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• Despite the high prevalence of mental health problems and disorders that develop in adolescence and early adulthood, young people tend to not seek professional help. Young men and young people from Indigenous and ethnic minority groups tend to be those most reluctant to seek help. • Young people are more inclined to seek help for mental health problems if they: • have some knowledge about mental health issues and sources of help; • feel emotionally competent to express their feelings; and • have established and trusted relationships with potential help providers. • Young people are less likely to seek help if they: • are experiencing suicidal thoughts and depressive symptoms; • hold negative attitudes toward seeking help or have had negative past experiences with sources of help; or • hold beliefs that they should be able to sort out their own mental health problems on their own. • Young people may seek help through talking to their family and friends, with family being more important for younger adolescents, and friends and partners becoming more influential later on. • The professionals most likely to act as gatekeepers to mental health services for young people are school counsellors, general practitioners, and youth workers. • Increasingly, Internet‐based information and interventions are being used to engage young people in the help‐seeking process.
MJA Volume 187 Number 7 1 October 2007 S35
The Medical Journal of Australia ISSN: 0025-
729X 1 October 2007 187 7 S35-S39
©The Medical Journal of Australia 2007
Getting there: proto-psychiatry
he reluctance of young people to seek professional help for
mental health problems is increasingly acknowledged as a
challenge to effective early intervention approaches. Engag-
ing in appropriate help is widely recognised as a generic protective
factor, and early treatment and prevention are vital during adoles-
cence and young adulthood (12–24 years) because of the high
prevalence of mental health problems at this stage of life. A recent,
large study from the United States reported that half of all life-long
mental disorders start by 14 years of age, and three-quarters by 24
years of age.
In Australia, the National Survey of Mental Health
and Wellbeing (NSMHWB) found a prevalence of mental disorder
of 27% for those in the 18–24-year age range.
While young
people have the greatest need for mental health interventions, they
are the least likely to seek help.
Reluctance to seek professional help
A wide range of studies, nationally and internationally, attest to
young people’s reluctance to seek professional mental health care.
For example, a school-based survey of 11 154 Norwegian youth
aged 15–16 years reported that, even at the highest symptom
levels for anxiety and depression, only a third had sought profes-
sional help.
Similarly, the most recent national survey data for
Australia show that only 29% of children and adolescents with a
mental health problem had been in contact with a professional
service of any type in a 12-month period.
In a Queensland study
of 3092 young adults aged 15–24 years, 39% of the males and
22% of the females reported that they would not seek help from
formal services for personal, emotional or distressing problems.
Young men tend to be even more reluctant to seek help than
young women. In the Queensland study mentioned above, 30% of
males, compared with only 6% of females, reported they would
not seek help from anyone.
While the sex difference in help-
seeking varies according to type of problem and source of help,
greater unwillingness is shown by young men.
This is of special
concern partly because of the substantially higher rates of com-
pleted suicide in men.
Young people who are Aboriginals or Torres Strait Islanders or
from other cultural and linguistic minority groups may be even
less likely to voluntarily seek professional help when needed.
There are very few studies specifically of help-seeking for these
population groups, and we have no knowledge of the process of
help-seeking among young people from ethnic minority groups.
This is a particular problem, given evidence of a very high level of
unmet need for Aboriginal and Torres Strait Islander young
and of reluctance to voluntarily seek help from mental
health services among people from some cultural and linguistic
It has been argued that the key to increasing access to mental
health services by Indigenous people is greater integration of
cultural and clinical competencies at both a system and practi-
tioner level.
For example, at the engagement level, introductions
between practitioners and Indigenous clients should recognise the
importance of land, country and genealogy, along with potential
barriers associated with language groups or tribal boundaries.
Forms of questioning that are open-ended, positively phrased, and
focus on narrative have also been suggested.
However, better
understanding of help-seeking processes and preferences of people
from Aboriginal and Torres Strait Islander backgrounds is urgently
When young people do seek help
Help-seeking is not a simple process of experiencing psychological
distress and seeking help. Although awareness of a problem (by
self or others) is a starting point, the symptoms of mental health
problems and mental disorders play a smaller role than might be
expected in prompting help-seeking.
A wide range of other
factors are involved, including appraisal of a problem as something
to seek help for, willingness to seek help and social norms that
encourage such behaviour, access to appropriate services, and
choosing a source of help.
When and how do young people seek professional help
for mental health problems?
Debra J Rickwood, Frank P Deane and Coralie J Wilson
Despite the high prevalence of mental health problems and
disorders that develop in adolescence and early adulthood,
young people tend to not seek professional help. Young men
and young people from Indigenous and ethnic minority
groups tend to be those most reluctant to seek help.
