Issues in Mental Health Nursing, 31:662–669, 2010

Copyright © Informa Healthcare USA, Inc.

ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.3109/01612840.2010.490929

Mental Health Treatment Fearfulness and Help-Seeking

Aphroditi Zartaloudi, PhD, MSc, RN

Department of Psychiatry, Sismanoglio General Hospital, Athens, Greece

Michael G. Madianos, MD, MPH, DrMed

Professor of Psychiatry, University of Athens, Athens, Greece

of research on help-seeking attitudes and can also predict actual

A majority of people meeting the criteria for mental disor-
ders underutilize mental health services. Treatment fearfulness
is a barrier to help-seeking. This study explores the way treat-
ment fearfulness affects the help-seeking behaviour of individuals
who sought help from the Community Mental Health Centre. A
total of 290 participants completed a structured questionnaire.
Information was obtained on a number of variables, including ori-
entation toward utilization of social networks, attitudes toward
seeking professional psychological help, opinions about psychia-
try, and fears about therapy. Factor analysis was conducted on
the scale, measuring fears about therapy. Those with fewer fears
about therapy have more positive network orientation, more posi-
tive attitudes toward seeking professional psychological help, and
more positive opinions about psychiatry so it is more possible
for those individuals to visit a mental health service sooner than
those with more fears. Reducing the delays in individuals initiat-
ing treatment requires clearer understanding of the contributing
factors.
Many people who could benefit from mental health services
do not seek help for their problems. A majority of people meet-
ing the criteria for mental disorders underutilize mental health
services (Cabassa, Zayas, & Hansen, 2006; Crabb & Hunsley,
2006; Jiménez, Alegrı́a, Peña, & Vera, 1997; Le Meyer, Zane,
Cho, & Takeuchi, 2009; Li & Browne, 2000; Sanchez & Gaw,
2007; Segal, Coolidge, Mincic, & O’Riley, 2005; Wells, Hough,
Golding, Burnam, & Karno, 1987).
Help-seeking is the active search for resources that are rele-
vant for the resolution of that problem. “An attitude is an indi-
vidual’s disposition to respond favorably or unfavorably to an
object, person, institution, or event, or to any other discriminable
aspect of the individual’s world” (Ajzen, 1989, p. 241).
According to Fischer and Turner (1970), one’s attitude to-
ward receiving help underlies actual help-seeking; the attitude a
person holds regarding help-seeking reflects his or her likelihood
to pursue counseling. This assumption has been the cornerstone
Address correspondence to Aphroditi Zartaloudi, PhD, MSc, RN,
Sismanoglio General Hospital, Department of Psychiatry 28–30, Olim-
brou str., 15235, Vrilissia, Athens, Greece. Tel: +30 2106130939,
+30 6974663525. E-mail: afroditi976@hotmail.com
help-seeking behaviour.
This research has highlighted the main reasons for individ-
uals’ unwillingness to seek help, such as thinking that no one
else could help them and that the individual had a problem he
or she could solve without help. The lack of knowledge of men-
tal health treatment effectiveness (Angermeyer & Matschinger,
1996; Scalora, Baumgartner, & Plank, 2003) and the belief that
a person should deal with his or her problems alone, without ex-
ternal help, are common reasons that decrease the possibility of
help-seeking. Attitudes and beliefs about help-seeking, together
with opinions about psychiatry and social network orientation,
were found to be predictive of seeking help from a mental health
professional.
Another barrier to help-seeking, mental health treatment fear-
fulness, has been examined by Deane and Chamberlain (1994),
Deane and Todd (1996), and Kushner and Sher (1989, 1991).
Kushner and Sher defined treatment fearfulness as “the sub-
jective state of apprehension that arises from aversive expec-
tations about the seeking and consumption of mental health
services” (1991, p. 4). They found that treatment fearfulness
was a multidimensional construct, encompassing expectations
about therapist responsiveness, image concerns, and coercion
concerns. These researchers hypothesized that there are more
treatment fears than their scale tapped, such as fear of embar-
rassment, fear of change, fears involving treatment stereotypes,
fears relating to negative past mental health experiences, and
fears relating to treatment type, such as exposure. Further, col-
lege students who sought treatment report more fears than those
not considering treatment; distress was related to both an in-
creased fearfulness and the likelihood of seeking services. They
concluded that the decision to seek treatment is an approach-
avoidance conflict between treatment fearfulness and mental
distress.
Deane and Chamberlain (1994) tested Kushner and Sher’s
(1989) approach-avoidance model of treatment seeking and
replicated the finding that both fear of treatment and distress
were related to help-seeking. They also found gender differ-
ences for this approach-avoidance model. Females reported both

