Awareness of beyondblue: the national depression initiative in Australian young people

Mental health stigma among college students: Test of an interactive online intervention

Objective: Young adults have low rates of help-seeking despite high rates of mental health problems, which relate to stigmatizing attitudes. Education as well as contact with people with mental health problems may improve stigmatization. The present pilot study tested the efficacy of an online interactive educational intervention that utilizes avatars depicting distressed individuals on stigmatizing attitudes toward mental illness and help-seeking. Participants and Methods: Eighty-five college student participants were assessed on self- and public-stigma as well as attitudes toward help-seeking and were randomly assigned to one of three conditions (intervention, control, post-test only). Results: Pre-post comparisons indicate that interactive programs may be an accessible and efficient means to reduce stigmatizing attitudes toward help-seeking among college students. Future studies should include follow-up assessments and measures of behavior and should consider individual differences. including personal mental health history.

Screening and treatment of depression - recommendations for Polish health professionals

INTRODUCTION

Epidemiological data clearly indicate that depression is becoming an increasingly important health and social problem today. Depressive disorders occur at all ages, in men and women, in different cultures, affecting individuals, their families, and, more broadly, the social and economic system of the country. The gap between the recorded number of treated patients and the prevalence of depression highlights the scale of unmet needs. With limited availability of specialists in psychiatric care, the most appropriate measures seem to be those aimed at increasing the competence of other health professionals in the diagnosis and treatment of depression.

MATERIAL AND METHODS

An overview of the literature and available recommendations for the prevention, screening, and treatment of depression was performed. This work was commissioned by the Polish Ministry of Health under the Depression Prevention Program 2016-2020.

RESULTS

Based on the literature review, we compiled the recommendations for Polish health professionals. These recommendations focus on the management of depression in the primary care setting and provide guidelines for health professionals other than psychiatrists concerning the prevention, screening, and treatment of depression.

CONCLUSIONS

We developed a clear recommendation for non-psychiatrists concerning the screening, treatment, and further management of patients with depression. Early detection of depression and implementation of treatment improves the outcomes and prognosis and reduces the mortality rate.

Screening for depression in young Indigenous people: building on a unique community initiative

Gurriny Yealamucka Health Service Aboriginal Corporation (GYHSAC) is an Indigenous community-controlled health organisation providing comprehensive primary care to the people of Yarrabah in far north Queensland, Australia. GYHSAC conducts an annual Young Person's Health Check (YPC) for people aged 15-25 years based on the Medical Benefits Schedule Item 715. However, the YPC is constantly evolving to meet the needs of the community, and in 2016, in response to concerns about psychological risk among Indigenous youth, GYHSAC teamed up with James Cook University to trial an adapted PHQ-9 depression screening tool (aPHQ-9) as part of the YPC. This study describes the 2016 YPC event, reports the prevalence of depressive symptoms, examines local issues related to the use of the screening tool and proposes recommendations for future health screening. Experienced health professionals conducted the aPHQ-9 assessment in a private area of the clinic. One-in-five young people were found to have moderate-severe symptoms or self-harm ideation in the previous 2 weeks; they were referred to the mental health service. The aPHQ-9 screening process was found to be straightforward and well accepted by staff and youth. Importantly, it provided valuable 'space' to facilitate communication on sensitive issues and was a conduit for speedy referral and follow up by trained staff. Based on our experience, we recommend dedicated depression screening in future routine community health checks for young people and adults.

Social and Emotional Wellbeing Screening for Aboriginal and Torres Strait Islanders within Primary Health Care: A Series of Missed Opportunities?

BACKGROUND

Social and emotional wellbeing (SEWB) is a critical determinant of health outcomes for Indigenous Australians. This study examined the extent to which primary healthcare services (PHSs) undertake SEWB screening and management of Aboriginal and Torres Strait Islander clients, and the variation in SEWB screening and management across Indigenous PHS.