Young people are more inclined to seek help for mental
health problems if they:
¾ have some knowledge about mental health issues and
sources of help;
¾ feel emotionally competent to express their feelings; and
¾ have established and trusted relationships with potential
help providers.
Young people are less likely to seek help if they:
¾ are experiencing suicidal thoughts and depressive
¾ hold negative attitudes toward seeking help or have
had negative past experiences with sources of help; or
¾ hold beliefs that they should be able to sort out their
own mental health problems on their own.
Young people may seek help through talking to their family
and friends, with family being more important for younger
adolescents, and friends and partners becoming more
influential later on.
The professionals most likely to act as gatekeepers to mental
health services for young people are school counsellors,
general practitioners, and youth workers.
Increasingly, Internet-based information and interventions are
being used to engage young people in the help-seeking
MJA 2007; 187: S35–S39
S36 MJA Volume 187 Number 7 1 October 2007
Recent reviews of studies about help-seeking emphasise the
importance of distinguishing between individual and structural
determinants of young people’s help-seeking behaviour.
ual determinants include factors such as mental health literacy,
attitudes and perceived stigma. Structural determinants comprise
family, school or community support systems, referral pathways,
health system structures and payment systems. Individual and
structural factors interact to determine when and how young
people seek and access help for mental health problems.
Mental health literacy and emotional competence
Young people are more likely to seek help when they recognise
that they have a mental health problem and have the knowledge,
skills and encouragement to seek help (see Kelly et al, page S26).
Mental health literacy comprises the ability to recognise mental
health problems; knowledge and beliefs about risks, causes and
effective treatments; and knowledge of how to seek mental health
information and services.
Lack of recognition of mental health
problems among young people
and their parents
is a major
“filter” to help-seeking. Poor mental health literacy is common
among young Australians, particularly adolescent boys, and is a
significant barrier to professional help-seeking.
More specifically, a certain level of emotional competence is
required to seek mental health help. When young people do not
know how to identify and describe emotions, or manage their
emotions in an effective and non-defensive manner, this impedes
On average, this competence appears less devel-
oped in young men.
Established and trusted relationships
For all types of health and mental health problems, if young people
want to talk to anyone, it is generally someone they know and
Consequently, they are more likely to seek help from their
friends and family for personal and emotional problems than from
other sources, including mental health professionals.
young people do seek professional help, it is from the more
familiar sources — family doctors and school-based counsellors.
When young people don’t seek help
Suicidal thoughts
Suicidal thoughts are quite common during adolescence and have
been shown to have a significant negating effect on help-seeking
In two Australian studies using non-clinical samples of
university students
and adolescents,
young people’s intentions
to seek help decreased as their level of suicidal ideation increased,
and they became more likely to indicate that they would not seek
help from anyone.
The mental health problems most commonly experienced by
young people — depression, anxiety and substance use
similarly act to negate help-seeking by increasing social with-
drawal and young people’s preference to keep their distress to
Reliance on self
As young people progress through adolescence they have a
growing need for autonomy and independence, and increasingly
believe they should be able to handle problems themselves.
large US study found that a third of adolescents with serious
suicidal ideation, depression, or substance use problems believed
that people should handle their own problems without outside
Similar findings are apparent in Australia, with the Child
and Adolescent component of the NSMHWB finding that 38% of
adolescents endorsed a desire to solve their own problems as a
barrier to seeking help.
Negative attitudes and fears regarding mental health
Stigma and negative attitudes toward seeking help from profes-
sionals are further barriers to professional help-seeking. Young
people are particularly concerned about being seen as “mental” by
their friends and others,
and the stigma of mental illness is
associated with less intention to seek help.
Believing that seeking help won’t be useful also presents prob-
lems; “thinking that nothing could help” was the second most
endorsed barrier (18%) in the NSMHWB.
Young people are often
unsure whether specific sources of help will actually make a
difference. For example, while general practitioners are one of the
most frequently accessed initial sources of professional help,
young people often do not know whether seeing a GP for a mental
health problem will be helpful.
Furthermore, young people have
been shown to prefer active treatment to watchful waiting, and
counselling approaches to medication.
Past experiences of seeking help that proved unhelpful also
contribute to negative attitudes. This can include experiences in
which the young person felt that they were not listened to or their
problems were not taken seriously.
Occasions when confidential-
ity was not kept, and fears about breaches of confidentiality, also
contribute to negative attitudes toward mental health services,
such as school counsellors.
