Abstract
Identifying the barriers to people's utilization of psychological services has always been a concern for mental health professionals and experts. Therefore, the present study aims to conduct a comprehensive review of the prominent cultural and social barriers to receiving psychological services. This study was conducted as a narrative review to extract practical and comprehensive knowledge regarding identifying major cultural and social barriers to accessing psychological services. The literature search focused on relevant studies in reputable national and international scientific databases up to 2023, and the obtained findings were examined using quantitative, qualitative, and analytical approaches. The results of the present study revealed four key cultural and social factors as barriers to psychological service utilization: societal stigma and labeling, religious beliefs, collectivism-individualism, and poverty. This study concludes that stigma and labeling, religious beliefs, collectivism, poverty, and financial difficulties play an inhibitory role in people's utilization of psychological services. Therefore, mental health stakeholders and policymakers should consider these factors and implement effective interventions to facilitate public access to psychological services.

Introduction
Psychological disorders are among the most prevalent illnesses affecting people worldwide, contributing significantly to the global burden of disability (Tse & Haslam, 2023). These disorders are clinically characterized by significant distress or impairment (Stein et al., 2021). In recent years, the prevalence of psychological disorders has been increasing in societies, highlighting the need for seeking help from others to prevent and resolve psychological problems (Seven et al., 2021; Colizzi et al., 2020). Studies have demonstrated that mental disorders in countries such as Iran, Bahrain, and Qatar carry a high disease burden (Nourbala et al., 2020). Individuals can utilize formal resources such as mental health professionals to help resolve their problems (Dasci et al., 2022). Research evidence indicates that psychological services and treatments are effective in treating and improving psychological symptoms and problems (Spada et al., 2020; Barnett et al., 2021). Despite the increasing prevalence of psychological disorders and their negative impact on various aspects of human life, as well as the high efficacy of psychological services, many people still hold negative attitudes toward psychological disorders and are less likely to seek treatment, with only about 10% of those in need seeking treatment (Al-Khatib et al., 2023; Doan et al., 2020; Yoshikawa et al., 2017).
The persistence and exacerbation of psychological disorders without treatment can undermine functioning across various life domains (Dembic, 2023). Individuals with psychological disorders experience significant hopelessness and low life satisfaction (Yildirim et al., 2023), face numerous behavioral and emotional problems (Sanchez et al., 2021), and have poor quality of life (Choo et al., 2019), yet they show little inclination to seek and utilize psychological services, which can create numerous problems for both individuals and society (Mohorakeye & Birayaza, 2012). Therefore, identifying influential factors related to the use of psychological services appears essential. A search of articles in this field reveals that various factors and phenomena affect the utilization of psychological services, with attitudes and cultural-social factors playing a prominent role in attracting researchers' attention (Chen et al., 2022). Salinas et al. (2020) found that negative cultural beliefs about patients with psychological disorders constitute a barrier to receiving psychological services and treatment adherence. Culture can be defined as a set of practices, symbols, values, and ideals constructed and shared by a society that can operate at both individual and social levels (Causadias et al., 2018). Cultural attitudes significantly influence mental health and related issues worldwide (Ahmad & Koncsol, 2022). In recent decades, numerous researchers have sought to identify factors affecting the use of psychological services, with many studies examining the role of culture in service utilization and treatment-seeking behaviors, sometimes yielding contradictory results. Given the accumulation of studies and the divergent findings, conducting a comprehensive study that can synthesize previous research findings and resolve disagreements among researchers is essential. This narrative review aims to examine the role of cultural and social attitudes in the use of psychological services.

