s00787 019 01469 4

European Child & Adolescent Psychiatry (2021) 30:183–211
https://doi.org/10.1007/s00787-019-01469-4
REVIEW
Why do children and adolescents (not) seek and access professional

help for their mental health problems? A systematic review
of quantitative and qualitative studies
Jerica Radez1 · Tessa Reardon1,2 · Cathy Creswell2 · Peter J. Lawrence3 · Georgina Evdoka‑Burton4 · Polly Waite1,2
Received: 12 February 2019 / Accepted: 31 December 2019 / Published online: 21 January 2020
© The Author(s) 2020
Abstract
Mental health disorders in children and adolescents are highly prevalent yet undertreated. A detailed understanding of the
reasons for not seeking or accessing help as perceived by young people is crucial to address this gap. We conducted a system-
atic review (PROSPERO 42018088591) of quantitative and qualitative studies reporting barriers and facilitators to children
and adolescents seeking and accessing professional help for mental health problems. We identified 53 eligible studies; 22
provided quantitative data, 30 provided qualitative data, and one provided both. Four main barrier/facilitator themes were
identified. Almost all studies (96%) reported barriers related to young people’s individual factors, such as limited mental
health knowledge and broader perceptions of help-seeking. The second most commonly (92%) reported theme related to
social factors, for example, perceived social stigma and embarrassment. The third theme captured young people’s percep-
tions of the therapeutic relationship with professionals (68%) including perceived confidentiality and the ability to trust an
unknown person. The fourth theme related to systemic and structural barriers and facilitators (58%), such as financial costs
associated with mental health services, logistical barriers, and the availability of professional help. The findings highlight the
complex array of internal and external factors that determine whether young people seek and access help for mental health
difficulties. In addition to making effective support more available, targeted evidence-based interventions are required to
reduce perceived public stigma and improve young people’s knowledge of mental health problems and available support,
including what to expect from professionals and services.
Keywords Children · Adolescents · Mental health · Barriers · Facilitators · Professional help
Introduction
Almost one in seven young people meet diagnostic criteria

