Abstract
Despite older adolescence being a risk period for the development of mental health concerns, mental health service engagement is low among 16- to 18-year-olds. As therapeutic attendance is linked to clinical outcome, it is important to understand engagement in this population. There is a paucity of research looking specifically at the older adolescent engagement phenomenon. Previous qualitative research into adolescent experiences has provided rich and detailed results. Interpretative phenomenological analysis was chosen as the methodological approach. Ten 16- to 18-year-olds were recruited from two London-based child and adolescent mental health services. Each young person was interviewed to understand his or her personal experience of engaging in mental health services, and associated engagement barriers and facilitators. Interviews were transcribed and underwent analysis. Analysis revealed ten subthemes subsumed within four superordinate themes: engagement begins at help seeking, strength of inner resolve, evolution of the self and in the clinic room. Themes are discussed in detail. Conclusions are drawn in relation to previous theory and research. When considering 16- to 18-year understandings of the engagement phenomena, key elements include clinician and service developmental appropriateness, negotiation of developmental tasks in relation to engagement, experience of the physical building environment, and awareness of service policy. Suggestions for clinical practice in relation to engagement facilitators and threat are made, and recommendations for future research proposed.
Highlights
Adolescence is thought to be a risk period for the development of mental health concerns (e.g., Vyas, Birchwood, & Singh, 2015) with older adolescence/early adulthood seeing a significant increase in symptomology (Murphy & Fonagy, 2012; Royal College of Psychiatrists, 2012)
16 to 18 years is a potential time of transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), which may impose its own challenges (National Institute for Health and Care Excellence [NICE], 2016; Singh, Evans, Sireling, & Stuart, 2005; Singh et al, 2008)
Superordinate themes were engagement begins at help seeking, strength of inner resolve, evolution of the self, and in the clinic room
Summary
Adolescence is thought to be a risk period for the development of mental health concerns (e.g., Vyas, Birchwood, & Singh, 2015) with older adolescence/early adulthood seeing a significant increase in symptomology (Murphy & Fonagy, 2012; Royal College of Psychiatrists, 2012). This occurs alongside reduced mental health service use. Engagement in services may be an important part of effective mental health treatment (YoungMinds, 2014). Service engagement could be a challenge (Royal College of Psychiatrists, 2012).
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