In a summary of young people’s help-seeking for health and social problems Barker, Olukoya, and Aggleton (2005) emphasise beliefs about a “need” for help as essential to help-seeking from professionals. It is emphasised that there may be inconsistencies between parent perceptions and the perceptions of young people regarding beliefs about a “need” for help.
2.3.1 Beliefs of young people experiencing psychosis.
There is some evidence that young people experiencing psychosis may access support due to an emerging belief that help is needed. Hardy, Dickson, and Morrison (2009)
thematically analysed interviews with ten young people with FEP who identified that they accessed services when they perceived a worsening of experiences such as paranoia, hearing voices or fluctuating mood. Therefore for some, at least, there is a move towards help-seeking when a crisis is reached and they believe that professional support may be required.
However, for other young people it appears a “need” for help is never realised, and help-seeking is initiated by others without their consent (Tanskanen et al., 2011). It is important to understand what differentiates young people who arrive at a “need” for help, and those who do not.
A qualitative study of eight participants using an interpretive interactionist approach indicated that young people waited many months before they disclosed their experiences to anyone because they did not want to cause anxiety in their family members (Boydell,
Gladstone & Volpe, 2006). A lack of willingness to disclose difficulties may also partially account for family reports of withdrawal (Bergner et al., 2008). Therefore, it appears that young people who lack confidence to disclose about their experiences to others may delay seeking. It would be useful to explore how beliefs of family members regarding help-seeking impact on young people’s beliefs towards accessing services to further understand how and when approaching professional help occurs.
Two experimental studies have looked at beliefs in the form of health locus of control in relation to help-seeking for psychosis in samples of 47 and 42 young people with FEP respectively (Skeate, Jackson, Birchwood & Jones, 2002; Haley, Drake, Bentall & Lewis, 2002). Individuals with psychosis were more likely to have a lower “internal” health locus of control, and higher “powerful other” health locus of control than normative data or a control group. Therefore individuals with psychosis may feel less personally responsible for their own health and believe that health outcomes are more greatly influenced by other influential people. This is consistent with research suggesting that people experiencing psychosis may place themselves at lower “social rank” than others, which would lead to high compliance with the wishes of important others (Birchwood et al., 2002). However, it could be argued that people who have recently accessed professional services, especially those who have been hospitalised, may be more likely to believe that their health care is determined by the actions of influential others. Unfortunately the measure used (Multidimensional Health Locus of Control Scales; Wallaston, Wallaston & De Vellis, 1978) did not allow for distinction of whether “powerful others” were considered to be those in their social network or
professionals. Interestingly, Haley et al. (2002) also found that a greater internal locus of control was significantly correlated with a shorter duration of untreated psychosis, which
suggests that those who believe they are more responsible for their own health are quicker to seek help than those who believe they are less responsible for their beliefs.
2.3.2 Family beliefs.
Corcoran et al. (2007) interviewed 13 family members of young people aged 16-24 regarding their involvement in the help seeking process, and analysed results using a
phenomenologically based approach. Families primarily appear to believe that there is a need for professional help-seeking when symptoms of psychosis became visible in young people through behaviour such as shouting or reporting “alarming” experiences (Corcoran et al., 2007). Many families sought help when they believed a young person’s behaviour
represented a risk to themselves or others (Bergner et al., 2008). Earlier help-seeking at this time was associated with family members having greater resources including contact with friends, especially if these friends had knowledge of services (Corcoran et al., 2007).
Families often sought help at the insistence or recommendation of others in their social network. This emphasises the importance of how the beliefs and perspectives of others in the wider social network may be implicated in help-seeking.
Monteiro et al. (2006) reported that relatives were concerned about using services that were perceived to be “aggressive and authoritarian”. There was also a belief that taking
medication and being with others with MHDs may make their relatives’ difficulties worse.
No positive connotations of seeking help were reported. Tanskanen et al. (2011) also reported that carers expressed misgivings about services and were worried about treatment. These studies aid understanding of when beliefs of those providing social support may be a barrier to young people seeking professional help. Studies are needed to similarly understand young people’s perceptions towards help-seeking from professionals.
2.3.3 Summary of beliefs towards help-seeking.
Young people sought professional support when they believed that it might be needed (Hardy et al., 2009), although not all young people reached this stage (Tanskanen et al., 2011). Delays in disclosure occurred when individuals believed family members might find their experiences anxiety-provoking (Boydell et al., 2006). Young people who believed that they were more responsible for their own health appeared quicker to seek help. Individuals who accessed services reported greater beliefs that others were responsible for health care, although it was unclear whether this was a response to being in services (Skeate et al., 2002;
Haley et al., 2002). Families were most likely to seek help when young people’s behaviour
appeared risky or others recommended accessing services (Corcoran et al., 2007). Some family members reported fears about mental health services (Monteiro et al., 2006;
Tanskanen et al., 2011).