for a mental health disorder [1]. Untreated mental health
disorders in children and adolescents are related to adverse
Electronic supplementary material The online version of this
health, academic and social outcomes, higher levels of
article (https://doi.org/10.1007/s00787-019-01469-4) contains
supplementary material, which is available to authorized users. drug abuse, self-harm and suicidal behaviour [2–4] and
often persist into adulthood [5]. Indeed, half of the lifetime
* Tessa Reardon mental health problems start by the age of 15 and nearly
tessa.reardon@psy.ox.ac.uk
three quarters by the age of 18 [6], creating a substantial
1
School of Psychology and Clinical Language Sciences, global socioeconomic burden [7]. These short and longer
University of Reading, Reading, UK term negative outcomes associated with youth mental health
2
Departments of Experimental Psychology and Psychiatry, problems emphasise the importance of early detection and
University of Oxford, Oxford, UK prompt access to professional treatment.
3
School of Psychology, University of Southampton, Effective, evidence-based treatments for mental health
Southampton, UK disorders in young people exist [8]. However, less than two-
4
Slough Community Mental Health Team, Berkshire thirds of young people with mental health problems and
Healthcare NHS Foundation Trust, Slough, UK their families access any professional help [9]. In general,
13
Vol.:(0123456789)
184 European Child & Adolescent Psychiatry (2021) 30:183–211
young people are more likely to get professional help if they to support and services consider young people’s views on
are older (i.e. adolescents more likely than children), Cauca- help-seeking, and by doing so address the barriers that are
sian, experiencing more than one mental health problem and pertinent to them.
suffering from behavioural rather than emotional disorders This study provides an up-to-date systematic review
[10, 11]. Besides from factors associated with treatment uti- of all studies where children and adolescents were asked
lisation (e.g. gender and race), a detailed understanding of about barriers and facilitators to help-seeking and accessing
the reasons that young people (rather than parents or profes- professional support in relation to a wide range of mental
sionals) do not seek and access professional help is crucial health difficulties, to inform ongoing and future interven-
to address the gap between the high prevalence of mental tions designed to improve treatment access. To fully address
health disorders in young people and low treatment utilisa- the complexity of the process of seeking and accessing pro-
tion. A recent systematic review of parent-reported barriers fessional help in young people, results from quantitative and
to accessing professional help for their child’s mental health qualitative studies were analysed and combined. By focusing
problems identified barriers related to systemic/structural on children and adolescents with a mean age of 18 years
obstacles (e.g. costs, waiting times), attitudes towards the or younger (and excluding any studies which only included
service providers and psychological treatment (e.g. trust and young adults over 21 years) findings will be especially rel-
confidence in professionals, the perceived effectiveness of evant to the school context, and youth services for under 19s.
treatment), knowledge and understanding of mental health
problems and the help-seeking process (e.g. recognition of
the problem, knowing where to get help) and family circum- Methods
stances (e.g. other responsibilities and family’s support net-
work) [12]. Amongst general practitioners (GPs), who often A systematic review was conducted following PRISMA
act as ‘gatekeepers’ between families and specialist services, guidelines [18] and was registered in the international pro-
commonly perceived barriers include difficulties identify- spective register of systematic reviews (PROSPERO), num-
ing and managing mental health problems (e.g. confidence, ber 42018088591, on 13/02/2018. A PRISMA checklist is
time, lack of specific mental health knowledge) and making provided in Online Resource 1.
successful referrals for treatment (e.g. lack of providers and
resources) [13].
As young people can take an active role in help-seeking, Literature search
particularly as they get older, it is important to ascertain
their own views on the barriers to seeking and accessing The initial search strategy and preliminary inclusion/exclu-
help for their mental health problems. A previous system- sion criteria followed a recent review of parent-perceived
atic review that focused on young people’s views found that barriers and facilitators to help-seeking and accessing treat-
young people most commonly fail to seek help because of ment for their children [12]. The search terms captured four
stigma, embarrassment, difficulties with recognising prob- major concepts: (1) barriers/facilitators, (2) help-seeking/
lems and a desire to deal with difficulties themselves [14]. accessing, (3) mental health, and (4) children/adolescents
However, this review only considered help-seeking for anxi- and parents (see Online Resource 2 for details of the search
ety, depression and general ‘mental distress’ and, therefore, strategy). The original search was launched in October 2014
does not capture barriers in the context of other mental [12] and replicated using the same strategy in October 2016
health disorders, or more recent literature published since and in February 2018. We used the NHS Evidence Health-
2009. Furthermore, the review included samples of young care database, combining Medline, PsycINFO and Embase,
adults (e.g. university students), making it hard to know the and the Web of Science Core Collection separately. Addi-
degree to which the reported barriers/facilitators are relevant tionally, we used hand-search methods to check the reference
for children and adolescents specifically. list of articles included in the full text screening stage, and
It is now widely recognised that high demands on special- performed backward and forward reference searching of key
ist services, limited available provision and long waiting lists papers to identify further studies of interest.
present key barriers to accessing child and adolescent mental
services [15]. This has prompted a range of recent initiatives Eligibility criteria
designed to increase the availability and accessibility of spe-
cialist services (e.g. Children and Young People’s Improving A study was included if child and/or adolescent (mean sam-
Access to Psychological Treatment (CYP-IAPT) Programme ple age up to 18) participants reported barriers and/or facili-
in the UK, KidsMatter in Australia), support within schools tators to seeking and accessing professional help for mental
[16, 17], and public resources (e.g. YoungMinds, Rea- health problems. Studies reporting only parental/caregiver’s
chOut). However, it is critical that efforts to improve access perceived barriers and facilitators, and studies including
13
European Child & Adolescent Psychiatry (2021) 30:183–211 185
only young adults (e.g. university students) were excluded. a final decision. In total, 53 studies were included in the
Similarly, studies that only reported factors associated with current review. Thirty studies provided qualitative data, 22
treatment utilisation and studies reporting barriers/facilita- provided quantitative data and one study provided both. For
tors related to ongoing treatment engagement (not initial two included studies, relevant results were reported in two
access to treatment) were excluded. The full list of inclusion/ separate papers, which were all included in a current review
exclusion criteria is available in Online Resource 3. [19–22].
The full process of study selection is presented in the
Study selection PRISMA flowchart (Fig. 1).
We selected the studies for the current review through an Data extraction
initial search in October 2014 conducted within the Rear-
don et al. [12] review, and two updated searches using the We used the data extraction form developed by Reardon
same search terms (October 2014–October 2016; and Octo- et al. [12], with minor amendments to reflect the fact that
ber 2016–February 2018). In total, 3682 studies published study participants were children/adolescents rather than
since October 2014 were identified from database searches parents. The form included the following information: (1)
and hand searching. After duplicates were removed, two methodology used (qualitative, quantitative or mixed meth-
independent reviewers from the team (JR, CT, GEB, and ods), (2) country of study, (3) study setting (e.g. school,
PL) screened 2582 abstracts, and 385 full texts. In cases of mental health clinic), (4) child/adolescent characteristics,
disagreement, a third reviewer was consulted (TR) to reach including age range, gender, ethnicity, area of living (e.g.
Fig. 1 PRISMA flowchart of study selection process
13
rural, urban), (5) type of mental health problem addressed/ an iterative process to refine codes, to group codes into
focus of the study and method of mental health assessment, families of codes (e.g. ‘perceived confidentiality’), and
(6) characteristics related to service use, and (7) key find- finally to group families of codes into overarching barrier/
ings relating to perceived barriers and facilitators, supported facilitator themes (e.g. ‘relationship factors’). Extracted
by quantitative or qualitative evidence. Where applicable, qualitative data were coded and organised following the
details regarding barrier/facilitator measures were recorded same procedure. Next, we developed a single-coding
for quantitative studies. For qualitative studies, we recorded framework capturing barriers and facilitators across quan-
details about the methods used (e.g. focus groups, inter- titative and qualitative studies. Codes generated in the pre-
views) and the areas of relevant questioning. Data extrac- liminary synthesis of qualitative and quantitative studies
tion was undertaken by two independent reviewers (JR and were combined and refined in this step, and organised into
GEB/PL/TR). 22 subthemes and 4 themes. To address the heterogene-
ity of the quantitative studies and to facilitate comparison
across studies, we ‘transformed’ the data [25]. In line with
Quality rating
the ESRC guidance, we developed a ‘common rubric’ to
summarise the quantitative data. After examining the per-
In line with the approach used by Reardon et al. [12], we
centages of participants who endorsed each specific bar-
used two adapted versions of quality rating checklists devel-
rier/facilitator across studies, we categorised each barrier/
oped by Kmet et al. [23]. One checklist was used to evaluate
facilitator into one of three groups [‘low’ (endorsed by
the quality of quantitative studies and another to evaluate the
0–10% of participants), ‘medium’ (endorsed by 10–30%
quality of qualitative studies. Quality checklists addressed
of participants) and ‘high’ (endorsed by more than 30%
the research question, study design, sampling strategy and
of participants)]. These groups reflect the relative distri-
data analysis. The quantitative checklist also addressed the
bution of the percentage of respondents who endorsed
robustness of the barrier/facilitator measure, and the qualita-
each barrier/facilitator across studies. Where applicable,
tive checklist addressed the credibility of the study’s conclu-
Likert-scale responses were converted into ‘percentage
sions (see Online Resource 4). The quality of the study that
endorsed’ by summing positive responses (e.g. ‘agree’
provided qualitative and quantitative data [24] was assessed
and/or ‘strongly agree’) before categorisation. Three stud-
using both scales. Two independent reviewers (JR and GEB/
ies reported only means and standard deviations for each
PL/TR) assessed the quality of each included study. Based
barrier/facilitator and no frequencies. In these cases, we
on the total score, each study was classified as ‘low’ (0–12
applied data standardisation and categorised responses
for quantitative and 0–11 for qualitative studies), ‘moderate’
into the three corresponding categories using percentile
(13–16 for quantitative and 12–15 for qualitative studies)
and z scores. To minimise the impact of barriers/facilita-
or ‘high’ (17–20 for quantitative and 16–18 for qualitative
tors reported by only a small minority (< 10%) of partici-
studies) quality. Discrepancies between the reviewers were
pants, barriers/facilitators categorised as ‘low’ frequency
discussed with a third reviewer (TR/CC). Each study was
were not included in subsequent analyses. As results from
included in the review, regardless of its quality.
qualitative studies were descriptive (non-numerical), this
kind of data transformation was not appropriate for quali-
Data synthesis tative studies.
We used graphical methods to present the percentage of
We conducted a narrative synthesis following ESRC guid- included studies that reported each specific barrier/facili-
ance [25], which outlines three main steps of analysis: (1) tator, and the corresponding percentage for qualitative
developing a preliminary synthesis, (2) exploring relation- and quantitative studies separately. Next, we explored the
