Young Service Users Research Articles

Parental Factors for Mental Health Service Engagement Among Chinese Young Adults.

Mental health service disengagement can have devastating consequences for people in need of mental health services. This study explored parental factors in mental health service engagement among Chinese young adult mental health service users. Seventy-two Chinese young adults, aged from 18 to 26years, were recruited from a Hong Kong community mental health service center. Nearly three-fifths (58.3%) of participants were female and over two-fifths (44.2%) attended college. Results of logistic regression analysis showed that Chinese young adult mental health service users with high levels of perceived need for services and low levels of perceived parental involvement in mental health services were more likely to engage in mental health services. However, concerns about the parent-child relationship, perceived parental encouragement and perceived parental demand for mental health service use were not associated with mental health service engagement. The practice implications of these results are discussed in light of the Chinese context.

Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register

Community-based epidemiological studies show transitions between psychiatric disorders are common during child development. However, little research has explored the prevalence or patterns of the diagnostic adjustments that occur in child and adolescent mental health services (CAMHS). Understanding diagnostic trajectories is necessary to inform theory development in developmental psychopathology and clinical judgements regarding risk and prognosis. In this study, data from CAMHS clinical records were extracted from a British mental health case register (N = 12,543). Analysis calculated the proportion of children whose clinical records showed a longitudinal diagnostic adjustment (i.e. addition of a subsequent diagnosis of a different diagnostic class, at > 30 days’ distance from their first diagnosis). Regression analyses investigated typical diagnostic sequences and their relationships with socio-demographic variables, service use and standardised measures of mental health. Analysis found that 19.3% of CAMHS attendees had undergone a longitudinal diagnostic adjustment. Ethnicity, diagnostic class and symptom profiles significantly influenced the likelihood of a diagnostic adjustment. Affective and anxiety/stress-related disorders longitudinally predicted each other, as did hyperkinetic and conduct disorders, and hyperkinetic and pervasive developmental disorders. Results suggest that approximately one in five young service users have their original psychiatric diagnosis revised or supplemented during their time in CAMHS. By revealing the most common diagnostic sequences, this study enables policy makers to anticipate future service needs and clinicians to make informed projections about their patients’ likely trajectories. Further research is required to understand how young people experience diagnostic adjustments and their psychological and pragmatic implications.

Identity negotiation processes among Black and Latinx sexual minority young adult mental health service users

The transition to adulthood presents particular challenges for Black and Latinx sexual minorities in need of mental health services. Identity formation and marginalization during this developmental period can interfere with help-seeking and lead to health disparities. Identity-specific psychosocial supports are needed to assist young adults to successfully navigate these challenges, but research on identity processes, help-seeking, and service-utilization among sexual minority young people of color is very limited. To better understand how multiple minority young people navigate their identities in the context of using, or choosing not to use, mental health services, this study qualitatively explored the experiences of 31 emerging adults. Through in-depth interviews, analyses revealed that young adults negotiated social identity norms about mental health help-seeking by separating from unhelpful norms, managing stigmatized aspects of identity, integrating helpful identity alternatives, and forming individualized perspectives on help-seeking that allowed them to maintain important connections to their minority group identities. Findings are discussed in relation to previous research on ethnic and sexual minority identity development and service utilization. Practice and research recommendations for increasing knowledge, improving help-seeking, and promoting resilience around young adults’ intersectional identities are offered.

Exploring Young People's Perceptions of the Effectiveness of Text-Based Online Counseling: Mixed Methods Pilot Study.