METHODS

Cross-sectional analysis between 2012 and 2014 of 3,407 Indigenous client records from a non-representative sample of 100 PHSs in 4 Australian states/territory was undertaken to examine variation in the documentation of: (1) SEWB screening using identified measurement instruments, (2) concern regarding SEWB, (3) actions in response to concern, and (4) follow up actions. Binary logistic regression was used to determine the factors associated with screening.

RESULTS

The largest variation in SEWB screening occurred at the state/territory level. The mean rate of screening across the sample was 26.6%, ranging from 13.7 to 37.1%. Variation was also related to PHS characteristics. A mean prevalence of identified SEWB concern was 13% across the sample, ranging from 9 to 45.1%. For the clients where SEWB concern was noted, 25.4% had no referral or PHS action recorded. Subsequent internal PHS follow up after 1 month occurred in 54.7% of cases; and six-monthly follow up of referrals to external services occurred in 50.9% of cases.

CONCLUSION

Our findings suggest that the lack of a clear model or set of guidelines on best practice for screening for SEWB in Indigenous health may contribute to the wide variation in SEWB service provision. The results tell a story of missed opportunities: 73.4% of clients were not screened and no further action was taken for 25.4% for whom an SEWB concern was identified. There was no follow up for just under half of those for whom action was taken. There is a need for the development of national best practice guidelines for SEWB screening and management, accompanied by dedicated SEWB funding, and training for health service providers as well as ongoing monitoring of adherence with the guidelines. Further research on barriers to screening and follow up actions is also warranted.

Young men's access to community-based mental health care: qualitative analysis of barriers and facilitators

BACKGROUND

Young men experiencing mental ill health report the lowest rates of professional help-seeking of any demographic group across the lifespan. This phase of life (i.e. adolescence and emerging adulthood) also corresponds to a period of disconnection from healthcare services for young men.

AIMS

The present exploratory qualitative study aimed to identify barriers and facilitators to mental health care, as identified by a sample of young help-seeking men and staff involved in mental health service provision.

METHOD

Interviews and focus groups were undertaken with 25 young males (mean = 18.80 years, SD = 3.56) and four service providers. Participants were recruited from headspace enhanced primary care early intervention centres in Australia.

RESULTS

Thematic analysis indicated four overarching barriers and facilitators. The identified barriers were male role expectations, talk therapy as unknown territory, difficulties navigating the system and intake processes. The identified facilitators were positive initial contact, effective cross-sector partnerships, availability of male practitioners and use of targeted messaging.

CONCLUSIONS

Given the ongoing low rates of help-seeking, high rates of suicide and other adverse outcomes for young men, priority research and clinical attention is needed for this group. Recommendations are offered for future research, including suggestions for implementation of targeted strategies addressing gender-based health needs.

Interventions to reduce discrimination and stigma: the state of the art

BACKGROUND

There is a rich literature on the nature of mental health-related stigma and the processes by which it severely affects the life chances of people with mental health problems. However, applying this knowledge to deliver and evaluate interventions to reduce discrimination and stigma in a lasting way is a complex and long-term challenge.

METHODS

We conducted a narrative synthesis of systematic reviews published since 2012, and supplemented this with papers published subsequently as examples of more recent work.

RESULTS

There is evidence for small to moderate positive impacts of both mass media campaigns and interventions for target groups in terms of stigma-related knowledge, attitudes, and intended behaviour in terms of desire for contact. However, the limited evidence from longer follow-up times suggests that it is not clear whether short-term contact interventions have a lasting impact.

CONCLUSIONS

The risk that short-term interventions may only have a short-term impact suggests a need to study longer term interventions and to use interim process and outcome data to improve interventions along the way. There is scope for more thorough application of intergroup contact theory whenever contact is used and of evidence-based teaching and assessment methods when skills training is used for target groups.

Psychiatric labels and other influences on young people's stigmatizing attitudes: Findings from an Australian national survey

BACKGROUND

Stigma is a major impediment to help seeking for mental disorders by young people. To reduce stigma and improve help seeking, a better understanding of the influences on different components of stigma for different disorders is required.

