MentalHealth Has
Bigger Challenges
Than Stigma
Rapid Report
Mental Health Million Project 2021

Mental Health Has Bigger
Challenges Than Stigma
Over 50% of those with clinical level mental health risks do not seek help. The major reasons are notknowing what kind of help to seek, thinking that it won’t make a difference, and a preference for self-help.

Summary
Today a great deal of focus in the arena of mental health concerns removing stigma to speak about
mental health challenges and to promote help seeking behavior. Here we provide insight into help seeking
behavior reported by ~45,000+ respondents in 2021 through the Mental Health Million project. We findthat over half of all people globally with clinical level mental health risks do not seek any help for theirchallenges. The major reasons are not knowing what kind of help to seek and thinking that seeking help
won’t make a difference. In the United States, only 25% of those not seeking help cite stigma or not
wanting others to know as a reason.

Introduction
The Mental Health Million project captures comprehensive mental wellbeing profiles of adults across 10
English speaking countries (or countries with a large English-speaking population) using a tool called
the MHQ. The MHQ captures symptoms across ten common mental health disorders as well as positive
attributes of mental function, to position individuals on a spectrum from clinical to thriving. Those in
the Clinical range of the scale represent those with symptoms that map to one or more DSM-5-defined
mental health disorders and those At risk exhibit 5 or more clinical level symptoms although they may
not map specifically to any single disorder. Together these groups comprised 30% of the respondents inQ1 of 2021 (N=13,416). The remaining respondents, classified from enduring to thriving, are consideredwithin the normal range, although some may have indicated a few symptoms of mental health disorders.

2All respondents were asked if they were currently seeking (or had sought in the last year) any professional
help for any mental health concern. Those who answered ‘No’ were asked to select from a list of possible
reasons. We present here these responses, providing insight into the deterrents to help seeking in theUnited States, United Kingdom and all 10 countries combined.

The majority with clinical mental
health challenges do not seek help
Across the English-speaking population of 10 countries 58% did not seek help for clinical level mental
health challenges. In the United States the number was 45% and in the UK it was 50%. In Australia andCanada the number was 45% and 47% respectively, meaning 55% and 53% did seek help. In contrast inSouth Africa, Singapore, Nigeria and India those not seeking help ranged from 61% to 81%.

% Clinical/At risk Not seeking help

Australia
United States
CanadaNew ZealandUnited KingdomIrelandSouth Africa
Singapore
India
Nigeria

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Conversely, it is interesting to note that across these 10 countries, 16% of those without clinical level
mental health challenges i.e. in the categories of enduring to thriving on the MHQ scale, nonethelesssought help for sub clinical challenges. In the United States this percentage was 21% and in the United
Kingdom it was 17%.

3

Lack of knowledge and confidencein treatment are key deterrents to help seekingAcross respondents from all ten countries who did not seek help for clinical level mental healthchallenges, the primary reason was a preference for self-help (36%) where people indicated thatthey preferred to manage their challenges on their own or did not think they needed mental healthtreatment or therapies. This was followed by a lack of knowledge of what kind of help to seek or whereto get it (34%) and a lack of confidence in mental health treatments (28%), which was largely because
respondents felt it wouldn’t help (19%), though 13% were fearful of being forced to take a medication orbeing committed. 22% were deterred from help seeking by stigma or fear of not wanting people to know
and 17% were deterred by lack of affordability.
This ranking differed from country to country, however. In the United States lack of confidence in themental health system topped the list at 37%, followed by a lack of knowledge of what kind of help to seek
(34%). These also topped the list in the United Kingdom at 32% for both. We note that the preference forself-help substantially dominated Asian countries, pushing it to the top reason across all respondents.
In the United States lack of affordability was an obstacle to getting help for 25% of people but was not asignificant issue in the United Kingdom (less than 5%) where healthcare is nationalized.

Percentage with Clinical Level Mental Health Challenges Not Seeking Help
10 Countries

United States

United Kingdom

Prefer self-help

Lack of confidence inmental health treatment

Lack of confidence inmental health treatment

Lack of knowledge

Lack of knowledge

Lack of knowledge

Lack of confidence inmental health treatment

Prefer self-help

Prefer self-help

StigmaLack of affordability
and accessStigmaLack of affordability
and accessStigmaLack of affordability
and access

0% 10% 20% 30% 40%

0% 10% 20% 30% 40%

0% 10% 20% 30% 40%

Getting to solutions
Altogether this demonstrates a mental health care system that is difficult to navigate and in which many
do not see value. While eliminating stigma may enable people to have easier conversations with friends
and family, for the majority there are more pressing challenges to help seeking. Thus moving towards
better care requires more than just talking about the problems.

4The ongoing efforts by many organizations to eliminate stigma may be behind its relatively smaller
prevalence as a barrier to help seeking. However, this data largely points to the need for greater clarity inthe mental health space to help individuals understand their specific challenges and direct them to theright resources. The core challenge, however, is which resources? Most currently available medications
and therapies tend to be effective only for some patients, and only partially so, introducing a great dealof trial and error (For example: Cuijpers & Christensen, 2017). Furthermore, as shown in the 2020 Mental
State of the World Report, a greater number of psychiatrists per 100,000, while closely correlated to thefraction who seek help for clinical level challenges, does not ultimately have much bearing on clinicalburden (Newson et al, 2021). To make progress therefore requires addressing this root challenge.

References:Cuijpers P, Christensen H. Are personalised treatments of adult depression finally within reach? Epidemiol
Psychiatr Sci. 2017 Feb;26(1):40-42. doi: 10.1017/S204579601600007X.
Newson JJ, Pastukh V, Sukhoi O, Taylor J and Thiagarajan TC, Mental State of the World 2020, Mental
Health Million project, Sapien Labs, March 20215