BackgroundYoung people aged 10-24 years are at the highest risk for mental health problems and are the least likely to seek professional treatment. Owing to this population’s high consumption of internet content, electronic mental (e-mental) health services have increased globally, with an aim to address barriers to treatment. Many of these services use text-based online counseling (TBOC), which shows promising results in supporting young people but also greater variance in outcomes compared with adult comparators.ObjectiveThis pilot study qualitatively explored the characteristics of users aged 15-25 years accessing TBOC services, their motivations for access, and their perceptions about factors believed to influence the effectiveness of these modalities.MethodsE-surveys were administered naturalistically to 100 young service users aged 15-25 years who accessed webchat and email counseling services via an Australian e-mental health service. Thematic analysis of qualitative themes and quantitative descriptive and proportional data presented in electronic surveys were examined across the areas of user characteristics, motivations for selecting TBOC modalities, and their perceptions of TBOC effectiveness.ResultsParticipants were predominately female high school students of Caucasian or European descent from middle socioeconomic status, living with their parents in major cities. Four domains and various themes and subthemes were related to participants’ reasons for accessing TBOC and perceptions of its effectiveness: user characteristics (ie, physical and mental health syndrome and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), factors perceived to increase effectiveness (ie, general therapeutic benefits, positive modality and service factors, and persisting with counseling to increase benefit), and factors perceived to decrease effectiveness (ie, negative modality and service factors, and persisting with counseling despite benefit).ConclusionsParticipants were motivated to use TBOC to increase their sense of safety in response to negative perceptions of their social skills and the response of the online counsellor to their presenting problem. By using TBOC services, they also sought to improve their access to mental health services that better met their expectations. Factors that increased effectiveness of TBOC were the counsellor’s interpersonal skills, use of text-based communication, and persisting with beneficial counseling sessions. Factors that reduced TBOC effectiveness were poor timeliness in response to service requests, experiencing no change in their presenting problem, not knowing what postcounseling action to take, and persisting with ineffective counseling sessions.

Co-designing a virtual world with young people to deliver social cognition therapy in early psychosis.

Co-design implies genuine partnership in the generation of knowledge between service users and researchers. Service user involvement in research has been encouraged in government policy, but it is rarely achieved, especially at trial initial stages. Co-designed with service users, we adapted existing manualised social cognition intervention for people with a first episode of psychosis to a virtual world environment. We invited a group of young people who have used mental health services to co-design a virtual environment to deliver an accessible social cognition intervention to a hard to engage service user group. We used an iterative process with young service users and the design team that included developing initial ideas, creating a prototype and testing the virtual world. Twenty young service users of local mental healthcare services provided feedback on the design and delivery of the intervention. Reflecting the demographic of the sample, young people felt the virtual environment should be familiar, urban spaces, akin to therapy rooms or classrooms they have used in real-life situations rather than non-traditional therapy spaces that were initially proposed. The co-design process led to the development of a specific design, approach and protocol to be tested in a proof-of-concept trial. Young service users were integral to an agile and iterative design. Technological innovations should be routinely co-designed and co-produced if they are to realise their potential to deliver acceptable and affordable mental health interventions.

Communal invalidation of young adults with co-occurring substance abuse and mental health issues

This study explores how young adults with co-occurring substance abuse and mental health issues experience the challenges of belonging to their local communities. The data were generated through qualitative in-depth interviews with seven young adult service users, six of whom were interviewed twice. The qualitative data analysis resulted in three overarching themes: the need to accept one’s own life and the structures surrounding it; being caught between conflicting social worlds; and moral fumbling in choices and actions. Using an empirical study, we suggest that a process of ‘communal invalidation’ operates through which young adults in the community are socially defined as inadequate. This invalidation serves as a formidable barrier to their recovery.

Online social work engagement and empowerment for young internet users: A quasi-experiment

BackgroundThe increasing penetration of Internet use among young people poses challenges for youth service engagement through bricks-and-mortar youth centers owing to the decline in the number of walk-ins. This study was to identify the psychosocial and behavioral outcome changes effected through online engagement and empowerment interventions offered to at-risk youths by three local social work youth service providers. MethodsA quasi-experimental design was adopted to compare the effects of online engagement and empowerment on 182 young service users with 191 age- and gender-matched controlled participants over nine months. ResultsSignificant improvement in emotional distress and social withdrawal behaviors were found in the intervention group. LimitationsNon-randomized study, nonequivalent comparison group DiscussionWhether online social work services can substitute offline services should be further examined in randomized controlled trials. Online social work intervention identifies its acceptability among young people and professional feedback holds promise for providing a complimentary route of alleviating emotional distress and social withdrawal in at-risk youths.

What would we use and how would we use it? Can digital technology be used to both enhance and evaluate well-being outcomes with highly vulnerable and disadvantaged young people?

