Australian rural adolescents’ experiences of accessing psychological help for a mental health problem Candice Boyd, Kristy Francis, Damon Aisbett, Krystal Newnham, Jessica Sewell, Graham Dawes and Sarah Nurse Centre for Health Research and Practice, University of Ballarat, Ballarat, Victoria, Australia Abstract Objective: This study aims to explore Australian rural adolescents’ experiences of accessing help for a mental health problem in the context of their rural communi- ties. Design and setting: A qualitative research design was used whereby university students who had sought help for a mental health problem during their adolescence were interviewed about their experiences. Interviews were conducted face-to-face at the university. Main outcome measures: A semi-structured interview schedule was designed around the study’s main research questions. Audio-taped interviews were transcribed and thematically coded using a constant comparative method. Participants: Participants were first-year undergradu- ate psychology students between the ages of 17 and 21 years who sought help for a mental health issue during their adolescence and who at that time resided in a rural area. Results: Participants highlighted various barriers to seeking help for mental health problems in the context of a rural community, including: social visibility, lack of anonymity, a culture of self-reliance, and social stigma of mental illness. Participants’ access to help was primarily school-based, and participants expressed a preference for supportive counselling over structured interventions. Characteristics of school-based helpers that made them approachable included: ‘caring’, ‘non- judgemental’, ‘genuine’, ‘young’, and able to maintain confidentiality. Conclusions: The findings support previous research that reveals barriers to help seeking for mental health problems that are unique to the culture of rural com- munities. The study raises questions about the merit of delivery of primary mental health care to young people via GPs alone and suggests that school-based counsel- lors be considered as the first step in a young person’s access to mental health care. KEY WORDS: help seeking, qualitative research, rural adolescent mental health, stepped care. Introduction The literature has identified various characteristics of rural communities that create barriers for seeking help for mental health problems beyond those that exist in urban areas. 1 Understanding barriers to seeking help for rural adolescents is important, as delays in seeking effec- tive help are known to poorly affect treatment outcome for a range of mental health problems that have their onset during this developmental period. 2–4 Therefore, research that aims to understand the barriers that rural adolescents face in accessing mental health care is clearly in the national interest. Although young people prefer informal sources of help (particularly peers) to formal sources, 5 research has also revealed that when seeking formal help for mental health problems adolescents look for several character- istics in potential helpers; that they are ‘nonjudge- mental’, able to ‘relate to teens’, and ‘make themselves available’. Barriers to help seeking are created if the potential helper is perceived as ‘psychologically inacces- sible (acts superior)’ or too busy. 6 There is a distinct lack of data on young people’s perceptions of GPs as formal sources of help, despite recent efforts in Australia to upskill rural GPs to address shortfall in mental health service delivery in rural areas. 7 Furthermore, results from studies conducted overseas reveal that adolescents’ perceptions of school-based mental health services are overwhelmingly positive. 8,9 In Australia, there is a need for research to gain a perspective on adolescents’ experiences of seeking help for mental health problems within a rural context, where significant barriers to accessing care exist. 10 The Correspondence: Dr Candice Boyd, Rural Adolescent Mental Health Group, Centre for Health Research and Practice, University of Ballarat, PO Box 55, Ballarat, Victoria, 3353, Australia. Email: c.boyd@ballarat.edu.au Accepted for publication 29 June 2006. © 2007 The Authors .