662
 TREATMENT FEARFULNESS AND HELP-SEEKING
approach and avoidance tendencies whereas men reported more
avoidance factors. Deane and Todd (1996) found that those re-
porting receiving prior help are less fearful than those having
had no prior contact with mental health services. They found
that 30% of the variance of help-seeking attitudes is predicted
by treatment fearfulness, psychological distress, and gender.
Stigma produced a unique predictive effect.
The purpose of this study was to explore the way mental
health treatment fearfulness and perceptions about therapy, as
measured by the Thoughts about Psychotherapy survey scale
(Kushner & Sher, 1989), affect individuals’ attitudes toward
seeking professional psychological help as well as their ori-
entation toward utilization of social resources and their actual
help-seeking behaviour from the Community Mental Health
Centre. The findings may be helpful in predicting and reduc-
ing or changing these fears in order to promote help-seeking
behaviour, especially for individuals in need.
MATERIAL AND METHOD
During 2003–2007, 1008 individuals had visited the
Zografou Community Mental Health Center (CMHC). Of these,
256 individuals had come to CMHC for reasons other than
seeking help (e.g., certificate). In this study, the original sam-
ple consisted of the remaining 752 persons. Of these 752, 180
(24.0%) were not traceable, having moved away from the area
or changed address, 198 persons (26%) refused to participate
for several reasons, and 76 (10%) were unable to complete
the interview due to their seriousness of their mental health
condition (organic brain syndrome or mental retardation). This
left 298 participants, but 8 participants were excluded because
their questionnaires were not completed. There were, ultimately,
290 participants, in this study. These participants were divided
into those who had sought help from other mental health non-
sectorized services during the previous 12 months (prior to their
visit to the Centre, group A, n = 134) and those whose visit
to the Center was their first ever contact with a mental health
service (first-timers, group B, n = 156). This division was made
in order to delineate possible underlying factors in help-seeking
with or without any previous service contact and referral before
reaching the CMHC. This group of 290 individuals, who sought
help from a CMHC during the four year study period, agreed to
participate in the survey and complete a questionnaire.
In 2000, twenty-one years after the opening of the first
CMHC in greater Athens (and Greece), another Center was
established, to serve another borough of greater Athens (Madi-
anos & Christodoulou, 2007). The catchment area consists of
150,000 middle and middle-lower class inhabitants. In the area
there are no psychiatrists in private practice. The Center is a ser-
vice provided by the University of Athens. The Zografou CMHC
includes the open Psychosocial Care Clinic, the Outreach Pro-
gram, and the Day Care Centre. The CMHC is staffed by a multi-
professional team. Help provided to the clients includes coun-
seling/psychotherapy, medication, or a combination of both.
663
The social, demographic, and clinical characteristics of
the individuals who visited the Zografou CMHC and partic-
ipated in the survey were analysed. The population is com-
prised of 35 men (26.1%) and 99 women (73.9%) in group
A and 30 men (19.2%) and 126 women (80.2%) in group B.
Demographic characteristics of this population are shown in
Table 1.
The untreated period for each individual was defined as the
time (in months) between the onset of psychopathological symp-
toms and the time when the suffering individuals first contacted
a mental health service or professional.
The first-timers (Group B) were employed on a full-time
basis to a greater extent than individuals in group A. In Group
A, individuals had “no employment for psychiatric reasons” to
a greater extent than individuals in group B.
Participants completed a structured questionnaire that in-
cluded the Attitudes Toward Seeking Professional Psychologi-
cal Help Scale (ATSPPHS; Fischer & Turner, 1970), the Orien-
tation Toward Utilization of Social Resources Scale (OTUSRS;
Vaux, Burda, & Stewart, 1986), the Thoughts about Psychother-
apy Survey (TAPS; Kushner & Sher, 1989), and the Opinions
About Psychiatry (Zartaloudi, 2008), on which factor analysis
was conducted. Information was obtained on a number of vari-
ables, including demographic characteristics, orientation toward
utilization of social networks, attitudes toward seeking profes-
sional, psychological help, attitudes toward psychiatry, and fears
about therapy.
The researcher conducted a pilot study before the actual dis-
tribution of the questionnaires. Twenty volunteers participated
in the pilot study. Feedback and comments were obtained from
each participant so that the final version of the instrument would
be of an appropriate length, clear, and free from biased language.
Translation was done by the researcher, and colleagues were
asked to judge the accuracy of the translation and to provide any
suggestions.
The participants were informed about the nature and purpose
of the research. Questionnaires were administered in a class-
room and took between 35 and 50 minutes to complete. Partic-
ipants were told that there are no correct or incorrect answers
and they should consider what their opinions are. The researcher
was available to answer questions. Participation in this study was
voluntary and the participants were free to stop participating at
any point. Information gathered was strictly confidential and no
names, codes, or any means to identify participants was used.
Only the researcher has had access to the data. The participants
of this study provided informed consent.
MEASURES
Demographic Data
The demographic questionnaire consisted of questions re-
garding the participant’s gender, educational level, occupation,
marital status, mode of living, and employment.
664 A. ZARTALOUDI AND M. G. MADIANOS