An increasing number of technology apps for managing wellbeing and mental health are permeating young people’s use of digital spaces. There are a range of online wellbeing tools which have been developed to promote self-tracking and build young people’s wellbeing and mental health, for example, Optimism, My Mood Tracker and Strava. Tracking outcomes of support with highly transient young people is, more broadly, a particular challenge for youth workers, evaluators and social researchers. Using digital apps to promote as well as monitor wellbeing with tech-savvy young people is an enticing prospect for youth support services, particularly with young people whose engagement with support is sporadic and unpredictable during periods of homelessness or other crisis situations. The use of purpose-designed digital apps may have the potential to not only benefit young people’s mental health and wellbeing, but also enhance the consistency and quality of their connection with support services. In principle, putting wellbeing digital tools directly into the hands, and phones, of young people who are accessing support services seems to make good sense. A great number of online resources have, however, relatively limited uptake in highly vulnerable youth populations. The design starting point must therefore be, what would they use and how would they use it? How can digital apps help to promote stronger support engagement, be aligned with young people’s perspectives and priorities of wellbeing, and enable better outcomes evaluation? This article shares learnings from a consultation with more than 400 young youth service users to build better understanding of their relationships with digital technologies, what they would use and how they would use it to better connect with support as well as to promote and record changes in wellbeing over time. Exploring the young people’s perspectives on wellbeing, service delivery and use of digital technologies has broad implications for the integration of digital technology into both service delivery and evaluation of youth programmes. The findings suggest that digital platforms can play a role in evaluating youth wellbeing over time. The prerequisites, are however, that young people’s autonomy and individuality must be supported. We need to start from a place that facilitates agency and creativity, and focuses on capturing qualitative data that meet young people in their world – even when this is challenging for us.

Advancing consumer engagement: Supporting, developing and empowering youth leadership in cancer care.

Advancing consumer engagement: Supporting, developing and empowering youth leadership in cancer care.

Young Service Users with Mental Health Problems: Barriers to Implementing a Symmetrical Human Service Relationship

Based on a multi-sited qualitative research study, this article applies a service user perspective when exploring how young service users with mental health problems experience the everyday relationship with service providers. Utilizing theoretical aspects from Institutional Ethnography, the article illustrates how different ruling ‘texts’ coordinate the everyday interactions between service users and professional front-line workers. The article argues that the institutional practice of distinguishing between the formal and informal sphere clashes with the study participants’ individual needs for a symmetrical relationship built on lasting and more personal care relations. The article further discusses the dilemmas of implementing a service relationship that requires the street-level bureaucrat to step outside the bureaucratically and formally defined work assignment to build informal and individual relations to the service users as an official part of their everyday work.

The provision of physical health care by nurses to young people with first episode psychosis: A cross-sectional study.

Background Registered nurses working in the area of mental health complete either a psychiatric/mental health or comprehensive/generalist nursing program, and their education preparation influences their physical health care nursing practices. The differences in educational preparation may be a contributory factor to nurses' delivery of physical health care to young people experiencing first episode psychosis. This paper addresses an identified gap in nursing practices related to physical health care of young mental health service users. Aim To examine the relationship between the educational preparation of nurses and attitudes, confidence level, perceived barriers and physical health care nursing practices. Method A cross-sectional survey was conducted in 2015 with 207 nurses using the modified Physical Health Attitude Scale for Mental Health Nurses (PHASe). Results Comprehensive/generalist prepared nurses were more likely to provide education on heart disease prevention and sexual health and support young people to stop cigarette smoking than psychiatric/mental health nurses. However, as the length of service progresses, the propensity for psychiatric/mental health nurses to be involve in smoking cessation increases. Implication for practice It is important to identify how nurses' educational preparation affects their nursing practices so as to address the gaps in their physical health literacy.