How to reach out to young people
Parents and peers
Friends and family are often consulted first and therefore have a
significant role in the pathway to professional services. Parents are
particularly important for younger adolescents. In childhood,
parental perception of problems is the starting point for referral to
professional services, and there is little evidence that children self-
The capacity for self-referral develops over adolescence, as
independence and autonomy from parents increase, but parents
continue to play a significant role, particularly until young people
are financially independent.
In understanding pathways to care, it should be recognised that
adolescents who are in their early to mid teens are still reliant on
adults, particularly parents, to help them recognise the presence of
a problem, facilitate access to appropriate help, and model appro-
priate help-seeking behaviour.
Parents’ and other adults’ (eg,
teachers’) perceptions of problems are critical to whether teenagers
are identified and referred to mental health services. Interestingly,
despite recent initiatives to encourage young people over 15 years
to independently seek mental health care,
there is some evidence
that parents do not think their children should make their own
appointments with doctors until about the age of 17 years.
As young people progress through adolescence, the role of
friends becomes more prominent, and peers increasingly have a
role in the help-seeking process.
For example, some visits to
school counsellors are from young people seeking help for one of
their peers.
MJA Volume 187 Number 7 1 October 2007 S37
For young adults, intimate relationships become an important
source of support; this applies particularly to men. Intimate
partners have been shown to exert a strong influence on men who
seek specialist psychological services.
Schools are an ideal and opportunistic setting in which to reach
out to young people.
For those aged up to 16 years, the school
setting is central, as school attendance is compulsory. Even for
older adolescents, school is central, as most remain at school to
complete Year 12.
For adolescents aged 13–17 years, the child
and adolescent component of the NSMHWB revealed that 16% of
those identified with a mental health problem had received
counselling in school.
School-related problems themselves have been shown to play an
important role in the help-seeking process for school-aged youth,
as these can be important indicators of other mental health
Within schools, teachers, school counsellors, and
other welfare and pastoral care staff have a major role in recognis-
ing mental health problems and referring young people to appro-
priate services.
A major initiative in Australia has been the development of
partnerships between schools and general practice to improve
young people’s access to mental health care. A resource kit has
been released based on what has been learnt from the MindMatters
Plus General Practice program to further encourage and support
such initiatives.
Importantly, ways to build referral pathwaysa
series of steps, shared understanding, and agreed ways of working
together between services in a local area are becoming better
understood. To address the mental health needs of teenagers at
school, schools need to be fully linked into referral pathways to
local health, mental health and community-support services.
Another approach to increasing help-seeking has been to train
GPs to conduct classroom lessons in high schools. These presenta-
tions cover a range of physical and mental health issues, and
provide both encouragement and practical advice on how to seek
help from a GP. This approach has shown encouraging results in
preliminary feasibility studies in regional and rural locations, with
adolescents reporting decreases in perceived barriers and increases
in help-seeking intentions for mental health problems up to 10
weeks after the class presentations.
Significant positive relation-
ships were also found between help-seeking intentions and the
frequency of actual consultations with GPs after the presentation.
General practice
General practice is essential to young people’s mental health and is
often the point of initial contact with professional services. Impor-
tantly, the presence of medical problems increases help-seeking
and provides an opportunity to investigate mental health issues.
However, there is a need to improve the ability of GPs to
recognise mental health problems in young people. For example, a
recent review showed that, in the US, the median rate of recogni-
tion of mental health problems in children by GPs was only
and was often dependent on parental expressions of concern.
Older youth who visit GPs on their own are reluctant to mention
their personal emotional problems, often because of concerns
about confidentiality and being viewed as weak or abnormal.
Recognition can be improved by GPs more frequently asking
parents, or young people themselves, about stress or personal
emotional difficulties. The process can be enhanced by providing a
welcoming environment, and taking time to listen carefully and
build rapport with young people. Also important is ensuring
privacy and clearly explaining confidentiality. Finally, GPs can
provide reassurance that it is common to feel distress at times, and
that symptoms can be a normal response to stressful events. At the
same time they can provide information and choices about
Young people may also require additional support and follow-
up from GPs as part of the referral process to specialist or other
mental health services. For example, discussing issues of confiden-
tiality, while explaining the need to share information and allowing
the young person to specify the information they don’t want
shared, can facilitate referral processes. Describing the potential
benefits of receiving mental health services, and explaining the
likely duration of therapy and what to expect in an initial mental
health consultation, including any costs that might be incurred,
are all reported to be helpful. GPs also need to explain how they
will continue to support young people throughout this process.