TABLE 1
Sociodemographic Characteristics of Groups A and B (n = 290)
Group A Group B
Sociodemographic Variables n % n % p
Gender Male 35 26.1 30 19.2 0.204
Female 99 73.9 126 80.8
TOTAL 134 100.0 156 100.0
Marital Status Single 66 49.3 78 50.0 0.063
Married 40 29.9 60 38.5
Divorced/Widowed 28 20.9 18 11.5
TOTAL 134 100.0 156 100.0
Education Elementary 17 12.7 31 20.0 0.128
High school 50 37.3 44 28.4
College/University graduates 67 50.0 80 51.6
TOTAL 134 100.0 155 100.0
Live with Parental family & with relatives 42 31.3 46 29.5 0.942
Own family 58 43.3 69 44.2
Lives alone 34 25.4 41 26.3
TOTAL 134 100.0 156 100.0
Occupation Professionals 31 24.4 52 33.3 0.438
Medium/small business owners, Clerks, Skilled workers 37 29.1 41 26.3
Pensioners & Housewives 36 28.3 38 24.4
Students 23 18.1 25 16.0
TOTAL 127 100.0 156 100.0
Employment Full time 45 33.6 73 47.1 < 0.0001
Part time 21 15.7 26 16.8
None 53 39.6 56 36.1
None/for psychiatric reasons 15 11.2 0 0.0
TOTAL 134 100.0 155 100.0