METHODS

In 2011, a telephone interview was conducted with a national sample of 2522 Australians aged 15-25 years. Participants were presented with a vignette of a young person portraying either depression, depression with suicidal thoughts, social phobia, post-traumatic stress disorder or psychosis. They were then asked what they thought was wrong with the person, exposure to mental health problems in themselves and in family or friends, stigmatizing attitudes, and their awareness of beyondblue.

RESULTS

Accurate psychiatric labeling of the mental disorder presented in the vignette and beyondblue awareness were the best predictors of less stigmatizing attitudes, followed closely by exposure to family or friends with mental health problems. Across vignettes, the personally held stigmatizing perception of mental health problems as a weakness rather than an illness was most strongly associated with these predictors.

LIMITATIONS

Stigma and labeling were assessed with reference to a vignette character and may not reflect actual experience or behaviors. Other limitations include the cross-sectional design and potential for social desirability bias in the stigma measure.

CONCLUSIONS

Findings suggest that community awareness campaigns (such as those by beyondblue) that encourage appropriate close contact with others affected by mental health problems and improved accurate psychiatric label use may have potential to counter various aspects of stigma, especially personal beliefs that mental illness is a weakness.

Mental health of Indigenous Australians: a review of findings from community surveys

OBJECTIVE

To assemble what is known about the mental health of Indigenous Australians from community surveys.

DATA SOURCES

A systematic search was carried out of publications and data sources since 2000 using PubMed, PsycINFO, Australian Medical Index, the National Library of Australia and datasets known to the authors.

STUDY SELECTION

Surveys had to involve representative sampling of a population, identify Aboriginal and Torres Strait Islander people and include a measure of mental health.

DATA EXTRACTION

11 surveys were found. Data were extracted on prevalence rates for Indigenous people by age and sex, along with comparison data from the general population, where available.

DATA SYNTHESIS

Across seven studies, Indigenous adults were consistently found to have a higher prevalence of self-reported psychological distress than the general community. However, two studies of Indigenous adolescents did not find a higher prevalence of psychological distress. Two surveys of parents and carers of Indigenous children and adolescents found a higher prevalence of behaviour problems.

CONCLUSIONS

There is an inequality in mental health between Indigenous and non-Indigenous Australians that starts from an early age. This needs to be a priority for research, preventive action and health services.

Associations between awareness of beyondblue and mental health literacy in Australian youth: Results from a national survey

OBJECTIVES

The aim of this paper is to examine whether Australian young people's awareness of beyondblue is associated with better recognition of depression and anxiety disorders, and better quality of beliefs about possible interventions and first-aid actions for these problems.

METHOD

In 2011, a telephone interview was conducted with a national sample of 3021 Australians aged between 15 and 25 years. Participants were presented with a vignette portraying depression, depression with suicidal thoughts, social phobia, post-traumatic stress disorder or psychosis in a young person. They were then asked about recognition of the disorder portrayed, their beliefs about the helpfulness or harmfulness of various interventions and first-aid actions, and their awareness of beyondblue. The quality of youths' beliefs was scored against health professionals' ratings of the same list of interventions and first-aid actions.

RESULTS

Beyondblue awareness was associated with more accurate recognition of the disorder portrayed in all vignettes except social phobia. It was also associated with beliefs about the helpfulness of first-aid actions that were more closely aligned with professional ratings for the depression, psychosis and social phobia vignettes. However, it was associated with beliefs about interventions for the psychosis vignette only.

CONCLUSIONS

Overall, the associations of beyondblue awareness with better mental health literacy were not specific to depression and anxiety disorders, which are their main focus. Beyondblue awareness is mostly unrelated to treatment beliefs, but seems to have non-specific associations with recognition of disorders and first-aid beliefs.

What are young adults saying about mental health? An analysis of Internet blogs

BACKGROUND

Despite the high prevalence of mental health concerns, few young adults access treatment. While much research has focused on understanding the barriers to service access, few studies have explored unbiased accounts of the experiences of young adults with mental health concerns. It is through hearing these experiences and gaining an in-depth understanding of what is being said by young adults that improvements can be made to interventions focused on increasing access to care.