Specialist services
Barriers to seeking help early from specialist mental health ser-
vices, and from alcohol and other drug services, can be particularly
strong. Studies exploring how young people with psychosis access
care highlight the highly variable pathways taken.
with 62 people aged 16–30 years experiencing first-episode
psychosis revealed a total of 307 previous contacts with various
professionals, 52% with mental health professionals and 17% with
In general, non-psychiatric contacts occurred first, followed
by psychiatric consultations, and the single most frequent initial
point of contact was with GPs (35.5%). The delay from the point
of recognition of first symptoms to first service contact averaged
112 days (median, 31 days) and was even longer to initial
treatment (mean, 273 days; median, 120 days). Reasons for such
delays include lack of knowledge regarding the presence of a
mental disorder, or inability to recognise it; stigma; uncertainty
about treatment effectiveness; and service structures being focused
on acute presentations.
Focus groups with youth found the dominant barrier to help-
seeking for substance use problems was a lack of self-motivation,
highlighting the relevance of motivational interviewing skills for
service providers. Other prominent themes were related to family
dynamics (eg, poor communication), and societal concerns related
to labelling and stigma. Young people’s perceptions of ideal
responses to harmful alcohol and other drug use included
improved relations with service staff, such as an initial compas-
sionate and non-judgemental reception, and greater access and
diversity of treatment options. These factors are consistent with
other studies showing that the first contact between the therapist
and youth is crucial and strongly determines the young person’s
decision to continue.
Confidentiality remains of utmost impor-
tance when engaging young people, and this is particularly
important in the context of accessing alcohol and other drug
Youth services
It is essential to recognise that many young people at high risk of
mental health problems do not have links to work, school, or even
a family doctor. For example, in 2004, 15.5% of teenagers and
22% of those aged 10–24 years were not in full-time study or
work, and these young people are at greater risk of mental health
S38 MJA Volume 187 Number 7 1 October 2007
Extra effort must be put into reaching young people
who are unemployed, homeless or otherwise marginalised from
mainstream health and community services.
Youth workers, particularly those working in neighbourhood
youth centres or shelters come in contact with young people who
are disconnected from social supports and who might otherwise
not be seen by other common gatekeepers, such as teachers,
school counsellors, GPs, and community health. Youth workers
are able to engage distressed young people by being highly
accessible, “befriending” them, and acting as advocates.
potentially have a critical role in linking more marginalised youth
with mental health services, but may need additional training to
better identify mental health problems and to more effectively refer
and collaborate with other services.
Self-help and complementary treatments
It is worth mentioning that young people often use self-help and
complementary treatments to deal with mental health problems. A
recent review argues that incorporating this understanding into
service delivery can enhance the therapeutic alliance, as well as
discourage the use of potentially harmful treatments and encour-
age the use of helpful ones.
Some particularly worthwhile
adjuncts to treatment include Internet-based sources of help, such
as MoodGym (, which have been
shown to be successful.
Internet-based information and support
are increasingly being taken up by young people.
Youth participation
A final point to make about when and how young people seek
mental health help is that it is essential for services to respect and
build upon young people’s growing independence and mastery.
This is acknowledged through the full and genuine participation of
young people in developing and implementing services to meet
their needs. Research evaluating programs that focus on young
people with substance use problems confirms that limited results
are achieved unless there is the opportunity for young people to be
directly involved and have active roles in service development and
To encourage and support adolescents and young
adults to seek professional help early for emerging mental health
problems, services must be informed and guided by the young
people themselves.
Competing interests
None identified.
Author details
Debra J Rickwood, PhD, MAPS, Professor, Psychology
Frank P Deane, DipClinPsych, PhD, MAPS, Professor, School of
Psychology; and Director, Illawarra Institute for Mental Health
Coralie J Wilson, BA(Hons), PhD, MAPS, Theme Coordinator, Personal
and Professional Development; Curriculum Coordinator, Behavioural
Health Sciences, Graduate School of Medicine; Visiting Senior Fellow,
Illawarra Institute for Mental Health
1 School of Health Sciences, University of Canberra, Canberra, ACT.
2 University of Wollongong, Wollongong, NSW.
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(Received 7 Mar 2007, accepted 1 Jun 2007)
... In most countries, opportunities for students to communicate with each other decreased due to the closing of schools/universities and the implementation of remote teaching and e-learning systems. Meanwhile, young people tend to avoid seeking professional help for mental health issues from "formal" sources and use more "informal" sources of help, such as family members and friends, compared with older people [10,11]. ...
