A minority of children and adolescents with mental health problems access treatment. The reasons for poor rates of treatment access are not well understood. As parents are a key gatekeeper to treatment access, it is important to establish parents’ views of barriers/facilitators to accessing treatment. The aims of this study are to synthesise findings from qualitative and quantitative studies that report parents’ perceptions of barriers/facilitators to accessing treatment for mental health problems in children/adolescents. A systematic review and narrative synthesis were conducted. Forty-four studies were included in the review and were assessed in detail. Parental perceived barriers/facilitators relating to (1) systemic/structural issues; (2) views and attitudes towards services and treatment; (3) knowledge and understanding of mental health problems and the help-seeking process; and (4) family circumstances were identified. Findings highlight avenues for improving access to child mental health services, including increased provision that is free to service users and flexible to their needs, with opportunities to develop trusting, supportive relationships with professionals. Furthermore, interventions are required to improve parents’ identification of mental health problems, reduce stigma for parents, and increase awareness of how to access services.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-016-0930-6) contains supplementary material, which is available to authorized users.

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BackgroundMental health problems are common and typically have an early onset. Effective treatments for mental health problems in childhood and adolescence are available, yet only a minority of children who are affected access them. This is of serious concern, considering the far-reaching and long-term negative consequences of such problems. Primary care is usually the first port of call for concerned parents so it is important to understand how primary care practitioners manage child and adolescent mental health problems and the barriers they face.AimTo ascertain primary care practitioners’ perceptions of the barriers that prevent effective management of child and adolescent mental health problems.Design and settingA systematic review of qualitative and quantitative literature in a primary care setting.MethodA database search of peer-reviewed articles using PsycINFO, MEDLINE®, Embase, and Web of Science, from inception (earliest 1806) until October 2014, was conducted. Additional studies were identified through hand searches and forward-citation searches. Studies needed to have at least one search term in four categories: primary care, childhood/adolescence, mental health, and barriers.ResultsA total of 4151 articles were identified, of which 43 were included (30 quantitative studies and 13 qualitative studies). The majority of the barriers related to identification, management, and/or referral. Considerable barriers included a lack of providers and resources, extensive waiting lists, and financial restrictions.ConclusionThe identification of a broad range of significant barriers highlights the need to strengthen the ability to deal with these common difficulties in primary care. There is a particular need for tools and training to aid accurate identification and management, and for more efficient access to specialist services.

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There is a lack of current data on help-seeking, and barriers to accessing professional support for child anxiety disorders. This study aimed to provide current data on the frequency and type of parental help-seeking, professional support received, and parent-reported barriers/facilitators in the context of child anxiety, and to explore factors associated with help-seeking, and parent-reported barriers among help-seekers and non help-seekers. We conducted a survey of help-seeking in parents of 222 children (aged 7-11) with elevated anxiety symptoms identified through screening in schools, 138 children of whom met diagnostic criteria for an anxiety disorder. Almost two-thirds (64.5%) of parents of children with an anxiety disorder reported seeking help from a professional; in 38.4% of cases parents reported that their child had received support from a professional to help manage and overcome their anxiety difficulties, and < 3% had received evidence-based treatment (CBT). Frequently reported parental barriers related to difficulties differentiating between developmentally appropriate and clinically significant anxiety, a lack of help-seeking knowledge, perceived negative consequences of help-seeking, and limited service provision. Non-help seekers were more likely than help seekers to report barriers related to thinking a child's anxiety may improve without professional support, and the absence of professional recognition. Findings identify the need for (i) tools for parents and primary school staff to help identify children who may benefit from professional support to overcome difficulties with anxiety; and (ii) increased evidence-based provision for child anxiety disorders, including delivery within schools and direct support for parents.

ObjectivesBreastfeeding confers important health benefits to both infants and their mothers, but rates are low in the United Kingdom and other developed countries despite widespread promotion. This study examined the relationships between personal and vicarious experience of infant feeding, self‐efficacy, the theory of planned behaviour variables of attitudes and subjective norm, and the likelihood of breastfeeding at 6–8 weeks post‐natally.DesignA prospective questionnaire study of both first‐time mothers (n = 77) and experienced breastfeeders (n = 72) recruited at an antenatal clinic in South East England.MethodsParticipants completed a questionnaire at 32 weeks pregnant assessing personal and vicarious experience of infant feeding (breastfeeding, formula‐feeding, and maternal grandmother’s experience of breastfeeding), perceived control, self‐efficacy, intentions, attitudes (to breastfeeding and formula‐feeding), and subjective norm. Infant feeding behaviour was recorded at 6–8 weeks post‐natally. Multiple linear regression modelled the influence of vicarious experience on attitudes, subjective norm, and self‐efficacy (but not perceived control) and modelled the influence of attitude, subjective norm, self‐efficacy, and past experience on intentions to breastfeed. Logistic regression modelled the likelihood of breastfeeding at 6–8 weeks.ResultsPrevious experience (particularly personal experience of breastfeeding) explained a significant amount of variance in attitudes, subjective norm, and self‐efficacy. Intentions to breastfeed were predicted by subjective norm and attitude to formula‐feeding and, in experienced mothers, self‐efficacy. Breastfeeding at 6 weeks was predicted by intentions and vicarious experience of formula‐feeding.ConclusionVicarious experience, particularly of formula‐feeding, has been shown to influence the behaviour of first‐time and experienced mothers both directly and indirectly via attitudes and subjective norm. Interventions that reduce exposure to formula‐feeding (perhaps by limiting advertising) or cushion mothers from its effects may enable more mothers to meet their breastfeeding goals. Statement of contribution What is already known on this subject? Rates of breastfeeding in the United Kingdom are low and resistant to change.Self‐efficacy may be an important and modifiable factor for breastfeeding initiation and maintenance. What does this study add? Self‐efficacy may only be a relevant factor among mothers who already have personal experience of breastfeeding.Vicarious experience of formula‐feeding has been shown to be related to a lower rate of breastfeeding at 6 weeks.

Random samples of 250–435 adults were interviewed by telephone in five different nations (N= 1,546): Belgium, Germany, Italy, the UK, and the United States. The interview included questions on respondent attitudes, knowledge, and opinions regarding homelessness; respondents' own personal experiences with homelessness and homeless people; and demographic characteristics of the respondents. The highest rates for lifetime literal homelessness were found in the UK (7.7%) and United States (6.2%), with the lowest rate in Germany (2.4%), and intermediate rates in Italy (4.0%) and Belgium (3.4%). Less compassionate attitudes toward the homeless were also found on many dimensions in the United States and the UK. Possible explanations of these findings, drawn from various theoretical perspectives, and policy implications are provided.