People with mental illness (PWMI) often internalise negative beliefs (self-stigma) or anticipate external sources of stigma (perceived stigma). This study examines how the two types of stigma affect the willingness to communicate for help – such communication is a vital aspect of good patient care and treatment outcome. Seventy-two participants from different ethnic backgrounds who had experienced mental illness responded to an online survey about their level of agreement with statements reflecting self- and perceived stigma and their willingness to disclose to various help sources. Face-to-face interviews with 17 of these respondents provided a deeper understanding of how stigma affected their help-seeking communication. The quantitative results seemed to suggest that self-stigma has a stronger negative correlation with willingness to seek help. Respondents preferred disclosing to friends above family members and health professionals. The results highlight the importance of building resilience to reduce self-stigma and thereby increase help seeking. Given the different ethnic backgrounds of the participants, there emerged some multicultural issues that would seem to contribute to persisting mental illness stigma. These and any cultural differences are discussed.

This thesis examines the role of patient and doctor perspectives in primary care depression management. The analytical term chosen to explore these perspectives is Kleinman's explanatory model (EM), defined as "notions about an episode of sickness and its treatment that are employed by all those engaged in the clinical process" (1980, p. 105). This research is exploratory and focuses mainly on patients, with input from a small number of general practitioners (GPs).I examine self-stigma in depression patients because there has been an attempt in recent years to reduce stigma by describing depression as a medical condition like diabetes. This may have decreased some public stigma, but the association between biomedical explanations for depression and patient self-stigma has not been studied in-depth. Self-stigma is the internalisation of negative stereotypes and prejudices about having mental illness and it can inhibit help-seeking and outcomes more than public stigma. Another factor that can influence depression outcomes is the therapeutic relationship between patient and their doctor. Studies report empathy and good communication as Quantitative analysis methods mainly consisted of non-parametric tests for differences between groups and strength of correlations. Interviews were analysed manually and with textual analysis software Leximancer.RQ1 results showed that most participants had a strong or moderate belief about whether biomedical and/or psychosocial factors caused their depression, and most EM beliefs did not change over time. RQ2 results indicated that biomedical belief was associated with lower helpseeking inhibition but also greater alienation. RQ3 results highlighted that endorsement of GPpatient cooperation was strongly positively correlated with communication effectiveness. Patient interviews yielded exemplars to illustrate these findings. RQ4 results from a paired study (n = 29) suggest that the GPs were aware of and concordant with their patient's EMs. Awareness appears to be more important in determining recovery than concordance. Incidentally, GP interviews showed that doctors mostly accorded importance to knowing their patient's EM but concordance was seen as less crucial.This thesis gives new understanding about depression EM beliefs that are associated with lower patient self-stigma and more effective GP-patient communication. Results from this research on awareness-concordance were not generalisable due to the small sample size, but future work with larger samples will undoubtedly yield more insights into the importance of EMs in primary care depression management.