Frank P. Deane

Young people's help-seeking for mental health problems

Abstract This paper summarises an ambitious research agenda aiming to uncover the factors that affect help-seeking among young people for mental health problems. The research set out to consider why young people, and particularly young males, do not seek help when they are in psychological distress or suicidal; how professional services be made more accessible and attractive to young people; the factors that inhibit and facilitate help-seeking; and how community gatekeepers can support young people to access services to help with personal and emotional problems. A range of studies was undertaken in New South Wales, Queensland and the ACT, using both qualitative and quantitative approaches. Data from a total of 2721 young people aged 14–24 years were gathered, as well as information from some of the community gatekeepers to young people’s mental health care. Help-seeking was measured in all the studies using the General Help Seeking Questionnaire (Wilson, Deane, Ciarrochi & Rickwood, 2005), which measures future help-seeking intentions and, through supplementary questions, can also assess prior help-seeking experience. Many of the studies also measured recent help-seeking behaviour using the Actual Help Seeking Questionnaire. The types of mental health problems examined varied across the studies and included depressive symptoms, personal-emotional problems, and suicidal thoughts. The help-seeking process was conceptualised using a framework developed during the research program. This framework maintains that help-seeking is a process of translating the very personal domain of psychological distress to the interpersonal domain of seeking help. Factors that were expected to facilitate or inhibit this translation process were investigated. These included factors that determine awareness of the personal domain of psychological distress and that affect the ability to articulate or express this personal domain to others, as well as willingness to disclose mental health issues to other people. The results are reported in terms of: patterns of help-seeking across adolescence and young adulthood; the relationship of help-seeking intentions to behaviour; barriers to seeking help—lack of emotional competence, the help-negation effect related to suicidal thoughts, negative attitudes and beliefs about help-seeking and fear of stigma; and facilitators of seeking help—emotional competence, positive past experience, mental health literacy, and supportive social influences. The paper considers the implications of the findings for the development of interventions to encourage young people to seek help for their mental health problems, and concludes by identifying gaps in the help-seeking research and literature and suggesting future directions.

Adolescent opinions about reducing help-seeking barriers and increasing appropriate help engagement

Effective mental illness prevention programs are important for the safety of youth and adolescents. Research suggests that programs should facilitate appropriate help seeking by lowering help-seeking barriers. This study used focus groups to obtain high school student opinions about actual help-seeking behaviors, reducing adolescent help-seeking barriers, raising sensitive issues with adolescents, and increasing appropriate help-source engagement. Transcript analysis revealed several themes. Relationship and trust were key approach factors for current help seeking. Memories of successful prior helping episodes were also important. Education about appropriate help seeking, presented in ways consistent with those currently used by adolescents (e.g., through peer networks), might reduce help-seeking barriers. Education should include key adults who act as gatekeepers within adolescent networks (e.g., parents and teachers). Assertive outreach and follow-up might be important factors for continued help-source engagement. Themes provide a basis for suggestions about ways to facilitate adolescent help seeking and maintain appropriate help-source engagement.

Treatment fearfulness and distress as predictors of professional psychological help-seeking

Abstract Only a small proportion of people who experience psychological distress seek professional psychological help. Treatment fearfulness is one of a number of factors thought to influence peoples tendency to seek or avoid mental health treatment. The aim of the present study was to provide additional validity information on the Thoughts About Therapy Survey (TAPS) (Kushner & Sher, 1989), and to determine whether fear of therapy and psychological distress were predictive of help-seeking. A non-clinical student sample completed measures of their treatment fears, expectations, anxiety, psychological distress and help-seeking likelihood. Concurrent and construct validity was confirmed for TAPS. Image Concerns, Stigma Concerns, Coercion Concerns and psychological distress were related to the likelihood that subjects would seek professional psychological help. Results are discussed in relation to educational approaches for reducing treatment fearfulness and the potential for increasing appropriate professi...

Relations between social and emotional competence and mental health: a construct validation study

Researchers working fairly independently of each other have created numerous measures of social and emotional competence (SEC). These measures tend to correlate (sometimes highly) with each other and with measures of stressful events, suggesting potential redundancy. We evaluated which, if any, SEC variables predicted unique variance in social and mental health after controlling for other SEC variables in the study and the impact of stressful events. Three-hundred and thirty-one university students participated in an anonymous, cross-sectional study. We measured stressful events, and a wide variety of SECs, including: social problem solving skill (effective problem orientation, automatic processing, and problem solving), alexithymia (difficulty identifying and describing emotions; minimising emotions), effective emotional control (low rumination, high impulse control, high aggression control, low defensive inhibiting of emotions), and level of emotional awareness. We also assessed a variety of aspects of social and mental health (e.g. depression, anxiety, hopelessness, suicidal ideation, life satisfaction, social support). Covariance analyses revealed that all SEC measures except minimising emotions had significant incremental value over the other measures and over stressful events in predicting social and mental health. The optimal set of predictors differed depending upon the type of health predicted. These findings have important implications for the design of social and emotional intervention programs.

