Promoting Adolescent Help-Seeking for Mental Health Problems: Strategies for School-Based Professionals
Walcott, Christy M., Music, Ajlana, National Association of School Psychologists. Communique
People seldom refuse help, if one offers it in the right way. - A. C. Benson
Extensive research suggests that adolescence is a critical developmental period, especially when it comes to factors that influence mental health problems (e.g., Evans et al., 2005; Rickwood, Deane, Wilson, & Ciarrochi, 2005). Major emotional, physical, and cognitive changes that occur during adolescence significantly impact mental health outcomes in adulthood. For example, many disorders, such as depression, substance use, anxiety, eating disorders, and psychosis, can reach peak incidence during the adolescent and early adulthood years. Regrettably, study after study highlights the limited use of mental health services by adolescents with emotional and behavioral problems (e.g., Cauce et al., 2002; Saunders, Resnick, Hoberman, & Blum, 1994; Sourander et al., 2001; Zwaanswijk et al., 2003, 2007). As such, systematic efforts to promote adolescent help-seeking are essential for improving long-term mental health outcomes. Defined as a "behavior of actively seeking help from other people," psychological help-seeking involves communicating with others to obtain help and support for troubling experiences (Rickwood et al., p. 4). There are two major sources of help-seeking in which adolescents can engage: informal help-seeking from family and friends and formal help-seeking from professional sources (e.g., counselors, psychologists, psychiatrists, clergy). School-based mental health professionals are one logical source of formal help for adolescents.
Seeking help and using social supports are protective factors for many adolescent outcomes, and adolescents generally display a greater preference for informal versus formal sources (e.g., Sheffield, Fiorenza, & Sofronoff, 2004). Despite the protective nature of seeking support from friends and family for mental health problems, it is important to question whether informal sources are sufficient for those experiencing significant emotional and behavioral problems. Although adolescents may find affiliative support from peers or family members, information and suggestions provided maybe inaccurate, unhelpful, or even damaging. This article discusses various strategies to promote professional help-seeking for emotional and behavioral problems. As noted in a review by Power, Eiraldi, Clarke, Mazzuca, and Krain, (2005) , we have much to learn about adolescent help-seeking strategies and how to improve service utilization. For this discussion, we assume that an adequate formal infrastructure of social services is available to adolescents, but that such services are underutilized. Although we recognize that this is not the case in many areas, the present focus is on underutilization of existing services. Using information from available research, we propose various strategies to encourage help-seeking among adolescents. Because most of these strategies have yet to be empirically validated, we conclude with suggestions for outcome evaluation.
To provide a framework, we point to three widely accepted stages of the help-seeking process: (a) problem recognition, (b) decision to seek help, and (c) service selection and utilization (Anderson, 1995; Goldsmith, Jackson, & Hough, 1988). Cauce and colleagues (2002), for example, used this framework to examine how culture and context permeate all three stages of this pathway. Particularly relevant to our discussion, they concluded that culturally competent practices are essential but irrelevant unless mental health providers can find ways to guide more minority adolescents to the available services. As mentioned, there has been a consistent trend that adolescents tend not to seek help from professional sources, but this is especially true for boys and those from minority groups (e.g., Cauce et al., 2002; Saunders, Resnick, Hoberman, 8c Blum, 1994; Sourander et al., 2001; Zwaanswijk et al., 2003, 2007). Thus, in this article, we focus on factors associated with the final stage of the model above, the selection and utilization (or lack thereof) of formal services. …