Gatekeeping Beliefs, Intent, and Behaviors Among Young People Experiencing Homelessness

Background/Purpose: Suicide is a serious problem among young people experiencing homelessness (YEH). Utilization of mental health services is a critical pathway for reducing suicide risk. Community gatekeepers can function as facilitators of service use and YEH are well-positioned to potentially serve as gatekeepers for their street-based peers. However, no known research has examined gatekeeper beliefs, intent, behaviors among YEH. This is critical as certain beliefs (i.e., preparedness/efficaciousness about engaging someone in distress) and intent-to-intervene with distressed persons have been shown to increase gatekeeping behavior (approaching and referring distressed individuals for services) in housed populations but have not been investigated among YEH. Thus, the current study had two aims: (1) describe gatekeeper beliefs, intent-to-intervene, and behaviors and (2) examine whether gatekeeper beliefs and intent-to-intervene are associated with gatekeeper behaviors.

Methods: Using a purposive sampling strategy, this study included 148 YEH (aged 14-24) from two drop-in centers providing subsistence services in a major Midwestern city. Participants completed an anonymous survey assessing a range of characteristics, including gatekeeper-related variables. For Aim 1, proportions and mean scores were calculated. For Aim 2, linear regression analysis was used. Preparedness beliefs, self-efficacy beliefs, and intent-to-intervene were examined in three separate multivariate models for each of two gatekeeper behavior outcomes (approach behavior= # of peers with whom the participant discussed concerns about the peer’s mental health in past 3 months; referral behavior= # of peers the participant connected with professional mental health services in past 3 months). Demographics were used as controls.

Results: For Aim 1, preparedness beliefs (M= 15.40), self-efficacy beliefs (M= 11.24), and intent-to-intervene (M= 5.13) were all at moderate levels. Nearly 60% of YEH had talked with at least one person in distress to express concerns about them and 50% had referred at least one person in distress to professional services in the past 3 months alone. More specifically, YEH, on average, approached 1.88 people in distress and linked 1.10 people to services. For Aim 2, preparedness beliefs (β=0.04; 95% CI=0.01, 0.07), self-efficacy beliefs (β=0.05; 95% CI=0.01, 0.09), and intent-to-intervene (β=0.08; 95% CI=0.01, 0.16) were positively associated with approach behavior. Preparedness beliefs (β=0.03; 95% CI=0.01, 0.06), self-efficacy beliefs (β=0.05; 95% CI=0.01, 0.08), and intent-to-intervene (β=0.11; 95% CI=0.05, 0.17) were also positively associated with referral behavior.

Conclusion/Implications: Our results show that many YEH are actively talking with peers about mental health concerns and connecting them with professional care. Moreover, these findings provide promising evidence that traditional targets of gatekeeper training programs (i.e., beliefs/intent) may be similarly viable in this vulnerable population. This is notable for at least three reasons. First, evidence-based practices for suicide prevention program are not often integrated into homelessness service settings. Second, intervention mechanisms cannot be assumed to operate similarly across populations; this point is emphasized in cross-cultural suicide prevention work, which takes on added significance because our sample was predominantly (86%) Black. Third, gatekeeper training may be especially attractive as a candidate for use with YEH given that it can be implemented (and sustained) at relatively low costs in under-resourced settings.