Lost in transition? Perceptions of health care among young people with mental health problems in Germany: a qualitative study

BackgroundThe transitioning of young patients from child and adolescent to adult mental health services when indicated often results in the interruption or termination of service. The personal views of young service users on current clinical practice are a valuable contribution that can help to identify service gaps. The purpose of this qualitative study was to explore the perceptions of health care of young people with mental health problems in the transition age range (16–25 years), and to better understand health behaviour, care needs and the reasons for disengaging from care at this point in time.MethodsSeven group discussions and three interviews were conducted with 29 young people in this age range. Discussions were audio-taped, transcribed verbatim and analysed following the reconstructive approach of R. Bohnsack’s documentary method.ResultsAn overarching theme and nine subthemes emerged. Participants displayed a pessimistic and disillusioned general attitude towards professional mental health services. The discussions highlighted an overall concern of a lack of compassion and warmth in care. When they come into contact with the system they often experience a high degree of dependency which contradicts their pursuit of autonomy and self-determination in their current life stage. In the discussions, participants referred to a number of unmet needs regarding care provision and strongly emphasised relationship issues. As a response to their care needs not being met, they described their own health behaviour as predominantly passive, with both an internal and external withdrawal from the system.ConclusionsResearch and clinical practice should focus more on developing needs-oriented and autonomy-supporting care practice. This should include both a shift in staff training towards a focus on communicative skills, and the development of skills training for young patients to strengthen competences in health literacy.

Use of a reference group in researching children’s views of psychotherapy in Malta

ABSTRACTThis paper explores the process and outcomes of a children’s reference group within the context of child psychotherapy research in residential care. The reference group was set up to consult children about the design of a research project which seeks to evoke, represent and understand children’s views of psychotherapy. No work to date has explored the experience of reference groups in the context of child psychotherapy in residential care in Malta. The paper contextualises the research within the literature on reference groups in child research, which identifies the potential of reference groups as a participative and co-reflexive activity which can inform research design. The paper critically examines the nature and conduct of the reference group by acknowledging the specific context of this work rather than assuming this is necessarily positive. It does so by specifying and evaluating the outcomes of the reference group in line with its aims. The paper draws on the recordings of the reference group meetings and reference group field notes taken by the researcher as key data which were thematically analysed. The main outcomes of the reference group include children’s contribution to the design of data collection methods especially in terms of not relying only on words during data collection. Children also identified key ethical issues from the point of view of young psychotherapy service users, especially in relation to issues of trust within a residential care context. Children also reviewed and appraised research information material. The reference group process drew from the researcher’s and participants’ contexts and contributed significantly to the researcher’s reflexive process especially in terms of acknowledging his power and positioning as an adult and his dual role as a practitioner/researcher.

Involving young people in drug and alcohol research

PurposeYoung people’s involvement should lead to research, and ultimately services, that better reflect young people’s priorities and concerns. Young people with a history of treatment for alcohol and/or drug problems were actively involved in the youth social behaviour and network therapy study. The purpose of this paper is to explore the impact of that involvement on the study and what was learnt about involving young people in drug and alcohol research.Design/methodology/approachThe initial plan was to form a young people’s advisory group (YPAG), but when this proved problematic the study explored alternative approaches in collaboration with researchers and young people. Input from 17 young people informed all key elements of the study.FindingsInvolvement of young people needs to be dynamic and flexible, with sensitivity to their personal experiences. Engagement with services was crucial both in recruiting young people and supporting their ongoing engagement. This research identified a need to critically reflect on the extent to which rhetorics of participation and involvement give rise to effective and meaningful involvement for young service users. It also highlights the need for researchers to be more flexible in response to young people’s personal circumstances, particularly when those young people are “less frequently heard”.Research limitations/implicationsThis research highlights the need for researchers to be more flexible in response to young people’s personal circumstances, particularly when those young people are “less frequently heard”. It highlights the danger of young people in drug and alcohol research being unintentionally disaffected from involvement through conventional approaches and instead suggests ways in which young people could be involved in influencing if and how they participate in research.Practical implicationsThere is an apparent contradiction between dominant discourses and cultures of health services research (including patient and public involvement) that often do not sit easily with ideas of co-production and young people-centred involvement. This paper provides an alternative approach to involvement of young people that can help to enable more meaningful and effective involvement.Originality/valueThe flexible and young people-centred model for involvement which emerged from this work provides a template for a different approach. This may be particularly useful for those who find current practice, such as YPAG, inaccessible.

What are \u201cgood outcomes\u201d for adolescents in public mental health settings?

