The specialty of psychiatry is responsible for conceptualizing mental illness into acute, maintenance, and chronic life phases, and suggests that concepts such as relapse, remission, and recovery are based on symptom profiles (Jacob, 2015). Sentiments like this, which continue to pervade mental health discourse largely as a result of the significant influence that psychiatrists exert, view recovery from mental illness as comparable to physical ailments; as amelioration of symptoms. Recovery, when perceived through this lens, means that a cure is derived from signs and symptoms of mental illness. In addition, people with mental illness have criticized traditional clinical measures for being too disability-oriented (Andresen, Caputi, & Oades, 2010). Despite the power, influence, and dominance of psychiatric concepts driven by the medical model, this approach to conceptualizing recovery is facing increased opposition (Amering & Schmolke, 2009; Ramon, Healy, & Renouf, 2007). Resistance to the medical model not only emanates from the psychosocial model of mental health, but greater acknowledgment of the voices and stories of people with mental illness. People with mental illness are now increasingly recognized as experts in their own recovery in mental health treatment discourse (Gingerich & Mueser, 2005). Recovery for people with mental illness is personal and is more akin to managing one's life, rather than the elimination and/or reduction of symptoms. Therefore, an individual's notion of personal recovery prioritizes growth and resilience over clinically treating symptoms, which usually relates to medication adherence (Slade, 2009).
Although there is no single definition of personal recovery, there are guiding principles, which indicate with hope and confidence that people with mental illness can live a meaningful life, despite the persistent symptoms associated with mental illness (Department of Health, 2019; Lieberman et al., 2008). Personal recovery, as opposed to clinical recovery, is often referred to as a journey rather than a process (Drake & Whitley, 2014; Shepherd, Boardman, & Slade, 2008). Jacob (2015) asserts that recovery-based research from a stakeholder perspective suggests that identity, risk and responsibility, social domain, power and control, hope and optimism, and the service-provision agenda are all principal themes. Furthermore, there is consensus surrounding the belief that quality care should be made available to all service users to promote recovery (Jacob, 2015). The current study reports on research of a person's intention to access services and care, to seek help—an area that may promote recovery. This is an area that is limited in terms of empirical evidence.
Personal recovery means being able to do what you want with your life and is different for every individual (Moxham et al., 2018). Personal recovery involves setting goals for the future and taking the necessary steps to reach the desired outcome. Although these goals may be entirely subjective, they reflect where the person would like to be and are meaningful on a personal level (Thomas et al., 2016). Personal recovery may be characterized as an ongoing and largely unchartered journey. It is integral that each person can identify what facilitates, supports, and maintains his/her personal recovery. The ability to seek help is an area that has illustrated promise in the personal recovery of people with mental illness ().
Help-Seeking and Mental Health
The idea of help-seeking is a well-documented and researched area within the field of mental illness and health. This area of research has been predominately focused on the elements that facilitate and/or thwart someone seeking assistance or help (Gulliver, Griffiths, & Christensen, 2010). A variety of factors, such as culture (Kung, 2004), sex (Yousaf, Popat, & Hunter, 2015), accessibility (Steele, Dewa, & Lee, 2007), and finances (Slaunwhite, 2015), influence whether a person seeks assistance to improve his/her mental health. Regardless of the reason a person does or does not seek help, a commonly held assumption is that if a person in need actively engages with the appropriate services, someone will attend to his/her health and well-being. For example, mental illness contributes significantly to individual and societal costs, partly because help-seeking is often delayed or completely avoided (Schnyder, Panczak, Growth, & Schultze-Lutter, 2017). According to Savage et al. (2016), only one third of people with mental illness seek professional help. Active help-seeking may also be influenced by the perceived benefit of care or previous negative experiences of treatment (). This finding highlights a disparity between the level of help-seeking behaviors and engagement with services for people with mental illness. The identification of these barriers is important, as it has been found that many people with mental illness do not feel valued or believe that the treatment they receive will assist them on their recovery journey. From a service perspective, Kilbourne et al. (2018) asserts that the quality of care and treatment for mental illness continues to be suboptimal, perpetuating this issue further.
As discussed previously, the concept of recovery is viewed as an outcome measure as people with mental illness are continuously embarking on a journey toward positive recovery. Understanding the elements that influence recovery are important, as mental health literature has indicated that it is a vital construct for people to strive toward (Moxham, Liersch, Taylor, Patterson, & Brighton, 2015; Moxham et al., 2017). Given that help-seeking has been shown to impact other health-related behaviors (Berridge, McCann, Cheetham, & Lubman, 2018; Vincent et al., 2018), the current study assumes that the concept of seeking help would be an important influence and predictor of recovery. As such, the current study has attempted to establish a conceptual framework, which is best illustrated in Figure 1.