OBJECTIVE

To move beyond past research by using an innovative qualitative research method of analyzing the blogs of young adults (18-25 years of age) with mental health concerns to understand their experiences.

METHODS

We used an enhanced Internet search vehicle, DEVONagent, to extract Internet blogs using primary keywords related to mental health. Blogs (N = 8) were selected based on age of authors (18-25 years), gender, relevance to mental health, and recency of the entries. Blogs excerpts were analyzed using a combination of grounded theory and consensual qualitative research methods.

RESULTS

Two core categories emerged from the qualitative analysis of the bloggers accounts: I am powerless (intrapersonal) and I am utterly alone (interpersonal). Overall, the young adult bloggers expressed significant feelings of powerlessness as a result of their mental health concerns and simultaneously felt a profound sense of loneliness, alienation, and lack of connection with others.

CONCLUSIONS

The present study suggests that one reason young adults do not seek care might be that they view the mental health system negatively and feel disconnected from these services. To decrease young adults' sense of powerlessness and isolation, efforts should focus on creating and developing resources and services that allow young adults to feel connected and empowered. Through an understanding of the experiences of young adults with mental health problems, and their experiences of and attitudes toward receiving care, we provide some recommendations for improving receptivity and knowledge of mental health care services.

Young people's recognition of mental disorders and beliefs about treatment and outcome: findings from an Australian national survey

OBJECTIVE

The aim of the study was to carry out a national survey in order to assess young people's recognition and beliefs about treatment for depression, anxiety disorders and schizophrenia/psychosis.

METHOD

In 2011, telephone interviews were carried out with 3021 Australians aged between 15 and 25 years. Participants were presented with a case vignette describing either depression, depression with suicidal thoughts, depression with alcohol misuse, psychosis/schizophrenia, social phobia or post-traumatic stress disorder (PTSD). Questions were asked about what was wrong with the person, help-seeking intentions and the likely helpfulness of a broad range of interventions.

RESULTS

Rates of recognition of depression were relatively high, with almost 75% of respondents using the correct label. Rates of recognition for the psychosis (schizophrenia) and PTSD vignettes were similar, with around one third of respondents using the correct labels. Only 3% of respondents were able to correctly label social phobia. Intentions to seek help were highest for depression with suicidal thoughts and lowest for social phobia, with family members nominated the most likely sources of help across all vignettes.

CONCLUSIONS

Most young people believe in the importance of seeking professional help and they have good recognition of depression. However, there is still potential for young people's mental health literacy to improve in the areas of recognition and treatment beliefs for all the mental disorders covered in this survey, particularly social phobia which has very low recognition rates and a lower perceived need for treatment.

Knowledge of and Attitudes Towards Behavioral Health Services Among Older Youth in the Foster Care System

This study examined knowledge of and attitudes toward services among 268 17-year olds with psychiatric diagnoses preparing to exit foster care. A structured interview assessed knowledge of services with vignette scenarios and attitudes with a standardized scale. Descriptive statistics described the extent of knowledge and attitudes among this population and regression analyses examined predictors of these dimensions of literacy. Most youth suggested a help source, but responses often lacked specificity. Gender and depression were the strongest predictors of knowledge and attitudes, respectively. Knowing which aspects of literacy are low, and for whom, can inform education efforts to improve access to care in adulthood.

How acceptable are one-off consultations for consumers? Further information on Item 291

OBJECTIVE

The aim of this paper is to evaluate consumer and carer views of one-off psychiatric assessments, Item 291 in the Australian Medicare system.

METHOD

Following general practitioner referral to a psychiatrist, consumers were invited to enroll in this study and provide: demographic data; a one-off face-to-face recorded interview 6-8 weeks following psychiatric assessment; and longitudinal assessment of their mental health, using the DASS, K10 and WHOQoL (prior to psychiatric assessment, 6-8 weeks after assessment and 3-4 months later).