BackgroundIn line with the evidence-based paradigm, routine outcome monitoring and clinical feedback systems are now being recommended and implemented in youth mental health services. However, what constitutes a good outcome for young service users is not fully understood. In order to successfully monitor outcomes that are clinically and personally relevant for the service user that are to benefit from these systems, we need to gain more knowledge of what young service users value as meaningful outcomes of youth mental health services.AimTo contribute knowledge into what constitutes “good outcomes” from the experiences of adolescent service users in public mental health systems.MethodsA qualitative in-depth study of the experiences and reflections from 22 adolescents aged 14–19 years, currently or recently being in public mental health services. The data material was analyzed using a systematic step-wise consensual qualitative research framework for team-based analysis.ResultsAn overarching theme of outcome as having developed a stronger autonomy and safer identity emerged from the analysis, with the subsequent five constituent themes, named from the words of the adolescent clients: (1) I’ve discovered and given names to my emotions, (2) I’ve started to become the person that I truly am, (3) I’ve dared to open up and feel connected to others, (4) I’ve started saying yes where I used to say no, and, (5) I’ve learned how to cope with challenges in life.Conclusion“Good outcomes” in youth mental health services should be understood as recovery oriented, sensitive to developmental phases, and based on the personal goals and values of each adolescent client.

Hearing the lived experience of young women with a rare genetic disorder 22q11.2DS regarding integrated care

Introduction: The lived experience of young people with chronic disease has seldom been heard in health research despite the clear policy imperative to hear the voices of children and young people as service users and rights holders. This participatory research sought to redress this by empowering young women with 22q11.2 Deletion Syndrome, a rare genetic disorder which can cause chronic, multiple and complex health difficulties, to express their lived experience of transitions from paediatric to adult care. Methods: Radically different from the old paradigm of positivist science, the transformative research methodology ‘Participatory Action Research’ (PAR) was chosen to empower participants by conducting research ‘with’ and not ‘on’ them, validating their lived experience and ability as service users to inform service provision and policy. Six young women with 22q11.2DS aged 21 to 35 years were recruited to a ‘Young Experts by Experience Panel’ (YEEP). Arts based, narrative methods including body map drawings, lifelines and photo-voice were employed to initially elicit qualitative themes. Subsequent focus group discussions explored these themes. Digital story methodology informed a short video highlighting the YEEP’s experience and recommendations regarding an integrated care clinic for children and young people with rare genetic disorders. Results: Research participation outcomes included enhanced health literacy, acceptance of diagnosis, peer support, self-advocacy, confidence, autonomy and a sense of belonging to a unique community. Emerging themes included acceptance of chronic illness, self-care management of mental health and wellbeing and the challenge of communicating with multiple care providers complicated by mild intellectual disability and speech and language difficulties. Identified health service needs included the need for an integrated care coordinator and an integrated multidisciplinary care clinic to support with the transition from paediatric to adult healthcare. Discussion: The young adult service users specified their preference for a ‘one stop shop’ to provide integrated care across their lifespan. They reported that the current absence of integrated care causes anxiety and fear as participants struggle to cope with explaining their rare disorder to healthcare providers, to communicate effectively with clinicians from multiple disciplines and with their reluctant dependence on ageing parental carers to facilitate access to appropriate healthcare. Conclusions: Integrated care provision was identified by participants as the pathway to greater autonomy, self-care, successful transitions and positive health outcomes. Lessons learned: This participatory approach to research was an empowering process for young adult patients which resulted in a compelling request to policy makers to enable integrated care for rare chronic diseases. Additionally producing a visual digital story of the research process facilitated dissemination of young people’s voices to be heard in multiple settings, including clinical, academic, community and policy environments. Limitations: Notwithstanding the unique richness of the qualitative findings into the lived experience of young adult female service users, the research was not informed by the male young adult experience of their chronic disorder due to lack of available male participants. Suggestions for future research: Further participatory research with children and young people with chronic rare diseases and their parents could usefully inform the development of an integrated care pathway as a model for chronic rare diseases. Such research should strive to include the perspective of both genders' perspective.

'The challenges of sharing information when a young person is experiencing severe emotional difficulties': implications for schools and CAMHS.

