I just don’t need it

As part of my MA in Counselling at the University of Manchester, I became interested in examining the experiences and attitudes of young people towards help-seeking. While counselling may today be more socially acceptable, and arguably more accessible, it does appear that some young people feel reluctant to seek help from these services. Why is this the case? How do they manage their problems? Who might they confide in? Where might they look for help? How does technology impact on their help-seeking options?

My study therefore attempted to capture young people's experiences and attitudes towards asking for help, in order to explore some of the issues that might cause delay or avoidance. We already know that up to a third of young people with mental health needs do not seek formal help. For example, one school-based study of 12 to 17 year olds in Germany reported that only 18.2 per cent of young people with a diagnosed anxiety disorder and 23 per cent of those with depressive disorders had accessed mental health services.1 Biddle et al explored the problems encountered by young people in accessing psychological services, in terms of a 'cycle of avoidance'. 2

Barriers and facilitators to seeking help

Young people who seek help through counselling 'face the potential threat of personal incompetence associated with being seen to need help'3 and the most frequently mentioned barrier to engaging in psychological help-seeking is fear of the stigma of mental illness. Another barrier is not wanting to bother other people with their personal problems - faced with an emotional problem, seeking help is the least preferred coping strategy in young people.4 Given the choice, 90 per cent of young people are more likely to tell their peers of their distress than a professional. Interestingly, trusted adults are identified as key facilitators in the help-seeking process of young people, but the actual experiences of young people seeking help seem to be complex and fraught with obstacles.

Powell and Clarke5 report that technology can play an important role in healthcare, beyond that of information seeking, and young people who do use technology to access help seem to do so in an attempt to retain a greater sense of anonymity and autonomy. This may be because technology offers 'more accessibility to this client group than traditional clinical formats'.6 Because it appeals to the needs of young people, mobile culture 'has evolved in providing a useful and engaging platform for supporting therapeutic services',7 and this became another area I was keen to explore in my interviews with young people.

The research

I held individual semi-structured interviews with eight young people, four male and four female, aged 14 to 16 years. I asked each participant to describe how they might deal with a problem, who they might confide in and why. There was an overwhelming response from all participants in terms of needing to manage their own problem and thus retain a sense of personal power and autonomy. Choosing who to tell depended on a number of factors. These included the level of trust in that person, kinship (ie family and close friendships), relevance (what that person's role might be in context to them) and the nature of their problem.

All participants could see the advantage of professional help, but, in most cases, this was not seen as an option for them personally.

In unravelling the research data, I was able to identify six main themes.

Theme 1

'It's my problem and I want to be able to choose who I share it with'

In sharing a problem, the young person ran the risk of losing control if the other person did not keep their problem confidential. Hence, risk assessments were made by the young person to decide whether to share their problem, and if so, with whom. Their strong preference for informal peer support in help-seeking was apparent.

'If there's a serious problem, I tend to think about it myself and I'd either go to a parent or a friend that I trust... Or if it was something to do with school I'd probably go to senior management, or my Head, or someone.' (A)

'Yeah, cos depending on what the problem is, you wouldn't want it... getting out and then... spreading and stuff like that.' (B)

'Normally, its just the people that I trust - If I've got like a friendship group and I've only got three people I trust, I only tell them - and I know they won't tell anyone else, cos I trust them.' (C)

Theme 2

Valuing relationships and social groups

Participants in this study frequently mentioned the value of peer relationships.

'Cos erm... I've got more of a relationship with my friends really, cos we've got like a close group of friends, you know, like about six, seven people and they all tend to trust each other, so if you got a problem, you could just talk to them.' (D)

'She was going through some problems with depression and she came to me and asked for help and I'd see her and like actually she was OK, cos there was like a big problem with self-harm, and she's got through it now... She came to me, she never told her parents. She was telling me.' (E)

Being there for each other felt part of the evolving role of a young person's social responsibility, as described by C:

'I tried to get it, I talked to her more, cos it said on the internet, erm... if they're going through this, they need people that are close to them, need people to talk to, so I was just always there for them.'

Theme 3

'Getting professional help is a good thing, but personally I just don't need it'

All participants could see the advantage of professional help, but, in most cases, this was not seen as an option for them personally.