ships between and within studies, and (3) assessing robust- relationship between study characteristics (e.g. qualitative/
ness of the synthesis. We chose this approach because of the quantitative methodology, country, use of a mental health
high methodological variability across studies and the pre- assessment to identify participants) and sample charac-
dominantly descriptive nature of the results. Consequently, teristics (e.g. mental health status, gender, area of living),
statistical meta-analysis was not feasible. and barrier/facilitator themes and subthemes. Where we
A preliminary synthesis was done separately for quan- identified a pattern related to study/sample characteristics,
titative and qualitative studies Each individual perceived details are reported below.
barrier or facilitator reported in each quantitative study We performed a sensitivity analysis to establish the
was assigned a code, and we reorganised the data accord- review’s robustness by examining the impact of ‘low’ qual-
ing to these initial codes (e.g. ‘assured confidentiality’, ity studies on the findings. These studies were removed
‘concerns around confidentiality’, ‘worrying that informa- and results related to themes, subthemes and conclusions
tion about me will be shared with others’). We then used
13
re-examined to determine whether they stayed the same than a half (58%) of qualitative studies reported facilitators to
or not. help-seeking, as well as barriers.
All analyses were led by the primary author (JR), with
regular discussions with other reviewers (TR/PW/CC) to Quality ratings
agree with the interpretation of codes and themes.
Overall, the quality of the studies varied, ranging from ‘low’
to ‘high’, with 65% of quantitative and 52% of qualitative
Results studies rated as ‘high’ quality, and 4% of quantitative and
13% of qualitative studies rated as ‘low’ quality. The weak
Study description aspects of qualitative studies tended to relate to methodolog-
ical issues, such as clarity and appropriateness of sampling
In total, 53 studies were included in the review, with 22 provid- strategy (e.g. insufficient detail on how study participants
ing quantitative data, 30 providing qualitative data, and 1 study were selected), data collection and analysis methods (e.g.
providing both [24]. Therefore, the total number of studies and only a very brief description of data analysis), whereas quan-
corresponding percentages in the results refer to 54 included titative studies most commonly failed to describe the barrier/
samples (23 quantitative and 31 qualitative). Study character- facilitator measure’s robustness (e.g. no details given about
istics are provided in Tables 1 and 2. the measure’s psychometric characteristics).
Studies varied widely on sample size (from 6 to 10,123),
participants’ age (from 7 to 21 years), country (with 48% of Barrier/facilitator themes
studies conducted in North America, 24% in Europe, 20% in
Australia and 8% in Asia), demographic profiles (with 20% of Four barrier/facilitator themes were identified from both the
studies focused on specific ethnic/gender groups and others qualitative and quantitative studies. The themes relate to (1)
with more varied samples), recruitment setting (with 72% of young people’s individual factors, (2) social factors, (3) fac-
studies conducted in schools, 17% in (mental) health settings, tors related to the relationship between the young person
and the others in varying community settings) and the type and the professional and (4) systemic and structural factors.
of mental health problem that was a focus of the study (with Barrier and facilitator themes and subthemes are summa-
30% of studies focused on mental health in general and the rised below. Barrier and facilitator themes and subthemes
remaining studies focused on specific mental health problems, identified in each study are available in Online Resource 5.
such as depression, anxiety, suicidal ideation and ADHD). In
half of the studies participants’ mental health was assessed (all 1. Young people’s individual factors
of these studies assessed young people’s mental health using
questionnaire measures, with the exception of four studies that The majority (96%) of studies reported barriers and facili-
used a standardised diagnostic assessment). Similarly, studies tators related to individual factors. Subthemes and their dis-
addressed various types of professional support, with some tribution across all studies, and across qualitative and quan-
(9%) focused on school-based (mental health) services and titative studies separately are outlined in Fig. 2.
the majority of remaining studies focused on any professional Barriers and facilitators related to knowledge about men-
help (50%) or on support available in a specific (mental) health tal health and mental health services were reported in more
setting (40%). In 41% of studies, participants’ service use was than half (53%) of the studies, and with high endorsement
not reported or assessed, and in others, some (2–57%) or all rates (> 30% of participants). Young people reported not
participants had received professional help for their mental knowing where to find help and/or whom to talk to [20, 34,
health problems. 37, 38, 42–46, 64, 65, 69, 73, 74] and failing to perceive a
In quantitative studies, young people were most com- problem as either serious enough to require help [20, 63] or
monly asked to endorse the presence or absence of barriers mental health related [32]. Young people’s broader percep-
from a list, or rate barriers using a 4–7 point Likert response tions of help-seeking were reported as barriers in 39% of
scale. Three quantitative studies asked open questions about studies, and as facilitators in 4%. This subtheme captured
help-seeking [26–28]. Less than a third (30%) of quantitative young people’s general attitudes towards mental health and
studies reported facilitators to help-seeking, with two of those help-seeking [31, 49, 53, 55, 59], help-seeking expectations
studies reporting facilitators only [29, 30]. [20, 27, 31, 33, 37, 38, 46, 48, 54, 59, 68, 75] and percep-
The majority of qualitative studies used one-to-one inter- tions about how help-seeking reflects on their character, such
views (45%), focus groups (32%), or both (16%) to collect as perceiving help-seeking as a sign of weakness [21, 49,
data, with the exception of two studies where they applied a 54, 60, 63, 73, 75]. The latter was reported in all studies
qualitative approach to analyse responses to open-ended sur- that included male-only samples. Young people commonly
vey questions [19, 20, 31]. Unlike quantitative studies, more (in 39% of the studies) endorsed the barrier of refusing to
13
Table 1 Characteristics of quantitative studies
188
References Number of Age (range) Country Ethnicity Females Area of Setting Focus of Mental health Source of Service use Barrier/ Quality
participants (%) living the study assessment profes- facilitator assessment
13
reporting sional help measure—
barriers/facili- details
tators
Boyd et al. 201 11–18 Australia No informa- 63% Rural School Anxi- CES-D Any pro- No informa- Open- 17 (high)
[26] tion ety and SASa fessional tion ended
Depres- help question
sion about
barri-
ers to
seeking
profes-
sional
help
Chandra 274 13–14 USA 46% white, 50% Suburban School Emotional Not assessed Mental 15.9% Ten bar- 17 (high)
and 27.4% concerns health received riers to
Minkovitz black, 9.5% services psychologi- help-
[32] Asian, cal services seeking
4.7% or counsel- and ‘no
Hispanic ling (past barriers’
and 9% year) option
multiracial
Cigularov 854 14–18 USA 78.3% 47% No infor- School Depression Not assessed Any pro- No informa- 26 barriers 18 (high)
et al. [33] Caucasian, mation and sui- fessional tion to help-
10.2% cidality help seeking;
Hispanic, 6-point
2% Asian/ Likert
Pacific, scale
1.7%
Native
Ameri-
can, 0.8%
African
American,
6.6% Other
Table 1 (continued)
tators
D’Amico 2883 14–18 USA 69% Cauca- 50% No infor- School Alcohol Adapted Alcohol No informa- 14 facilita- 16 (moder-
et al. [29] sian, 13% mation related question- related tion tive ate)
Hispanic, problems naire to services factors;
5% Asian and con- assess 5-point
American/ cerns drinking Likert
Pacific habits scale
Islander, (6.7%
2% Ameri- ‘heavy
can Indian/ drinkers’
Alaskan and 21%
Native, 1% ‘problem
African drinkers’)
American,
10% ‘other’
Freedenthal 101 (out 15–21 USA American 72% 51.5% Participant Suicidality Questions Any pro- 40.59% saw a Open- 17 (high)
and Stiff- of 356 Indians lived on home about fessional MH profes- ended
man [27] screened the res- suicidality help sional; question
for suicidal ervation, (100% ever 12.87% about
thoughts)b 48.5% thought of/ consulted barri-
in urban attempted a school ers to
areas suicide; counsellor seeking
59.4% or teacher. profes-
suicidal sional
thoughts, help with
24% multi- suicidal
ple suicide thoughts
attempts, or behav-
10% one iour.
suicide
attempt, 6%
number of
attempts
not given),
YSR
13
189
Table 1 (continued)
190
13
tators
Gould et al. 519 13–19 USA 78% white, 50% Urban and School Feeling BHS (10% Any pro- Hotline/sub- 16 barriers 17 (high)
[34] 3% African rural very above fessional stance pro- to help-
American, upset, threshold) help gramme/ seeking
13% His- stressed CIS (28% including other health
panic, 1% or angry above hotlines profes-
Asian, 4% threshold) sional:
other 1.7–3.1
(last year),
2.1–3.3
(ever):
School
counsellor/
MH profes-
sional:
21.1–22-
3(last year),
29.5–29.8
(ever)
Gould et al. 24 (out of 317 13–19 USA 58.3% white, 54% No infor- School Suicidality SIQ-JR (33% Mental None HUQ 17 (high)
[35] identified 20.8% mation serious health
‘at risk’ and Hispanic, suicidal services
who did not 12.5% ideation),
seek help Asian, seven ques-
after referral 8.3% other tions about
at baseline)b suicide
attempt
history
(25% past
suicidal
attempts),
BDI-IA
(58.3%
depression),
DUSI, CIS
(37.5%)c
Table 1 (continued)
tators
Guo et al. 865 Latin M = 12.6, USA Latin Ameri- 51% No infor- School Internalis- SDQ (20.3% SBMHS 12.9% Nine 15 (moder-
[36] American SD = 1.96 can mation ing and elevated referred to reasons ate)
exter- symptoms) SBMHS for not
nalising and CIS (past seeking
problems academic help
year)
936 Asian Asian SDQ (13.9% 3.2% referred
American American elevated to SBMHS
symptoms) (past
CIS academic
year).
Guterman 858 Arab 14–17 Israel 46.7% Arab 57.9% No infor- School Emotional Adapted Any Pro- 11.5% sought 16 reasons 18 (high)
et al. [37] and 53.3% mation dis- version of fessional help from for not
Jewish tress— My ETV Help MH profes- seeking
exposure (87% wit- sional, 10% help
to com- nessed ≥ 1 from youth
munity act of group or
violence community religious
violence leader,
(past year) 9.2% from
teacher and
8.7% from
medical
professional
977 Jewish 14-17 54.5% Adapted 4.1% sought
version of help from
My ETV MH profes-
(92.5% wit- sional,
nessed ≥ 1 3.5% from
act of youth group
community or religious
violence leader,
(past year) 2.7% from
teacher and
2.1% from
medical
professional
13
191
Table 1 (continued)
192
13
tators
Haavik 1249 M = 17.6, Norway No informa- 56% Rural and School MH in Not assessed MH Ser- School- Nine barri- 18 (high)
et al. [38] SD = 1.15 tion urban general vices based MH ers to
services: help-
11–29.8%, seeking;
Special- 5-point
ist MH Likert
services: scale
9.7–10.5%,
Youth
health
station/GP:
16.2–32.9%
Khairani 21 (out of 215 13–20 Malaysia 99.1% 57% Rural Primary Depression Structured Medical 9.5% of those No details 15 (moder-
et al. [39] screened for Malays, care self-report profes- reporting about the ate)
depression 0.9% clinic question- sionals significant barrier
symptoms)b Indians naire with depressive measure
ten ques- symptoms
tions on had sought
depressive medical
symptoms help for
based on these
the DSM-
IV (100%
met criteria
for depres-
sion)
Kuhl et al. 280 14–17 USA 84% Cau- 50% No infor- School MH in 50-item Any pro- 30% of BASH 16 (moder-
[40] casian, mation general measure fessional participants ate)
9.8% Asian of physi- help were cur-
American, cal and rently or
4% His- psychiatric previously
panic, 0.4% symptoms in therapy
African developed
American, by Dubowa
2.1% no
ethnicity
specified.
Table 1 (continued)
tators
Lubman 2456 14–15 Australia 84.2% born 50% Rural and School Depres- Not assessed Any pro- 30% sought BASH-B 20 (high)
et al. [41] in Aus- urban sion and fessional help for
tralia; 1.9% alcohol help MH prob-
in New abuse; lems from
Zealand, any pro- teachers or
1.4% in fessional health pro-
the United help fessionals
Kingdom,
1.1% in
India and
1.0% in
China
Meredith 184 13–17 USA 14.2% White, 78% No infor- Primary Depression DISC— Any pro- 55% reported Seven 20 (high)
et al. [24] depressedb 32.7% mation care depression fessional receiving barriers;
184 non- Black, clinic module help depression 5-point
depressedb 49.3% His- (100% of counselling Likert
panic, 3.8% ‘depressed’ (6 months scale
Other and 0% after
of ‘non depression
depressed’ was identi-
sample fied)
met the No informa-
diagnostic tion
criteria for
depressive
disorder
in last
6 months)
Muthu- 131 smokers 13–17 Malaysia No informa- No infor- No infor- School Emotional YSRa Primary 5.3% sought 16 reasons 15 (moder-
palani- 268 non- tion mation mation and care pro- help for not ate)
appen smokers behav- viders No informa- seeking
et al. [42] ioural tion help
problems
13
193
Table 1 (continued)
194
13
