Seeking Mental Health Services Research Articles

Perceived control moderates the internalized stigma model of seeking mental health services in distressed older adults.

Older adults are especially unlikely to seek mental health services, and internalized stigma is a key reason why. However, little research has investigated which older adults are particularly likely to have stigma influence help-seeking. To address this, we tested whether perceived control (PC) moderates an internalized stigma model in which public stigma is internalized as self-stigma, which negatively predicts help-seeking attitudes and help-seeking intentions. We employed moderated mediation analysis of cross-sectional, secondary data from 348 psychologically distressed Canadian adults aged 65 years and older. Participants completed an online survey that included measures of public stigma of help-seeking, self-stigma of help-seeking, help-seeking attitudes, conditional help-seeking intentions, psychological distress, and PC. PC emerged as a moderator of the internalized stigma model. Those lower in PC were more likely to have public stigma negatively predict help-seeking intentions through the serial mediation of (a) self-stigma and (b) help-seeking attitudes. Further, those lower in PC were more likely to have public stigma internalized as self-stigma and more likely to have negative help-seeking attitudes predict lower help-seeking intentions. Finally, those lower in PC also had lower help-seeking intentions in the face of low levels of self-stigma. These results contribute to a nuanced understanding of which older adults are unlikely to seek help. Identifying PC as a moderator of the internalized stigma model suggests that interventions that enhance PC should protect against public stigma's internalization and improve help-seeking behaviors for older adults who need such help. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluation of a student pharmacist-led depression screening program in a community pharmacy.

One in 5 adults in the United States have depression and are at risk for suicide, the 11th leading cause of death in the United States. Community pharmacy settings are ideal for increasing access to mental health services. Our objectives were to assess PHQ-9 scores and evaluate participant satisfaction in a student pharmacist-led depression screening program in a community pharmacy. Student pharmacists trained in mental health first aid recruited participants 18 to 90 years old in a community pharmacy to complete the PHQ-9 and provided mental health education, referrals, and resources. A 2-week follow-up was completed, and participants reported on actions taken since the initial visit. Descriptive statistics, independent t tests, and χ 2 tests were used in data analysis. Twelve depression screening events were held, and 70 participants completed the screenings. The mean age was 52 years, and 75.7% were female. PHQ-9 scores ranged from 0 to 24 with an average of 3.96. Most participants (92.9%) reported the depression screening program was helpful. More than 90% of participants completed the 2-week follow-up, and 92.3% reported being comfortable seeking mental health services from a pharmacist. About half (53.8%) reported reading the educational materials, 24.6% helped a friend or family member, and 16.9% made an appointment with their health care provider. Student pharmacists successfully provided depression screenings and mental health education in a community pharmacy. Most participants had low PHQ-9 scores, found the program helpful, and are willing to utilize mental health services in a community pharmacy.

Changing the narrative: Addressing American Indian/Alaska Native mental health needs through academic holistic support

American Indian/Alaska Natives (AIAN) have some of the highest health disparities and poorest outcomes of all racial or ethnic minority groups in the United States. Across all age groups, suicide is 2.5 times higher in AIANs than the national average (National Indian Council on Aging, 2019). Cultural and institutional barriers prevent AIAN undergraduate and graduate college students from seeking mental health services, and many serious mental health problems remain untreated.While numerous barriers to mental health services exist for AIAN students, Indigenous faculty and support staff who share deep understanding of history, culture and traditional view of health and wellness can reduce the barriers and promote mental health and wellness for students. Shifting the focus to introduce a new narrative gives way to greater recognition of factors that create health and may help academic institutions provide holistic support for AIAN and other underrepresented students. The new narrative includes holistic strength-based support, social support, and fostering cultural identity and pride enhances mental health and success. Indigenization of the doctoral nursing curriculum supports faculty who are committed to decolonizing course content and institutionalized pedagogy.Improved health outcomes for Indigenous individuals and other underrepresented students will positively affect communities through increasing diversity of APRNs, nursing faculty, and nursing scholars.

