Improving help-seeking in adolescence: the importance of mental health stigma and mental health literacy.

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Adolescence is a particularly vulnerable period for the development of mental health problems, with around half of all mental health problems emerging before the age of 14 (Kessler et al., 2005). Despite adolescent mental health being a public health priority there is a notable lack of help-seeking among young people. Around two thirds of adolescents do not access formal support despite showing clinical symptoms of a mental health problem (Merikangas et al., 2011). One explanation for this lack of help-seeking is stigma which is consistently noted as one of the most significant barriers to help-seeking among adolescents (Gulliver et al., 2010). Given the strong link between stigma and a lack of help-seeking, the reduction of mental health stigma among young people has been identified as a priority area for research and policy development (WHO, 2013). Adolescents who do not seek help are seven times more likely to see a worsening of mental health problems (Neufeld et al., 2017). There is therefore a clear need to improve help-seeking, and to do so, we need to better understand the impacts of stigma on adolescents' help-seeking behaviour. Results from my PhD research suggest that perceived stigma from friends and parents is associated with decreased help-seeking among adolescents aged 12-17. Therefore, it may be beneficial to consider whether information can be provided to both parents and adolescents together, to reduce perceived stigma from parents. Additionally, findings suggest that peer-led initiatives may be helpful in reducing perceived stigma from friends. However, adolescents' views have often been overlooked in the development of anti-stigma strategies, thus reducing their effectiveness (Gronholm et al., 2018). Adopting a co-production approach (i.e. where young people and researchers share power and responsibility for research) would enable young people to contribute to and shape the decisions that affect their lives. During the fellowship, a co-production approach will be adopted with young people in partner schools and via links with See Me (Scotland's national anti-stigma programme). This will build on statistical findings of my PhD by enabling young people to consider the key research findings and identify potential family and peer-based anti-stigma strategies. By working together, young people will be enabled to help shape research output based on what they believe are the key messages resulting from the PhD, and what the best methods of disseminating to young people and other key stakeholders would be.I will expand on my PhD with additional qualitative research in the form of focus groups with young people. I plan to work with schools in the rural areas, where stigma is known to be a greater barrier to help-seeking. This would further enhance our understanding of the impact of stigma on rural young people's help-seeking behaviour by bringing their own perspectives into the research process to inform and enhance our understanding of issues as they affect their lives. Research questions include:-To what extent do young people living in rural areas perceive stigma towards mental health problems to be a significant issue within their communities?-Does stigma impact on help-seeking intentions of adolescents living in rural communities?-What do adolescent in rural areas perceive as being facilitators of successful help-seeking?Findings will be used to inform my future research, and to inform work with young people in partner organisations such as See Me. Findings will make important contributions to knowledge by highlighting adolescent voices and experiences of stigma, as well as signposting solutions to stigma's negative consequences, as identified by adolescents themselves. Improving young people's mental health, as well as rural mental health, is a key part of the Scottish Government's Mental Health Strategy, 2017-2027, therefore the research will have important implications for policy development.