Research Methodology
This study is a narrative review conducted to collect and analyze key concepts related to cultural-social barriers in the use of psychological services. Unlike systematic reviews, the primary aim here was to present a comprehensive picture of the topics discussed in selected articles without using specific criteria for article selection and screening. The volume of academic publications is rapidly increasing, making it increasingly difficult to keep up to date and define the boundaries of each specific field of science. However, emphasizing diverse review studies on broad and scattered areas of science helps researchers in this updating process (Basilio et al., 2022). Accordingly, this study was conducted as a narrative review with the aim of extracting practical and comprehensive knowledge from the accumulated knowledge in the scientific field regarding the role of attitudes and cultural and social factors in the use of psychological services. The researchers searched Scopus, Web of Science, and Sid databases, along with the Google Scholar search engine, to collect relevant scientific studies from 2015 to 2023. They extracted relevant and reliable domestic and international articles and, after thoroughly reviewing the content and texts of these articles, categorized and described the data obtained from the discussion and conclusion sections of studies relevant to the research objective. Subsequently, the most influential factors frequently addressed in domestic and international studies were identified and organized into appropriate categories.

Discussion
Stigma and Labeling
One of the factors affecting the use of psychological services, influenced by a society's culture, is the concern about stigma or labeling by society (Fa'alogo-Lilo & Cartwright, 2021). Stigma or labeling refers to the discrediting, devaluing, and shaming of an individual due to possessing certain characteristics, which can lead to negative social experiences such as isolation, rejection, marginalization, and discrimination (Subu et al., 2021). Research by Molloy et al. (2020) indicated that each society's culture significantly affects concerns about stigma or labeling of psychological disorders. Consequently, concern about labeling or social stigma causes individuals to show less inclination to seek and use psychological services (Kader et al., 2023). Babić et al. (2017) believe that social stigma or labeling associated with mental illness that may be attributed to individuals leads to social isolation and marginalization of affected individuals, creating feelings of alienation that can negatively influence their decision-making regarding treatment and use of mental health services. Stigma operates through two fundamental concepts: public stigma and personal stigma or self-labeling. Public stigma can lead to personal stigma or self-labeling. Perceptions such as "people with mental illnesses are dangerous, incompetent, and less productive," "people with mental disorders are unsuitable for employment," and "others would not want to work with someone with a mental illness" exemplify public and social stigma. Conversely, society's perceptions and behaviors toward mental illness cause individuals to internalize these assumptions, leading them to think about themselves based on society's perceptions and exhibit expected behaviors, thus confirming people's beliefs and assumptions, resulting in the individual's ostracization. The various labels attached to individuals due to mental illness are so demeaning and distressing that individuals, fearing disclosure, lose motivation to seek psychological services and initiate treatment (Alat et al., 2023).
Religion and Religious Beliefs
Religion and religious beliefs, as important aspects of cultural identity, play a significant role in defining mental illness and evaluating appropriate actions for addressing and treating these illnesses (Moreno et al., 2022). Overall, religion and spirituality have an important, meaningful, and relevant relationship with mental health, such that religious individuals can interpret various daily activities adaptively, employ numerous calming activities in their lives, experience less depression and anxiety, and enjoy greater life satisfaction due to having religious meaning in life (Coelho-Júnior et al., 2022; Khan, 2019). Despite their effective role in preventing the development of psychological disorders, religion and religious beliefs may act as barriers to utilizing psychological services after the emergence of psychological problems (Hove, 2023). Religion influences many different aspects of individuals' decision-making processes. Some studies suggest that religion may affect how individuals perceive mental illness and whether and through what means they seek help for psychological problems (Syafitri & Rahmah, 2021; Carey et al., 2021). Research has shown that certain aspects of religiosity, such as the level of fundamentalism or conservative beliefs, perceived conflict between psychology and religion, and value disconnect between mental health professionals and religious individuals, are negatively correlated with attitudes toward psychotherapy and willingness to seek professional psychological help. Religious individuals show greater inclination to seek help from religious figures rather than mental health professionals. Religious individuals in the United States and other Western cultures exhibit negative attitudes toward seeking mental health services due to cultural beliefs, lack of knowledge, and perceived stigma (Tanhan & Francisco, 2019). Furthermore, religious individuals hold misconceptions and negative attitudes regarding mental illness, which can be a vital factor in the avoidance and reduction of treatment-seeking behaviors for psychological services (Dardas & Simmons, 2015).