Attitudes toward Seeking Professional Psychological Help
Scale (ATSPPHS)
This scale (Fischer & Turner, 1970) consists of 29 items
that are grouped into the following four subscales: Subscale I,
Recognition of Personal Need for Professional Help; Subscale
II, Tolerance of Stigma Associated with Seeking Psychologi-
cal Help; Subscale III, Interpersonal Openness; and Subscale
IV, Confidence in Mental Health Professional. Factor anal-
ysis was conducted on the ATSPPHS for the population of
the community residents who sought help from CMHC dur-
ing 2003–2007 (Zartaloudi, 2008), resulting in four factors.
Factor 1, Assertiveness toward help-seeking; Factor 2, Isola-
tion; Factor 3, Ambivalence toward help-seeking; and Factor 4,
Stigma.
Factor 1 includes items related to individuals’ recognition
of their own need for help from a mental health professional
and their confidence in mental health professionals. Factor 3
includes items related to individuals’ lack of recognition of
their need for help from a mental health professional and their
lack of confidence in mental health professionals (Both Factor
1 and Factor 3 are a combination of Subscales I and IV of
Fischer and Turner’s [1970] scale). Confidence in mental health
professionals plays a major role in individuals’ assertiveness
toward help-seeking (Factor 1) and is a very important parameter
in this process, as is the recognition of personal need for help
from a mental health professional. The same observations are
made in the process of individuals’ ambivalence toward help-
seeking.
Concerns about therapist responsiveness (Factor 2 from the
factor analysis conducted on the Thoughts about Psychother-
apy Survey, as shown in Results), which is understood to mean
therapist competence and professionalism, is strongly related
to confidence in mental health professionals. Thoughts about
therapy affect assertiveness toward help-seeking. Factor 2 (Iso-
lation) includes items that refer to the ability or inability of a
person to reveal personal information to others and is similar
with Subscale III of Fischer and Turner’s (1970) Scale. Factor
4 (Stigma) of the present study includes items that refer to fear
of stigmatization and is similar with Subscale II of Fischer and
Turner’s (1970) Scale.
 TREATMENT FEARFULNESS AND HELP-SEEKING
Orientation toward Utilization of Social Resources
Scale (OTUSRS)
The OTUSRS (Vaux, Burda, & Stewart, 1986) is a 20-item
scale designed to measure people’s orientation to having a social
network by assessing their feelings about the advisability or
usefulness of seeking social help, their past history of having
actually sought social help, and the extent to which they feel
that others cannot be trusted.
Network Orientation is a set of beliefs and perceptions about
how worthwhile it is to ask the people you know personally for
help. In other words, whether you think they will come through
for you or not. An individual with negative network orientation
may suffer because of an unwillingness to use the sources of
help, rather than due to a lack of sources for help.
Vaux (1985) and Vaux et al. (1986) found three subscales that
emerged from the factor analysis of the items on the OTUSRS:
Subscale I, Independence/Advisability, which contains items
indicating the advisability and usefulness or not of seeking help
and expressions of independence; Subscale II, History, which
contains items indicating a positive or negative history with
social (informal) help-seeking; and Subscale III, Mistrust, which
contains items suggesting that others may not be trusted.
Factor analysis was conducted on the OTUSRS for commu-
nity residents who sought help from CMHC during 2003–2007
(Zartaloudi, 2008), resulting in three factors. Factor 1, Interper-
sonal communication (items indicating the usefulness of seeking
help and a positive history with social or informal help-seeking);
Factor 2, Distrust (items indicating that others cannot be trusted);
Factor 3, Isolation (items indicating the non-usefulness of seek-
ing help and a negative history with social or informal help-
seeking).
Opinions about Psychiatry
Participants’ opinions about psychiatry were measured by a
20-item scale, divided into three subscales: Factor 1, Effective-
ness of Psychiatry; Factor 2, Ineffectiveness of Psychiatry; and
Factor 3, Stigma (Zartaloudi, 2008).
There are few measures of treatment-seeking behaviors or
attitudes. Many simply have items such as “I fear being looked
down on” (Stefl & Prosperi, 1985). An attitudinal measure, the
Thoughts about Counseling Survey (TACS; Pipes, Schwartz,
& Crouch, 1985) measured 15 possible fears about therapy,
such as “would the counselors think I am more disturbed than
I am?”. This measure had two subscales: therapist competence
and stigma concerns. Students who used campus counseling
facilities reported fewer fears of counseling services that did
students who did not seek such services (Pipes et al., 1985).
Kushner and Sher (1989) used the TACS (Pipes et al., 1985) to
develop the Thoughts about Psychotherapy Survey (TAPS). This
measure assesses fears about psychological services. The new
instrument adds four items for a third subscale, fear of change.
Some wording also has been changed, namely “counselors” and
“counseling” were replaced with “therapists” and “therapy” to
provide a broader definition of mental health workers and ser-
665
vices. The 19 items on this scale are rated on a five-point Likert
scale (1 = no concern; 5 = very concerned). The participant’s
level of concern for each of the 19 items is identified.
Factor analysis validated the three subscales; therapist re-
sponsiveness (concerns about therapist competence and pro-
fessionalism), image concerns (concerns about being judged
negatively by oneself or by others for seeking treatment), and
coercion concerns (fears about being pushed to think, do, or
say things against one’s will (Kushner& Sher, 1989). Internal
consistencies ranged from .87–.92 (.87 for image concerns, .88
for coercion concerns, .92 for therapist responsiveness). Factor
analysis also was conducted on this scale in the present study and
the 19 items are divided into two factors, presented in Results.
STATISTICAL METHODS—DATA ANALYSIS
T-test was employed to examine whether significant dif-
ferences existed between mean values. Chi square tests were
used to compare the two groups on several categorical vari-
ables. The statistical analysis was performed by using the
Statistical Package for Social Sciences, version 13 (Norusis,
2005).
Independent variables were selected for entry into Logistic
Regression Analysis on the basis of their predicting power on the
time spent between onset of psychopathology and help-seeking
(dependent variable). Spearman’s rho correlation was conducted
for correlations between the scores of the scales and between
the period of untreated disorder and the score of the scale in
Groups A and B. Internal consistency reliabilities for the TAPS
(Kushner & Sher, 1989) were computed. Factor analysis (prin-
cipal components’ factor analysis varimax rotation) was con-
ducted on the TAPS.
All the factor analyses, conducted in this study for AT-
SPPHS, OTUSRS, and TAPS, were conducted in community
residents suffering from mental health problems or mental dis-
orders and not student respondents who had sought help from the
CMHC.
RESULTS
Factor analysis (principal components’ factor analysis vari-
max rotation) was conducted on data from community residents
who sought help from CMHC during 2003–2007. The TAPS
(Kushner & Sher, 1989) is divided to two factors. Factor 1, Fear
of Change (items 16, 17, 19, 18, 15, 11, 13, 12, 14, 9) and Factor
2, Concerns of Therapist Responsiveness (items 4, 3, 7, 8, 5, 6,
10. 2).
Factor 1: Fear of Change
High scores on this factor indicate that respondents have
concerns about being pressured to do things in therapy they
don’t want to do, learning things about themselves that they
don’t really want to know, or having the therapist find out things
that the individuals don’t want the therapist to know about their
life.
666 A. ZARTALOUDI AND M. G. MADIANOS