Interdependent stigma of seeking mental health services: Examining a new scale across eight countries/regions.

Although the presence of mental health stigma associated with seeking help has been demonstrated in many parts of the world, this work has largely been from an independent perspective (i.e., "I will be perceived as crazy") rather than from an interdependent perspective (i.e., "My family will be viewed negatively"). Interdependent stigma of seeking help (i.e., the extent to which people believe their family would be devalued and shamed if they seek psychological help) may be an important type of stigma that has not been assessed. Based on self-construal theory, the present study sought to develop and evaluate the psychometric properties of an Interdependent Stigma of Seeking Help (ISSH) scale in eight different countries and regions (i.e., Australia, Brazil, Germany, Hong Kong, Taiwan, Türkiye, the UAE, the United States). Findings suggest that the psychometric properties of the eight-item ISSH are adequate for research purposes (a unidimensional scale with full invariance and internal consistency estimates from .84 to .94). The ISSH was moderately related to other measures of stigma and psychological distress. Some differences in the relationship with specific outcomes by country and region were found, and there were notable country differences in the latent mean levels of ISSH, with Hong Kong and Taiwan having the highest means, and Australia, the United States, and Brazil having the lowest levels. Results suggest that the ISSH could be used to help clarify the complex relationships between stigma and other variables of interest and might be useful in developing culturally relevant interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Subjective experiences, perceptions, and meanings associated with barriers to seeking mental health care among first responders

ABSTRACT Objective Seeking mental health services can be challenging for first responders due to various barriers that impede access to care. The objective of this study was to gain a deeper understanding of the subjective experiences, perceptions, and meanings associated with seeking services among first responders. Methods The survey-design instrument consisted of questions regarding stress, psychological health, health-related difficulties, and potential barriers to treatment that first responders may experience. The questions were asked in multiple formats including multiple choice, select all that apply, and one open-ended question. This paper includes responses from the optional open-ended question (n = 78). Researchers conducted data analysis using ATLAS.ti and the analysis followed a thematic approach. Results Three (3) themes and several sub-themes were identified. First responders provided diverse explanations for their reluctance to seek care, such as organisational and leadership factors, stigma related to mental health, concerns about being red-flagged, limited access to care, and the financial implications of treatment. A prevailing sentiment was a lack of trust in the mental health field. Discussion By giving voice to the lived experiences of first responders, this study can inform the development of targeted interventions and support programs that address their specific needs and enhance overall well-being of first responders.

Acculturation and Depression Help-Seeking Intentions in a Majority Mexican American College Student Sample.

Work has not examined if acculturation or enculturation may predict endorsed benefits, barriers, and intentions to seek mental health services for depression, specifically among Latino students enrolled in a rural and majority Latino immigrant institution of higher education. An improved understanding of factors informing mental health help-seeking is needed to identify possible intervention points to address gaps in accessing depression treatment. Participants (N = 406) read a vignette depicting a person with depressive symptoms. Participants were asked if they would seek help for depression if in the situation described in the vignette. Participants provided text responses about their preferences for managing depression symptoms and their mental health help-seeking history. Additionally, participants completed a self-report depression symptom screener, demographic surveys, acculturation assessment, and questionnaires on perceived benefits and barriers to seeking mental health services. Path analysis was used to test the link between acculturation status and intent to seek services for depression, with benefits and barriers as mediators. The results revealed that higher perceived benefits and lower barriers were directly associated with greater intentions to seek help. Furthermore, an indirect effect of acculturation on help-seeking intentions via higher perceived benefits of seeking care was observed. These findings persisted after controlling for age, gender, depression, and history of seeking care for depression. Future work should test the replicability of this finding with diverse college students living in predominantly immigrant communities. Universities might consider tailoring outreach initiatives to provide information on the range and accessibility of mental health services, the location of mental health service centers, and the procedures for accessing such services.

Exploring barriers to seek mental health services among patients with severe mental illness and their caregivers in a modified assertive community treatment program: A qualitative thematic analysis.

