The Mental Help Seeking Attitudes Scale (MHSAS) was developed by Dr. Joseph H. Hammer, Dr. Michael C. Parent, and Douglas A. Spiker. The paper detailing the development, reliability, and validity evidence for the MHSAS score is published in the peer-reviewed academic Journal of Counseling Psychology. You can download a pre-press PDF of the paper for free or access a typeset PDF of the paper via your institution. To request permission to use, or obtain a copy of, the instrument, scroll to the bottom of this page.
Here is the APA-style citation for the paper and instrument:
Hammer, J. H., & Parent, M. C., & Spiker, D. A. (2018). Mental Help Seeking Attitudes Scale (MHSAS): Development, reliability, validity, and comparison with the ATSSPH-SF and IASMHS-PO. Journal of Counseling Psychology, 65, 74-85. doi: 10.1037/cou0000248
What does the MHSAS measure?
The MHSAS is a 9-item instrument designed to measure respondents’ overall evaluation (unfavorable vs. favorable) of their seeking help from a mental health professional if they found themselves to be dealing with a mental health concern. A higher score indicates a more positive attitude toward seeking help.
How do I administer the MHSAS?
The MHSAS can be administered via an electronic/internet format or a paper & pencil format.
How do I score the MHSAS?
Research evidence from two studies (i.e., Study 1 and Study 2 of Hammer, Parent, & Spiker, 2018) suggests that the MHSAS is unidimensional. Therefore, only a single MHSAS total score using the nine items should be calculated and interpreted. You can download SPSS Syntax to Score the MHSAS to make cleaning and scoring easier, or download sample Mplus Syntax to Model a Latent MHSAS Factor (see below for links).
The MHSAS score is created by calculating he mean score across all 9 items, after reverse scoring items 2, 5, 6, 8, and 9 (so that a high score on all items indicates a more favorable attitude). The resulting mean score should range from a low of 1 to a high of 7. Per Parent’s (2014) 20% recommendation, a mean score should only be calculated for those respondents who answered at least 8 of the 9 items. See Schlomer et al. (2010) for information on best practices regarding the handling of missing item-level data. More detailed instructions on scoring the MHSAS are provided with the copy of the MHSAS (see below).
How do I interpret the MHSAS score?
The MHSAS score is a measure of help seeking attitudes (Hammer, Parent, & Spiker, 2018), as it is known in the literature on professional mental health treatment seeking behavior. More precisely, the MHSAS score is a numerical quantification of the degree to which a person reports having a negative versus positive attitude toward their seeking help from a mental health professional.
Can I put respondents into categories based on their MHSAS score?
Some instruments allow researchers to place respondents into categories (e.g., the Kessler-6 can be used to categorize respondents as low distress, moderate distress, and severe distress). To ensure the validity of these categories, the categories and the associated cutoff scores (i.e., cut points, cut scores) that help place respondents into the different categories, must be empirically established. Such studies have not yet been done on the MHSAS, so it is not yet possible to place respondents into different attitude categories based on their MHSAS score. It is not uncommon for some users of the MHSAS to create and justify their own set of MHSAS categories on the basis of logic, theory, or empirical data they have collected. However, we encourage you to be cautious if you choose to do this, as you must be prepared to provide evidence that your suggested categories are valid and reliable. Furthermore, cut scores may vary across the population of interest, so cut scores developed with one population may not generalize to other populations, with reinforces the importance of caution when adapting cut scores from other published studies that used the MHSAS.
What is the factor structure of the MHSAS?
Hammer, Parent, and Spiker (2018) found evidence that the 9 items of the MHSAS conform most closely to a unidimensional measurement model. This means that most of the 9 items’ variance was accounted for by a single evaluative “help seeking attitudes” factor.
What evidence exists regarding the reliability and validity of the MHSAS score?
Results across Hammer, Parent, and Spiker’s (2018) two studies provide initial support for the reliability and validity of the MHSAS score within community-dwelling U.S. adult samples.