Individualism and Collectivism
Another factor that appears to influence the use of psychological services is collectivist and individualist culture. Collectivist culture is one in which strong emotional bonds exist between individuals, emphasizing awareness and personal identity as part of a group and prioritizing common goals over personal interests (Natalia & Fridari, 2022). Regarding the relationship between collectivist and individualist cultures, researchers have found that cultural factors, including individualist and collectivist cultures, can significantly influence individuals' attitudes toward seeking psychological help (Holmes & Gallou, 2014; Zhiano et al., 2021). Individuals in collectivist cultures show greater adherence to psychological treatments compared to individualist individuals. However, while treatment adherence is higher in collectivist societies, this adherence occurs after individuals have already consulted mental health professionals. Prior to consulting professionals and receiving psychological services, collectivist culture can act as a deterrent and barrier (Yamawaki & Green, 2020). In collectivist cultures, there is a strong emphasis on conforming to social norms, encouraging members to devalue and label anything perceived as deviating from norms. Consequently, collectivist cultures have greater concerns about mental illness and are more involved in stigmatizing themselves and others (Yu et al., 2021). Individual beliefs about stigma in a culture can limit the likelihood of seeking help from mental health professionals and influence the probability of seeking professional care for mental health problems (Bracke et al., 2019). Additional reasons for the role of collectivist cultural values in treatment-seeking include that these societies show greater tendency to suppress and limit their emotions, have less inclination to express and share emotions—especially regarding mental health issues—and individuals in collectivist cultures, compared to individualist cultures, hold negative attitudes toward labeling associated with mental health issues due to fear of social rejection (Mohankumar, 2022; Chen et al., 2015). These factors can result in lower inclination to use psychological services and seek help from mental health professionals in collectivist societies.
Poverty
Poverty, financial problems, and the high cost of mental health services have long been recognized as factors influencing the non-use and non-seeking of mental health services (Mohorakeye & Brasaza, 2022). A study by Kataoka et al. (2002) found that 80% of children from poor and low-income families in need of mental health services received mental health services even 12 months after identifying their illness and treatment need. Among those living in poverty and in need of mental health care, fewer than 15% receive psychological services and care, and very few of these individuals living in poor communities continue treatment after services are provided (Hodgkinson et al., 2017). Parents and families with lower socioeconomic status, including poverty and financial problems, may face difficulties in providing frequent and ongoing professional mental health care to family members with psychological problems, with approximately 17% of reasons for not seeking and using mental health services attributed to poverty and related problems (Saade et al., 2023). Various financial barriers, including inability to pay costs, health insurance that does not cover any mental health treatment or counseling, or insurance that inadequately covers treatment or counseling, can affect the use and seeking of mental health services (Mojtabai, 2021). Clients with psychological problems, due to financial and economic inability, may show less inclination to use mental health services. The high cost of therapy sessions, low family income, and financial inability to afford transportation to access psychological services act as barriers preventing clients from benefiting from mental health services when needed (Aldalaykeh, 2019; Knourek, 2021; Mokri, 2019).

Conclusion
The findings of this study demonstrate that cultural and social factors play a significant role as either facilitators or barriers in the seeking and utilization of mental health services. Four major cultural-social factors were identified: stigma or labeling by society, religion and religious beliefs, individualism/collectivism, and poverty. These factors have been consistently confirmed across multiple quantitative and qualitative studies as influential in the use or non-use of psychological services. Based on these findings, mental health professionals and policymakers should consider these factors when designing interventions and policies to facilitate public access to psychological services. Recommendations include: increasing awareness among conservative religious individuals about professional mental health treatment; implementing interventions to reduce stigma and labeling concerns in societies where these issues are prevalent; addressing the reluctance to seek psychological services in collectivist societies by reducing fears and concerns; and implementing practical measures in impoverished communities to improve access to mental health services. While the identified factors are not culture-specific and have been observed across various societies, future researchers are encouraged to extract culture-specific factors with a focus on domestic studies and to consider this important issue in their original research. Ultimately, the findings highlight the need for culturally sensitive approaches to mental health service delivery and the importance of addressing systemic barriers to ensure equitable access to psychological care.