TABLE 2
Factor Analysis of the Thoughts about Psychotherapy Survey
Item Factor 1 Factor 2
16. Whether I will be pressured to make changes in my lifestyle that I feel unwilling or .835
unable to make right now.
17. Whether I will be pressured into talking about things that I don’t want to. .842
19. Whether the thought of seeing a therapist would cause me to worry, experience .791
nervousness, or feel fearful in general.
18. Whether I will end up changing the way I think or feel about things and the world in .771
general.
15. Whether I will be pressured to do things in therapy I don’t want to do. .736
11. Whether the therapist will find out things I don’t want him/her to know about me and .619
my life.
13. Whether I’ll lose control of my emotions while in therapy. .594
12. Whether I will learn things about myself I don’t really want to know. .537
14. Whether the therapist will be my competent to address my problem. .479
9. Whether my friends will think I am abnormal for coming. .459
4. Whether the therapist will take my problem seriously. .831
3. Whether the therapist will be honest with me. .787
7. Whether the therapist will think I am a bad person if I talk about everything I have been .595
thinking and feeling.
8. Whether the therapist will understand my problem. .581
5. Whether the therapist will share my values. .628
6. Whether everything I say in therapy will be kept confidential. .682
10. Whether the therapist will think I am more disturbed than I am. .507
2. Whether I’ll be treated as a person in therapy. .726

