 and Academic problems, t (148) =
2.55, p 0.01, with females receiving higher score than males.

Studies show females have a higher intention of seeking help or

going into counseling than males (Brown, 2011; Do et. al., 2019).
Females are more likely to be more open in seeking help and have a
more positive outlook on the expertise of the therapist than males.

3.6 The significant relationship between Attitude and Help-seeking

behavior of Gen Z towards mental health.

There was a very weak correlation among authoritarianism and

psychological concerns and interpersonal concerns r (148) = 0.06, p =
0.45; authoritarianism and drug/alcohol problems r (148) = 0.14, p =
0.08; and authoritarianism and weight control r (148) = 0.12, p = 0.15.
However, there was a very weak negative correlation among
authoritarianism and academic problems r (148) = -0.06, p = 0.48.

There was a very weak correlation among benevolence and

psychological concerns and interpersonal concerns r (148) = 0.06, p =
0.49; benevolence and drug/alcohol problems r (148) = 0.06, p = 0.45;
and benevolence and weight control r (148) = 0.21, p = 0.01. However,
there was a very weak negative correlation among benevolence and
academic problems r (148) = -0.01, p = 0.95.

There was a very weak correlation among social restrictiveness

and psychological concerns and interpersonal concerns r (148) = 0.09,
p = 0.28; social restrictiveness and academic problems r (148) = 0.07,
p = 0.42; social restrictiveness and drug/alcohol problems r (148) =
0.24, p = 0.00; and social restrictiveness and weight control r (148) =
0.15, p = 0.07.

There was a very weak correlation among CMHI and psychological

concerns and interpersonal concerns r (148) = 0.02, p = 0.84; CMHI
and drug/alcohol problems r (148) = 0.09, p = 0.27; and CMHI and
weight control r (148) = 0.05, p = 0.58. However, there was a very
weak negative correlation among CMHI and academic problems r (148)
= -0.07, p = 0.41.

According to Brown (2011), attitude is related to the intention to

seek help. Similar to the result of this study which shows that there is
a relationship between the attitude and help-seeking behavior of Gen Z

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towards mental health; however, it is weak. The relationship between

attitudes and behavior does not occur consistently (Cherry, 2021),
which has been consistent with the result of this study.

Most of Gen Z has awareness towards mental health. Though

inconsistent, most of them have an accepting attitude towards mental
health which drives them to have an intention to seek help; however,
inadequate knowledge and conformity may take place which can
influence their attitude and behavior. Modification of their point of view
can happen temporarily through compliance or permanently through
internalization, this is due to fear of being left out, aspiration of being
aligned with what is perceived as correct by society, and precariousness
(McLeod, 2021).

3.7 Experiences of Gen Z regarding mental health issues

With the experiences of the co-researchers, the sunflower was derived

as the symbolic representation of the eidetic insight that emerged in this
study which is “Holistic Reinforcement - Self as a present.”

According to Proflowers (2015), sunflowers serve as an ideal

present to someone. It is known to bring happiness as they are called
“happy flowers.” The sunflower's meaning originated in the sun.
Sunflower symbolizes “adoration, loyalty, and longevity.” In addition to
that, along with its light color as the sun, the sunflower is known to
share vitality and subsistence needed for life

Individual themes are located in the outermost petals. The individual

themes emerged based on the experiences of the co-researchers. The
outer petals are the four composite themes “Family’s cognizance,”
“Intrapersonal impact,” “Social relationship domination” and “Functional
implementation” derived from the ten individual themes. Individual
themes under Family cognizance are “Perceive as a joke” and “Typical
subject”. Individual themes including “Interest in resiliency” and
“Religious Belief” were combined into a composite theme called
“Intrapersonal impact.” Social relationship domination was generated
through individual themes “Self-support,” “Negation of emotion” and
“Social criticism.” “Enlightenment,” “Enhancement of mental health
service” and “Ineffective enactment” are the individual themes that were
combined resulting in a theme called “Functional Implementation”.

These themes emphasize that instilling knowledge regarding mental

health can be beneficial yet it is insufficient; proper application of the
awareness acquired towards mental health needs to be prioritized;

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mental health services need an improvement; the stigma towards

mental health is still present and; devastation of mental health also
occurs due to people displaying excessive criticism.

Out of the four composite themes, two interlacing themes were

obtained, namely, “Personal modification” and “Social accountability”
located in inner petals. Personal modification refers to the intrapersonal
impact and family’s cognizance. Social accountability refers to the social
relationship domination and functional implementation.

