Adolescents' perceptions of barriers and facilitators to engaging in mental health treatment: A qualitative meta-synthesis

Problem: One in seven children, aged 3-17, have a mental health diagnosis with suicide being the second leading cause of death in the United States in persons aged 10-24. Adolescents are at high risk for mental health disorders, substance use, and risky behaviors, yet most adolescents never receive treatment. Research is needed to answer the question, "What are adolescents' perceived barriers and facilitators to engaging in mental health treatment?" Methods: A four-step qualitative meta-synthesis design included: A structured research question and search strategy, data immersion through quality appraisal, thematic synthesis of primary research studies, and reciprocal translation of derived themes. Findings: Eight studies met inclusion criteria. Autonomy was the primary theme that emerged. Meta-synthesis produced five subthemes: (a) choice as integral to engagement, (b) stigma as barrier to engagement, (c) quality of the therapeutic relationship as integral to engagement, (d) systemic influences as both barrier and facilitator to engagement, and (e) mental health literacy as crucial factor in decision to engage. Conclusion: Adolescents require autonomy to engage in mental health treatment. Improving treatment engagement in adolescents requires interventions that address their ability to be autonomous.