Regarding internal structure evidence of validity, IRT analysis was used to select nine items that discriminate among individuals at different levels (i.e., unfavorable, neutral, or favorable attitudes) of the construct. A unidimensional measurement model accurately reproduced the observed covariation among the nine MHSAS items in both Study 1 and Study 2, providing initial support for the structural generalizability of the MHSAS.
Regarding reliability, the MHSAS items demonstrated internal consistency across both studies, and temporal stability over three weeks. Test content evidence of validity was also provided via feedback from experts and community adults, who rated the MHSAS instructions and items as sufficiently clear, relevant, and representative of the intended construct.
Validity evidence regarding relationships with conceptually related constructs was also presented. Convergent evidence of validity was demonstrated when the MHSAS score demonstrated the hypothesized relationships with the following variables: subjective norms, perceived behavioral control, intention, public stigma, self-stigma, anticipated risks and benefits, and Fischer and Farina’s (1995) Attitudes Toward Seeking Professional Psychological Help scale – Short Form (ATSPPH-SF) score and the Psychological Openness subscale score of Mackenzie, Knox, Gekowski, & Macaulay’s (2004) Inventory of Attitudes Toward Seeking Mental Health Services (IASMHS-PO). Incremental evidence of validity was demonstrated when the MHSAS demonstrated the ability to account for unique variance, beyond that accounted for by the ATSPPH-SF and IASMHS-PO, in intention to seek help. Finally, known-group evidence of validity was provided when women and those who had previously sought mental health services were shown to report more favorable attitudes than did their demographic counterparts.
Further evidence of reliability and validity has been published by other scholars (see the “What studies have used the MHSAS” section below). Of note, 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.
What evidence exists regarding the measurement equivalence/invariance (ME/I) of the MHSAS score?
Results from Hammer, Parent, and Spiker’s (2018) ME/I analyses indicated that the MHSAS demonstrated strong ME/I (i.e., invariance of all factor loadings and intercepts) across gender, past help seeking experience, and psychological distress. This suggests that, for these key help seeking groups, the MHSAS had a similar theoretical structure and meaning, relations between the MHSAS and external variables could validly be compared, and mean differences in the MHSAS score could validly be compared.
What are some current limitations of the MHSAS?
All instruments have limitations. The MHSAS is no exception. I believe it is important that potential users of the MHSAS know what these limitations are so that they can make informed choices about how to use the MHSAS. These limitations also present researchers with opportunities to conduct and publish new research studies on the psychometric properties of the MHSAS. Feel free to reach out to me if you are interested in conducting such a study with my help.
- First, our findings are tied to the nature of our sample of community adults living in the USA. While one-third of the participants in our sample identified as People of Color, our cell sizes for each racial/ethnic group were not large enough to allow properly-powered ME/I analyses. These analyses are an important next step to verifying the conceptual and measurement equivalence of the attitudes construct, as operationalized by the MHSAS. Until these analyses are conducted, the appropriateness of using the MHSAS to make racial/ethnic comparisons remains an open question. The appropriateness of the MHSAS for use with these other populations also remains an open question (this is not an exhaustive list): children and adolescents, those with less formal education or low socioeconomic status, specific clinical/medical populations, those with little exposure toward mental healthcare specifically and the healthcare system generally, and those who reside in other countries or are not fluent in American English.
- Second, test-criterion evidence of validity would provide additional support for the utility of the MHSAS. Specifically, comparing the ability of the MHSAS, ATSPPH-SF, and IASMHS-PO to predict future help seeking behavior would provide important predictive evidence of validity for these help seeking attitudes instruments.
- Third, the degree of fit of the unidimensional measurement model for the MHSAS across diverse samples is of central importance. It is possible that, in future studies, some of the nine MHSAS items will evidence correlated residuals (i.e., the desire for certain doublets or triplets of items to correlate with each other even after the overall factor has a chance to account for shared variance among the nine items), which could produce local model misfit and therefore global model misfit. If such a reality comes to pass, our research team will seek to refine the MHSAS to remove this limitation. If you administer the MHSAS and find evidence of poor unidimensional model fit, please contact Dr. Joseph Hammer.