Affordability, lack of public mental healthcare facilities, inadequate insurance coverage, and stigma and discrimination are barriers to mental healthcare utilization in India. There is limited research on these barriers and the factors influencing the use of mental health services. To explore the barriers to seeking mental healthcare for individuals with severe mental illness and their caregivers in a modified assertive community treatment program. In a qualitative study using a descriptive thematic analysis, we conducted in-depth interviews with 19 adults, including seven individuals with severe mental illness and twelve caregivers. All the participants had been in the modified assertive community treatment program for at least two years. Using thematic analysis, we identified and grouped codes into subthemes and then clustered into themes. Three major themes on barriers to seeking mental health services emerged: service-related factors, societal-related factors, and illness-related factors. Service-related factors included affordability, accessibility and geographical disparity, and noncoverage under insurance schemes. Societal-related factors included social stigma and discrimination, lack of mental health service knowledge and seeking other forms of treatment, and poor social support. Illness-related factors included poor insight into the illness and no relief from the symptoms despite medication. Barriers to seeking mental healthcare can be categorized as service-related, societal-related, and illness-related. Identifying these factors will improve mental health service delivery.

Delivery of Mental Health Services in Bhutan: Challenges and Way Forward

ABSTRACTBhutan is known for its developmental philosophy of Gross National Happiness. Bhutan introduced mental health services in 1997 with the launch of Mental Health Program. Mental health includes psychological, emotional, and social well‐being. The Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital in the capital city Thimphu is the only psychiatric unit providing specialized mental health services in Bhutan. The psychiatric unit consists of multidisciplinary team rendering both out‐ and in‐patient mental health services. However, mental health services were gradually integrated in district hospitals, Primary Healthcare Centres and in schools. Although mental health services are an essential component of the healthcare system, the system faces numerous difficulties. Inaccessibility to mental health services due to geographical location and inadequate mental health professionals poses challenges in addressing mental health issues. Mental health issues are perceived differently, and the people with mental health issues often suffer from stigmatization creating barriers in seeking mental health services. Therefore, misconception and stigma associated to mental illness also cause greater challenges in delivering mental health services. Mental health funding has been substantially lower than the World Health Organization recommended mental health budget, amounting to 1% of health budget. Inadequate mental health funding remained a serious concern for the last few decades. Adequate mental health funding is vital in expanding the overall Mental Health Program and improving both the quality and quantity of mental health professionals. Additionally, enhancing community mental health initiatives will reinforce mental health services. Furthermore, there is a need for advancements in evidence and mental health research to support evidence‐based practices and enhance mental health literacy.

Barriers to Seeking Mental Health Help in Saudi Arabia: A Systematic Review.

Globally, mental disorders have become a significant burden, affecting a substantial number of individuals. Accessing mental health services is crucial for effective treatment and improving outcomes. However, significant barriers to seeking health services can impede access and contribute to the treatment gap. This systematic review aims to identify and analyze the perceived barriers to seeking mental health services in Saudi Arabia. A comprehensive search was conducted among four databases (PubMed, Web of Science, ProQuest, and Science Direct) to identify relevant studies published between 2018 and 2023. Studies that investigated barriers that could prevent psychiatric patients from seeking mental health services in Saudi Arabia were included. Data extraction and synthesis were performed to identify common themes and barriers. The review included a total of six studies that examined barriers to seeking mental health services in Saudi Arabia. The identified barriers encompassed a range of factors, including stigma, lack of awareness, concerns about confidentiality, limited availability of services, negative attitudes towardprofessional help, and cultural and religious beliefs. The lack of knowledge, as well as the negative attitude towardmental health care, was a perceived barrier to help-seeking in most studies. Furthermore, stigma was consistently reported as a predominant barrier, preventing individuals from seeking mental health care. This systematic review highlights the barriers to seeking mental health services in Saudi Arabia. Addressing these barriers is essential for improving access to mental healthcare and reducing the treatment gap. Strategies should focus on destigmatization efforts, increasing awareness, ensuring confidentiality and privacy, providing culturally appropriate care, and addressing structural limitations. By implementing these strategies, healthcare systems can improve access to mental health care and the overall well-being of individuals experiencing mental disorders in Saudi Arabia.