tators
Samargia 497 (those 16 USA 86.9% White, 65% Rural and School and Psycho- DHS and Mental 100% 11 reasons 17 (high)
et al. [43] who 0.9% Afri- urban com- logical or DHHSa health for not
reported can Ameri- munity emo- services seeking
having fore- can, 3.2% centres tional help
gone mental Native problems
health care American,
from 878 6.1% multi-
screened) racial, 1.7%
Asian,
1.1% His-
panic
Sharma 354 13–17 India No informa- 48% Urban School Depression Not assessed Any pro- No informa- No details 9 (low)
et al. [44] tion fessional tion about the
help barrier
measure
Sheffield 254 15–17 Australia 89.7% 51% No infor- School MH in The DASS- Any pro- 9.1% sought Nine barri- 17 (high)
et al. [45] Australian mation general 21a fessional help for ers to
and 10.3% help a mental help-
from other illness; seeking
countries 31.2% for
(mainly a personal,
Asia, emotional
Europe, or behav-
and the ioural prob-
United lem (past
Kingdom) 12 months)
Table 1 (continued)
tators
Sylwestrzak 10,123 13–18 USA 65.6% non- 49% Rural and Household Emotional As a part of Any pro- > 63% 14 reasons 14 (moder-
et al. [46] Hispanic urban and and NCS-A fessional reported for not ate)
whites, school behav- Study they help seeking seeking
15.1% non- ioural were asked treatment to help
His- panic problems about MH manage and
blacks, and cop- symptomsa cope with
and 14.4% ing with emotions;
Hispanics stress 11.6% to
help with
controlling
problem
behaviours
and 6.9% to
help cope
with stress
Wilson and 1037 13–21 Australia 95% Aus- 59% Urban School and Psycho- Not assessed MH Ser- No informa- BASH-B 18 (high)
Deane tralian, youth logical vices tion
[47] remain- com- problems
ing 5% munity
European, groups
Asian,
North
or South
American,
Middle
Eastern,
and ‘other’
Wilson 1184 11–17 Australia No informa- 50% Urban School Depression CES-D MH Ser- No informa- Open- 16 (moder-
et al. [28] tion (10.5% with vices tion ended ate)
moder- question
ate–severe about
depression per-
symptoms) ceived
barri-
ers to
seeking
profes-
sional
help
13
195
Table 1 (continued)
196
13
tators
Wilson 173 (trial) 14–16 Australia 88% Austral- 58% No infor- School Psycho- Not assessed Help-seek- 6.9–8.1% had BETS 18 (high)
et al. [30] ian, 6% mation logical ing with ≥ 1 consul-
European, problems GPs tation with
2% Asian GP about
psychologi-
cal health
118 (compari- 86% Austral- 60% 1.7–4.2% had
son group) ian, 9% ≥ 1 consul-
European, tation with
2% Abo- GP about
riginal psychologi-
cal health
Wu et al. 119 7–13 USA 82% White, 50% No infor- Commu- Paediatric MASC, MH Ser- 100% TAQ-CA 20 (high)
[48] 12% mation nity men- anxiety CAIS- vices
African tal health C/P, CDI,
American, centres PARS,
3% Asian, ADIS-IV-
3% other C/P (66%
GAD, 43%
Social Pho-
bia, 41%
ADHD,
39%
Separation
Anxi-
ety, 29%
Specific
Phobia)
CAIS-C/P Child Anxiety Impact Scale-Child/Parent Report, CDI Children’s Depression Inventory, CES-D Centers for Epidemiologic Studies Depression Scale, CIS Columbia Impairment
Scale, DASS-21 Depression Anxiety Stress Scale, DHS Minnesota Students Survey, DHSS Youth Risk Behaviour Survey, DISC Diagnostic Interview Schedule for Children, DUSI Drug Use
Screening Inventory, HUQ Help-Seeking Utilization Questionnaire, MASC Multidimensional Anxiety Scale for Children, MH mental health, My ETV My Exposure to Violence Scale, PARS
Pediatric Anxiety Rating Scale, SAS Self-rating Anxiety Scale, SBMHS school-based mental health services, SDQ Strengths and Difficulties Questionnaire, SIQ-JR Suicidal Ideation Question-
naire, TAQ-CA Treatment Ambivalence Questionnaire-Child (Anxiety) Version, YSR Youth Self-Report
a
Results of MH assessment not reported. ADIS-IV-C/P Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent Versions, BASH Barriers to Adolescents Seeking Help, BASH-B the
brief version of the Barriers to Adolescents Seeking Help scale
b
Mental health assessment used to identify participants. BETS Barriers to Engagement in Treatment Screen, BDI-IA Beck Depression Inventory, BHS Beck Hopelessness Scale
c
The same methods were used in baseline screening
Table 2 Characteristics of qualitative studies
References Number of Age Country Ethnicity Females Area of Setting Focus of Mental health Source of Service use Barrier/ Quality
participants (range) (%) living the study assessment profes- facilitator Assessment
barriers/ details
facilitators
Balle 8 17–18 Norway 88.5% Nor- 75% No infor- School MH in No previ- Any profes- 0% current, Interviews 17 (high)
Tharald- wegian, mation general ous MH sional 25%
sen et al. 12.5% problemsb help previous
[49] immi- contact
grant with pro-
back- fessional
ground. help.
Becker 13 12–17 USA Majority 38% No infor- Commu- MH in Not assessed MH ser- No infor- Interviews 16 (high)
et al. [50] Caucasian mation nity— general vices mation and focus
outreach groups
and sup-
port pro-
grammes
for
military
families
Breland- 29 11–17 USA African No infor- Rural, No infor- Depression Not assessed Any profes- No infor- Interviews 12 (moder-
Noble American mation urban and mation. sional mation and focus ate)
et al. [51] suburban help groups
Bullock 15 14–18 Canada 100% 87% No infor- The Suicidality K-SADS-PL, Any profes- 100% Interviews 12 (moder-
et al. [52] Canadian mation Depres- SCID- sional ate)
with sive II (53% help
hetero- Disorders depressive
geneous (outpa- disorder,
ethnici- tient) 33% cluster
ties (i.e. Program B personal-
mixed of a psy- ity disorder)
European, chiatric questions
Aborigi- hospital about suici-
nal). One dality (60%
youth lifetime
was a 2nd suicide
gen- attempt, 40%
eration multiple
migrant. attempts)
Bussing 148 14–19 USA No infor- 59% Rural and School ADHD Screening Psychiatric/ 57% had a Open- 14 (moder-
et al. [31] mation urban questions medical previous ended ate)
with parents and psy- ADHD survey
and CASA chologi- treatment questions
(74% ADHD cal help
13
197
high risk).
Table 2 (continued)
198
13
barriers/ details
facilitators
Chandra 57 13–14 USA 30% 74% Suburban School MH in Not assessed MH ser- 38.6% Interviews 16 (high)
and African general vices within
Minko- American and
vitz [53] 10.5%
outside
the
school
Clark et al. 29 12–18 Australia No infor- 0% Rural and School Clinical 28% history Any profes- 28% had Interviews 17 (high)
[54] mation urban and MH anxiety of anxiety sional previ- and focus
Clinic diagnosisb help ously groups
sought
profes-
sional
help
De Anstiss 85 13–17 Australia 100% 56% No infor- Commu- MH in Not assessed MH ser- Not clear Focus 15 (moder-
and Zia- refugees mation nity— general vices groups ate)
ian [55] of mixed refugee
ethnic centres,pro-
back- grammes,
grounds schools
Del Mauro 31 7–18 USA 87.1% 71% Rural and Community MH in Not assessed Psycho- 19.4% ≥ 1 Focus 15 (moder-
and Cauca- urban general logical therapy groups ate)
Jackson sian, 3.2% help session
Williams African
[56] Ameri-
can, 3.2%
Asian,
3.2%
Hispanic,
3.2% not
reported
Doyle et al. 35 16–17 Ireland No infor- 66% Urban School MH in Not assessed Help-seek- No infor- Focus 12 (moder-
[57] mation general ing in mation groups ate)
schools
Table 2 (continued)
barriers/ details
facilitators
Fleming, 39 13–16 New Zea- 49% Maori, 26% No infor- School— Depression Not assessed Health No infor- Focus 16 (high)
Dixon land 38% mation alterna- providers mation groups
and Pacific tive and com-
Merry Islands, schooling puter-
[58] 10% New pro- based
Zealand grammes help
European for
students
excluded
or alien-
ated from
main-
stream
education
Fornos 65 13–18 USA 89% No infor- Urban School Depression Not assessed Any profes- No infor- Focus 10 (low)
et al. [59] Mexican– mation sional mation groups
American help
Fortune 2954 (out 15–16 UK 82% White, 54% No infor- School Self-harm Questions Any profes- No infor- Open- 13 (moder-
et al. [19, of 6020 12% mation and suici- about self- sional mation ended ate)
20] screened)c Asian, 3% dality harm (10% help survey
Black and lifetime questions
3% Other self-harm)
and scales
to measure
depression,
impulsivity,
anxiety and
self-esteema
13
199
Table 2 (continued)
200
13
barriers/ details
facilitators
332 who did 15–16 UK 88% White Around No infor- School Self-harm Questions Any profes- 14% got Open- 13 (moder-
not seek 75% mation about self- sional help ended ate)
help before harm (100% help before survey
self-harm lifetime the epi- questions
(out of history of sode of
593 with self-harm) self-harm
a lifetime and scales 1.4% got
history of to measure help
self-harm)c depression, after the
412 who did impulsivity, episode
not seek anxiety and of self-
help after self-esteema harm
self-harm
(out of
593 with
a lifetime
history of
self-harm)c
Francis 52 14–16 Australia No infor- 71% Rural School MH in Not assessed Any profes- No infor- Focus 16 (high)
et al. [60] mation general sional mation groups
help
Gonçalves 16 12–17 Portugal 25% Por- 31% No infor- School MH in Not assessed Any profes- 31.3% had Focus 14 (moder-
et al. [61] tuguese mation general sional previous groups ate)
(African help psycholo-
descend- gist visit
ent)25%
Cape
Verde,
18.8%
Brasil,
18.8%
Angola,
12.5%
Other
Table 2 (continued)
barriers/ details
facilitators
Gronholm 29c 12.2–18.6 UK 65.5% 65.50% Urban School Inter-/exter- SDQ (100% Any profes- No infor- Interviews 18 (high)
et al. [62] White, nalising borderline or sional mation
31% disorder clinical level help
Black, and risk of inter-/
3.4% of devel- externalising
Asian oping disorder
psychotic PLE (100%
disorder ≥ 1 ‘yes’
response
to question
regarding
psychotic-
like experi-
ences)
Hassett and 8c 16–18 UK No infor- 0% No infor- Clinic— Self-harm ≥ 2 episodes MH ser- 100% Interviews 17 (high)
Isbister mation mation CAMHS and suici- of self- vices
[63] dality harm (past
12 months)b
Huggins 6 18 USA No infor- No infor- Rural and School MH in Not assessed School- No infor- Interviews 17 (high)
et al. [64] mation mation urban general based mation
mental
health
services
Kendal 23 11–16 UK No infor- 65% Urban School Emotional Not assessed School- 39% had Interviews 15 (moder-
et al. [65] mation difficul- based used ate)
ties pastoral the MH
support service in
school
Klineberg 30 15–16 UK 40% Asian, 80% Urban School Self-harm Adapted Any profes- No infor- Interviews 16 (high)
et al. [66] 23% version of sional mation
Black, A-Cope help
20% (33% never
Mixed self-harmed,
ethnic- 30% self-
ity, 13% harmed
White once, 37%
British more than
and White once)
Other
13
201
Table 2 (continued)
202
13
barriers/ details
facilitators
Leavey, 48 14–15 UK No infor- 50% Urban School Emotional Not assessed Primary No infor- Focus 11 (low)
Rothi and mation and men- care pro- mation groups
Paul [67] tal health viders
problems
Lindsey, 16 11–14 USA 100% 50% Urban School MH in Not assessed MH ser- 44% Focus 17 (high)
et al. [68] African general vices received groups
American school-
based
counsel-
ling
Lindsey 18c 14–18 USA 100% 0% Urban Community Depression CES-D (100% MH ser- 55% of Interviews 16 (high)
et al. [21, African based elevated vices them
22] American mental levels of were in
health depression treatment
centres symptoms)
and after-
school
programs
for youth
Mcandrew 7c 13–17 UK 100% 100% No infor- n/a Self-harm 100% experi- Any profes- No infor- Interviews 13 (moder-
and White mation and suici- enced self- sional mation ate)
Warne British dality harm and/ help
[69] or suicidal
behaviourb
Meredith 16c 13–17 USA No infor- No infor- No infor- Primary Depression Diagnostic Any profes- Not clear Interviews 10 (low)
et al. [24] mation mation mation care clinic Interview sional
Schedule for help
Children—
depression
module
(100% met
criteria for
depression)
Muel- 10 No infor- USA Upper mid- No infor- Suburban Community Suicidality Not assessed Any profes- No infor- Interviews 11 (low)
ler and mation dle class mation sional mation and focus
Abrutyn commu- help groups
[70] nity
Table 2 (continued)
barriers/ details
facilitators
Pailler 60 12–18 USA 65% 52% Urban Tertiary Depression Not assessed MH ser- No infor- Interviews 18 (high)
et al. [71] African care vices mation
Ameri- children’s
can, 27% hospital
White,
8% multi-
racial
Prior [72] 8 13–17 UK (Scot- No infor- 75% No infor- School MH in Not assessed School 100% Interviews 15 (moder-
land) mation mation general counsel- received ate)
ling school
counsel-
ling
Timlin- 26 14–18 USA 100% 15% Suburban School MH in Not assessed Any profes- Not clear Interviews 17 (high)
Scalera White general sional
et al. [73] help
Wilson and 23 14–17 Australia 91% Aus- 52% Urban School MH in Not assessed Any profes- No infor- Focus 16 (high)
Deane tralians of general sional mation groups
[74] European help
descent,
4%
Aborigi-
nal, 4%
Pakistani
Wisdom 22 14–19 USA 90% White 59% No infor- School Depression Assessed by Primary Not clear Interviews 16 (high)
et al. [75] (non-His- mation and MH primary care care pro- and focus
panic), Clinic providersa viders groups
other peo-
ple with
African,
Hispanic,
and Asian
heritage
CASA Child and Adolescent Services Assessment, CES-D Centers for Epidemiologic Studies Depression Scale, K-SADS-PL Schedule for Affective Disorders and Schizophrenia for School-Age
Children-Present and Lifetime Version, MH mental health, SCID-II Structured Clinical Interview for DSM-IV Axis II
a
Study does not provide results of MH assessment
b
Study does not provide information on how MH was assessed
c
Mental health assessment used to identify participants
13
203
Fig. 2 Percentage of all (per- 46% 7%

