To the Editor: The article in the July issue by Bruwer and colleagues (1) described attitudinal and structural barriers to mental health care and predictors of treatment dropout in South Africa. The study found that the most commonly cited reason for not seeking care was a low perceived need for treatment and that lack of health insurance was an important reason for treatment dropout. Similar results were found by Sareen and colleagues (2) in a study that compared the United States, Ontario, and the Netherlands. Remarkably, fear of stigmatization was not frequently cited as a reason for not seeking care in the studies. However, it should be noted that these studies did not include persons with more severe psychiatric disorders, such as psychosis.