The stigma towards seeking help among university students: a cross-sectional study in Jordan

BackgroundMental disorders affect one in two people globally, with COVID-19 exacerbating anxiety and depression. Stigma, a major hindrance to seeking mental health services, manifests as public, perceived, and self-stigma. Cultural misconceptions contribute to public stigma. Studies show high stigmatization among university students, impacting help-seeking behavior. Arab populations exhibit varied attitudes influenced by religious beliefs. The research aims to bridge gaps in understanding stigma among university students in Jordan, focusing on the impact of post post-COVID-19 era on mental health perceptions. The study hypothesizes differences in attitudes and stigma between medical and non-medical students, investigating these aspects in Jordan.MethodsA cross-sectional study assessed attitudes and stigma related to seeking help among 1,151 university students in Jordan from June 20th to July 20th, 2023. The sample included diverse participants from Jordanian universities. Data were collected through an online survey covering sociodemographic details, psychological background, and attitudes using the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPH). Ethical considerations included approval from the University of Jordan Institutional Review Board and informed consent from participants.ResultsThe survey included 1151 participants. The overall mean age was 20.34 years. Among the participants, 761 (66.1%) were medical students, while 390 (33.9%) were non-medical students. The overall mean ATSPPHS score was 16.30. Medical students exhibited a significantly more positive attitude (73.3%) compared to non-medical students (26.7%). Being a medical student was associated with higher odds of having a positive attitude while being male was found to be a negative predictor.ConclusionFindings revealed that being a medical student and having prior mental health education were linked to more favorable attitudes, whereas male students tended to hold more negative views. Incorporating mental health education into non-medical curricula could be beneficial in diminishing stigma and fostering positive attitudes toward seeking help.

Barriers To and Attitudes Toward Seeking Mental Health Services Among Collegiate Marching Band Artists.

Marching band (MB) artists experience stressors influencing their physical, mental, and emotional health warranting medical support, and they face challenges similar to those of other college students and athletes. Mental health illnesses exist in collegiate and MB settings, but barriers affect access to treatment. To examine MB artists' perceived barriers to and attitudes toward seeking care from mental health professionals. The secondary aim was to explore barriers to and attitudes about seeking mental health counseling between genders and history of pursuing mental health counseling. Cross-sectional study. Online survey. A total of 534 MB artists (women = 312, men = 222; age = 19.7 ± 1.4 years). Participants completed surveys on demographics and past medical history along with the Barriers to Help Seeking Checklist, the Attitudes Toward Seeking Professional Psychological Help-Short Form Scale (ATSPPH-SF), and the Mental Help Seeking Attitudes Scale (MHSAS). Descriptive statistics were calculated to assess demographic data. Cross-tabulations and χ2 statistics were used to evaluate individual barriers (Barriers to Help Seeking Checklist) between genders. Scales were scored 1 to 7 and 10 to 30 on the MHSAS and ATSPPH-SF, respectively. A 1-way analysis of variance measured differences in the total mean score on the ATSPPH-SF between genders. The highest barrier reported was lack of time to seek services (69.1%; n = 369), followed by 47.6% (n = 254) for services not available during my free time. Average scores were 4.0 ± 0.4 on the MHSAS (indicating neutral attitudes toward seeking help) and 17.97 ± 5.48 on the ATSPPH-SF (indicating slightly positive attitudes to seeking help). No differences were seen for the total mean scores on the MHSAS and ATSPPH-SF between genders. Marching band artists' barriers to and attitudes toward mental health care influenced their ability to seek care in times of need and demonstrated some similarities to those of collegiate athletes. Awareness of the obstacles MB artists face in receiving mental health care will assist health care providers in advocating for improved care in this setting.

Emergency psychiatric assistance: Black individuals’ perceptions of police and other factors that influence mental health service seeking.