Adolescents who need help the most are the least likely to seek it: The relationship between low emotional competence and low intention to seek help

It has been found that university students who were the least skilled at managing their emotions also had the lowest intention of seeking help from a variety of nonprofessional sources (e.g. family and friends). The present study sought to extend these findings by focusing on adolescents, examining a larger number of emotional competencies, and exploring the possibility that social support explains the relationship between emotional competence and help-seeking. A total of 137 adolescents (aged 16-18) completed an anonymous survey that assessed social support, emotional competencies, and intention to seek help from a variety of professional and nonprofessional sources. As expected, adolescents who were low in emotional awareness, and who were poor at identifying, describing, and managing their emotions, were the least likely to seek help from nonprofessional sources and had the highest intention of refusing help from everyone. However, low emotional competence was not related to intention to seek help from professional sources (e.g. mental health professionals). The significant results involving nonprofessional sources were only partially explained by social support, suggesting that even adolescents who had high quality support were less likely to make use of that support if they were low in emotional competence.

Do difficulties with emotions inhibit help-seeking in adolescence? The role of age and emotional competence in predicting help-seeking intentions

We examined whether adolescents who are poor at identifying, describing, and managing their emotions (emotional competence) have lower intentions to seek help for their personal-emotional problems and suicidal ideation, as observed in adult studies. We also examined whether age moderated the relationship between competence and help-seeking. Two hundred and seventeen adolescents completed measures of emotional competence, help-seeking, hopelessness, and social support. Results indicated that adolescents who were low in emotional competence had the lowest intentions to seek help from informal sources (i.e., family and friends) and from some formal sources (e.g., mental health professionals), and the highest intentions to seek help from no-one. There was one important age-related qualification: difficulty in identifying and describing emotions was associated with higher help-seeking intentions amongst young adolescents but lower intentions among older adolescents. Social support, hopelessness, and sex could not entirely explain these relationships. Thus, even those who had high quality social support had less intention to use it if they were low in emotional competence.

Clinical norms, reliability and validity for the hopkins symptom checklist-21

The Hopkins Symptom Checklist-21 (HSCL-21) was administered to 141 psychotherapy clients attending for their first visit at an outpatient psychology department. Some preliminary normative data is provided along with support for the reliability and validity of the HSCL-21 with a clinical sample. The HSCL-21 showed sensitivity to change over the course of psychotherapy. Due to its brevity, it may be preferable to longer symptom-distress measures for repeated measurement in monitoring, client progress over therapy.

Suicide prevention in Aboriginal communities: application of community gatekeeper training.

Objective : Concern over the high rate of suicide among Aboriginal people on the south coast of NSW led to the development of a project aimed at preventing youth suicide in the Aboriginal communities of the Shoalhaven. This paper describes the development, implementation and evaluation of the project.

Testing the validity of the Recovery Assessment Scale using an Australian sample

Objective: Mental health services in Australia are increasingly becoming recovery orientated. However, there are varying meanings for recovery and few measures that specifically target recovery outcomes. The current study aimed to assess the construct and concurrent validity of a patient self-report measure, the Recovery Assessment Scale (RAS). Method: Participants were 168 individuals with severe and persistent psychiatric disability who were participants in the Australian Integrated Mental Health Initiative (AIMhi) project. They completed self-report recovery and other mental health measures and their case workers completed the Health of the Nation Outcome Scales. Exploratory and confirmatory factor analyses were carried out to examine the factor structure of the RAS. Results: Exploratory factor analysis of the RAS produced five factors that were replicated using confirmatory techniques. Each factor has satisfactory internal reliability (Cronbach α range = 0.73–0.91). The factors displayed convergent validity with positive and significant correlations with other recovery measures. Concurrent validity was demonstrated with significant but lower correlations with symptoms and clinician-rated measures of psychiatric functioning. Conclusion: The factors of the RAS are consistent with the consumer literature on recovery. Correlations with other variable suggest that the RAS is measuring something different from traditional symptom or functional mental health measures. Further research is needed to clarify the extent to which the RAS is able to capture the range of recovery experiences that have been described by patients.

Factors influencing mental-health help-seeking in Arabic-speaking communities in Sydney, Australia

Traditionally, the utilization of mental-health services by Arabic-speaking communities in Australia has been low. Interviews were conducted with 35 key informants from Arabic-speaking backgrounds, exploring their perceptions of mental illness in the Arab community, together with preferred forms of support and treatment. Transcript analysis of audio-taped interviews identified key themes that inhibited professional mental-health help-seeking and utilization of mental-health services. Shame and stigma appeared to be the overwhelming hindrance to accessing services, due to the strong cultural prohibitions on exposing any personal or family matters to outsiders. The findings emphasized the perceived negative effect of mental illness on important cultural institutions, such as marriage. The results revealed strong concerns about confidentiality and lack of trust in service providers. Religious leaders were identified as important sources of help for mental-health problems. Better promotion of existing mental-health services, working more closely with Arabic religious leaders, and families were some of the suggested strategies to improve help-seeking and mental-health service utilization.