Conceptual illustration of recovery and help-seeking behavior.
Note. The concept of help-seeking will predict/influence the overall recovery for people with mental illness.
The aim of the current study was to examine whether the help-seeking behaviors of people with mental illness will facilitate and/or contribute to personal recovery.
Participants were 120 people with mental illness from New South Wales, Australia. Reported mental health conditions among participants included depression, bipolar disorder, schizophrenia, anxiety, schizoaffective disorder, alcohol addiction, posttraumatic stress disorder, and borderline personality disorder. Participants were recruited from Recovery Camp, a psychosocial and educational program designed to restore the overall functioning of people with mental illness (Moxham et al., 2017). Data were collected from all participants to measure and evaluate their help-seeking behavior and perceptions of personal recovery and was undertaken at a single time point. Participants were given the option to read the consent form independently or have it read to them. It was explained that their participation in the study was voluntary, and that they could withdraw from the research at any time.
Two quantitative measures were used within the current study to examine the level of help-seeking behavior in people with mental illness and how it relates to personal recovery. The General Help Seeking Questionnaire (GHSQ; Wilson, Deane, Ciarrochi, & Rickwood, 2005) is a 10-item, 7-point Likert scale that is used to examine the help-seeking intentions of a person, should they experience (a) personal or emotional problems (PEP) and/or (b) suicidal ideation (SI). A score for both PEP and SI is calculated by averaging responses from the five specific items within each subscale. Higher scores are associated with a person more likely to seek assistance. Previous research has demonstrated that the GHSQ possesses an appropriate level of reliability and validity for use in the field of mental health and illness (Wilson et al., 2005).
The personal recovery of each participant was assessed using the Recovery Assessment Scale (RAS; Hancock, Scanlan, Honey, Bundy, & O'Shea, 2015). Using the 38-item RAS, participants were asked to use the 4-point scale to identify where they thought they aligned best per each item. An overall score is calculated by summing the responses from all items, which would allow for a range between 38 and 152. Hancock et al. (2015) have identified the RAS as being a valid and reliable tool for use in the area of mental illness.
The current study was granted approval through the University of Wollongong, Australia, Ethics Committee.
Data Collection and Analysis
Participants were asked to complete the RAS and GHSQ. The surveys were completed using a paper and pencil format that took approximately 10 to 15 minutes. Raw data from the RAS and GHSQ were entered into Microsoft® Excel and checked for accuracy by a research assistant. The data were imported into SPSS version 21.0 for further analysis. Subscales from Recovery, PEP, and SI were calculated for each participant using the procedures outlined above. To illustrate an overall picture and ensure a level of reliability, mean, standard deviation, and Cronbach's alphas were calculated. Pearson-product correlations were conducted to examine the strength and direction of any relationships between study variables. The final analysis step was a multiple linear regression using scores for PEP and SI as independent variables and Recovery as the dependent variable.
The results of the descriptive and reliability analysis are displayed in Table 1. Table 2 provides the data of the Pearson correlation analysis.
Descriptive and Reliability Statistics for Study Variables
Correlation of Study Variables
A multiple regression analysis was conducted to predict how recovery is influenced from PEP and SI. It was found that PEP and SI significantly predicated recovery (F [2,119] = 44.016, p ≤ 0.001, R2 = 0.429). Both predictive variables of PEP (t  = 8.497, p ≤ 0.01) and SI (t ) = 2.780, p ≤ 0.01) also significantly predicted the level of recovery.
The intent of the current study was to examine whether help-seeking behaviors of people with mental illness had an influence on personal recovery. Upon analysis of the obtained data from participants, the help-seeking variables of PEP and SI significantly predicted the construct of personal recovery. These results provide empirical evidence that help-seeking behaviors have a significant impact on the personal recovery of people with mental illness. As such, understanding the elements, constructs, and factors that facilitate a positive recovery journey for a person with mental illness can be viewed as a critical area of inquiry. The ability to understand if certain constructs (e.g., help-seeking behavior) facilitate changes in behaviors or better health outcomes can allow for better overall care. Previous studies have examined what elements influence the recovery journey. For example, constructs such as self-determination (Perlman et al., 2017), hope, and empowerment (Picton et al., 2018) have been linked with personal recovery. Results from the current study can extend the body of knowledge by adding that seeking help when a person is experiencing PEP and SI can positively impact a person's personal recovery.
