Mental disorder is common amongst young adults and is associated with many adverse outcomes. Data, however, indicate that young adults are particularly unlikely to seek help for such distress. This paper describes a qualitative study of 23 young adults (aged 16 to 24 years) with mental distress. Interviewing was used to obtain detailed narratives of illness behaviour and to explore reasons for non-help-seeking. Help-seekers and non-help-seekers were interviewed. The findings allowed development of an explanatory model -the cycle of avoidance (COA) -which contributes towards attempts to provide a dynamic understanding of help-seeking behaviour. Dominant approaches tend to be deterministic and static and to account for non-help-seeking in terms of 'barriers' to care, which although easily translated into targets for policy intervention, are superficial representations of complex issues. The COA conceptualises helpseeking as a circular process and offers a model of 'non-help-seeking' in which lay conceptions of mental distress, the social meanings attached to 'help-seeking' and treatment, and the purposeful action of individuals, assume central importance. Although derived in the context of young adulthood and mental distress, this model may have wider applicability as a theoretical template for explaining non-help-seeking in other age groups and conditions, and other illness behaviours.

Recentreports of suicide by young people have highlighted the possible influence of internet sites. Lucy Biddle and colleagues investigate what a web search is likely to find

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The need for schools to support children and young people's mental and emotional health is increasingly emphasised in policy initiatives, yet the role of teachers in this has been under explored. This paper reports findings from qualitative, semi‐structured interviews with 14 school staff at eight secondary schools in England, examining emotional health and well‐being (EHWB) activities in which they were involved. Three emergent themes are discussed: (1) a strongly held belief that teaching and EHWB are inevitably linked; (2) a perception that many colleagues outside the study sample are reluctant to engage in EHWB work; and (3) a concern that teachers’ own emotional health needs are neglected, leaving them unable or unwilling to consider those of pupils. The findings endorse whole‐school approaches to emotional health, with a focus on teachers’ training and support needs and clearer aims, including consideration of how such work fits with the broader goals of schools.

Patients with cancer have a high prevalence of distress. Needs assessment can be performed quickly and inexpensively. However, the DT&PL was not cost effective in improving patient mood states. It is important to explore the reasons for this so that oncology units can design better services to support patients.

BackgroundThere is concern over the potential impact of the Internet on self-harm and suicidal behaviour, particularly in young people. However, little is known about the prevalence and patterns of suicide/self-harm related Internet use in the general population.MethodsCross sectional study of 3946 of the 8525 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) who were sent a self-report questionnaire including questions on suicide/self-harm related Internet use and self-harm history at age 21 years.ResultsSuicide/self-harm related Internet use was reported by 22.5% (886/3946) of participants; 11.9% (470/3946) had come across sites/chatrooms discussing self-harm or suicide, 8.2% (323/3946) had searched for information about self-harm, 7.5% (296/3946) had searched for information about suicide and 9.1% (357/3946) had used the Internet to discuss self-harm or suicidal feelings. Suicide/self-harm related Internet use was particularly prevalent amongst those who had harmed with suicidal intent (70%, 174/248), and was strongly associated with the presence of suicidal thoughts, suicidal plans, and history of self-harm. Sites offering help, advice, or support were accessed by a larger proportion of the sample (8.2%, 323/3946) than sites offering information on how to hurt or kill yourself (3.1%, 123/3946). Most individuals (81%) who had accessed these potentially harmful sites had also accessed help sites.Limitations(i) There were differences between questionnaire responders and non-responders which could lead to selection bias and (ii) the data were cross-sectional, and we cannot conclude that associations are causal.ConclusionsSuicide/self-harm related Internet use is common amongst young adults, particularly amongst those with suicidal thoughts and behaviour. Both harmful and helpful sites were accessed, highlighting that the Internet presents potential risks but also offers opportunities for suicide prevention.

Prevention strategies should focus on countering perceptions of hanging as a clean, painless and rapid method that is easily implemented. However, care is needed in the delivery of such messages as some individuals could gain information that might facilitate fatal implementation. Detailed research needs to focus on developing and evaluating interventions that can manage this tension.

Rates of hospital presentation for self-harm have increased in recent years, and although clinical practice guidelines on clinical provision prioritize positive patient experiences, the quality of provision remains variable. This systematic review provides an updated and extended synthesis of qualitative research on the following: (a) patients’ experiences of treatment following presentation to hospital; and (b) patients’ perceptions of the impact of treatment on recurrent self-harm and/or suicidal ideation, and future help-seeking. Twenty-six studies were identified for inclusion in the final synthesis. Three meta-themes emerged: (a) individuals undertake extensive identity work when presenting with self-harm, navigating the process of becoming a patient, and negotiating the type of patient they want to be; (b) care ranges from gentle to hostile, with care at admission and discharge being particularly disorientating; and (c) negative experiences of clinical treatment may increase future self-harm. Emerging research gaps include the need for further theoretically informed qualitative research in this area.