Emergency psychiatric assistance: Black individuals’ perceptions of police and other factors that influence mental health service seeking.

A cross-sectional study of the relationship between frequency of cannabis use and psychiatric symptoms among people seeking mental health and addiction services in Nova Scotia (2019–21)

BackgroundCannabis use may be a modifiable risk factor for mental health problems; however, the role of cannabis use frequency in population seeking mental health and addiction services remains unclear. This study aimed to: 1) compare the prevalence and functional impact of psychiatric symptoms among frequent, infrequent, and non-users of cannabis; and 2) evaluate the associations between cannabis use frequency and functional impact of psychiatric symptoms in help-seeking individuals. MethodsData from the Mental Health and Addictions (MHA) Central Intake system in Nova Scotia, Canada was used. Participants aged 19–64 who received MHA Intake assessments from September 2019 to December 2021 with complete information about substance use were included (N = 20,611). Cannabis use frequency over past 30 days was categorized into frequent (>4 times a month), infrequent (≤4 times a month), and non-use. Psychiatric symptomatology consists of five domains: mood, anxiety, psychosis, cognition, and externalizing behaviors. Multivariate ordinal logistic regression was used to examine the associations between cannabis use frequency and functional impact of psychiatric symptoms. ResultsFrequent and infrequent cannabis users had a higher prevalence of psychiatric symptoms in each domain than non-users, while no significant differences were found between frequent and infrequent users. Frequent cannabis use was associated with greater functional impact of psychiatric symptoms in each domain compared to non-users, while infrequent use was only associated with greater functional impact of externalizing behaviors. ConclusionFrequent cannabis use is associated with increased prevalence and functional impact of psychiatric symptoms among adults seeking mental health services.

Contrasting ecological contexts among treatment-seeking military sexual assault survivors: Consideration of relationships with sexual and gender minority identification.

Survivors of military sexual trauma (MST) seeking mental health services may present with concerns extending beyond symptom relief. Attention to social, economic, and coping resource contexts is salient for care consideration. Although those identifying as sexual and gender minorities (SGM) are overrepresented among service members exposed to assaultive MST, research contrasting ecological resource variability among treatment seekers is limited. The present study delineates modifiable risk and protective factors that might be used to inform MST-related health care for Veterans, broadly, and SGM-identifying Veterans, specifically. Veterans (N = 493, 12.8% identifying as SGM) presenting for treatment secondary to military sexual assault completed a semistructured clinical interview and intake survey including demographic characteristics, diversity-related factors, and access to psychosocial resources. SGM/non-SGM-identifying groups were contrasted on individual-, interpersonal-, and community-level ecological characteristics. SGM-identifying Veterans were less likely to report access to sufficient financial resources and had double the prevalence rate of housing instability in contrast to non-SGM-identifying Veterans. No significant differences emerged in terms of past-year interpersonal violence exposure, endorsement of helpful spiritual beliefs, or availability of social support based on SGM identification. Findings underscore the importance of attending to the intersection of SGM identity and ecological factors that can influence Veterans' clinical presentation and treatment engagement. Recommendations for provision of MST services are made. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study.

Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support.

Elderly transgender mental health: Global and local challenges

ABSTRACT Elderly transgender mental health has been a neglected facet of mental health for many years. The current article reviews the global and local challenges faced when catering to elderly transgender mental health. These include trauma and stigma that may be faced when seeking mental health services, in addition to the stigma of belonging to the transgender community. There are many barriers in access to health-care services that have been highlighted, and there are factors such as social discrimination, victimization, hate crime, and domestic violence that add to the barriers. Lack of proper clinics that cater to their needs, improper coverage in health-care insurance, and lack of coverage of sex-change operations also add to the existing burden. Workplace issues and their impact on mental health along with stigma and workplace discrimination are also discussed. The review tries to give an overview of the issues faced, so that clinicians treating these populations are appraised of the same.