centage of 54 included samples Knowledge about MH and MH services
39%
57%
3%
13%
that reported barrier/facilitator),
qualitative (percentage of 31 39%
42%
4%
3%
included qualitative samples Broader perceptions of help-seeking 35% 4%
that reported barrier/facilitator)
39%
and quantitative (percentage 26%
of 23 included quantitative Preference for self-reliance 57%
samples where a ‘large’ (> 30) 35% 4%
Factors associated with commitment to the process of
or ‘medium’ (10–30) percentage help-seeking
26% 6%
48%
of participants endorsed the bar-
rier/facilitator) studies reporting 26% 2%
13%
barriers and facilitators relating Perceived effectiveness of professional help 43% 4%
to young people’s individual
factors 20% 6%
16% 6%
Perceived autonomy 26% 4%
24%
23%
Preference for informal support 26%
Ability to verbalise the need for help and to talk about 22%
16%
MH difficulties 30%
20%
13%
Emotional and motivational factors 30%
7% 11%
3% 10%
Past experiences 13% 13%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Percentage of studies
Overall (barrier) Qualitative (barrier) Quantitative (barrier)

Overall (facilitator) Qualitative (facilitator) Quantitative (facilitator)
seek help because of a desire to cope with their problems on reported in a quarter of the studies. Young people reported
their own [20, 21, 24, 26–28, 33, 34, 37, 40–42, 45–47, 50, that they were more likely to seek help if they perceived
54, 56, 61, 68, 73]. This subtheme was reported in nearly it to be their own choice [65, 72] and less likely to seek
all studies that included young people with elevated levels help if they perceived it as their parents’/teachers’ choice
of depression symptoms or experiences of self-harm, and [48, 61, 67]. A preference for informal support was reported
mostly in quantitative studies with high rates of endorse- as a barrier to seeking professional help in 24% of studies;
ment. In 35% of the studies, young people reported barriers young people reported that they would prefer to discuss their
related to uncertainty about whether problems were serious mental health difficulties with family members and friends
enough to require help [34, 35, 37, 40, 42, 62, 66, 73, 74] than professionals [22, 26, 34, 40, 42]. The subtheme of
and expectations that the problems would improve on their young people’s ability to verbalise the need for help and to
own [33–35, 40, 42, 43, 46]. Young people also endorsed talk about mental health difficulties was the next most com-
barriers which related to a reluctance to attend appointments mon barrier to help-seeking, and endorsed by young people
and adhere to recommended treatments [24, 71]. Factors in 22% of studies overall, and more commonly reported in
associated with commitment to the process of help-seeking quantitative than qualitative studies. One-fifth of the stud-
were usually endorsed with a high frequency within quanti- ies reported emotional and motivational factors related to
tative studies. Around a quarter of studies reported the per- the nature of their problem, such as anxiety [39–41, 43, 47,
ceived effectiveness of professional help to be the reason for 69] and depression symptoms [20, 27, 33, 40], and a lack of
(not) seeking professional help, with most studies reporting motivation [54, 58] as barriers to seeking professional help.
that young people were doubtful about the effectiveness of Unsurprisingly, anxiety and depression symptoms were most
professional help [31–35, 37, 40, 42, 44–46, 48, 50, 67, 72]. frequently reported as posing barriers in the studies that
This reason was endorsed by young people with or without included participants with elevated levels of psychological
previous experience of professional help. Notably, perceived distress. This subtheme only captured barriers and was more
effectiveness was more commonly reported in quantitative frequently reported in the quantitative studies than qualita-
studies than qualitative studies. The extent to which young tive studies. Young people also reported past experiences
people perceive help-seeking as their own decision was to be both facilitators [26, 40, 47, 53, 73, 74] and barriers
13
[35, 40, 46, 53] to seeking professional help for their men- 3. Relationship factors
tal health problems. Past positive experience was the most
commonly reported facilitator, reported in 15% of studies. A large proportion of studies (68%) reported barriers and
facilitators related to the relationship between the young per-
2. Social factors son and a mental health professional. The distribution of
subthemes across studies overall, and among qualitative and
The second theme describes barriers and facilitators quantitative studies, is outlined in Fig. 4.
related to social factors and this theme was reported in 92% Issues related to perceived confidentiality were reported
of studies. Subthemes in this category are outlined in Fig. 3. as barriers in 28% and facilitators in 6% of the studies [19,
The vast majority of studies reported barriers (76% of 29, 33, 36, 37, 39, 45, 47, 50, 56, 57, 59, 62, 64–66, 69, 73,
studies) related to perceived stigma [19–21, 26, 27, 31, 74]. Young people also reported concerns regarding disclos-
32, 49, 50, 54–62, 64, 68, 69, 72, 73] and young people’s ing personal information to a person they do not know well
experienced and/or anticipated embarrassment as a conse- [22, 26, 28, 32, 33, 35, 42, 57, 58, 65, 68, 72, 74]. Barri-
quence of negative public attitudes [20, 22, 27, 28, 32, 33, ers and facilitators related to young people’s perceptions of
36, 37, 40–42, 44, 47–49, 58, 61, 64, 69], and these barriers contact with professionals were reported in one-fifth of the
were usually reported by a high percentage of young people studies (20%). Young people reported that they are more
within studies. Reduced public stigma and public normali- likely to seek help if they feel respected [63, 66], listened
sation of help-seeking were reported as related facilitators to [29, 30, 69] and not judged [69], and less likely if they
in four (13%) qualitative studies [57, 63, 72, 74]. Views and feel they are being judged or not taken seriously [20, 37, 38,
attitudes towards mental health and help-seeking within 56, 69]. Lastly, young people endorsed barriers and facili-
young people’s support networks, such as family, friends, tators related to similarities/differences between them and
teachers and GPs, were reported as barriers in 17% of stud- professionals in 13% and 6% of studies, respectively. This
ies, and as facilitators in 19% of studies. In most of these subtheme was most frequently reported in qualitative stud-
studies, these barriers/facilitators were reported by a high ies that included ethnically diverse samples, ethnic minori-
percentage of participants. Notably, positive views and ties and only male participants, and included references
encouragement from young people’s support networks were to the gender [63], ethnicity/race [21] and age [40, 47] of
commonly reported facilitators (26% of qualitative and 9% professionals.
of quantitative studies) [21, 32, 52, 59, 61, 63, 72, 73]. This
subtheme was more frequently reported in studies including 4. Systemic and structural factors
ethnically diverse samples, ethnic minorities or only male
participants than studies with predominantly Caucasian, and Barriers and facilitators related to systemic and structural
mixed-gender samples. Anticipated consequences of help- factors were reported by 58% of studies overall. We identi-
seeking on young people’s social network included the fear fied six subthemes which are outlined in the Fig. 5.
of being taken away from their parents [59], fear of losing Logistical factors, such as lack of time [24, 35, 40, 42],
status in a peer group [49] and making their family angry or interference with other activities [24, 48], transportation
upset [48] and were reported as barriers in 29% of qualitative difficulties [36, 42, 45] and costs associated with mental
and 13% of quantitative studies. health services [24, 31, 35, 36, 38, 40–43, 45, 46, 50, 59,
61, 71] were reported in a large proportion of studies, and
Fig. 3 Percentage of overall

