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Reactions to symptoms of mental disorder and help seeking in Sabah, Malaysia.Abstract Background: A better understanding is needed about how people make decisions about help seeking. Materials: Focus group and individual interviews with patients, carers, healthcare staff, religious authorities, traditional healers and community members. Discussion: Four stages of help seeking were identified: (1) noticing symptoms and initial labelling, (2) collective decision-making, (3) spiritual diagnoses and treatment and (4) psychiatric diagnosis and treatment. Conclusion: Spiritual diagnoses have the advantage of being less stigmatising, giving meaning to symptoms, and were seen to offer hope of cure rather than just symptom control. Patients and carers need help to integrate different explanatory models into a meaningful whole.