National Collegiate Athletic Association Coaches’ Beliefs Toward Seeking Mental Health Services for Themselves: Instrument Validation and Exploratory Investigation

While the environment in which National Collegiate Athletic Association coaches operate makes them susceptible to mental health issues, many do not seek professional help. The Reasoned Action Approach posits that attitudes, perceived behavioral control, and perceived norms shape intentions for help-seeking behaviors. This study was designed to: (a) validate two commonly utilized instruments measuring psychological help-seeking beliefs for use with National Collegiate Athletic Association coaches; (b) assess coaches’ attitudes, perceived behavioral control, and perceived norms toward seeking mental health services for themselves; and (c) examine differences in beliefs based on gender, race, coaching role, age, and coaching experience. N = 1,424 National Collegiate Athletic Association Division I, II, and III coaches participated. Confirmatory factor analyses indicated the Inventory of Attitudes Toward Seeking Mental Health Services provides valid and reliable measurements for participants’ beliefs toward seeking services for themselves. Participants reported moderately positive attitudes, perceived behavioral control, and perceived norms. Male coaches indicated significantly lower positive beliefs than female coaches.

Exploring Pathways to Care in the Zimbabwean Mental Health Sector

This study investigated pathways to care in mental health treatment in Zimbabwe. Survey method was used to gather data through interviews and focus group discussions. For a period spanning over one year, the researcher randomly interviewed service providers, clinic staff, patients, caregivers/parents and community leaders. 20 Patients and 40 parents/caregivers were randomly selected as they seek services while 80 urban clinic staff, 50 from farm clinics, 50 from peri-urban clinics. 20 major referral hospital staff and 10 ATR practitioners, 30 FBO practitioners were purposively sampled making a total number of 300 participants. Results from these encounters revealed that people seeking mental health services use more than one treatment mode. Others use two while the majority use all three. There are varying factors contributing to their choice of pathway to care. Some notable factors revealed were that demographic and socioeconomic characteristics as well as health status shape how one enters mental health care and the subsequent perceptions of the effectiveness of that chosen path. additionally, the pathway to mental health care is associated with perceptions about the effectiveness of treatment. Additionally, severity of a mental illness has a strong bearing on the choice of pathway to treatment. Findings also revealed that only the medical pathway is used during daylight while half consulted faith based healers during daytime. For ATR the majority visit clandestinely after consulting hospitals during the day. It was concluded that mental health service in Zimbabwe is provided by three means which constitute pathways to care. These are the medical model, the traditional healers and the faith based practitioners. Results were inconclusive as to the efficacy of these pathways to care since some are concurrently used. From the above conclusions, the following recommendations are proposed: multi sectoral collaboration should be encouraged, evidence based practices to be enforced and further research into FBOs and ATR efficacy as well as the correlation between these pathways to care.

Supplemental Material for Emergency Psychiatric Assistance: Black Individuals’ Perceptions of Police and Other Factors That Influence Mental Health Service Seeking

Supplemental Material for Emergency Psychiatric Assistance: Black Individuals’ Perceptions of Police and Other Factors That Influence Mental Health Service Seeking

ACT-Enhanced Behavior Therapy for a Hispanic Adult with Trichotillomania: A Case Report

Trichotillomania, also known as Hair-Pulling Disorder, is characterized by recurrent pulling out of one’s hair over brief episodes or sustained periods of time and results in hair loss. ACT-enhanced behavior therapy (A-EBT) has been shown to be an effective approach in the treatment of trichotillomania by promoting psychological flexibility around hair pulling urges and teaching stimulus control and habit reversal training. However, there is limited support of A-EBT for clients with an ethnic minority identity. This case report focuses on an adult, Hispanic female client, Luna (pseudonym), who received eight sessions of A-EBT for the treatment of trichotillomania. At post-treatment, Luna showed significant improvements in number of hairs pulled, trichotillomania specific psychological flexibility, depression and anxiety. Luna’s case highlights barriers to care such as potential resistance in seeking mental health services, the influence of family members’ beliefs on receiving mental health services, and the limited access to specialized treatment of trichotillomania.