... Healthcare workers who participated in the studies included in the present review were predominantly female. Previous studies have shown that young individuals tend to avoid seeking professional help for mental health issues and use more informal sources of help, such as family Environmental Health and Preventive Medicine (2023) 28:53 members, parents, and friends, compared with older persons [10,11], and that help-seeking behaviors tend to be more frequent among females than males [41]. Future studies should focus on help-seeking intentions/behaviors for non-mental health-related issues as well as mental health issues among male healthcare workers, especially older males, during public health crises. ...
... On the other hand, a cross-sectional study in Canada indicated that, although the proportion of those who used formal mental health support was low (i.e., approximately 20% of all participants), nearly 80% of healthcare workers sought informal peer support, and of these, 70% found such help-Environmental Health and Preventive Medicine (2023) 28:53 seeking to be effective [26]. Previous studies have shown that the sources of help-seeking for mental health problems vary across age groups; young individuals tend to avoid seeking professional assistance for mental health issues and use more informal sources [10,11]. Thus, future studies should examine the state of help-seeking for non-mental health-related issues as well as mental health-related issues from informal sources in the general population under the social context that forces people to stay away from close contact and keep distance from intimate persons and social activities (e.g., the COVID-19 pandemic). ...
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Background: Students and workers have been subjected to increased levels of psychological distress due to the quarantine policy and containment measures during the COVID-19 pandemic. This scoping review aimed to present an overview of published evidence regarding formal and informal help-seeking intentions/behaviors for non-mental health-related issues as well as mental health-related issues among students and workers during the pandemic. Methods: In June 2022, we searched MEDLINE, APA PsycNet, and CINAHL for articles reporting the state of help-seeking intentions/behaviors among students and workers during the pandemic. Peer-reviewed original articles published in English were selected. Results: In total, 150 articles were identified, and 12 articles were selected for final analysis after removing articles that met the exclusion criteria. Three studies targeted university students, and nine targeted healthcare workers. Study settings were restricted to Western countries and China. Of the 12 studies, 11 were observational and predominantly cross-sectional studies. Two longitudinal studies using student samples suggested that university students became more reluctant to seek help from both formal and informal sources during the COVID-19 pandemic compared to before, despite the increased need for support during the pandemic. Among healthcare workers, the proportions of those who sought help from formal sources in person were low (7–26%), even among those with mental health issues, despite the increase in the need for mental health services. One randomized controlled study reported that a brief video-based intervention increased treatment-seeking intentions among healthcare workers in the intervention group compared with the non-intervention group. Conclusions: The present review revealed that, although most studies included in the final analysis were cross-sectional, intentions/behaviors to seek help from both formal and informal sources decreased among university students, even those with mental health issues. Among healthcare workers, while the frequency of help-seeking from formal sources in person was low, a brief online intervention was suggested to be useful for promoting help-seeking from formal sources. During public health crises such as the COVID-19 pandemic, system and infrastructure development of online help-seeking services could potentially promote formal and informal help-seeking intentions/behaviors for diverse issues, including non-mental health-related issues, among university students and healthcare workers/providers.
... Future studies using RI-CLPM to examine directionality in these associations across each source of help may be useful in developing broader prevention strategies for adolescent depression. Beyond this, even when adolescents can seek help, the probability of accessing mental health services can vary depending on the source of help; adolescents may still rely on adults, particularly their parents, to facilitate access to appropriate help [35]. Furthermore, considering that adolescents may receive mental health services through more familiar professionals, such as general practitioners and school counselors [35], it may be more difficult for Japanese adolescents to receive services as the Japanese system does not have general practitioners [36], and there are few full-time school counselors (almost all of them are part-time workers [37]). ...
... Beyond this, even when adolescents can seek help, the probability of accessing mental health services can vary depending on the source of help; adolescents may still rely on adults, particularly their parents, to facilitate access to appropriate help [35]. Furthermore, considering that adolescents may receive mental health services through more familiar professionals, such as general practitioners and school counselors [35], it may be more difficult for Japanese adolescents to receive services as the Japanese system does not have general practitioners [36], and there are few full-time school counselors (almost all of them are part-time workers [37]). The strength of our study is the first application of RI-CLPM to examine the within-person prospective associations between help-seeking intentions and depressive symptoms in a general population of adolescents from the TTC study with a high followup rate (82.5% at T4). Sufficient control for a full range of timeinvariant between-person confounders (from known possible factors such as sex and dwelling environments [8,12] to unknown factors) with relatively lower attrition bias enables us to obtain clearer estimates of the within-person prospective association, which can lead to better understanding of longitudinal relationships between help-seeking intentions and depressive symptoms. ...