- It is important to know what the MHSAS does, and does not, measure. The MHSAS assesses help seeking attitudes related to seeking help from mental health professionals as a group (e.g., psychologists, counselors, social workers, psychiatrists). As it is currently constructed, the MHSAS is not designed to help researchers detect differences in attitudes toward certain types of mental health professionals versus other types of mental health professionals. Nor is it designed to measure attitudes toward seeking help for mental health concerns from medical physicians, religious professionals (e.g., priests, rabbis), or informal help seeking sources (e.g., family, friends, relatives, teachers). Per the Standards for Educational and Psychological Testing, researchers interested in using the MHSAS to measure attitudes toward these other help seeking sources would need to first adapt the MHSAS and then provide evidence of reliability and validity for this adapted version of the MHSAS, prior to using it for the desired application.
What studies have used the MHSAS?
As of June 2023, this Google Scholar search indicates that the MHSAS has been mentioned 176 times. Here is an incomplete list of Published Papers using Hammer Instruments (check the MHSAS tab), some of which provide further psychometric evidence of reliability and validity of the MHSAS. If you published a study that should be added to this list, please contact me.
May I translate the MHSAS into another language?
Yes, you may translate it. If your publish a peer-reviewed journal article that documents evidence of reliability and validity for the translated version, I would be happy to provide a link to your published paper and/or a downloadable copy of the translated version of the instrument on this webpage.
When translating the MHSAS, please follow published best practices for translating self-report instruments. A poor translation can lead to a translated instrument that fails to measure what it is supposed to measure. Here are some helpful resources on this topic:
- A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus (Epstein et al., 2015) – read this article first.
- Cross cultural adaptation & psychometric validation of research instruments: A methodological review (Arafat et al., 2016) – read this article second.
- Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline (Sousa & Rojjanasrirat, 2011)
- Cross cultural adaptation & psychometric validation of instruments: Step-wise (Yasir, 2016)
- Cross-cultural adaptation and validation of psychological instruments: Some considerations (Borsa et al., 2012)
- Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations (Gjersing et al., 2010)
- Operationalizing the cross-cultural adaptation of epidemiological measurement instruments (Reichenheim & Moraes, 2007)
- Guidelines for the process of cross-cultural adaptation of self-report measures (Beaton et a., 2000)
- Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines (Guillemin et al., 1993)
How do I obtain a copy of the MHSAS?
Before using the MHSAS, we ask that you obtain permission to use the MHSAS by filling out the online Hammer Instrument Permission Form.
The MHSAS is free for use in nonprofit academic research by those who have (or are being supervised by a professor who has) an advanced professional degree in a mental health profession and relevant training in the use of assessment instruments. Those seeking permission to use the MHSAS for other purposes (e.g., commercial, profit, clinical, republication) may be charged a fee. The authors retain the copyright for the instrument.
Please note that any modifications/adaptations to the MHSAS may affect the reliability and/or validity of results. For this reason, modification of the MHSAS is generally discouraged, is the sole responsibility of the researcher, and must be clearly described in any published or printed materials mentioning the modified version of the MHSAS.
You can download the SPSS Syntax to Score the MHSAS to make cleaning and scoring easier. You can also download sample Mplus Syntax to Model a Latent MHSAS Factor, which will need to be adjusted to work for your specific data file.
You can view how the MHSAS looks to participants when properly implemented within a Qualtrics.com online survey. You can also download this .qsf file, which will let you import a copy of the MHSAS as a standalone survey into your Qualtrics.com researcher account. Here’s Qualtrics.com’s FAQ regarding importing and exporting files.
Finally, below is a step-by-step video example of how I created a Qualtrics online survey containing the MHSAS as well as the Mental Help Seeking Intention Scale, which measures another important help seeking factor from the Theory of Planned Behavior.
Hint: If you watch the video on the YouTube website (by starting the video and then clicking on the “YouTube” icon in the lower right hand corner of the video window), you’ll be able to see a list of topics I talk about in the video description; clicking on a given topic will fast forward you to that part of the video. You are encouraged to listen to only the parts of the video that you’re interested in.