Supporting the education of children and young people with complex emotional mental health difficulties requires schools to have knowledge of their needs. Exchanging information about less visible mental health difficulties is, however, known to be complex. Exploring the perceptions of young people experiencing problems can explicate some of this complexity and identify solutions. Yet their views are rarely given credence in this context. The findings were derived from a broader qualitative study exploring the school experiences of young people, aged 14-16years, identified by CAMHS as having severe emotional difficulties. Their parents' and teachers' perceptions were also explored. Data were collected via semistructured interviews and analysed using thematic analysis. Findings demonstrated that young people experiencing emotional difficulties need to feel safe about exchanging private information pertaining to their mental health. Teachers having a basic knowledge of mental health promoted their safety as this ensured confidentiality. Participants reported that CAMHS practitioners needed to be more proactive regarding the practicalities of exchanging information. Arguably, teachers need to have basic knowledge of mental health and schools need clearer mental health confidentiality guidance. CAMHS also have responsibility in identifying more information exchange mechanisms and young service users and parents can play a part in this.

Youth outside the labour force — Perceived barriers by service providers and service users: A mixed method approach

BackgroundYoung people who are neither in employment nor in education or training (NEET) have received increasing attention in Western countries. While some young people in the labour force are unemployed because of a shortage of jobs, others would be without employment even in periods of economic growth, when more jobs are available. The latter group is referred to as neither in the labour force nor in education or training (NLFET), and such people need intervention to improve their chances of work participation. However, this group is poorly understood, and more knowledge is needed to develop efficient measures. The purpose of the study is to investigate the NLFET population and to identify barriers to education or employment. MethodInterviews were conducted at all labour and welfare offices in a representative county in Norway, and an internet-based survey among 586 persons aged 18–29years who met the NLFET criteria was conducted. Sixty case managers of young service users and 30 managers/assistant managers were interviewed at the 25 offices in the county. ResultsThe local labour and welfare offices prioritize young clients, and some have designated follow-up teams for young service users. Three main barriers to education or employment were identified through the interviews at the offices: client motivation, the sense of lack of achievement/defeat, and unrealistic expectations about working life. A survey of the young people revealed other barriers, such as health problems (60%), low education (55%), lack of work experience (41%), the feeling of being exhausted (38%), low self-esteem (36%), feeling depressed (35%), sleeping problems (35%), and very often a combination of these barriers. ConclusionsHealth problems, social and other problems are highly prevalent among the NLFET population. The majority of the population wanted to find a job or to complete their education. We conclude that mental health problems often camouflage social problems. Treatment of complex problems should not be left to mental health services. Given the nature of the barriers identified, follow-up by strong multi-professional teams, including social work and health professions, should be part of the measures allocated to the NLFET population.

Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support.

BackgroundThe Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world.ObjectiveThe aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2).MethodsKooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset.ResultsThe findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves individuals making an explicit suggestion of what they believe the poster should do.ConclusionsThis study adds to the research exploring what young people discuss within online forums and provides insights into how these communications take place. Furthermore, it highlights the challenge that organizations may encounter in mediating support that is multidimensional in nature (informational-emotional, directive-nondirective).

Direct and indirect associations between dysfunctional attitudes, self-stigma, hopefulness and social inclusion in young people experiencing psychosis

ObjectiveSocial inclusion and vocational activity are central to personal recovery for young people with psychosis. Studies with people experiencing long term psychosis suggest negative self-beliefs are important, but less is known about whether this association is present for young service users or about the potential influence of positive self-beliefs such as hopefulness. The aim of the current paper was to investigate the direct and indirect associations between dysfunctional attitudes, self-stigma, hopefulness, social inclusion and vocational activity for young people with psychosis. MethodA 5-month longitudinal study was conducted with young psychosis service users. Measures of dysfunctional attitudes and self-stigma and vocational activity were obtained at baseline. Measures of hopefulness, social inclusion and vocational activity were obtained at follow-up. ResultsHopefulness mediates the associations between self-stigma, social inclusion and vocational activity. Self-stigma may have a greater influence on social inclusion with age. Dysfunctional attitudes do not significantly predict social inclusion or change in vocational activity status. ConclusionFindings suggest that the impact of self-stigma may extend beyond social and occupational withdrawal and undermine subjective community belonging. Findings encourage an increased emphasis on facilitating hopefulness for young people who experience psychosis.