PEP can stem from a variety of factors, such as family, work, school, and significant life events. As a result, an individual may experience sadness, guilt, fear, and negative thoughts. SI can be viewed as a self-worth or self-hate factor where the individual does not place value or worth on his/her life (Turnell, Fassnacht, Batterman, Calear, & Kyrios, 2019).
Self-concepts such as low self-worth or self-hate can manifest into thoughts of taking one's life, and PEP and SI are commonly experienced within the field of mental illness (Christensen, Batterham, Mackinnon, Donker, & Soubelet, 2014). Help-seeking behavior during times of distress can play an impactful role in a person's recovery. There are many organizations, groups, and health care centers across Australia and abroad that are designed to assist people in identifying and coping with mental health needs. Yet, participation in these services is low and infrequent (Meadows, Enticott, Inder, Russell, & Gurr, 2015).
The current study limitations are the small sample, which did not allow for a deeper analysis of participants by other demographic elements, such as age, sex, and possible diagnosis. In addition, lack of consensus on the definition of recovery may have limited the generalizability of the results to a larger population.
Globally, theorists and researchers are interested in understanding the connection between a person's intentions and behaviors. Previously, researchers in the health care field have applied frameworks such as the Behavior-Change Theory (Davis, Campbell, Hildon, Hobbs, & Michie, 2015) and/or the Self-Determination Theory (Ryan & Deci, 2017) to examine a person's intent or whether to engage in that behavior.
The current study sheds light on the connection among seeking help, treatment, and recovery in people with mental illness. Although engaging in behaviors is not the focus of the current study, results demonstrate that seeking help (e.g., intention) and recovery are connected. It is essential that health providers consider the steps that might be taken for people with mental illness between intention and action with mental health services. In addition, there is also cause for consideration of the ability of a service to facilitate positive personal recovery.
Conclusion and Recommendations
There is considerable scope to improve the understanding and knowledge of personal recovery. This article has demonstrated that personal attitudes toward help-seeking behaviors, such as PEP and SI, are associated with active help-seeking for mental illness. Campaigns promoting help-seeking behaviors should target these personal attitudes.
One of the key recommendations that has emerged from the current study includes the identification and implementation of mechanisms and approaches to reduce stigma. Reducing stigma will encourage and support people with mental illness to engage in help-seeking behaviors. Therefore, this article recognizes that personal attitudes to mental health help-seeking behaviors are influencing factors on whether a person seeks help for mental health. However, identifying factors is not enough. For active mental health help-seeking behaviors to be achieved, the person must be provided and/or directed to the tools by which he/she can act to improve personal recovery. Findings from the current study may be used to help inform the design of interventions to increase help-seeking behaviors.
- Amering, M. & Schmolke, M. (2009). Recovery in mental health: Reshaping scientific and clinical responsibilities. Sussex, UK: Wiley-Blackwell. https://doi.org/10.1002/9780470743171 doi:10.1002/9780470743171 [CrossRef]
- Andresen, R., Caputi, P. & Oades, L. G. (2010). Do clinical outcome measures assess consumer-defined recovery?Psychiatry Research, 177(3), 309–317. https://doi.org/10.1016/j.psychres.2010.02.013 PMID: doi:10.1016/j.psychres.2010.02.013 [CrossRef]20227768
- Berridge, B. J., McCann, T. V., Cheetham, A. & Lubman, D. I. (2018). Perceived barriers and enablers of help-seeking for substance use problems during adolescence. Health Promotion Practice, 19(1), 86–93. https://doi.org/10.1177/1524839917691944 PMID: doi:10.1177/1524839917691944 [CrossRef]
- Christensen, H., Batterham, P. J., Mackinnon, A. J., Donker, T. & Soubelet, A. (2014). Predictors of the risk factors for suicide identified by the interpersonal-psychological theory of suicidal behaviour. Psychiatry Research, 219(2), 290–297. https://doi.org/10.1016/j.psychres.2014.05.029 PMID: doi:10.1016/j.psychres.2014.05.029 [CrossRef]24947914
- Davis, R., Campbell, R., Hildon, Z., Hobbs, L. & Michie, S. (2015). Theories of behaviour and behaviour change across the social and behavioural sciences: A scoping review. Health Psychology Review, 9(3), 323–344. https://doi.org/10.1080/17437199.2014.941722 PMID: doi:10.1080/17437199.2014.941722 [CrossRef]
- Department of Health. (2019). Recovery and mental health. Retrieved from https://www.healthdirect.gov.au/mental-health-recovery
- Drake, R. E. & Whitley, R. (2014). Recovery and severe mental illness: Description and analysis. Canadian Journal of Psychiatry, 59(5), 236–242. https://doi.org/10.1177/070674371405900502 PMID: doi:10.1177/070674371405900502 [CrossRef]25007276
- Gingerich, S. & Mueser, K. T. (2005). Illness management and recovery. In Drake, R. E., Merrens, M. R. & Lynde, D. W. (Eds.), Evidence-based mental health practice: A textbook (pp. 395–424). New York, NY: WW Norton & Co.
