OBJECTIVE: To study the role of religious advisors in mental health problems in six European countries and to compare it to data from the USA. METHODS: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD) study, a cross-sectional study, conducted in Belgium, France, Germany, Italy, the Netherlands and Spain. 21,425 individuals, 18 and older, were interviewed with the Composite International Diagnostic Interview 3.0. Findings were compared to the National Comorbidity Survey (NCS) and replication of the NCS (NCS-R) in the US. RESULTS: In ESEMeD, 0.6% of individuals (0.3% exclusively) sought help from religious advisors concerning mental health problems during the previous year, compared to 2.6% in NCS and 3.4% (for human services) in NCS-R in the US. Among those using any form of service, 6.9% consulted religious advisors (12.2% in Germany to 2.1% in Spain) compared to 18.8% in the US. Being younger (less than 25 years old), being older (more than 64) and religiosity are associated with the use of religious advisors, whereas being a student is associated with a lower probability. CONCLUSIONS: Seeking help from religious advisors for mental health problems varies dramatically among ESEMeD countries. Except for Germany, organised religion in the ESEMeD countries could not be considered as an alternative.