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Clinical Child Psychology and Psychiatry
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The Different Stages and Actors Involved in the Process Leading to the Use of Adolescent Mental Health Services

Marieke Zwaanswijk

NIVEL and Erasmus Medical Centre, The Netherlands, M.Zwaanswijk{at}nivel.nl

Jan Van Der Ende

Erasmus Medical Centre, The Netherlands

Peter F.M. Verhaak

NIVEL, The Netherlands

Jozien M. Bensing

Utrecht University and NIVEL, The Netherlands

Frank C. Verhulst

Erasmus Medical Centre, The Netherlands

Although a substantial number of adolescents suffer from emotional or behavioural problems, only a minority receive mental health care. In order to understand this discrepancy, this article aims to increase insight into the help-seeking process. First, a model of the help-seeking process for adolescent psychopathology was formulated. This model takes into account the sequential nature of help seeking and the involvement of multiple actors (adolescents, parents and teachers) and service providers (general practitioners, mental health care professionals, teachers, and friends/relatives). Using structural equation modelling, the model was empirically tested on 114 Dutch adolescents (aged 12—17 years), who were selected for having emotional or behavioural problems from a representative general practice sample. Of these 16.5% had used mental health services. The sequence of stages and the actors involved in the process leading to mental health care use was similar across gender. Parents and adolescents had a comparable impact on this process. The general practitioner functioned as gatekeeper to mental health care, whereas the teacher's role in the process was limited. Interventions aimed at increasing adolescent mental health service use should be directed at parents and adolescents, and at the roles of school personnel and general practitioners in the detection of problems and referral.

Key Words: adolescent • mental health services • psychopathology • service use

Clinical Child Psychology and Psychiatry, Vol. 12, No. 4, 567-582 (2007)
DOI: 10.1177/1359104507080985
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