title: The different stages and actors involved in the process leading to the use of adolescent mental health services.
abstract: Although a substantial number of adolescents suffer from emotional or behavioural problems, only a minority receive mental health care. In order to understand this discrepancy, this article aims to increase insight into the help-seeking process. First, a model of the help-seeking process for adolescent psychopathology was formulated. This model takes into account the sequential nature of help seeking and the involvement of multiple actors (adolescents, parents and teachers) and service providers (general practitioners, mental health care professionals, teachers, and friends/relatives). Using structural equation modelling, the model was empirically tested on 114 Dutch adolescents (aged 12-17 years), who were selected for having emotional or behavioural problems from a representative general practice sample. Of these 16.5% had used mental health services. The sequence of stages and the actors involved in the process leading to mental health care use was similar across gender. Parents and adolescents had a comparable impact on this process. The general practitioner functioned as gatekeeper to mental health care, whereas the teacher's role in the process was limited. Interventions aimed at increasing adolescent mental health service use should be directed at parents and adolescents, and at the roles of school personnel and general practitioners in the detection of problems and referral.
authors: NIVEL and Erasmus Medical Centre, The Netherlands. M.Zwaanswijk@nivel.nl
authors: Marieke
authors: M
authors: Zwaanswijk
authors: Jan
authors: J
authors: Van der Ende
authors: Peter F M
authors: PF
authors: Verhaak
authors: Jozien M
authors: JM
authors: Bensing
authors: Frank C
authors: FC
authors: Verhulst
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000342:Affective Symptoms / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005178:Faculty; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services; D020380:Needs Assessment; D009426:Netherlands; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012017:Referral and Consultation; D012931:Social Environment; D012944:Social Support