(percentage of 54 included sam- 76% 7%
Views and attitudes towards MH and help-seeking in the 71% 13%
ples that reported barrier/facili- wider environment 83%
tator), qualitative (percentage of
31 included qualitative samples 17% 19%
that reported barrier/facilitator) Views and attitudes towards MH and help-seeking within 13% 26%
YP's support network 22%
and quantitative (percentage 9%
of 23 included quantitative 22%
samples where a ‘large’ (> 30) Anticipated consequences of help-seeking on social 29%
or ‘medium’ (10–30) percentage network 13%
of participants endorsed the bar- 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
rier/facilitator) studies reporting Percentage of studies
barriers and facilitators relating
to social factors Overall (barrier) Qualitative (barrier) Quantitative (barrier)
13

28% 6%
ples that reported barrier/facili- Perceived confidentiality 26%
tator), qualitative (percentage of 9% 11%
31 included qualitative samples 10% 16%
Perception of contact with professionals 9% 4%
and quantitative (percentage 19% 6%
13% 10%
of 23 included quantitative Ability to trust unknown person 26%
samples where a ‘large’ (> 30)
13% 6%
or ‘medium’ (10–30) percentage 13% 10%
of participants endorsed the bar- Similarity between YP and MH professional 13%
rier/facilitator) studies reporting 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
barriers and facilitators relating Percentage of studies
to relationship factors

