Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies

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 systematic 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 perceptions 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: Adolescents; Barriers; Children; Facilitators; Mental health; Professional help.

Fig. 1

PRISMA flowchart of study selection process

Fig. 2

Percentage of all (percentage of 54 included samples that reported barrier/facilitator), qualitative (percentage of 31 included qualitative samples that reported barrier/facilitator) and quantitative (percentage of 23 included quantitative samples where a ‘large’ (> 30) or ‘medium’ (10–30) percentage of participants endorsed the barrier/facilitator) studies reporting barriers and facilitators relating to young people’s individual factors

Fig. 3

Percentage of overall (percentage of 54 included samples that reported barrier/facilitator), qualitative (percentage of 31 included qualitative samples that reported barrier/facilitator) and quantitative (percentage of 23 included quantitative samples where a ‘large’ (> 30) or ‘medium’ (10–30) percentage of participants endorsed the barrier/facilitator) studies reporting barriers and facilitators relating to social factors

Fig. 4

Percentage of overall (percentage of 54 included samples that reported barrier/facilitator), qualitative (percentage of 31 included qualitative samples that reported barrier/facilitator) and quantitative (percentage of 23 included quantitative samples where a ‘large’ (> 30) or ‘medium’ (10–30) percentage of participants endorsed the barrier/facilitator) studies reporting barriers and facilitators relating to relationship factors

Fig. 5

Percentage of overall (percentage of 54 included samples that reported barrier/facilitator), qualitative (percentage of 31 included qualitative samples that reported barrier/facilitator) and quantitative (percentage of 23 included quantitative samples where a ‘large’ (> 30) or ‘medium’ (10–30) percentage of participants endorsed the barrier/facilitator) studies reporting barriers and facilitators relating to systemic and structural factors