Purpose: Cross-sectional studies have shown an association between lower help-seeking intentions and greater depressive symptoms among adolescents. However, no longitudinal study has examined the direction of this association. The current study investigated whether help-seeking intentions and depressive symptoms are reciprocally associated at the within-person (individual) level during early to mid-adolescence. Methods: Longitudinal data on help-seeking intentions and depressive symptoms in adolescents were obtained from a population-based birth cohort study (Tokyo Teen Cohort; N = 3,171) at four time points (10y, 12y, 14y, and 16y). A random intercept cross-lagged panel model was used to evaluate the within-person prospective associations between help-seeking intentions and depressive symptoms. Results: At the within-person level, significant associations were consistently observed between antecedent greater depressive symptoms and subsequent lower help-seeking intentions across all time points (10y-12y: standardized regression coefficient (β) = -0.12, p < .001; 12y-14y: β = -0.07, p < .05; and 14y-16y: β = -0.09, p < .01). Meanwhile, significant within-person associations were partly observed between antecedent lower help-seeking intentions and subsequent greater depressive symptoms from 10y to 12y (β = -0.07, p < .05) and from 14y to 16y (β = -0.12, p < .001). These prospective associations were almost the same when adjusted for the number of potential confidants as a time-varying confounder. Discussion: Adolescents with worsening depressive symptoms may become increasingly reluctant to seek help over time. Proactive early recognition and intervention with support from parents, teachers, and other individuals may facilitate the management of depression in adolescents.
... The majority of programs that focus on altering individual modifiable factors that facilitate help-seeking, intervene at the level of parental behaviors or attitudes, leaving young people, themselves, out of the equation (11). While engaging parents is a relevant strategy, especially among younger age groups, a targeted approach would be beneficial for young people, themselves, as long as it addresses hindering and facilitating factors related to help-seeking such as the stigma surrounding mental illness (12), knowledge of mental health problems, and young people's preference for self-reliance (3,13). ...
... MHK can broadly be understood as knowledge related to distinct categories such as symptoms of common mental health disorders, coping with stress and positive mental health, etiology and risk factors of mental illness, and treatments for mental illness. MHK, and especially particular MHK categories such as recognizing mental illnesses and their symptoms as well as trusting therapeutic processes, have been identified as facilitating factors for help-seeking (10,13). Thus, it is worthwhile to separately consider items of the MHK scale that are related to these particular domains. ...
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Background Because the majority of mental illnesses develop early in life, effective preventative public mental health interventions are needed. Interventions fostering mental health literacy can be used to enhance personal resources and capacities to facilitate mental health care and thus, address help-seeking barriers. A Canadian mental health literacy school curriculum was adapted, piloted, and evaluated for the use in German schools. The study presents the intervention’s effects on mental health knowledge and help-seeking efficacy among 10 th grade students in Germany. Methods 10 th grade students (aged 14–17 years old) from one secondary school participated in a pre- and post-intervention control group study. Both groups completed a questionnaire at two time points assessing mental health knowledge and help-seeking efficacy. Repeated measure analysis of variance (ANOVA) was employed to evaluate the intervention’s effects. Results Data from 188 students was eligible for analysis. The analysis of the baseline data reveals a high comparability of the two groups in terms of demographics, and initial mental health knowledge and help-seeking efficacy scores. ANOVA results showed significant improvements for the intervention group having a large effect size for mental health knowledge ( f = 0.574, p < 0.001, partial η ² = 0.25) and a medium effect size for help-seeking efficacy ( f = 0.311, p < 0.001, partial η ² = 0.09). Conclusion The first-time application and evaluation of an adapted mental health literacy school curriculum shows significant increases in mental health knowledge and help-seeking efficacy, two core dimensions of mental health literacy, among 10 th grade students in Germany. Further studies are needed to confirm these results as well as have a more in-depth analysis on the interrelations of the different dimensions of mental health knowledge and help-seeking practices.
... Following this, it was also clear that users must be aware of who is supporting them. A systematic review of barriers to young people seeking mental health support identified that trusting the source of support is key [27], and it has been suggested that young people are more likely to seek support from their peers rather than mental health professionals [28]. ...
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Background Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. Objective The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. MethodsA full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. ResultsParticipants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) “progress” is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. Conclusions This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians.