Factor 2: Concerns of Therapist Responsiveness
Individuals with high scores on this factor show greater con-
cerns about their therapists’ competence and professionalism.
Factor analysis conducted on the scale used in this study is
shown in Table 2.
Internal consistency reliabilities for the scale and subscales
used in this study were computed (Cronbach’s alpha .901 for
Factor 1 and .867 for Factor 2; Cronbach’s alpha for the total
score of the Thoughts about Therapy Scale is .920).
Each item is a statement scored on a 5-point Likert scale
(1 = no concern, 2 = slight concern, 3 = concerned, 4 =
much concern, 5 = very concerned). Scores are computed for
each subscale and a total score is given as well. The total score
is obtained by summing the item scores. Low scores indicate
fewer concerns about therapy while high scores indicate greater
concerns.
In Group B, participants that had a previous experience with
a family member that had asked and received help from a men-
tal health professional had less fear about mental health treat-
ment than participants that didn’t have a similar experience
(p = 0.027). In Group A, this correlation is not statistically
significant. In Group B there is a statistically significant dif-
ference among the subscales that measure fears about therapist
responsiveness (p = 0.041) and the incident of a family member
receiving help from a mental health professional when the par-
ticipant had a family member who received help from a mental
health professional, the participant seemed to be less concerned
about the therapist’s responsiveness.
In Group A there was a statistically significant difference
among the therapist responsiveness scale and the incidence of
a friend having had a mental health problem (p = 0.05) and
receiving mental help (p = 0.023). When the participant had a
friend with a mental problem who received help from a mental
health professional, the participant seems to be less concerned
about the therapist’s responsiveness. This is understood to mean
that the participant was then less concerned about the therapist’s
ability (whether he or she will really understand the participant’s
problem, whether he or she thinks the participant is in a more
serious condition than the participant believes), the therapist’s
consistency, and the therapist’s professionalism (whether he or
she will disclose information about the participant’s health con-
dition, whether he or she will be honest with the participant, or
whether he or she will respect the participant as a person during
therapy).
The correlation of the Thoughts about Therapy Scale and
the duration of untreated disorder showed a difference at sta-
tistically significant levels (p = 0.007) in Group B. In Group
A there was no statistically significant difference. In Group B
 TREATMENT FEARFULNESS AND HELP-SEEKING 667

TABLE 3
Spearman’s Rho Correlation Matrix: Total Scores Regarding Attitudes toward Seeking Professional Psychological Help,
Orientation toward Utilization of Social Resources, and Opinions about Psychiatry among Groups A and B
Spearman’s rho
Attitudes toward Seeking
Professional Orientation toward Utilization of
Psychological Help Social Resources Scale Opinions about Psychiatry
Group A Group B Group A Group B Group A Group B
Thoughts about −0.474 −0.456 −0.417 −0.318 −0.402 −0.473
Psychotherapy
Survey
p < 0.001.

