The truth about people seeking help for psychological issues or mental health problems is that availability of health services and accessibility are never, in and of themselves, enough. Whether someone actually seeks help or not depends, in part, on an individual’s attitude about mental illness as well as the stigma he or she may feel coming from society. In particular, those who contemplate killing themselves may have access to help but choose not to seek it out because of the stigma they feel.

What is Stigma?

Stigma is derived from the Greek and refers to a mark of disgrace; criminals, slaves, and even soldiers were visibly branded in order to be easily identified. Commonly, people use the term “stigma” to suggest the shame or disgrace associated with a particular circumstance, quality, or person. For instance, prostitution and mental illness all carry some stigma in most communities.

In social psychological theory, there are two types of stigma. The ‘discredited’ have some obvious difference from ‘normal’ people, as is the case with someone who has lost an arm. The ‘discreditable’ have some difference that’s not immediately apparent, as is the case with a ex-convict; someone meeting an ex-convict for the first time would not immediately know the convict’s history. Most forms of mental illness, then, generally fall under the category of discreditable stigma, in that they can be hidden. Unfortunately, that is precisely the problem.

When mental illness is hidden, it also goes untreated and the illness may become worse. Yet, mental illness and the social dynamics surrounding it are complex. It is not always a matter of simply speaking up about symptoms of depression or suicidal thoughts that leads to someone receiving the help he or she needs. According to the American Foundation for Suicide Prevention, half to three-quarters of all people who attempt suicide tell someone about their intention.

Whether it works for everyone or not, seeking help does prevent suicide for many people and should always be encouraged.


Researchers of a recent study published in Social Psychiatry and Psychiatric Epidemiology chose to investigate how differences in attitudes and stigma within a general population are related to willingness to seek professional and informal help in low-suicide rate regions (the Netherlands) as compared to a high-suicide rate region (Flanders).

By means of a mailed questionnaire, the researchers gathered data on 2,999 Dutch and Flemish respondents between 18 and 65 years old. In particular, they assessed participants’ attitudes concerning seeking help, perceived stigma, self-stigma, shame, and their intention to seek help.

“People in the Netherlands, where suicide rates are low, have more positive attitudes toward help seeking and experience less self stigma and shame compared to the people in Flanders, where suicide rates are relatively high,” wrote the authors. In fact, feelings of stigma decreased the chance that participants might talk to a friend or family member, while feelings of shame meant they were more likely to use psychotropic drugs to deal with their problems rather than seek help.

In an unrelated study conducted in the U.S., researchers wanted to understand the barriers that exist for college students who are at elevated suicide risk to seek professional help. Participants in the study included 165 non–treatment seekers recruited as part of an online intervention for college students at elevated suicide risk. The researchers collected data using online questionnaires.

“The most commonly reported barriers included perception that treatment is not needed (66 percent), lack of time (just over one quarter of respondents) and preference for self-management (18 percent),” wrote the authors. “Stigma was mentioned by only 12 percent of students.”

Perhaps as a society, then, Americans are further along the road of abolishing any stigma surrounding mental illness than many suspect. Certainly, the national rate of suicide, ranked somewhere in the middle on a global comparison conducted by the World Health Organization, suggests as much.

Sobering Statistics

That said, a quick perusal of statistics suggest that the nation as a whole has quite a ways to go. In 2010, 38,364 people committed suicide in the U.S., making suicide the 10th leading cause of death for all ages in 2010. Among American Indians/Alaska Natives between the ages of 15 and 34, suicide is the second leading cause of death. Suicide risk increases with age. Currently, the age group with the highest suicide rate in the U.S. is middle-aged men and women between the ages of 45 and 64. The suicide rate is highest among white men over the age of 65. In 2011, 487,700 people were treated in hospital emergency rooms for non-fatal self-inflicted injuries.

The final fact to remember is that many many more people attempt suicide than achieve it: there is one suicide for every 25 attempts, according to the Centers for Disease Control and Prevention. Help is always available through the American Foundation for Suicide Prevention.

Sources: Reynders A, Kerkhof AJFM, Molenberghs G, van Audenhove C. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry and Psychiatric Epidemiology. 2013.

Czyz EK, Horwitz AG, Eisenberg D, Kramer A, King CA. Self-reported Barriers to Professional Help Seeking Among College Students at Elevated Risk for Suicide. Journal of American College Health. 2013.