Whom to ask for help in case of a mental disorder? Preferences of the lay public

Background: Although socio-cultural factors have been recognised as an important predictor in shaping help-seeking behaviour, few attempts have been made in this regard to specify the nature and impact of socio-cultural factors such as attitudes and belief systems prevalent in society. Methods: We investigated the lay public's attitudes toward help-seeking regarding psychiatric disorders, and their determinants, in a cross-sectional national survey in Germany (n = 1564), using structured interviews with vignettes depicting a person either suffering from depression or from schizophrenia. Two distinct methodological approaches (rating vs ranking) were applied. Results: Public opinion considers mental health professionals helpful in treating schizophrenia but not in the treatment of depression. For depression, public opinion clearly favours the lay support system and believes in involving the family physician if the former resource is exhausted. Determinants of help-seeking recommendations were problem definition, perception of the cause of distress and anticipated prognosis, as well as resentment against mental health professionals. Conclusion: Our results suggest that attitudes and belief systems prevalent in society have a major impact on help-seeking behaviour, both through transmission to the person suffering from mental distress via his/her social network and through the person's own attitudes formed in the process of socialization. Implications are pointed out for the daily work of mental health care providers, health care planning and public discussion of mental health issues.