when there are more fears and worries about psychiatric or
psychological treatment, the duration of untreated disorder is
longer.
Where the average values of the scales in Groups A and B
are compared there is no difference between the two groups in
the Attitudes toward Seeking Professional Psychological Help
Scale and in the Orientation toward Utilization of Social Re-
sources Scale. In the Opinions about Psychiatry Scale and the
Thoughts about Therapy scale, statistically significant differ-
ences were noticed. Group B had more positive opinions about
psychiatry and less fears about therapy compared to Group A.
Individuals who had sought help from another mental health
care service prior to their visit to CMHC (Group A) had more
and greater fears towards therapy compared to those with no
prior experience with a psychiatric service (Group B).
Correlations between the scores of the Thoughts about Psy-
chotherapy Survey and the other three scales are shown in
Table 3. Statistically significant differences between these cor-
relations were noticed. The results indicate the way these mea-
sures are related. Those with fewer fears about therapy have
more positive attitudes toward seeking professional psychologi-
cal help, more positive opinions about psychiatry, more positive
network orientation.
Finally a logistic regression with the duration of untreated
mental disorders as the dependent variable was carried out.
The scales used in this study entered in the analysis as inde-
pendent variables. Results showed that Thoughts (fears) about
Therapy affect the duration of untreated mental disorders in
Group A as well as Orientation toward Utilization of Social
Resources.
DISCUSSION
Fears are most likely multifaceted, culturally influenced and,
in some cases, idiosyncratic. Treatment fears influence individ-
uals’ decision to seek mental health services. Treatment fearful-
ness may affect service consumption directly and in combination
with a number of other factors known to inhibit treatment
seeking. Fearful responses to actual or imagined aspects of
mental health service may also serve to increase individuals’
reluctance to seek help.
When the individual’s orientation towards the use of his or
her social support network is more positive, the attitude towards
seeking help from a mental health specialist is more positive,
the individual’s attitude towards psychiatry is more positive, and
the fears towards treatment are less. All these correlations create
a favourable environment for the seeking of help.
When the fears and worries of treatment are greater, the
period until the individual seeks help is longer. The fear of
treatment suspends help-seeking (Deane & Chamberlain, 1994;
Dean & Todd, 1996; Kushner & Sher, 1989, 1991) and includes
fear of embarrassment and change, fear of different stereotypes
related to treatment, fear related to previous negative experience
with mental health services, and fear related to the treatment
type.
Psychiatric therapy is a potentially difficult, embarrassing,
and overall risky enterprise with respect to the individual’s sense
of self and environmental homeostasis. Change, even for the
better, requires a letting go of the familiar and a taking on of the
unknown.
Group A has more fears towards treatment and a less posi-
tive attitude towards psychiatry. Group A, by definition, includes
individuals that sought help from the CMHC for their mental
problem after having the experience accessing another mental
health service. It seems that the previous experience of mental
health treatment caused more anxieties about the therapist and
treatment compared to those without this experience (individ-
uals from Group B). Given that individuals in Group A, com-
pared to those of Group B, experience more severe symptoms
and are unable to have a job or perform their daily activities,
they may feel weak, useless, and have low self-esteem. They
also may feel more threatened by and vulnerable toward the
therapist and have increased mental health treatment fears as
the seriousness of their condition and their decreased everyday
functioning make the mental health treatment a more painful
experience.
668 A. ZARTALOUDI AND M. G. MADIANOS
In Group B those that had a previous experience with a family
member that had asked for and received help from a mental
health professional had less fear for the mental health treatment
than people that didn’t have a similar experience. Less fear,
which means greater trust in therapy and in the therapist, led to
more favorable attitudes toward help-seeking and it is likely that
it would lead to visiting the appropriate services sooner. Contact
with a member of the family that complies with mental health
treatment creates more intimacy with this body of knowledge
and resolves false impressions that the individual might have or
myths that surround mental illness.
In Group B, those individuals who had a member of their
family seek help from a mental health professional showed less
concerned for the therapist’s responsiveness. In Group A, those
individuals who had a friend who received help from a mental
health professional seemed to be less concerned about the ther-
apist’s responsiveness, meaning they were less concerned about
the therapist’s ability, consistency, professionalism.
Studies show that previous experiences of clients affect their
expectations and evaluations of their treatment. Their expecta-
tions, which are summarized into positive and negative attitudes
towards help-seeking, are an “almost globally ignored factor”
in this body of literature (Weinberger & Eig, 1999).
People’s attitudes represent their expectations for therapy.
Individuals with positive attitudes are more likely to seek help
(Cepeda-Benito & Short, 1998; Kelly & Achter, 1995,) and they
expect more gains when they are treated while individuals with
