Experiences of engaging with mental health services in 16-18 year olds: An interpretative phenomenological analysis

Objectives: Despite older adolescence being a risk period for the development of mental health concerns, engagement with mental health services is low amongst 16-18 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 some rich and detailed results. The current study aimed to explore older adolescent sense-making of their engagement with mental health service experiences, barriers and facilitators, in order to contribute to a sparse understanding. Research questions were:
• What is the 16 to 18-year-old understanding of their experience of engaging in mental health services?
• What is their understanding of their experience of engagement facilitators and engagement barriers?
Method: Ten 16 to 18 years olds were recruited from two London-based Child and Adolescent Mental Health Services. Each young person was interviewed in order to understand their personal experience of engaging in mental health services, and associated engagement barriers and facilitators. Interviews were transcribed and underwent Interpretative Phenomenological Analysis.
Results: Analysis revealed twelve subthemes subsumed within five superordinate themes: engagement begins at help seeking, strength of inner resolve, evolution of the self, in the clinic room, and, existing within service walls: physical and policy-based boundaries. The interaction between theme is explored.
Conclusions: Conclusions are drawn in relation to previous theory and research. When considering 16-18 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.