Help-seeking attitude is one of the most frequently studied help-seeking perception constructs and has perhaps the richest measurement tradition of all help-seeking constructs. When studying the behavior of seeking help from a mental health professional, “attitude” is shorthand for “attitude toward seeking help from a mental health professional.”
The 29-item Attitudes Toward Seeking Professional Psychological Help scale (ATSPPH; Fischer & Turner, 1970) was the first help seeking attitudes instrument to see wide use. The ATSPPHS was not grounded in a theoretical framework and psychometric problems led to the development of the 10-item short form (ATSPPH-SF; Fischer & Farina, 1995), designed to produce a single total score. However, concerns with the unidimensionality, internal consistency (a type of reliability), and construct-irrelevant-variance have been raised about the ATSPPHS and ATSPPH-SF (Hammer et al., 2018). Seeking to address limitations of the ATSPPH-SF, Mackenzie, Knox, Gekoski, and Macaulay (2004) developed the 24-item Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS). However, concerns with construct underrepresentation, incongruence with the Theory of Planned Behavior, cross-cultural utility, and construct-irrelevant variance have been raised about the IASMHS (Hammer et al., 2018).
To address the aforementioned limitations of older help-seeking attitude instruments, Hammer and colleagues (2018) documented the development of, and initial psychometric evidence (e.g., reliability, validity) for, the 9-item Mental Help Seeking Attitudes Scale (MHSAS) that uses a 7-point semantic bipolar scale (-3 to +3) The MHSAS has been used in 60+ empirical studies. Bian and colleagues (2023) conducted a systematic review of patient-reported outcome measures (PROM) of mental health help-seeking attitude and the MHSAS was the only instrument whose overall quality was rated as “class A” out of the 13 PROMS that were assessed. The MHSAS measures attitude in a manner consistent with the definition of attitude specified by the reasoned action tradition, including the Theory of Reasoned Action, Theory of Planned Behavior, and Integrated Behavioral Model of Mental Health Help Seeking (IBM-HS).
Hammer and colleagues (2024) made a series of formatting adjustments to the MHSAS to improve the instrument and found additional evidence of satisfactory psychometric performance, including using an adjusted 7-point scale (1 to 7).
Most recently, Hammer and colleagues (2026) synchronized the language of six measures (i.e., Mental Help Seeking Attitude Scale [MHSAS], Perceived Norm: Injunctive Scale [PN:IS], Perceived Norm: Descriptive Scale [PN:DS], Personal Agency: Autonomy Scale [PA:AS], and Personal Agency: Capacity Scale [PA:CS], Mental Help Seeking Intention Scale [MHSIS]) to a shared definition of mental health help-seeking behavior and provided evidence of reliability and validity for these six synchronized measures. This battery of measures assesses central constructs of the Integrated Behavioral Model of Mental Health Help Seeking (IBM-HS), including the three mechanisms (attitude, perceived norm, personal agency) and intention. This 2026 version of the MHSAS consists of 9 items and uses a 6-point Likert scale (1 to 6), and measures attitude in a conditional manner by incorporating a hypothetical mental health concern vignette scenario into the instrument instructions. Dr. Hammer recommends use of this 2026 version of the MHSAS for all future projects.