Qualitative analysis of key informant interviews about adolescent stigma surrounding use of school mental health services

Stigma related to targeted school-based mental health interventions: A systematic review of qualitative evidence

“…Most studies (5 out of 7) addressed early interventions for students experiencing emotional distress in the context of psychosocial stressors. These interventions were described as 'school mental health services' (Huggins et al, 2016), 'school counselling services' (Prior, 2012a(Prior, , 2012b, an intervention to enhance protective factors for young people experiencing change, loss and transition events and early signs of emotional distress (Dickinson et al, 2003), an intervention for students with social and emotional difficulties in school and family settings (Evans et al, 2015), and a school-based emotional support service for 'young people with emotional difficulties/mental health issues, which had the potential to cause a crisis or have a negative effect on emotional well-being' (p. 219) (Segrott et al, 2013). Only two studies (Garmy et al, 2015;Kvist Lindholm and Zetterqvist Nelson, 2014) A C C E P T E D M A N U S C R I P T 11 focused on programmes with an explicit diagnostic focus, both involving cognitivebehavioural interventions for students at risk for depression.…”

“…Contact with TSMHIs was considered to be revealing of mental health status, leading to negative labelling from peers (Huggins et al, 2016;Prior, 2012a). Two types of negative characterisations were indicated: labels that emphasised difference and deviation from the norm (e.g., "weird", "abnormal", "deviant"), and labels that reflected stereotyped attitudes towards people with mental health difficulties (e.g., "psycho", "mental" or "mad") (Prior, 2012a(Prior, , 2012b.…”

“…Stigma was also evident in anticipated and experienced hostile reactions from peers, including overt bullying and teasing, and feeling rejected, judged, and dismissed (Huggins et al, 2016;Prior, 2012b). Teachers and counsellors were also perceived as a source of discrimination, with accounts of students feeling "hated" and being treated unequally due to contact with TSMHIs (Evans et al, 2015;Prior, 2012b).…”

“…Given the sensitivities around disclosure of mental health difficulties and service use in schools, it is not surprising that confidentiality and trust were frequently mentioned as key considerations for overcoming stigma-related barriers. Improved privacy was discussed in relation to the physical environment where TSMHIs were provided, for example by avoiding rooms with clear glass windows that made counselling sessions visible to others (Huggins et al, 2016). Enhanced confidentiality was also discussed in terms of using discreet methods, M A N U S C R I P T 16 such as passes for generic appointments, to signal that a student needed to leave class (Segrott et al, 2013).…”

“…These strategies facilitated engagement with TSMHIs, as once a sense of confidentiality and trust was established students felt able to fully engage with the support and discuss their difficulties (Prior, 2012b). Service providers likewise described how their ability to provide effective support was dependent on the extent to which students perceived them to be trustworthy and respectful of confidentiality (Huggins et al, 2016).…”