negative attitudes are less likely to seek help and when they are
treated they expect little change (Leaf et al., 1985).
Patients have certain expectations as far as the process and
professionals’ personal characteristics are concerned. The in-
consistency between a patient’s expectations and his or her real
help-seeking experience can become a disappointing situation
that may result in premature termination or withdrawal from
therapy. Patients expect that the specialists are highly trained
and educated, oriented to the problem, and interested in the
personality of their clients and in clients’ health status (Tinsely
& Harris, 1976). Individuals with a mental illness want to be
treated as a person in therapy. Individuals with more realistic
views about mental illness are more likely to ask for help (Hall
& Tucker, 1985) than individuals with more complicated views
of mental health treatment (Furnham & Wardley, 1990). Indi-
viduals with mental health problems need a therapist, someone
who will take their problem seriously and will understand their
problem. The therapeutic relationship between the patient and
the mental health specialist is a crucial point for the evolution
and the outcome of the process of help-seeking. Studies have
found that teenagers don’t ask for help because they think that
adults wouldn’t take their problems seriously and preferred to
turn to their friends for help since they share common experi-
ences with them (Offer, Howard, Schonert, & Ostrove, 1991;
Rickwood & Braithwaite, 1994)
Interpersonal confidence is a necessary element in the doctor-
patient relationship in order for the patient to be able to reveal
painful and personal private information about his or her life and
health, to disclose personal emotions and thoughts, and accept
guidance through life changes that are difficult (Ogborn, 1995).
Individuals feel concerned by many aspects of mental health
treatment. Regarding medication, they worry about the effec-
tiveness, the side effects, and the risk of drug addiction. Individ-
uals feel concerned about the effectiveness and the frequency
of the counseling sessions, the time necessary to complete the
treatment, and that they have to talk about private matters and
sometimes painful experiences to others (Ogborn, 1995).
The recognition and understanding of their patients’ prob-
lems, the support, encouragement, and counseling, and the ten-
dency of the professional to make patients feel comfortable are
considered necessary qualities of mental health specialists by
people seeking help (Douma, Dekker, De Ruiter, Verhulst, &
Koot, 2006; Eiraldi, Mazzuca, Clarke, & Power, 2006).
The positive expectation of treatment outcome can prepare
an individual for a change. The client’s willingness to partici-
pate actively within the therapeutic relationship with the mental
health professional is very important (Gomes-Schwartz, 1978).
An individual who does not understand, or has unrealistic ex-
pectations of, mental health treatment when visiting an expert is
more likely to consider treatment to be ineffective or a failure.
In the Triandis (1980) model, intentions are expressed
through a number of actions that depend on the emotional state
of the individual towards a specific behaviour, whether pleasant
or not. This emotional state is influenced by similar previous ex-
periences (i.e., help-seeking from a mental health professional
is influenced by similar previous experiences).
STUDY LIMITATIONS
The study sample has specific socioeconomic characteristics
and the results cannot be generalized to populations from other
socioeconomic environmental settings. It is possible that find-
ings will be different among urban areas and for other provinces
and large cities.
Given the delays that certain patients seem to have until they
visit the CMHC for the first time, there are probable limitations
of memory and accuracy of specific information, as these pieces
of information are gathered retrospectively. In Group A there
also is the possibility that previous experience with treatment
has affected participants’ memory and the accuracy of their
responses. A future study could benefit from interviews with
family members so that the collected data can be cross-checked.
CONCLUSION
A significant number of persons suffering from serious men-
tal disorders had prolonged delays in accessing appropriate treat-
ment. This underscores the complexity of accessibility to the
mental health care system in a metropolitan catchment area.
Prompt seeking of treatment for mental disorders enhances the
likelihood of positive outcomes, thus understanding the fac-
tors that can contribute to reducing fearfulness in help-seeking
 TREATMENT FEARFULNESS AND HELP-SEEKING
is very important. Previous positive experiences of friends or
family involvement with mental health professional can lessen
fearfulness or reluctance to seek treatment and modify indi-
viduals’ perceptions of therapists and mental health treatment.
This may lead to the duration of untreated disorder becoming
shorter. When the individuals’ orientation towards the use of
their social support network and their attitude towards mental
health help-seeking and psychiatry are more positive, their fears
toward treatment are less. These correlations create a favorable
environment for the seeking of help. Personal attitudes and be-
liefs about help-seeking and psychiatry are predictive of early
or delayed help-seeking behavior. Further investigation must be
carried out so that mental health professionals can continue to
better understand their clients’ needs and fears.
Declaration of interest: The authors report no conflict of
interest. The authors alone are responsible for the content and
writing of this paper.
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