Abstract
BackgroundMany distressed minority adolescents with little access to professional mental health services use teachers and school counselors as their main consultation sources. This paper presents data from the Galilee study on factors that may increase the probability of adolescents’ help-seeking in school and discusses the needed linkage between the school mental health services and those provided by other agencies, in the framework of the Mental Health Reform in Israel.MethodsThis cross-sectional survey included 1639, 9th grade students living in 5 Arab localities in the Galilee in northern Israel, representative of the Muslim and Druze populations. The study was carried out in two stages: in the screening stage, the Strengths and Difficulties Questionnaire (SDQ) was completed in the classroom. During the follow-up stage 704 students were selected and interviewed at home regarding service use in school and wellbeing at home. Their mothers were interviewed as well providing information on sociodemographic traits of the family. Total response rate was 69.3 % during the screening stage and 84.4 % during the follow-up. Students were categorized according to their SDQ scores and all students in the higher 25th percentile (high risk) and a simple systematic sample without replacement of those in the lower 75 % (low risk) were included in the follow-up study.ResultsSignificantly more high risk than low risk students reported having felt the need to seek professional help (14.0 and 6.5 % respectively) and more high risk than low risk consulted a school source (27.1 and 15.2 %, respectively). Bivariate analyses show that among Muslim adolescents more high risk than low risk consulted a school source (30 vs. 16.2 % respectively) and among high risk students more Muslim than Druze sought help from a school source (30 vs. 18 %). Higher consultation rates were found among adolescents who felt uncomfortable at home, than among those who felt very comfortable. Binary logistic regression showed that for high risk adolescents, only religion remained significantly associated with help-seeking in school: Muslim students were 2 times more likely to seek help than Druze students. In the low-risk group, students who do not feel comfortable at home were 3.3 times more likely to seek help than those who feel comfortable at home. The main sources of consultation for both risk groups were the school counselor and the grade teacher.ConclusionsA constellation of factors may be associated with help-seeking in school by minority Israeli Arab adolescents: they are students at higher risk for an emotional or behavioral disorder, they have more socio-economic hardship, they feel less comfortable at home and they are more likely to live in the larger Muslim cities. Adolescents with less family support and particularly those not classified as being at high risk, are more likely to seek help from school counselors and teachers. The school staff may need additional training to care for the mental health needs of students. There is a need to integrate the school mental health services with the other government agencies that provide services to children and adolescents.
Highlights
Many distressed minority adolescents with little access to professional mental health services use teachers and school counselors as their main consultation sources
A constellation of factors may be associated with help-seeking in school by minority Israeli Arab adolescents: they are students at higher risk for an emotional or behavioral disorder, they have more socioeconomic hardship, they feel less comfortable at home and they are more likely to live in the larger Muslim cities
In the low-risk group, wellbeing at home remained significantly associated with help seeking in school: students who do not feel comfortable at home were 3.3 times more likely to seek help than those who feel comfortable at home
Summary
Many distressed minority adolescents with little access to professional mental health services use teachers and school counselors as their main consultation sources. It is known that a relatively small percentage of distressed adolescents seek professional mental health care in the community, as most usually prefer to consult family members or friends [1,2,3]. It is known that minorities in general have lower rates of mental health services utilization than the majority population, due to poor availability and accessibility of services in the community [4,5,6,7]. Among minority adolescents, rates of help-seeking in school are higher than among majority adolescents [1, 8] due to the ability of the school-based services to be available at all times, the low cost and the fact that there is no need for special transportation [9]. Some studies show that adolescents perceive school staff as more acquainted with their lives and as better able to understand their difficulties than mental health professional sources and that students believe school staff will continue to value them despite the disclosure of their weaknesses [12, 13]
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