DOI 10.1515/ijamh-2013-0320 Int J Adolesc Med Health 2013; aop Sarah Ketchen Lipson* A comprehensive review of mental health gatekeeper-trainings for adolescents and young adults Abstract: Mental disorders account for a larger burden of disease among adolescents and young adults than any other class of health conditions, and most of these disorders are untreated. Gatekeeper-trainings represent a potentially powerful mechanism for increasing access to treatment. This article is a comprehensive review of 21 gatekeeper-training studies conducted in schools and other youth settings around the world. Despite the wide- spread use of these programs, little is known about how they actually affect the abilities and actions of trained gatekeepers and the subsequent help-seeking behav- iors of adolescents and young adults. Certain outcomes (knowledge, attitudes, and self-efficacy) have been com- monly measured whereas others (behaviors, skills, and population-level outcomes) have rarely been assessed. The studies reviewed here also suggest that positive train- ing effects often diminish over time. The article identifies opportunities for advancing gatekeeper-training research and practice. Keywords: adolescents; gatekeeper-trainings; mental health; schools; young adults. *Corresponding author: Sarah Ketchen Lipson, Department of Health Management and Policy, University of Michigan School of Public Health, SPH II, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA, E-mail: sklipson@umich.edu Introduction Mental health problems among adolescents and young adults Mental disorders account for a larger burden of disease among adolescents and young adults than any other class of health conditions (1). In the U.S. 15.8% of high school students report having seriously considered suicide at least once in the past 12 months (2). More than 25% experience depressive symptoms severe enough to impair their daily activities (3). Similarly in college student pop- ulations around the world, mental health problems are highly prevalent (4–7) and appear to be increasing (8). Despite the significant burden of disease, the major- ity of mental disorders go untreated in adolescent and young adult populations (9). Identifying effective popu- lation-level interventions to narrow the “treatment gap” – the difference between the prevalence of mental health problems and the prevalence of treatment use (10) – could make a significant impact during an important period of life. Gatekeeper-trainings (GKTs) represent a promising paradigm for narrowing the treatment gap for adolescents and young adults. Gatekeeper-trainings GKTs are universal, primary prevention programs that aim to: (i) increase knowledge about mental health prob- lems and the ability of gatekeepers to recognize and appropriately intervene in the face of such problems, and, as a result, (ii) increase the help-seeking behaviors of the target population. The term “gatekeeper” was first defined in 1971 to be “any person to whom troubled people are turning for help” [(11), p. 39]. Key gatekeepers interact with others in environments of work, play, and in various community settings (12). Bartenders, hairdressers, postal carriers, athletic coaches, waitresses, and many others have been recognized as potential gatekeepers based on their natural position to carry out informal observation, detection, and assistance for those in distress (13). GKTs have been used in diverse groups and locations, including for veterans (14), active military personnel (15), and abo- riginal people (16), and in places of worship (17), senior living centers (18), prisons (19), workplaces (20), and in high schools, colleges, and universities. In school-based settings, teachers, staff, and students are commonly trained as gatekeepers. GKTs are typically considered suicide prevention programs, although they are also used to address other mental health problems. Specific GKTs have been widely