You Can’t Help Me: Internalized Mental Illness Stigma and Help Seeking Behavior

Nat Shogren, BA

McLean Hospital – Clinical Psychology Intern

Scientific Abstract


Previous research has shown that high rates of internal mental illness stigma (ISMI) negatively predict help seeking behaviors (Cooper et al., 2003; Sirey et al., 2001). However, there is little consensus on why this dynamic occurs. Studies have indicated that individuals often seek help from more informal sources before turning to mental health professionals (MHPs; Boldero & Fallon, 1995; Offer et al., 1991) and that rates of high rates of shame and perceptions of stigma predict negative attitudes towards working with MHPs (Connor et al., 2009). Accordingly, the present study hypothesized that ISMI may encourage individuals to seek help from MHPs with lower perceived qualification, and that this may influence formal help seeking behaviors more generally. 


College students (N = 60) responded to online questionnaires. Participant responses to the Internalized Mental Stigma Inventory (Chang et al., 2016) were summed into a composite score. Participants also answered questions regarding their history of treatment, MHPs that they had previously worked with, and MHPs that they would be willing to work with in the future. Data from the ISMI scale and the previous and future MHP qualification scale were subjected to bivariate correlation and linear regression analyses.


Higher ISMI values were positively correlated with more recent therapeutic encounters (p = 0.02.), higher levels of professional healthcare degree in past providers (p = 0.031) and higher levels of desired professional healthcare degree in future providers (p = 0.036). A follow up regression analysis indicated that ISMI levels significantly predicted desired levels of past (p = 0.031) and future provider perceived qualification (p = 0.036). 


Participants with higher rates of internalized stigma were more likely to desire future treatment from MHPs with professional healthcare degrees. This is an important consideration for current understandings of help seeking behavior, suggesting the desire for help from MHPs with more formal training could actually negatively influence the rate at which individuals with high rates of ISMI receive the help that they need. 


SoundCloud Transcript

Hello everyone and welcome to my presentation, “You Can’t Help Me: Internalized Mental Illness Stigma and Help Seeking Behavior”


Let’s get right into it. Previous research has indicated that internalized stigma of mental illness negatively predicts help seeking behaviors: Essentially, that participants who stigmatize their own experience of mental illness are far less likely to be involved in formal methods of treatment.


Interestingly, there is little consensus on why stigma discourages participation in treatment and help seeking behavior. Other studies have indicated that people usually seek help from informal sources before turning to formally trained mental health providers, and that endorsemets of external and internal stigma predicts a distrust of MHPs and formal methods of therapy.


Accordingly, the present study wanted to investigate whether the relationship between internalized mental illness stigma and low rates of treatment can be explained by the idea that internalized stigma encourages patients to seek help from more informal or less conventionally trained sources.


For methods, this study used a sample of college students who had previously received help for their mental struggles.  These students were asked to identify the type of provider they had worked with and the type of provider that they wanted to work with in the future. These scores were then recoded on the basis of ‘training’ that providers had received. Providers with a doctorate were given a score of 3, providers with a masters degree were given a score of 2, and informal or non-mental health specific providers were given a score of 1. Participants also completed the Internalized Mental Stigma Inventory.


The analysis yielded some very interesting results. As you can see in the middle, higher rates of internalized mental illness stigma predicted a desire for future treatment from MHPs with higher levels of perceived training or qualification. This finding is reflected by the results over on the right side, in that higher ISMI predicted a desire for MHPs with more formal training, predicted a higher level of qualification for previous providers, and predicted more recent treatment.


These results have interesting implications. The current study hypothesized that high rates of ISMI may encourage individuals to seek less formal avenues of treatment. The data indicated the reverse to be true, in that higher rates of self-stigma predicted a desire for more qualified providers. In interpreting these results, the findings indicate that the desire for formal treatment itself may in fact provide a barrier to help-seeking, in that the belief that one requires more formal or intense treatment may discourage help seeking because it may frame treatment as a more daunting endeavor. From this, and interpretation could be that ISMI may decrease help seeking behavior because it leads people to conclude that they require an unrealistic or unattainable amount of treatment in order for their mental states to improve. This idea is supported by research would suggest that ISMI significantly reduces patient’s confidence and self advocacy. Future work should investigate our desire for higher MHP qualification may dissuade help seeking or alter perceptions of treatment outcomes. Thank you for spending the time to look at my work and please come to my zoom meeting if you have any questions or would like to discuss the implications of these findings.

Live Zoom Session – March 9th

research Areas


Nat Shogren, BA, Julianne Wilner Tirpak, Ph.D., Vinu Arunagiri, Ph.D.

Principal Investigator

Vinu Arunagiri, PhD