Background. Individuals often avoid or delay seeking professional help for mental health problems. Stigma may be a key deterrent to help-seeking but this has not been reviewed systematically. Our systematic review addressed the overarching question: What is the impact of mental health-related stigma on help-seeking for mental health problems? Subquestions were: (a) What is the size and direction of any association between stigma and help-seeking? (b) To what extent is stigma identified as a barrier to help-seeking? (c) What processes underlie the relationship between stigma and help-seeking? (d) Are there population groups for which stigma disproportionately deters help-seeking?Method. Five electronic databases were searched from 1980 to 2011 and references of reviews checked. A meta-synthesis of quantitative and qualitative studies, comprising three parallel narrative syntheses and subgroup analyses, was conducted.Results. The review identified 144 studies with 90 189 participants meeting inclusion criteria. The median association between stigma and help-seeking was d = − 0.27, with internalized and treatment stigma being most often associated with reduced help-seeking. Stigma was the fourth highest ranked barrier to help-seeking, with disclosure concerns the most commonly reported stigma barrier. A detailed conceptual model was derived that describes the processes contributing to, and counteracting, the deterrent effect of stigma on help-seeking. Ethnic minorities, youth, men and those in military and health professions were disproportionately deterred by stigma.Conclusions. Stigma has a small-to moderate-sized negative effect on help-seeking. Review findings can be used to help inform the design of interventions to increase help-seeking.

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Short educational workshops can produce positive changes in participants' reported attitudes towards people with mental health problems.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Method. School nurses (n = 33) were purposively sampled from four school nursing teams in two English cities for a series of focus groups. The focus group data were audio-recorded, transcribed and subsequently analysed using 'framework'. Results. Four principal themes emerged from the data. In these themes, school nurses were found to value their involvement with the mental health of young people, recognising this as an important area of practice. Several obstacles to their work in this area were identified: heavy workloads, professional rivalries, a lack of confidence and limited education and training opportunities. The importance of support from local specialist mental health teams was emphasised. Permanent repository linkConclusions. School nurses can be engaged in mental health work though, as public health specialists, their role should focus on health promotion, assessment, signposting and early intervention activities. To facilitate mental health work, school nurses are able to draw on established interpersonal skills and supportive networks; however, workload and a lack of confidence need to be managed and it is important that they are supported by constructive relationships with local specialist mental health teams.Relevance to clinical practice. This study has implications for nurses and healthcare practitioners interested in enhancing the mental health of children and young people in school settings.