Lastly, the core theme located in the center is called “Holistic

Reinforcement-Self as a present.” In a sunflower, this is where seed can
be found. A seed is important in the existence of a plant. As individuals,
we can be the seeds in organizing mental health in the country. In an
effective and appropriate manner, it should start from ourselves
radiating to people around us and lastly to the society. Every one of us
can be a present to each other like a sunflower, representing a good
step in the developing mental health in the Philippines leading to a fully
bloomed mental health.

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Figure 1. Holistic Reinforcement- Self as a present

The negative belief towards mental health is a responsibility of

every individual and that means including ourselves. Being open to
mental health is a good thing; however, it is still far from the envisioned
mental health acceptance that people deserve. There’s an awareness
towards mental health yet resistance to high acceptance is present.

With the experiences shared by the co-researchers, establishing a

proper belief and practice towards mental health holistically is
important. Holistic reinforcement in this study means that the
establishment needs to start within an individual self, reaching close
relationships, which include the family members which will subsequently
influence the whole society with the proper mental health lead and
support from the government.

Every individual will serve as a present to one another in terms of

mental health as a companion which will guide everyone towards proper
help-seeking in times of difficulties where proper thinking and decision
making is temporarily in chaos through “Kumustahan” or socialization in

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a good way where listening, sharing, understanding and acceptance

exists instead of competition, criticism and neglection which is
congruous with remotivation therapy.

4.0 Conclusion

Most of Gen Z has awareness towards mental health and their intention
to seek help is high. Due to social influence and deficient knowledge,
resistance towards a very high accepting attitude towards mental health
is present.

Most of Generation Z experienced issues regarding mental health

in the Philippines such as the stigma; inaccessibility of mental health
care service; and inadequate proper implementation of mental health
awareness. Improvement of mental health care in the Philippines should
be given attention such as ensuring the sustainability of mental health
programs; widespread promotion using different platforms or mediums
to promote mental health, mental health facilities and services such as
spreading of helpful information in social media applications, radio, and
television; and set activities that will enhance the knowledge and skills
of individuals regarding mental health. Practicing social accountability
online and offline is deeply encouraged through avoiding unnecessary
and excessive criticism, reactions, and comments; and creating a good
environment through an accepting and understanding approach when
socializing.

5.0 Recommendations

Derived from the findings of this study, the program “Holistic

Reinforcement” emerged. This program is about allowing people to allow
good socialization as a habit.

According to Temple University (2016), the remotivation therapy

proponent is Mrs. Dorothy Hoskins Smith. Remotivation therapy aims to
emphasize the ability of the patients. It aims to assist individuals
through “self-esteem” improvement, “awareness” and “socialization.”
Therapy in a small group of individuals enables the patient to think and
be in touch with reality through actively communicating and
participating. It has five steps. The first step is called the “Climate of
acceptance” in which greetings happen and trust is developed. This is
the time where the therapist acknowledges the patient by saying
positive things. The second step refers to “Bridge to the real world.”
This is the step where the therapist introduces the topic of the meeting.

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In introducing the topic to the client, the therapist must utilize bounce
questions in which there are linear or nonlinear questions.

After the introduction, the activity planned will then begin. Step 3
is called “Sharing the world we live in.” In this step, questions will be
asked regarding the topic discussed. Materials that will relate to the topic
are also presented in step 3 until step 4. Step 4 refers to the
“Appreciation of the work of the world” where the conversation will move
into making the topic related to the activities that the client encountered
in their life. Lastly, step 5 is called “Climate of Appreciation” in which
the session ends. The session should end in a positive way by saying
positive things, acknowledgment for their participation, and also sharing
small incentives for the client to enjoy.

Inspired by this therapy, “Holistic Reinforcement” was developed

in which the main focus will be making socialization a habit in which the
main topic will be mental health.
● Program Title: Holistic Reinforcement
● Description: Holistic Reinforcement is a three days program
developed to encourage Gen Z to practice socialization daily that
will create an accepting community through utilization of
remotivation therapy. It is a program that provides a way of
proper communication and allows an individual to be present with
another person with or without difficulties.
● General Objectives:
a) To expand knowledge of Generation Z regarding mental
health. Generation Z needs to acquire additional knowledge
about mental health that is not only limited to coping
strategies but also conditions of mental health in the
Philippines which allows them to have a sense of
responsibility and decrease the uncertainty.
b) To build up the communication skills of the Generation Z
essential for a proper way of socialization.
● Target Group: Higher School ng UMAK: at least 10 students
● Evaluation:
Participants will:
a) Verbalize insights regarding mental health conditions in the
Philippines such as mental health programs by the national
government, stigma and mental health facilities; and
appropriate coping strategies in times of disturbances.
b) Demonstrate “kumustahan/ socialization” technique.
Contributors: Ramon Joshua B. Manzano and Margaret May A. Ga

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