Help Seeking Patterns from Childhood to Young Adulthood in Low-Income Young Adults That Accessed Psychiatric Emergency Care

Background: Rates of mental health service use drop precipitously from adolescence into young adulthood (Pottick et al, 2008), while incidence of mental disorders peaks (Newman et al, 1996).  And, young adults with fewer resources such as those who experienced homelessness, involvement with public systems, poverty, and trauma are disproportionately affected by mental illness (i.e. McMillen et al, 2005; Whitbeck et al, 2007). This study sought to understand reasons for prior help-seeking in a marginalized group of young adults who accessed emergency crisis services and examine whether there were meaningful subgroups based on childhood/adolescent service use experiences. The overall aim was to inform efforts to intervene earlier, prevent psychiatric crises, and promote equity in young adult outcomes for this disadvantaged and underserved group.

Methods: Fifty-five young adults (age 18-25) with a diagnosis of Bipolar (47%), Depression (39%) or Schizophrenia (14%) were interviewed in a short-term inpatient crisis stabilization unit for uninsured patients. Interviews used a structured protocol, then a semi-structured qualitative guide to elicit participants’ history of symptoms and attempts to manage them.  Analysis included a two-stage process.  First, three analysts first read a set of 10 transcripts and identified preliminary sub-groupings of participants based on patterns of symptoms and service use and classified each participant based on an interview summary. Then, in a second stage, analysts read and diagrammed full interviews within each group, specifically focused on understanding each episode of help seeking and the factors that influenced it.      

Results: The sample (n=55) was ethnically diverse and gender balanced.  Most had prior experiences of outpatient services (n=48) and half had prior experience of inpatient hospitalization (n=27).  Four service use pattern subgroups were identified.  One was characterized by onset of symptoms in young adulthood (n=10). This group presented symptoms as a change from prior functioning and were more invested in psychiatric treatment compared to other groups.  The majority of participants reported onset of symptoms in childhood or early adolescence (n=45).  Among those, three groups emerged: (1), consistent services through childhood and adolescence (n=8), (2) intermittent services (n=31), and (3) no services (n=6).  Across these three groups, caregivers (both natural supports and social service providers) were prominent in determining service use patterns. Cultural beliefs about help-seeking were often translated through caregivers and shaped these behaviors. It was common for participants to disengage from formal services as they shifted to autonomous decision making during the transition to adulthood. Many chose to manage mental health symptoms with illegal substances during this transition. 

Conclusion: Among this marginalized group, most had onset of symptoms in childhood or adolescence. Findings highlight the importance of natural supports and service providers in connecting or not connecting them with treatment. Public education on mental illness that is culturally tailored could assist in removing stigma around formal help seeking.  In addition, disengagement during the transition period when young people take over their own decision making was common.  Flexible service models that can maintain engagement and allow for exploration of treatment options could assist in keeping a connection to positive supportive services.