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This article is related to the obstacles and barriers in seeking professional mental help support among the youths. The challenges includes, social stigma, lack of awareness, financial barriers, difficulty in accessing the desired services, long distance to the services, concerns about confidentiality, etc.. These can lead to avoiding or delay in the needed mental health treatment. In the present study, the data were collected from a total of 200 respondents with 100 males and females each ranging between the age group of 14-29. The research was particularly based on qualitative research method. The main findings of this article have related to the respondents who have successfully approached for clinical help and the obstacles faced by the youths in seeking mental health support.
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Objective: This research was conducted with the aim of identifying the experiences of Iranian adolescents and therapists from the therapeutic relationship and analyzing the strategies, causal, intervening, contextual conditions and consequences of the therapeutic relationship. Methods: The current research method is practical and qualitative type of grounded theory. The population of this research included adolescents aged 15-18 years who had a history of referral to psychotherapy and therapists in Tehran in 2021-2022. Sampling continued in a purposeful manner until the limit of theoretical saturation and finally 18 teenagers and 7 therapists were selected. The participants were subjected to semi-structured interviews. In order to analyze the data, Corbin and Strauss (2014) theme analysis method was used. Results: Data analysis has led to the production of 6 main themes including the challenges of the therapeutic relationship between the therapist and the adolescent, causal factors, background factors, intervening factors, strategies and consequences. Also, 17 core themes including unpleasant experiences transmitted in the therapeutic relationship, therapeutic relationship under the shadow of personal fears and concerns, internal factors, external factors, personality qualifications, appearance indicators, moral and scientific qualifications, factors Macro, family factors, cultural factors, social factors, driving and motivational strategies, passive strategies, educational, emotional, cognitive, behavioral and 89 concepts were the primary concepts. Conclusion: Overall, the results of this research showed that the degree of the therapeutic relationship being desirable or not depends on the way therapists use strategies and personality qualifications, appearance indicators and moral and scientific qualifications.
Background: The prevalence of mental health problems is high, and they have a wide-ranging and deleterious effect on many sectors in society. As well as the impact on individuals and families, mental health problems in the workplace negatively affect productivity. One of the factors that may exacerbate the impact of mental health problems is a lack of 'mental health literacy' in the general population. This has been defined as 'knowledge and beliefs about mental disorders, which aid their recognition, management, or prevention'. Mental Health First Aid (MHFA) is a brief training programme developed in Australia in 2000; its aim is to improve mental health literacy and teach mental health first aid strategies. The course has been adapted for various contexts, but essentially covers the symptoms of various mental health disorders, along with associated mental health crisis situations. The programmes also teach trainees how to provide immediate help to people experiencing mental health difficulties, as well as how to signpost to professional services. It is theorised that improved knowledge will encourage the trainees to provide support, and encourage people to actively seek help, thereby leading to improvements in mental health. This review focuses on the effects of MHFA on the mental health and mental well-being of individuals and communities in which MHFA training has been provided. We also examine the impact on mental health literacy. This information is essential for decision-makers considering the role of MHFA training in their organisations. Objectives: To examine mental health and well-being, mental health service usage, and adverse effects of MHFA training on individuals in the communities in which MHFA training is delivered. Search methods: We developed a sensitive search strategy to identify randomised controlled trials (RCTs) of MHFA training. This approach used bibliographic databases searching, using a search strategy developed for Ovid MEDLINE (1946 -), and translated across to Ovid Embase (1974 -), Ovid PsycINFO (1967 -), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Common Mental Disorders Group's Specialised Register (CCMDCTR). We also searched online clinical trial registries ( and WHO ICTRP), grey literature and reference lists of included studies, and contacted researchers in the field to identify additional and ongoing studies. Searches are current to 13th June 2023. Selection criteria: We included RCTs and cluster-RCTs comparing any type of MHFA-trademarked course to no intervention, active or attention control (such as first aid courses), waiting list control, or alternative mental health literacy interventions. Participants were individuals in the communities in which MHFA training is delivered and MHFA trainees. Primary outcomes included mental health and well-being of individuals, mental health service usage and adverse effects of MHFA training. Secondary outcomes related to individuals, MHFA trainees, and communities or organisations in which MHFA training has been delivered DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We analysed categorical outcomes as risk ratios (RRs) and odds ratios (ORs), and continuous outcomes as mean differences (MDs) or standardised mean differences (SMDs), with 95% confidence intervals (CIs). We pooled data using a random-effects model. Two review authors independently assessed the key results using the Risk of Bias 2 tool and applied the GRADE criteria to assess the certainty of evidence MAIN RESULTS: Twenty-one studies involving a total of 22,604 participants were included in the review. Fifteen studies compared MHFA training with no intervention/waiting list, two studies compared MHFA training with an alternative mental health literacy intervention, and four studies compared MHFA training with an active or an attention control intervention. Our primary time point was between six and 12 months. When MHFA training was compared with no intervention, it may have little to no effect on the mental health of individuals at six to 12 months, but the evidence is very uncertain (OR 0.88, 95% CI 0.61 to 1.28; 3 studies; 3939 participants). We judged all the results that contributed to this outcome as being at high risk of bias. No study measured mental health service usage at six to 12 months. We did not find published data on adverse effects. Only one study with usable data compared MHFA training with an alternative mental health literacy intervention. The study did not measure outcomes in individuals in the community. It also did not measure outcomes at our primary time point of six to 12 months. Four studies with usable data compared MHFA training to an active or attention control. None of the studies measured outcomes at our primary time point of six to 12 months. Authors' conclusions: We cannot draw conclusions about the effects of MHFA training on our primary outcomes due to the lack of good quality evidence. This is the case whether it is compared to no intervention, to an alternative mental health literacy intervention, or to an active control. Studies are at high risk of bias and often not sufficiently large to be able to detect differences.