RESULTS

Consumer and carer enrollment were very difficult to obtain. Sufficient consumers (8) enrolled to provide meaningful qualitative data. Most had good mental health literacy, had severe and chronic mental health problems, and appreciated the opportunity to access a mental health expert and receive a management plan. Overall, GPs had appropriately informed consumers of the process. Following assessment, the GP and consumer were implementing the suggested management plan. Negative statements included instances of failure to improve, insufficient appointments with the psychiatrist, and concern with GP follow-up.

CONCLUSION

One-off psychiatric assessments using Item 291 appear highly acceptable to referred consumers. Qualitative outcomes showed trends towards an improvement in mental health, in an appropriate target group.

Healthy minds for country youth: help-seeking for depression among rural adolescents

OBJECTIVE

To assess depression recognition, barriers to accessing help from health professionals and potential sources of help for depression among rural adolescents.

DESIGN

Cross-sectional survey.

SETTING

Two rural secondary schools in south-east South Australia.

PARTICIPANTS

Seventy-four secondary school students aged 14 to 16 years.

MAIN OUTCOME MEASURE(S)

Depression recognition was measured using a depression vignette. Helpfulness of professionals, barriers to seeking help and help-seeking behaviours for depression were assessed by self-report questionnaire.

RESULTS

Depression was identified in the vignette by 73% (n = 54) of participants. Participants indicated that it would be more helpful for the vignette character to see other health professionals (98.6%, 95% CI, 92.0-100.0%) than a doctor (82.4%, 72.1-89.6%). Barriers to seeking help from doctors and other health professionals were categorised into logistical and personal barriers. Participants agreed more strongly to personal (mean = 2.86) than logistical barriers (mean = 2.67, P < 0.05) for seeing a doctor. Boys and girls responded differently overall, and to personal barriers to seeing an other health professional. Sources of help were divided into three categories: formal, informal and external. Informal sources of help (mean = 4.02) were identified as more helpful than both formal (mean = 3.66) and external sources (mean = 3.72, P < 0.001). Gender differences were observed within and between the three sources of help categories.

CONCLUSIONS

Recognising symptoms of depression was demonstrated in this study. Helpfulness of professionals, barriers to seeking help and potential sources of help for depression were identified. More work is required for improving depression literacy and providing effective interventions specifically for rural adolescents.

Reach Out Central: a serious game designed to engage young men to improve mental health and wellbeing

Reach Out Central (ROC) is a serious game drawing on the principles of cognitive behaviour theory that has been designed to improve the mental health and wellbeing of young people, particularly men. ROC was developed over a 3-year period from 2003 to 2006, in consultation with young people aged 16-25 years who use the Reach Out mental health website http://www.reachout.com). ROC was launched online in September 2007. A traditional and viral awareness campaign was designed to engage young men, particularly "gamers". In the first month after launch, ROC had 76 045 unique website visits, with 10 542 new members (52% male) joining Reach Out. An independent online evaluation involving 266 young people aged 18-25 years was conducted between August 2007 and February 2008 to examine psychological wellbeing, stigma and help seeking in ROC players. Overall results indicated that ROC was successful in attracting, engaging and educating young people. Young women reported reduced psychological distress and improved life satisfaction, problem solving and help seeking; however, no significant changes were observed for young men. Although ROC was successful in attracting young men, demonstrating that the concept resonates with them, the service failed to keep them engaged. Further research is needed to explore how (or what changes need to be made) to sustain young men's engagement in the game.

Help-seeking for substance use, anxiety and affective disorders among young people: results from the 2007 Australian National Survey of Mental Health and Wellbeing

OBJECTIVE

To provide a more detailed analysis of the relationship between type and severity of mental disorders (substance use, anxiety and affective disorders) and help-seeking in those aged 16-24 years compared to those aged 25-44 and 45-85 years.

METHOD

Data from the National Survey of Mental Health and Wellbeing (NSMHWB) which was conducted in 2007. The survey sample comprised residents of private dwellings across Australia aged 16-85 years.