'I think other people need it more than me, cos I've got friendship groups, I've got teachers and even if I need, I can go to my mum, or I could go to my cousins and they'd always help me out.' (C)

In F's case, some help-seeking options were seen as being more acceptable than others: 'I definitely feel I could utilise it, but yeah, nothing as extreme as ChildLine, but yeah, if I was aware of these organisations that provide this help, I'd definitely try it.' (F)

Theme 4

'If I did need help, there's stuff that might get in my way'

Issues to do with personal and public identity, such as perceived stigma, were frequently mentioned as barriers to seeking help.

'If I can't deal with my own problems and I'm going to someone else, I would feel, like, weak, but that's just cos I like to work things out myself, most of the time.' (E)

'People might judge you on you having counselling.' (G)

'No, I'd be unsure of where to go to ask for the help.' (F)

Theme 5

'Tell me again, how do I get to see you?'

One set of possible barriers to accessing counselling concerned a lack of awareness of the counsellor's role, what they do, who they are and, therefore, whether they could trust them. Participants made suggestions as to how the non-visibility of counsellors within the school could be improved:

'...anything just to give advice, like letters... just so they can read them and stuff like that.' (G)

'Erm, like more assemblies in school, more like education for it, say.' (E)

Theme 6

'It needs to feel safe'

In considering how to improve counselling services, each participant was asked what they might do to make it more appealing.

'Like, if there's people like me, they might not want to go to a person and maybe they could chat online or...'(H)

'...maybe more like education websites and stuff. We can get help privately and not through people you know. You can just talk to someone off the internet, so you can tell them your problems and they see how you can resolve it, but not like saying tell your parents, or just tell each other.' (E)

One interviewee suggested:

'Like online chatting services, so you could talk to someone, like there and then... maybe.' (A)

Overview

The participants, while appreciating the merits of professional help-seeking, perceived it as something for other people and not necessarily as being applicable to themselves. All participants riskassessed their problem, not only to keep some control, but in choosing a reliable and trustworthy source of help. Some participants acknowledged that, depending on its gravity, telling a friend might also pose a further risk that others might find out about it.

The consequence of others finding out about a problem was, at times, seen as a threat to their self-image, ie the stigma of being labelled by others as 'different', which could therefore affect their public identity.

Other barriers mentioned by participants included a lack of trust in the counsellor, or a lack of trust in the service, with an implied lack of knowledge about mental health and mental ill-health. There was, as well, the experience of simply not knowing what was available in terms of services and how they might access them. For instance, most participants did not know that there were school-based counsellors available at the school, or how they might access them.

Participants were also asked to suggest ways in which psychological services could be improved, by making them more accessible and appealing to young people. Suggestions included a variety of different help-seeking options, 'including texting services' (D), 'apps' (A) and 'online education websites' (E). The preferred and frequently used means of communication among this group was a smartphone to access social media. Education about services, through presentations at school assemblies and PSHE lessons, was seen as informative and useful, by personalising and normalising counselling, and integrating it more into the context of everyday school life. However, there were still anxieties for these young people, in relation to safety and trust, and a lack of knowledge around the helping services on offer. This is perhaps something that needs addressing in future.

References

1 Essau CA. Frequency and patterns of mental health services utilization among adolescents with anxiety and depressive disorders. Depression and Anxiety 2005; 22: 130-137.

2 Biddle L, Donovan J, Sharp D et al. Explaining non-help-seeking amongst young adults with mental distress: a dynamic interpretive model of illness behaviour. Sociology of Health and Illness 2007; 29(7): 983-1102.

3 Vogel DL, Wade NG, Hackler AH. Perceived public stigma and the willingness to seek counselling: the mediating roles of self-stigma and attitudes towards counselling. Journal of Counselling Psychology 2007; 54(1): 40-50.

4 Copeland EP, Hess RS. Differences in young adolescents' coping strategies based on gender and ethnicity. Journal of Early Adolescence 1995; 15(2): 203-19. In: Rothi MD, Leavey G. Mental health help-seeking and young people: a review. Pastoral Care In Education: an International Journal of Personal, Social and Emotional Development 2006; 24:3: 4-13.

5 Powell J, Clarke A. Internet information-seeking: a population survey. British Journal of Psychiatry 2006; 189: 273-277.

6 Hanley T. Understanding the online therapeutic alliance through the eyes of adolescent service users. Counselling and Psychotherapy Research 2012; 12(1): 35-43.

7 Matthews M, Doherty G, Sharry J et al. Mobile phone mood charting for adolescents. British Journal of Guidance and Counselling 2008; 36(2): 113-129.