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In this article. a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed.
Timetables for adolescents’ behavioural autonomy were examined using a modified version of Feldman and Quatman’s (1988) teen timetable measure with 73 middle-class African American middle adolescents (M age ¹ / 4 14.96 years, SD ¹ / 4 1.29) and their parents (73 mothers and 44 fathers), who were followed longitudinally for 3 years. African American mothers’ and fathers’ expectations for adolescents’ behavioural autonomy did not differ, but expectations varied greatly across issues, and mothers consistently endorsed later timetables than did adolescents. Autonomy expectations each could be described in terms of two empirically derived, conceptually meaningful, and internally consistent composites pertaining to personal and prudential issues. They were earlier for personal than prudential issues and for prudential issues, for boys than for girls. Mothers’ (but not adolescents’) expectations for the desired timing of adolescents’ autonomy over personal and prudential issues predicted increased autonomy over those issues 3 years later.
For young people still at school, the school setting is vital to their mental health and wellbeing. Not only does the school environment have a direct and indirect impact on mental health, it provides an opportunistic setting in which to identify and respond to emerging mental health problems. To do this effectively, schools and school staff must work in collaboration with the young people themselves, their families, and other support services within the community, particularly primary health care services, including general practice. The importance of developing effective partnerships and care pathways between schools and the primary health care sector is being increasingly acknowledged, and initiatives such as MindMatters Plus GP have advanced our understanding in this area.
Runaway/homeless shelters document high levels of substance abuse among runaway youth, at least double that of school youth. These youth present a constellation of problems and research suggests that this population may be unique in the range and intensity of associated problems. Most studies to date have collected self-report data on these youth; virtually no research has examined treatment effectiveness with the population. Given the void of treatment outcome research with these youths, there is need for identifying potent interventions. Given that issues of engagement and retention must assume prominence in the development of new treatments, this article presents a family-based treatment engagement strategy successfully employed with a sample of substance-abusing youth staying in a southwestern shelter. Youth and primary caretakers are engaged separately by the therapist utilizing motivating factors appropriate to context of the families' lives and to the developmental position of the client.
Effective mental illness prevention programs are important for the safety of youth and adolescents. Research suggests that programs should facilitate appropriate help seeking by lowering help-seeking barriers. This study used focus groups to obtain high school student opinions about actual help-seeking behaviors, reducing adolescent help-seeking barriers, raising sensitive issues with adolescents, and increasing appropriate help-source engagement. Transcript analysis revealed several themes. Relationship and trust were key approach factors for current help seeking. Memories of successful prior helping episodes were also important. Education about appropriate help seeking, presented in ways consistent with those currently used by adolescents (e.g., through peer networks), might reduce help-seeking barriers. Education should include key adults who act as gatekeepers within adolescent networks (e.g., parents and teachers). Assertive outreach and follow-up might be important factors for continued help-source engagement. Themes provide a basis for suggestions about ways to facilitate adolescent help seeking and maintain appropriate help-source engagement.
Self-help Internet interventions have the potential to enable consumers to play a central role in managing their own health. This paper contains a systematic review of 15 randomised controlled trials of the effectiveness of self-help Internet interventions for mental disorders and related conditions. Conditions addressed by the interventions included: depression, anxiety, stress, insomnia, headache, eating disorder and encopresis. Most interventions were reported to be effective in reducing risk factors or improving symptoms, although many of the studies had methodological limitations. Three of the interventions that reported positive outcomes are available without charge to the public.