28% 2%
ples that reported barrier/facili- Logistical factors 43%
tator), qualitative (percentage of 28%
31 included qualitative samples Costs of professional help
16%
43%
and quantitative (percentage 15% 4%
16% 6%
of 23 included quantitative Availability of professional help 13%
samples where a ‘large’ (> 30) 7% 7%
or ‘medium’ (10–30) percent- Accessibility of professional help
6% 10%
9% 4%
age of participants endorsed
the barrier/facilitator) studies 2% 6%
3% 10%
reporting barriers and facilita- Use of information technology
tors relating to systemic and 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
structural factors
Percentage of studies
predominantly in quantitative studies. Two-thirds of stud- Robustness of data synthesis

ies reporting costs as a barrier to professional support were
American and studies reporting transportation difficulties Sensitivity analysis was performed by excluding four ‘low
were more commonly conducted in rural areas than in cit- quality’ studies (three qualitative and one quantitative) and
ies. Young people also frequently reported barriers (15% re-examining the distribution of themes and subthemes
of the studies) and facilitators (4% of the studies) related to among the remaining studies. There was minimal change in
the availability of professional help. Limited availability of relation to the distribution of barrier/facilitator subthemes
professional services and excessive waiting times were the across qualitative and quantitative studies, and the overall
most commonly reported barriers within this subtheme [24, results remained similar and conclusions unchanged.
26, 38, 54, 60, 68, 73]. Studies also reported barriers related
to difficulties accessing or reaching support, for example,
difficulties making an appointment or the attitude of staff Discussion
towards them [19, 24, 33, 67]. The last subtheme captured
young people’s perceptions of the role of information tech- This review identified 53 studies addressing barriers and
nology in help-seeking. In 10% of qualitative studies, young facilitators to seeking and accessing professional help for
people identified opportunities to communicate distress and mental health problems as perceived by children and adoles-
attend treatment via digital tools as facilitators to seeking/ cents. We identified four themes across the studies. Barriers
accessing treatment [54, 58, 63, 67]. All of these studies and facilitators related to young people’s individual factors
were conducted in the UK, Australia or New Zealand. and to social factors were identified in the vast majority of
the studies. Young people also commonly reported barriers
13
and facilitators related to the relationship between them and (2) positive perceptions of the contact between them and
professionals and to systemic and structural factors. professionals were the most commonly reported facilitators.
Among barrier/facilitator subthemes, young people most These observed differences are likely to reflect the larger
frequently endorsed barriers and facilitators related to soci- number of studies included in the current review than the
etal views and attitudes towards mental health and help- previous review, with nearly two-thirds of included studies
seeking, such as perceived public stigma and embarrassment published since the review by Gulliver et al. [14]. Further-
associated with mental health problems. Young people also more, the current review excluded studies with only young
often perceived a lack of knowledge about mental health adult participants (e.g. university students), who may well
and the available help as a barrier to help-seeking. Young perceive different barriers and facilitators to seeking help
people with a prior experience of mental health difficulties than younger adolescents.
reported that, during their difficulties, they had not recog-
nised the need for professional help and had not perceived Implications
their problems as not serious enough to require help. Young
people’s negative expectations and attitudes towards pro- Our findings highlight many potential ways to improve
fessionals, and perceiving help-seeking as a sign of one’s access to treatment for young people experiencing mental
weakness, were commonly reported across studies as well. health difficulties. First, the review highlights the ongoing
The latter subtheme was almost always reported in studies need to minimise perceived mental health stigma among
which included only male participants, highlighting poten- young people. There are a growing number of large-scale
tial gender differences in perceived barriers [54]. Adoles- public health initiatives (e.g. Time to Change in the UK and
cents also often endorsed a preference to rely on themselves Opening Minds in Canada) and school-based interventions
when facing mental health difficulties rather than seeking [76] that are designed to reduce stigma and improve young
professional help, which was again especially prominent in people’s mental health and help-seeking literacy. Once the
studies where participants had previous experience of men- effectiveness of such programmes has been demonstrated,
tal health difficulties. Notably, this subtheme was far more widespread dissemination is critical, making constructive
commonly reported in quantitative than qualitative studies. conversations about mental health a part of the daily school
Compared to qualitative studies, quantitative studies also routine. Our findings indicate that these interventions should
more commonly reported barriers and facilitators related to focus on improving young people’s knowledge and under-
a commitment to the process of help-seeking, such as not standing of mental health problems, [54], equipping young
perceiving a problem as serious enough and waiting for the people with self-help skills and strategies [34], normalis-
problem to improve on its own. Lastly, the extent to which ing mental health problems and the process of help-seeking
young people believed information shared between them [63, 74], ‘demystifying’ professional help [72], explain-
and professionals would be treated as confidential seemed ing which problems require help and which may not [20],
to play a significant role in whether young people decide to and informing young people about where to find help and
seek help or not. what to expect from it [30, 40], including explaining the
This review’s findings are broadly consistent with the therapeutic ‘ground rules’ (e.g. confidentiality). If we want
previous review by Gulliver and colleagues that focused to close the gap between high prevalence of mental health
on young people’s help-seeking for anxiety, depression and disorders and low treatment utilisation, sufficient service
distress [14]. Our review makes a significant further contri- provision and professional support must be widely avail-
bution to the existing literature by including young people’s able for young people. Providing services within the school
perceived barriers for a wider range of mental health diffi- environment could address the systemic and structural
culties. In line with our findings, Gulliver et al. [14] identi- barriers by minimising the effort required to access youth
fied that the most common barriers and facilitators related mental health services. Further, this could help reduce the
to public, perceived and self/stigmatising attitudes, mental barriers related to logistical factors, such as lack of time
health knowledge, young people’s preference for self-reli- and transportation difficulties. Indeed, hundreds of schools
ance and perceived confidentiality. However, Gulliver et al. in the UK already work collaboratively with local child and
[14] reported that structural factors (e.g. logistical factors adolescent mental health services to offer specialist sup-
and costs related to professional help), anxiety symptoms, port and treatments to young people, teachers and parents
and characteristics of mental health service providers were at school [77]. With careful implementation, this may also
more common than we found in this review. Furthermore, be less stigmatising than a clinic environment [16], poten-
while Gulliver et al. [14] found that past positive experiences tially helping greater numbers of young people to seek and
of help-seeking was the most frequently reported facilita- access evidence-based treatments [78]. In addition, young
tor across studies, we found that (1) positive attitudes and people should be as equipped as possible to help themselves.
encouragement from young people’s support network and Digital tools might be a means to increase access to support
13
for mental health problems, and young people in studies February 2018 and, therefore, any relevant studies published
in our review identified benefits of, for example, text mes- since this date were not included in the review. Similar to
sages [63, 67] to self-refer and to communicate with pro- previous research [12], our review identified that existing
fessionals directly Similarly, young people suggested using quantitative barrier/facilitator questionnaire measures are
computerised psychological treatments [58], which might (1) more focused on barriers than facilitators and (2) tend to
be especially appropriate for those who find it hard to talk overlook some barriers/facilitators, especially those related
about their feelings in person, and may help improve young to the role of young people’s support network and the char-
people’s perceived independence. Equally, ensuring services acteristics of the relationship between young people and
are free at the point of use would minimise financial barriers professionals. Results from the quantitative studies might,
to help-seeking/accessing. As young people’s support net- therefore, at least partly reflect the fact that young people
works, especially families, seem to play the most important were not asked about certain barriers and facilitators. These
facilitative role in their process of help-seeking/accessing, limitations of quantitative studies highlight the importance
professionals should be mindful about seeking appropriate of including qualitative studies as well.
family involvement, whilst balancing this against young
people’s desire to make their own decisions about receiving
help. It is clear that wherever interventions are provided, Conclusions and further research
they must promise young people privacy [65] and promote
their agency, control and self-determination [72]. The main reasons for (not) seeking and accessing profes-
sional help given by young people are those related to men-
Strengths and limitations tal health stigma and embarrassment, a lack of mental health
knowledge and negative perceptions of help-seeking. Young
This review provides a comprehensive overview of the most people also reported a preference for relying on themselves
common reasons given by young people about why they may when facing difficulties, and issues with committing fully to
or may not seek and access professional help when experi- the process of help-seeking/accessing. Widespread dissemi-
encing mental health difficulties. The inclusion of qualita- nation of evidence-based interventions delivered in schools
tive studies provided additional contextual information and targeting perceived public stigma and young people’s mental
more detailed insight into young people’s experiences than health knowledge is needed. Furthermore, the collaboration
was commonly captured in quantitative studies. By including between schools and mental health services is essential to
all recent studies focusing on a wide range of mental health enable young people and their families to access evidence-
difficulties, it provides an update to and extension of the based support within settings that minimise the logistical
previous review published nearly a decade ago. Although the barriers. Mental health professionals should also offer young
eligibility criteria for this review were narrower (i.e. exclud- people different ways to access help on their own, includ-
ing the studies with only young adults), there were twice as ing using digital tools, which have a potential to facilitate
many studies included in this review as in the previous one, help-seeking behaviour and promote young people’s agency.
highlighting the rapid development of this field and the need Our review identified a few possibilities for further
for an updated review. Finally, the review was conducted research. The lack of established self-report quantitative
using rigorous and systematic methodology. Nevertheless, measures of barriers and facilitators of seeking and access-
the review has some limitations. Due to the high variability ing mental health support for young people highlights the
of included studies it was not possible to carry out detailed need to develop and evaluate a new questionnaire. Findings
group comparisons in relation to the type of mental health from the qualitative studies should be considered when
problem, source of professional help, study setting and revising the content of the existing questionnaire items to
participants’ treatment utilisation. Furthermore, only four ensure all relevant barriers/facilitators are captured, and their
studies used a standardised diagnostic assessment to assess prevalence can be established. To inform mental health ser-
participants’ mental health, and many studies did not report/ vices for specific disorders in children and young people,
assess participants’ mental health at all, making it hard to studies examining barriers and facilitators to seeking and
perform reliable comparisons of findings among adolescents accessing professional help for children and adolescents
with different mental health problems. Another limitation experiencing specific mental health difficulties are required.
relates to the fact that the review only includes studies pub-
lished in English in peer-reviewed journals and, therefore, Acknowledgements JR is funded by the University of Reading through
an Anniversary PhD Scholarship. CC, PJL and TR are funded by an
findings from studies published in other languages and in NIHR Research Professorship awarded to CC (NIHR-RP-2014-04-018).
alternative publications were not captured here. Finally, it is PW is supported by an NIHR Post-Doctoral Fellowship (PDF-2016-09-
important to acknowledge that the systematic search used to 092). The views expressed are those of the authors and not necessarily
identify studies for inclusion in this review was conducted in those of the NHS, the NIHR or the Department of Health. The authors
13
thank Caitlin Thompson, BSc student of University of Reading, for J Behav Heal Serv Res 36:492–504. https: //doi.org/10.1007/s1141
help with abstract and full-text screening, and Dr Cyra Neave from the 4-008-9139-x
Anna Freud Centre for insight into practical aspects of school-based 11. Chavira DA, Stein MB, Bailey K, Stein MT (2004) Child anxi-
mental health interventions. The research materials can be accessed by ety in primary care: prevalent but untreated. Depress Anxiety
contacting the corresponding author. 20:155–164. https://doi.org/10.1002/da.20039
12. Reardon T, Harvey K, Baranowska M et al (2017) What do par-
ents perceive are the barriers and facilitators to accessing psy-
Compliance with ethical standards chological treatment for mental health problems in children and
adolescents? A systematic review of qualitative and quantitative
Conflict of interest The authors declare that they have no conflict of studies. Eur Child Adolesc Psychiatry 26:623–647. https://doi.
interest. org/10.1007/s00787-016-0930-6
13. O’Brien D, Harvey K, Howse J et al (2016) Barriers to manag-
Open Access This article is licensed under a Creative Commons Attri- ing child and adolescent mental health problems: a systematic
bution 4.0 International License, which permits use, sharing, adapta- review of primary care practitioners’ perceptions. Br J Gen Pract
tion, distribution and reproduction in any medium or format, as long 66:e693–e707. https://doi.org/10.3399/bjgp16X687061
as you give appropriate credit to the original author(s) and the source, 14. Gulliver A, Griffiths KM, Christensen H (2010) Perceived barri-
provide a link to the Creative Commons licence, and indicate if changes ers and facilitators to mental health help-seeking in young peo-
were made. The images or other third party material in this article are ple: a systematic review. BMC Psychiatry 10:113. https://doi.
included in the article’s Creative Commons licence, unless indicated org/10.1186/1471-244X-10-113
otherwise in a credit line to the material. If material is not included in 15. Moore A, Gammie J (2018) Revealed: hundreds of children wait
the article’s Creative Commons licence and your intended use is not more than a year for specialist help. Health Service J. https://