RESULTS

More than one in four Australians aged 16-24 years experienced a mental disorder in the preceding 12 months. This compared to one in five in those aged 16-85 years. Fewer than one in four 16-24-year-olds with a 12-month mental disorder accessed health services in a 12-month period compared with just over one in three of those aged 16-85. The gap in help-seeking was primarily related to higher rates of substance use disorders and low help-seeking associated with these, particularly in young men.

CONCLUSIONS

Findings from the 2007 NSMHWB show that the gap in help-seeking in young people with mental health problems is largely due to high rates of substance use disorders and the low rates of help-seeking associated with these. In order to address this gap there is a need for better coordination and integration of mental health and alcohol and drug services within primary care settings. Population health approaches that tackle erroneous beliefs about alcohol and related harms and improve overall mental health literacy are also needed.

Australian young people's awareness of headspace, beyondblue and other mental health organizations

Objective: The aim of this paper is to assess young people's awareness of mental health organizations supporting their age group. Of particular interest was awareness of headspace, which was created in 2006 to provide youth-oriented mental health services, and of beyondblue, which aims to raise community awareness of depression, anxiety and related disorders. Method: A telephone survey was carried out on a national sample of young people who were part of a 2-year follow-up study of youth mental health literacy. Data were analysed for those aged 13-25 years. Results: Awareness was highest for beyondblue and telephone helplines; headspace had established some awareness, particularly in areas where its services operate. However, awareness was unrelated to the participant's psychological symptoms in the past year. Conclusions: If youth-oriented services are to be successful, young people need to know about them. Awareness campaigns need to be targeted at the sub-group who have greatest need for these services, namely those with mental health problems.

Mental health literacy as a function of remoteness of residence: an Australian national study

Background

Although there have been many population studies of mental health literacy, little is known about the mental health literacy of people who reside in rural areas. This study sought to determine the impact of remoteness on public knowledge of depression and schizophrenia.

Methods

The mental health literacy of residents of major cities, inner regional, and outer-remote (including outer regional, remote, and very remote) regions were compared using data from a 2003–04 Australian national survey of the mental health literacy of 3998 adults. Measures included the perceived helpfulness of a range of professionals, non-professionals and interventions, and the causes, prognosis, and outcomes after treatment for four case vignettes describing depression, depression with suicidal ideation, early schizophrenia and chronic schizophrenia. Participant awareness of Australia's national depression initiative and depression in the media, their symptoms of depression and exposure to the conditions depicted in the vignettes were also compared.

Results

Mental health literacy was similar across remoteness categories. However, inner regional residents showed superior identification of the disorders depicted in the suicidal ideation and chronic schizophrenia vignettes. They were also more likely to report having heard of Australia's national depression health promotion campaign. Conversely, they were less likely than major city residents to rate the evidence-based treatment of psychotherapy helpful for depression. Both inner regional and outer-remote residents were less likely to rate psychologists as helpful for depression alone. The rural groups were more likely to rate the non-evidence based interventions of drinking and painkillers as helpful for a depression vignette. In addition, outer-remote residents were more likely to identify the evidence based treatment of antipsychotics as harmful for early schizophrenia and less likely to endorse psychiatrists, psychologists, social workers and general practitioners as helpful for the condition.

Conclusion

Mental health awareness campaigns in rural and remote regions may be most appropriately focused on communicating which interventions are effective for depression and schizophrenia and which mental health and other professionals are trained in the best-practice delivery and management of these. There is also a need to communicate to rural residents that alcohol and pain relievers are not an effective solution for depression.

First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents

BACKGROUND

Little is known about the best ways for a member of the public to respond when someone in their social network develops a mental disorder. Controlled trials are not feasible in this area, so expert consensus may be the best guide.

METHODS

To assess expert views, postal surveys were carried out with Australian GPs, psychiatrists and psychologists listed on professional registers and with mental health nurses who were members of a professional college. These professionals were asked to rate the helpfulness of 10 potential first aid strategies for young people with one of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Data were obtained from 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses, with respective response rates of 24%, 35%, 40% and 32%. Data on public views were available from an earlier telephone survey of 3746 Australian youth aged 12-25 years and 2005 of their parents, which included questions about the same strategies.