- Gulliver, A., Griffiths, K. M. & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10(1), 113. https://doi.org/10.1186/1471-244X-10-113 PMID: doi:10.1186/1471-244X-10-113 [CrossRef]
- Hancock, N., Scanlan, J. N., Honey, A., Bundy, A. C. & O'Shea, K. (2015). Recovery Assessment Scale-Domains and Stages (RAS-DS): Its feasibility and outcome measurement capacity. The Australian and New Zealand Journal of Psychiatry, 49(7), 624–633. https://doi.org/10.1177/0004867414564084 PMID: doi:10.1177/0004867414564084 [CrossRef]
- Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian Journal of Psychological Medicine, 37(2), 117–119. https://doi.org/10.4103/0253-7176.155605 PMID: doi:10.4103/0253-7176.155605 [CrossRef]25969592
- Kilbourne, A. M., Beck, K., Spaeth-Rublee, B., Ramanuj, P., O'Brien, R. W., Tomoyasu, N. & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: A global perspective. World Psychiatry; Official Journal of the World Psychiatric Association (WPA), 17(1), 30–38. https://doi.org/10.1002/wps.20482 PMID:29352529
- Kung, W. W. (2004). Cultural and practical barriers to seeking mental health treatment for Chinese Americans. Journal of Community Psychology, 32(1), 27–43. https://doi.org/10.1002/jcop.10077 doi:10.1002/jcop.10077 [CrossRef]
- Lieberman, J. A., Drake, R. E., Sederer, L. I., Belger, A., Keefe, R., Perkins, D. & Stroup, S. (2008). Science and recovery in schizophrenia. Psychiatric Services (Washington, D.C.), 59(5), 487–496. https://doi.org/10.1176/ps.2008.59.5.487 PMID: doi:10.1176/ps.2008.59.5.487 [CrossRef]
- Meadows, G. N., Enticott, J. C., Inder, B., Russell, G. M. & Gurr, R. (2015). Better access to mental health care and the failure of the Medicare principle of universality. The Medical Journal of Australia, 202(4), 190–194. https://doi.org/10.5694/mja14.00330 PMID: doi:10.5694/mja14.00330 [CrossRef]25716601
- Moxham, L., Hazelton, M., Muir-Cochrane, E., Heffernan, T., Kneisl, C. & Trigoboff, E. (Eds.). (2018). Contemporary psychiatric-mental health nursing: Partnerships in care. Sydney, Australia: Pearson, Education.
- Moxham, L., Liersch, S., Taylor, E., Patterson, C. & Brighton, R. (2015). Preliminary outcomes of a pilot therapeutic recreation camp for people with a mental illness: Links to recovery. Therapeutic Recreation Journal, 49(1), 61–75.
- Moxham, L., Taylor, E., Patterson, C., Perlman, D., Brighton, R., Heffernan, T. & Sumskis, S. (2017). Goal setting among people living with mental illness: A qualitative analysis of recovery camp. Issues in Mental Health Nursing, 38, 420–424. doi:10.1080/01612840.2016.1271067 [CrossRef]28165874
- Onken, S. J., Dumont, J. M., Ridgway, P., Dornan, D. H. & Ralph, R. O. (2002). Mental health recovery: What helps and what hinders? A national research project for the development of recovery facilitating system performance indicators phase one research report: A national study of consumer perspectives on what helps and hinders recovery. Retrieved from https://recoverycontextinventory.com/images/resources/What_Helps_and_What_Hinders.pdf
- Perlman, D., Patterson, C., Moxham, L., Taylor, E. K., Brighton, R., Sumskis, S. & Heffernan, T. (2017). Understanding the influence of resilience for people with a lived experience of mental illness: A self-determination theory perspective. Journal of Community Psychology, 45(8), 1026–1032. https://doi.org/10.1002/jcop.21908 doi:10.1002/jcop.21908 [CrossRef]
- Picton, C., Patterson, P., Moxham, L., Taylor, E. K., Perlman, D., Brighton, R. & Heffernan, T. (2018). Empowerment: The experience of Recovery Camp for people living with a mental illness. Collegian (Royal College of Nursing, Australia), 25(1), 113–118. https://doi.org/10.1016/j.colegn.2017.04.005 doi:10.1016/j.colegn.2017.04.005 [CrossRef]
- Ramon, S., Healy, B. & Renouf, N. (2007). Recovery from mental illness as an emergent concept and practice in Australia and the UK. The International Journal of Social Psychiatry, 53(2), 108–122. https://doi.org/10.1177/0020764006075018 PMID: doi:10.1177/0020764006075018 [CrossRef]17472085
- Ryan, R. M. & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation development, and wellness. London, UK: Guilford Press.