permitted by statutory regulation or exceeds the permitted use, you will www.hsj.co.uk/quality-and-perfor mance/revealed-hundreds-of-
need to obtain permission directly from the copyright holder. To view a children-wait-more-than-a-year-for-specialist-help/7023232.artic
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. le. Accessed 15 Sept 2018
16. Department of Health, Department of Education (2017) Trans-
forming children and young people’s mental health provision:
a green paper. Crown Copyright. https://assets.publishing.servi
References ce.gov.uk/government/uploads/system/uploads/attachment_data/
file/664855/Transforming_children_and_young_people_s_menta
1. Polanczyk GV, Salum GA, Sugaya LS et al (2015) Annual l_health_provision.pdf. Accessed 15 Sept 2018
research review: a meta-analysis of the worldwide prevalence 17. Department of Health, Department of Education (2018) Govern-
of mental disorders in children and adolescents. J Child Psychol ment response to the consultation on transforming children and
Psychiatry Allied Discip 56:345–365. https://doi.org/10.1111/ young people’s mental health provision: a green paper and next
jcpp.12381 steps. Crown Copyright. https://assets.publishing.service.gov.uk/
2. Green H, McGinnity A, Meltzer H et al (2005) Mental health government/uploads/system/uploads/attachment_data/file/72889
of children and young people in Great Britain, 2004. Palgrave 2/govern ment- respon se-to-consul tatio n-on-transf ormin g-childr en-
Macmillan, Basingstoke and-young-peoples-mental-health.pdf. Accessed 15 Sept 2018
3. Pompili M, Serafini G, Innamorati M et al (2012) Substance 18. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Systematic
abuse and suicide risk among adolescents. Eur Arch Psychia- reviews and meta-analyses: the PRISMA statement. Annu Intern
try Clin Neurosci 262:469–485. https://doi.org/10.1007/s0040 Med 151:264–269. https: //doi.org/10.1371/journa l.pmed10 00097
6-012-0292-0 19. Fortune S, Sinclair J, Hawton K (2008) Adolescents’ views on
4. Riegler A, Völkl-Kernstock S, Lesch O et al (2017) Attention preventing self-harm. Soc Psychiatry Psychiatr Epidemiol 43:96–
deficit hyperactivity disorder and substance abuse: an investiga- 104. https://doi.org/10.1007/s00127-007-0273-1
tion in young Austrian males. J Affect Disord 217:60–65. https:// 20. Fortune S, Sinclair J, Hawton K (2008) Help-seeking before
doi.org/10.1016/j.jad.2017.03.072 and after episodes of self-harm: a descriptive study in school
5. Ford T, Collishaw S, Meltzer H, Goodman R (2007) A prospec- pupils in England. BMC Public Health 8:1–13. https: //doi.
tive study of childhood psychopathology: independent predic- org/10.1186/1471-2458-8-369
tors of change over 3 years. Soc Psychiatry Psychiatr Epidemiol 21. Lindsey MA, Korr WS, Broitman M et al (2006) Help-seeking
42:953–961. https://doi.org/10.1007/s00127-007-0272-2 behaviors and depression among African–American adolescent
6. Kim-Cohen J, Caspi A, Moffitt TE et al (2003) Prior juvenile boys. Soc Work 51:49–58
diagnoses in adults with mental disorder: developmental follow- 22. Lindsey MA, Joe S, Nebbitt V (2010) Family matters: the role of
back of a prospective-longitudinal cohort. Arch Gen Psychiatry mental health stigma and social support on depressive symptoms
60:709–717 and subsequent help seeking among African–American boys. J
7. Prince M, Patel V, Saxena S et al (2007) No health without men- Black Psychol 36:458–482. https://doi.org/10.1177/0095798409
tal health. Lancet 370:859–877. https://doi.org/10.1016/S0140 355796
-6736(07)61238-0 23. Kmet LM, Lee RC, Cook LS (2004) Standard quality assessment
8. Reynolds S, Wilson C, Austin J, Hooper L (2012) Effects of criteria for evaluating primary research papers from a variety
psychotherapy for anxiety in children and adolescents: a meta- of fields. Alberta Heritage Foundation for Medical Research
analytic review. Clin Psychol Rev 32:251–262. https: //doi. (AHFMR), Edmonton
org/10.1016/j.cpr.2012.01.005 24. Meredith LS, Stein BD, Paddock SM et al (2009) Perceived barri-
9. Sadler K, Ti Vizard, Ford T et al (2018) Mental health of children ers to treatment for adolescent depression. Med Care 47:677–685.
and young people in England, 2017. Health and Social Care Infor- https://doi.org/10.1097/MLR.0b013e318190d46b
mation Centre, Leeds 25. Popay J, Roberts H, Sowden A et al (2006) Narrative synthe-
10. Chavira DA, Garland A, Yeh M et al (2009) Child anxiety disor- sis in systematic reviews: a product from the ESRC methods
ders in public systems of care: comorbidity and service utilization. programme. ESRC Methods Program. https://doi.org/10.13140
/2.1.1018.4643
13
26. Boyd CP, Hayes L, Nurse S et al (2011) Preferences and inten- help-seeking behavior. Southeast Asian J Trop Med Public Health
tion of rural adolescents toward seeking help for mental health 43:1273–1279
problems. Rural Remote Health 11:1–13 43. Samargia LA, Saewyc EM, Elliott BA (2006) Foregone mental
27. Freedenthal S, Stiffman AR (2007) “They might think i health care and self-reported access barriers among adolescents.
was crazy”: young American Indians’ reasons for not seek- J Sch Nurs 22:17–24
ing help when suicidal. J Adolesc Res 22:58–77. https://doi. 44. Sharma M, Banerjee B, Garg S (2017) Assessment of mental
org/10.1177/0743558406295969 health literacy in school-going adolescents. J Indian Assoc Child
28. Wilson CJ, Rickwood D, Deane FP (2007) Depressive symptoms Adolesc Ment Heal 13:263–283. https://doi.org/10.3760/cma.j.i
and help-seeking intentions in young people. Clin Psychol 11:98– ssn.0366-6999.2012.11.010
107. https://doi.org/10.1080/13284200701870954 45. Sheffield JK, Fiorenza E, Sofronoff K (2004) Adolescents’ will-
29. D’Amico EJ, McCarthy DM, Metrik J, Brown SA (2004) Alcohol- ingness to seek psychological help: promoting and preventing
related services: prevention, secondary intervention, and treat- factors. J Youth Adolesc 33:495–507. https://doi.org/10.1023/
ment preferences of adolescents. J Child Adolesc Subst Abuse B:JOYO.0000048064.31128.c6
14:61–80. https://doi.org/10.1300/J029v14n02_04 46. Sylwestrzak A, Overholt CE, Ristau KI, Coker KL (2015) Self-
30. Wilson CJ, Deane FP, Marshall KL, Dalley A (2008) Reducing reported barriers to treatment engagement: adolescent perspec-
adolescents’ perceived barriers to treatment and increasing help- tives from the National Comorbidity Survey-Adolescent Supple-
seeking intentions: effects of classroom presentations by gen- ment (NCS-A). Community Ment Health J 51:775–781. https://
eral practitioners. J Youth Adolesc 37:1257–1269. https://doi. doi.org/10.1007/s10597-014-9776-x
org/10.1007/s10964-007-9225-z 47. Wilson CJ, Deane FP (2012) Brief report: Need for autonomy and
31. Bussing R, Koro-Ljungberg M, Nohuchi K et al (2012) Willing- other perceived barriers relating to adolescents’ intentions to seek
ness to use ADHD treatments: a mixed methods study of percep- professional mental health care. J Adolesc 35:233–237. https://
tions by adolescents, parents, health professionals and teachers doi.org/10.1016/j.adolescence.2010.06.011
regina. Soc Sci Med 74:92–100. https://doi.org/10.1016/j.socsc 48. Wu MS, Salloum A, Lewin AB et al (2016) Treatment con-
imed.2011.10.009.Willingness cerns and functional impairment in pediatric anxiety. Child Psy-
32. Chandra A, Minkovitz CS (2006) Stigma starts early: Gender chiatry Hum Dev 47:627–635. https://doi.org/10.1007/s1057
differences in teen willingness to use mental health services. J 8-015-0596-1
Adolesc Heal 38:754.e1–754.e8. https://doi.org/10.1016/j.jadoh 49. Balle Tharaldsen K, Stallard P, Cuijpers P et al (2017) ‘It’s a bit
ealth.2005.08.011 taboo’: a qualitative study of Norwegian adolescents’ percep-
33. Cigularov K, Chen PY, Thurber BW, Stallones L (2008) What tions of mental healthcare services. Emot Behav Difficulties
prevents adolescents from seeking help after a suicide educa- 22:111–126. https://doi.org/10.1080/13632752.2016.1248692
tion program? Suicide Life-Threat Behav 38:74–86. https://doi. 50. Becker SJ, Swenson RR, Esposito-Smythers C et al (2014) Bar-
org/10.1521/suli.2008.38.1.74 riers to seeking mental health services among adolescents in
34. Gould MS, Greenberg T, Munfakh JLH et al (2006) Teenag- military families. Prof Psychol Res Pract 45:504–513. https://
ers’ attitudes about seeking help from telephone crisis services doi.org/10.1037/a0036120
(hotlines). Suicide Life-Threat Behav 36:601–613. https://doi. 51. Breland-Noble AM, Wong MJ, Childers T et al (2015) Spir-
org/10.1521/suli.2006.36.6.601 ituality and religious coping in African–American youth with
35. Gould MS, Marrocco FA, Hoagwood K et al (2009) Service depressive illness. Ment Heal Relig Cult 18:330–341. https://
use by at-risk youths after school-based suicide screening. J doi.org/10.1080/13674676.2015.1056120
Am Acad Child Adolesc Psychiatry 48:1193–1201. https://doi. 52. Bullock M, Nadeau L, Renaud J (2012) Spirituality and religion
org/10.1097/CHI.0b013e3181bef6d5 in youth suicide attempters’ trajectories of mental health service
36. Guo S, Kataoka SH, Bear L, Lau AS (2014) Differences in utilization: the year before a suicide attempt. J Can Acad Child
school-based referrals for mental health care: understanding Adolesc Psychiatry 21:186–193
racial/ethnic disparities between Asian–American and Latino 53. Chandra A, Minkovitz CS (2007) Factors that influence mental
youth. School Ment Health 6:27–39. https://doi.org/10.1007/ health stigma among 8th grade adolescents. J Youth Adolesc
s12310-013-9108-2 36:763–774. https://doi.org/10.1007/s10964-006-9091-0
37. Guterman NB, Haj-Yahia MM, Vorhies V et al (2010) Help- 54. Clark LH, Hudson JL, Dunstan DA, Clark GI (2018) Barriers
seeking and internal obstacles to receiving support in the wake and facilitating factors to help-seeking for symptoms of clini-
of community violence exposure: the case of Arab and Jewish cal anxiety in adolescent males. Aust J Psychol. https: //doi.
Adolescents in Israel. J Child Fam Stud 19:687–696. https://doi. org/10.1111/ajpy.12191
org/10.1007/s10826-010-9355-x 55. De Anstiss H, Ziaian T (2010) Mental health help-seeking
38. Haavik L, Joa I, Hatloy K et al (2017) Help seeking for mental and refugee adolescents: qualitative findings from a mixed-
health problems in an adolescent population: the effect of gen- methods investigation. Aust Psychol 45:29–37. https: //doi.
der. J Ment Heal. https://doi.org/10.1080/09638237.2017.13406 org/10.1080/00050060903262387
30 56. Del Mauro JM, Jackson Williams D (2013) Children and ado-
39. Khairani O, Zaiton S, Faridah MN (2005) Do adolescents attend- lescents’ attitudes toward seeking help from professional men-
ing Bandar Mas primary care clinic consult health professionals tal health providers. Int J Adv Couns 35:120–138. https://doi.
for their common health problems? Med J Malaysia 60:134–139 org/10.1007/s10447-012-9172-6
40. Kuhl J, Jarkon-Horlick L, Morrissey RF (1997) Measuring bar- 57. Doyle L, Treacy MP, Sheridan A (2017) ‘It just doesn’t
riers to help-seeking behavior in adolescents. J Youth Adolesc feel right’: a mixed methods study of help-seeking in Irish
26:637–650. https://doi.org/10.1023/A:1022367807715 schools. Adv Sch Ment Health Promot 10:113–126. https://doi.
41. Lubman DI, Cheetham A, Jorm AF et al (2017) Australian ado- org/10.1080/1754730X.2017.1285710
lescents’ beliefs and help-seeking intentions towards peers experi- 58. Fleming TM, Dixon RS, Merry SN (2012) “It’s mean!” the
encing symptoms of depression and alcohol misuse. BMC Public views of young people alienated from mainstream education on
Health 17:1–12. https://doi.org/10.1186/s12889-017-4655-3 depression, help seeking and computerised therapy. Adv Ment
42. Muthupalaniappen L, Omar J, Omar K et al (2012) Emotional Heal 10:195–203. https://doi.org/10.5172/jamh.2011.10.2.195
and behavioral problems among adolescent smokers and their
13
59. Fornos LB, Mika VS, Bayles B et al (2005) A qualitative study under-resourced black youth: adolescent and caregiver perspec-
of Mexican–American adolescents and depression. J Sch Health tives. J Child Fam Stud 22:107–121. https://doi.org/10.1007/
75:162–170. https://doi.org/10.1111/j.1746-1561.2005.00017.x s10826-012-9668-z
60. Francis K, Boyd C, Aisbett D et al (2006) Rural adolescents’ 69. McAndrew S, Warne T (2014) Hearing the voices of young peo-
attitudes to seeking help for mental health problems. Youth Stud ple who self-harm: implications for service providers. Int J Ment
Aust 25:42 Health Nurs 23:570–579. https://doi.org/10.1111/inm.12093
61. Gonçalves M, Moleiro C, Goncalves M, Moleiro C (2012) 70. Mueller AS, Abrutyn S (2016) Adolescents under pressure: a new
The family–school–primary care triangle and the access to durkheimian framework for understanding adolescent suicide in
mental health care among migrant and ethnic minorities. J a Cohesive Community. Am Sociol Rev 81:877–899. https://doi.
Immigr Minor Heal 14:682–690. https://doi.org/10.1007/s1090 org/10.1177/0003122416663464
3-011-9527-9 71. Pailler ME, Cronholm PF, Barg FK et al (2009) Patients’ and
62. Gronholm PC, Thornicroft G, Laurens KR, Evans-Lacko S caregivers’ beliefs about depression screening and referral in the
(2017) Conditional disclosure on pathways to care: coping pref- Emergency Department. Pediatr Emerg Care 25:721–727. https
erences of young people at risk of psychosis. Qual Health Res ://doi.org/10.1097/PEC.0b013e3181bec8f2
27:1842–1855. https://doi.org/10.1177/1049732316680337 72. Prior S (2012) Young people’s process of engagement in school
63. Hassett A, Isbister C (2017) Young men’s experiences of counselling. Couns Psychother Res 12:233–240
accessing and receiving help from child and adolescent mental 73. Timlin-Scalera RM, Ponterotto JG, Blumberg FC, Jackson MA
health services following self-harm. SAGE Open. https://doi. (2003) A grounded theory study of help-seeking behaviors among
org/10.1177/2158244017745112 white male high school students. J Couns Psychol 50:339–350.
64. Huggins A, Weist MD, McCall M et al (2016) Qualitative analysis https://doi.org/10.1037/0022-0167.50.3.339
of key informant interviews about adolescent stigma surrounding 74. Wilson CJ, Deane FP (2001) Adolescent opinions about reducing
use of school mental health services. Int J Ment Health Promot help-seeking barriers and increasing appropriate help engagement.
18:21–32. https://doi.org/10.1080/14623730.2015.1079424 J Educ Psychol Consult 12:345–364. https://doi.org/10.1207/
65. Kendal S, Keeley P, Callery P (2014) Student help seeking from S1532768XJEPC1204_03
pastoral care in UK high schools: a qualitative study. Child 75. Wisdom JP, Clarke GN, Green CA (2006) What teens want: bar-
Adolesc Ment Health 19:178–184. https: //doi.org/10.1111/ riers to seeking care for depression. Adm Policy Ment Heal Ment
camh.12029 Heal Serv Res 33:133. https: //doi.org/10.1007/s10488 -006-0036-4
66. Klineberg E, Kelly MJ, Stansfeld SA, Bhui KS (2013) How do 76. Mellor C (2014) School-based interventions targeting stigma of
adolescents talk about self-harm: a qualitative study of disclosure mental illness: systematic review. Psychiatr Bull 38:164–171.
in an ethnically diverse urban population in England. BMC Public https://doi.org/10.1192/pb.bp.112.041723
Health. https://doi.org/10.1186/1471-2458-13-572 77. Wolpert M, Cortina M (2018) CASCADE Framework: supporting
67. Leavey G, Rothi D, Paul R (2011) Trust, autonomy and relation- joint working between education and mental health professionals.
ships: the help-seeking preferences of young people in secondary CAMHS Press, London
level schools in London (UK). J Adolesc 34:685–693. https://doi. 78. Fazel M, Hoagwood K, Stephan S, Ford T (2014) Mental health
org/10.1016/j.adolescence.2010.09.004 interventions in schools 1: mental health interventions in schools
68. Lindsey MA, Chambers K, Pohle C et al (2013) Understanding in high-income countries. lancet Psychiatry 1:377–387. https://
the behavioral determinants of mental health service use by urban, doi.org/10.1016/S2215-0366(14)70312-8
13

s00787 019 01469 4

Uploaded by

Copyright:

Available Formats

s00787 019 01469 4

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

s00787 019 01469 4

Uploaded by

Copyright:

Available Formats

European Child & Adolescent Psychiatry (2021) 30:183–211

Why do children and adolescents (not) seek and access professional

Keywords Children · Adolescents · Mental health · Barriers · Facilitators · Professional help

Almost one in seven young people meet diagnostic criteria

Fig. 1 PRISMA flowchart of study selection process

Fig. 2 Percentage of all (per- 46% 7%

Overall (barrier) Qualitative (barrier) Quantitative (barrier)

Fig. 3 Percentage of overall

Fig. 4 Percentage of overall

Fig. 5 Percentage of overall

predominantly in quantitative studies. Two-thirds of stud- Robustness of data synthesis

You might also like