Table 3.
Key themes on barriers to formal help-seeking
| Key barrier themes | Studies on local Filipinos (n = 4) | Studies on overseas Filipinos (n = 11) | Total (n = 15) |
|---|---|---|---|
| (A) Systemic, structural and economic barriers | |||
| 1. Financial constraints (e.g., high cost of service, lack of health insurance, fear of losing job, precarious nature of employment) | 2 | 10 | 12 (80%) |
| 2. Inaccessibility of mental health services (e.g., lack of familiarity or information on available mental health services, different structure of mental health system, lack of time, geographical dispersal) | 2 | 6 | 8 (53%) |
| 3. Immigration/Residency status (e.g., nativity, fear of deportation) | N/A | 7 | 7 (47%) |
| (B) Socio-cultural barriers | |||
| 1. Social stigma (e.g., attack on family reputation or negative perception of one’s cultural group, preservation of the family’s dignity, fear of social exclusion, being labelled as ‘crazy’) | 2 | 8 | 10 (67%) |
| 2. Sense of religiosity (e.g., preference for religious clergy, strong religious belief, reliance on faith organizations) and/or spirituality | 2 | 6 | 8 (53%) |
| 3. Language difficulty (e.g., lack of language proficiency in the host country) | 0 | 6 | 6 (40%) |
| 4. Adherence to Asian cultural values of conformity; lack of acculturation | 1 | 4 | 5 (33%) |
| 5. Use of alternative health care (e.g., indigenous healing methods, use of herbal medicines, consultation with elders in the community) | 0 | 2 | 2 (13%) |
| (C) Psychosocial barriers | |||
| 1. Self-stigma (e.g., concern for loss of face, sense of shame or embarrassment, fear of being judged negatively, fear of negative reactions from family or friends, sense of being a disgrace, self-blame, fear of being labeled as ‘crazy’, sense of being weak) | 2 | 9 | 11 (73%) |
| 2. Influence of social support/network (e.g., presence of and preference for family and friends as source of help, lack of friends to provide influence) | 3 | 6 | 9 (60%) |
| 3. Previous negative experience of help-seeking (e.g., experience of discrimination, lack of trust on or rapport with healthcare provider) | 1 | 7 | 8 (53%) |
| 4. Concerns on confidentiality and privacy, treatment fears e.g., concerns on trustworthiness or competence of the mental health care provider, effect of medication) | 2 | 5 | 7 (47%) |
| 5. Lack of awareness of mental health need (e.g., low perception of distress; normalization of mental health problems) | 1 | 6 | 7 (47%) |
| 6. Misconceptions about mental illness (i.e., on nature, causes and effects of mental health problems) | 2 | 4 | 6 (40%) |
| 7. Sense of self-reliance (e.g., perceived resilience, coping ability, sense of self-responsibility) | 0 | 3 | 3 (20%) |
| 8. Fear of hurting or becoming burden to others | 0 | 3 | 3 (20%) |