RESULTS

A clear majority across the four professions believed in the helpfulness of listening to the person, suggesting professional help-seeking, making an appointment for the person to see a GP and asking about suicidal feelings. There was also a clear majority believing in the harmfulness of ignoring the person, suggesting use of alcohol to cope, and talking to them firmly. Compared to health professionals, young people and their parents were less likely to believe that asking about suicidal feelings would be helpful and more likely to believe it would be harmful. They were also less likely to believe that talking to the person firmly would be harmful.

CONCLUSION

Several first aid strategies can be recommended to the public based on agreement of clinicians about their likely helpfulness. In particular, there needs to be greater public awareness of the helpfulness of asking a young person with a mental health problem about suicidal feelings.

Influences on young people's stigmatising attitudes towards peers with mental disorders: national survey of young Australians and their parents

BACKGROUND

Little is known about the development of stigma towards people with mental disorders.

AIMS

To investigate stigma in young Australians and the influence of exposure to mental disorders, parental attitudes and information campaigns.

METHOD

A national telephone survey was carried out with 3746 people aged 12-25 years and 2005 co-resident parents. Stigmatising attitudes were assessed in relation to four vignettes (depression, depression with alcohol misuse, social phobia and psychosis).

RESULTS

Stigma was found to have multiple components labelled 'social distance', 'dangerous/unpredictable', 'weak not sick', 'stigma perceived in others' and 'reluctance to disclose'. Exposure to mental disorders and help-seeking in oneself or others was associated with lower scores on some components of stigma but not on others. Young people's attitudes showed specific associations with those of parents. Exposure to campaigns was associated with reductions in beliefs that the person is 'weak not sick'.

CONCLUSIONS

Personal experiences, parental attitudes and campaigns all affect stigmatising attitudes.

Where to seek help for a mental disorder? National survey of the beliefs of Australian youth and their parents

OBJECTIVE

To determine the intentions that young people have for seeking help if they were to develop a mental disorder.

DESIGN, PARTICIPANTS AND SETTING

National telephone survey of 3746 Australians aged 12-25 years and 2005 co-resident parents, which asked questions about vignettes portraying either depression, depression with alcohol misuse, social phobia or psychosis.

MAIN OUTCOME MEASURES

Where participating young people or co-resident parents would seek help if they (or their child) had one of the problems portrayed in the vignettes; barriers to seeking help.

RESULTS

For adolescents, family was the main source of intended help, mentioned by 45%-60% (depending on the vignette), while general practitioners were mentioned by only a small minority (4%-13%). For young adults, family was relatively less important (21%-31%) and GPs relatively more so (19%-34%). By contrast, parents frequently mentioned GPs as an intended source of help for their children (by 40%-72% of parents of adolescents and 61%-76% of parents of young adults). For young people, the main barriers to seeking help were embarrassment or concern about what others might think, while the main barrier for parents was resistance from the child.

CONCLUSIONS

Recent initiatives to extend the uptake of treatment for mental disorders have been centred around GPs as the initial point of help-seeking. Few young people see GPs as a preferred source of help, and action is needed to alter this perception or to reform mental health services to be more attractive to this age group.

Improving mental health literacy as a strategy to facilitate early intervention for mental disorders

Good mental health literacy in young people and their key helpers may lead to better outcomes for those with mental disorders, either by facilitating early help-seeking by young people themselves, or by helping adults to identify early signs of mental disorders and seek help on their behalf. Few interventions to improve mental health literacy of young people and their helpers have been evaluated, and even fewer have been well evaluated. There are four categories of interventions to improve mental health literacy: whole-of-community campaigns; community campaigns aimed at a youth audience; school-based interventions teaching help-seeking skills, mental health literacy, or resilience; and programs training individuals to better intervene in a mental health crisis. The effectiveness of future interventions could be enhanced by using specific health promotion models to guide their development.