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Shame, stigma, and a lack of knowledge about mental health problems, are some of the barriers that prevent young people from seeking professional help for anxiety and depression. New research has identified many of these barriers.
Some, such as a lack of trust in professionals, or limited support from their families, could also affect other groups. But others were specific to teenagers, such as a growing need for autonomy and independence.
Anxiety and depression are the most common mental health problems in teenagers, yet only a minority access professional help. The new findings emphasise the need for interventions that target teenagers and reach their families, schools, and society as a whole. They also show how working with teenagers could ensure that new interventions in mental health and help-seeking are meaningful for this age group.
What’s the issue?
The most common mental health disorders teenagers experience are anxiety and depression. One in twelve (8%) experience anxiety and one in twenty (5%) depression. Some have both at the same time.
One in three teenagers with these conditions (and their families) do not seek or access any professional help. Existing research into the barriers they face has mainly come from studies of young people who have successfully accessed a mental health service. This means little is known about those who do not seek or access help. A better understanding of the barriers they face is needed to improve their access to care.
This study aimed to improve understanding of how teenagers with anxiety or depression identified in local secondary schools feel about seeking and accessing professional help.
Children at two secondary schools filled in a questionnaire. The researchers used their answers to identify 22 young people (aged 11-17) who had anxiety and/or depression. They were then interviewed about their knowledge, attitude and experience of the disorders and of seeking help. Their parents were interviewed separately.
Four themes were identified.
1. Understanding their problem: “I just thought I was my kind of normal.”
Teenagers recognised some symptoms of anxiety and depression but they, along with parents and teachers, struggled to distinguish symptoms from typical teenager experiences. Young people often did not know where help was available outside school. Older teenagers in particular wanted to learn more about mental health problems and available support, even though they made limited use of existing resources.
2. Revealing their feelings: “I was scared of telling people how I felt.. I thought they will judge me and then they’ll think that there's something wrong with me.”
Teenagers could feel embarrassed about disclosing their problem and worried what others would think of them. They struggled to put their feelings into words, and to start a conversation. They preferred their parents or professionals to bring up the subject and would only discuss it with someone they trusted. Shyness and feelings of hopelessness created further barriers. Older adolescents and boys in particular were worried about upsetting their parents or friends by sharing their feelings.
3. Indecision: “There’s like a part of me that wants help and a part that doesn’t.”
Teenagers, especially boys, wanted to be self-reliant and to show themselves and others that they are strong enough to cope on their own. They were concerned about being seen as weak or as an attention-seeker. They were unclear about what professional help would involve and sometimes ‘too proud’ to seek it.
4. The role of others: “If it wouldn’t be for X, I would still be suffering.”
Adolescents did not seek professional help on their own and needed adults to arrange it. But parents and teachers did not always recognise the need. Parents reported lacking knowledge about child and adolescent mental health services (CAMHS) and said they needed to be persistent to get help. Families had different experiences of the process but emphasised the need to be well-supported by schools.
Why is this important?
Many of the barriers to seeking help relate to common experiences of adolescence, such as a growing need for autonomy and being concerned about what others think. The study highlights the important role of parents and school staff in helping teenagers access support. The balance between a teenager’s autonomy and adult input is a delicate one.
Policymakers and those creating interventions to increase the uptake of mental health services by teenagers need to take these factors into account.
Better understanding of anxiety and depression, and of the help available, is needed. Teenagers want age-appropriate interventions and parents need support to enable their young people to access professional help. Interventions developed with the input of young people are more likely to meet their needs.
The researchers aim to develop interventions for anxiety and depression in teenagers that address these barriers.
The teenagers in the study suggested regular screening for mental health problems in schools. Health assemblies could introduce the warning signs of anxiety and depression. Regular, informal conversations about mental health with their parents and other adults could help them better explain their feelings.
Parents need to know where to seek help. Schools and GPs are the first place they go to and need to be familiar with local services and support for teenagers. The teenagers in this study emphasised the importance of trust; this is a reminder to professionals to explicitly discuss confidentiality with them.
Families with limited financial and emotional resources found seeking and accessing support particularly difficult. These families need extra support from professionals. More broadly, continued efforts to normalise mental health problems and to reduce stigma will be helpful.
The study may not have included some disadvantaged groups such as parents who do not speak English. The lead author is planning to explore the barriers to help-seeking among young people from minority ethnic backgrounds with mental health problems.
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This NIHR Alert is based on: Radez J, and others. Adolescents’ perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study. European Child & Adolescent Psychiatry 2021; doi:10.1007/s00787-020-01707-0
A review of research into help-seeking by young people: Radez J, and others. Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child & Adolescent Psychiatry 2021;30:183–211
Research exploring why parents do or do not seek help for their children: Reardon T, and others. Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study. European Child & Adolescent Psychiatry 2018;27:1023–1031
YoungMinds is a charity offering mental health support for young people, parents and those who work with young people.
The Anna Freud National Centre for Children and Families provides mental health and wellbeing resources for young people.
Funding: Two authors were funded by NIHR Research Professorship; another by an NIHR Post-Doctoral Fellowship.
Conflicts of Interest: The study authors declare no conflicts of interest.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.