- Savage, H., Murray, J., Hatch, S. L., Hotopf, M., Evans-Lacko, S. & Brown, J. S. L. (2016). Exploring professional help-seeking for mental disorders. Qualitative Health Research, 26(12), 1662–1673. https://doi.org/10.1177/1049732315591483 PMID: doi:10.1177/1049732315591483 [CrossRef]
- Schnyder, N., Panczak, R., Groth, N. & Schultze-Lutter, F. (2017). Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis. The British Journal of Psychiatry, 210(4), 261–268. https://doi.org/10.1192/bjp.bp.116.189464 PMID: doi:10.1192/bjp.bp.116.189464 [CrossRef]28153928
- Shepherd, G., Boardman, J. & Slade, M. (2008). Making recovery a reality. London, UK: Sainsbury Centre for Mental Health.
- Slade, M. (2009). Personal recovery and mental illness: A guide for mental health professionals. Cambridge, UK: Cambridge University Press. https://doi.org/10.1017/CBO9780511581649 doi:10.1017/CBO9780511581649 [CrossRef]
- Slaunwhite, A. K. (2015). The role of gender and income in predicting barriers to mental health care in Canada. Community Mental Health Journal, 51(5), 621–627. https://doi.org/10.1007/s10597-014-9814-8 PMID: doi:10.1007/s10597-014-9814-8 [CrossRef]25563485
- Steele, L., Dewa, C. & Lee, K. (2007). Socioeconomic status and self-reported barriers to mental health service use. Canadian Journal of Psychiatry, 52(3), 201–206. https://doi.org/10.1177/070674370705200312 PMID: doi:10.1177/070674370705200312 [CrossRef]17479529
- Thomas, N., Farhall, J., Foley, F., Leitan, N. D., Villagonzalo, K. A., Ladd, E. & Kyrios, M. (2016). Promoting personal recovery in people with persisting psychotic disorders: Development and pilot study of a novel digital intervention. Frontiers in Psychiatry, 7(196), 196. https://doi.org/10.3389/fpsyt.2016.00196 PMID: doi:10.3389/fpsyt.2016.00196 [CrossRef]
- Turnell, A. I., Fassnacht, D. B., Batterham, P. J., Calear, A. L. & Kyrios, M. (2019). The Self-Hate Scale: Development and validation of a brief measure and its relationship to suicidal ideation. Journal of Affective Disorders, 245, 779–787. https://doi.org/10.1016/j.jad.2018.11.047 PMID: doi:10.1016/j.jad.2018.11.047 [CrossRef]
- Vincent, A. D., Drioli-Phillips, P. G., Le, J., Cusack, L., Schultz, T. J., McGee, M. A. & Wittert, G. A. (2018). Health behaviours of Australian men and the likelihood of attending a dedicated men's health service. BMC Public Health, 18(1), 1078. https://doi.org/10.1186/s12889-018-5992-6 PMID: doi:10.1186/s12889-018-5992-6 [CrossRef]30165836
- Wilson, C., Deane, F., Ciarrochi, J. & Rickwood, D. (2005). Measuring help-seeking intentions: Properties of the general help-seeking questionnaire. Canadian Journal of Counselling, 39(1), 15–28.
- Yousaf, O., Popat, A. & Hunter, M. S. (2015). An investigation of masculinity attitudes, gender, and attitudes toward psychological help-seeking. Psychology of Men & Masculinity, 16(2), 234–237. https://doi.org/10.1037/a0036241 doi:10.1037/a0036241 [CrossRef]
Descriptive and Reliability Statistics for Study Variables
Correlation of Study Variables