Breaking down barriers to help-seeking

What is the help-seeking process?

In one of the few comprehensive studies into help-seeking behaviour in Australia, Rickwood et. Al. (2005) define help seeking in four stages:

Awareness and appraisal of problems

The ability to recognise symptoms, and that you have a problem that may require intervention from someone else.

Expression of symptoms and need for support

This awareness must be able to be articulated or expressed in words that can be understood by others, and the help-seeker must feel comfortable to do so.

Availability of sources of help

Sources of help and support in dealing with the problem need to be available and accessible, and the help-seeker must have an understanding of where/how to get that support.

Willingness to seek out and disclose to sources

The help-seeker must be willing and able to disclose their inner state to the source of help.

For us to help young people get to the help they need, we need to find ways to help them recognise that they have a mental health problem that they can't overcome on their own, to have the ability to express what they are feeling, to know where they can get help, and to be willing to seek out that help.

What barriers are preventing young people from seeking help?

Many studies have been done into the key barriers to help seeking. A detailed literature review was published in 2010 by Guillver et al. which reviewed 15 qualitative and 7 quantitative studies of young people's experiences of help-seeking for anxiety or depression. Key themes in the barriers young people identified to help-seeking were:

Stigma and embarrassment

The most frequently reported of all the barriers. Public, perceived and self-stigmatising attitudes to mental illness create an embarrassment and fear of identifying with a mental illness or seeking help about it. Also prominent among young people was a general concern about what others, including the source of help, might think of them if they were to seek help.

"Because you can't see it, it's not real. Unless I'm in physical pain, there's no reason to go seek help." - ReachOut.com focus group participant.

Problems recognising symptoms (poor mental health literacy)

It was frequently reported that young people simply don't know how to identify when the difficulties they are facing are beyond the normal threshold of storm and stress. One study reported that young people were aware of their distress, but continuously altered their definition of what was "normal" distress to avoid seeking help.

"Stress is normal…" - Eisenberg (2007), in Gulliver et al.

Preference for self-reliance

A consistent factor in both qualitative and quantitative research was the trend that young people prefer to rely on themselves, rather than seeking outside help for the problems they were facing. To seek help from someone else is often seen as an indicator of weakness, or not being capable of dealing with normal life problems.

Confidentiality and trust

A major concern for many young people was a lack of trust with respect to the potential source of help. Fears of a breach of confidentiality leading to exposure, distrust of the credibility or authenticity of providers, perceptions of judgmental attitudes, and a lack of familiarity were all identified as aspects of this barrier.

Hopelessness

Additionally, Rickwood et al. suggested that the feeling or perception of hopelessness was a strong contributor to the help negation effect (a consistent pattern where the higher someone's levels of distress, the less likely they are to access support).

"I felt that no person or helping service could help." - Dubow (1990), in Gulliver et al.

What are effective facilitators of help-seeking?

In the review of existing literature, Gulliver et al. found research that looked at what facilitates help-seeking behaviour was far less comprehensive. Some of the key factors which had been reported in the previous studies were:

Positive past experiences

Three studies investigating facilitating factors reported positive past experiences of help-seeking or support as a significant influence on help-seeking. This could also include increased mental health literacy and service knowledge from earlier help-seeking.

Social support and encouragement from others

Influences such as parents who are supportive and open to professional support as a factor in good health and wellbeing, or friends who have had positive experiences, were positive influences on help-seeking. Interestingly, young people were observed to be more likely to seek or recommend help for a friend, than to seek help themselves.

Emotional confidence/mental health literacy

Rickwood et al. found that one of the most important factors in help-seeking was young people having the ability and confidence to identify and articulate their emotions, and their ability to recognise and understand the symptoms of a mental health difficulty.

What's your experience?

The research shows us key trends in the way young people seek help, and the reason's why they don't, but the real challenge is taking this down to the level on which we engage with young people. Share your experiences and insights to help other health professionals to break down these barriers to help seeking.

• What's the hardest barrier you've come up against when supporting young people around mental health?
• What has made it easier for young people to access support?
• How do you broach the topic of mental health with young people?