Summary Report: Information Seeking Behaviour

summary document

Information-Seeking Behaviour of Young People & Mental Health

Guiding question for this report: How do youth access mental health information?

Which pathways are likely to be most helpful?

This document presents a summary of the information found in the CYCC Network’s knowledge synthesis report Information-Seeking Behaviour of Young People & Mental Health.

This report brings together existing research and practice-based knowledge to explore how youth seek information related to mental health. Our report highlights the different pathways that youth use to find out about mental health, and examines the complex barriers that make it difficult for youth to access the mental health information they need.

Core Concepts The CYCC Network

Knowledge Mobilization

The CYCC Network is a national body with an international reach. We bring together youth, community groups, front line practitioners, government officials, and researchers, all working with children and youth in challenging contexts (CYCC) throughout diverse Canadian communities.

We know how to help kids do well in their lives. Now we just need to share what we know with each other.

The CYCC Network represents a combination of local commitment, combined with a national and international platform.

“Knowledge mobilization� is the process of taking really good ideas and turning them into action. And then taking practices and linking them with theory.

It means that good research doesn’t have to just end up on a library shelf. It also means that communities across the country are sharing their ideas of what works with at-risk kids.

To improve mental health and well-being for vulnerable and at-risk children and youth in Canada and around the world.

Resilience The capacity of young people to navigate their way to the psychological, social, cultural and physical resources they need for well-being. Resilience is also their capacity as individuals, and collectively within communities, to negotiate for these resources to be provided and experienced in culturally meaningful ways.

Best Practices Best Practices emerge when programs and other interventions use evidence-informed practice, and combine these findings with the right mix of programming elements that fit community needs and assets.

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Knowledge Diagram

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Feedback Loop

Feedback Loop

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Evidence Based Practise

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To truly provide the best service and interventions for at-risk young people, diverse types of knowledge need to be shared and integrated. Academic research (evidence-informed practice) needs to be linked to what service providers are learning (practice-based evidence) and to local community knowledge.

Practise Based Evidence

Local Knowledge

*arrows show the flow of knowledge

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Core Concepts con't

Populations

Vulnerable children and youth are not all the same; they differ in terms of their experiences, contexts, and cultures. They face common threats to their mental health that come from constraints and challenges built into their community and societal structures. No young person or population of young people is inherently more vulnerable than another. It is the contexts in which they reside that makes them more vulnerable.

These populations may include: •

Children and youth affected by war (e.g. child soldiers, refugees)

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Children and youth in military families

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Children and youth affected by natural disasters

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Immigrant children and youth

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Children and youth subject to maltreatment

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Children and youth in alternative care (e.g. juvenile justice system)

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Aboriginal children and youth

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Homeless children and youth

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Youth gangs

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Child labourers in the workplace or who have been trafficked

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Children and youth living with health-related challenges (i.e. chronic or mental illness)

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These factors often intersect, such that a child or youth is likely to experience several stressors at once.

Some of the common factors that shape these contexts are:

Historical oppression Populations who have been historically exposed to continuous levels of violence and mass trauma such as colonialism, war, genocide, and slavery, typically display higher rates of mental health illness such as suicide ideation, depression, anxiety, and alcohol and substance abuse. Historical oppression can create cycles of violence and trauma within individuals, relationships and communities that can be passed on from one generation to the next.

Marginalization Marginalization is the process by which individuals or groups live at the periphery of society because of their exclusion from the economic, social, political, and/or cultural arenas of everyday life. This process is linked to social status and can have a significant impact on how resources are accessed and mobilized, and how decisions are negotiated and made.

Social Exclusion Social exclusion is exclusion from economic, social, political and/or cultural arenas or everyday life because of indicators such as gender, ethnicity, race, and class. It can be experienced at a personal, community or institutional level. As with historical oppression, marginalization and poverty, experiencing social exclusion can lead to low selfesteem, feelings of hopelessness and depression, and increased risk-taking behaviours, as well as other adverse mental health outcomes.

Poverty Poverty may be one of a range of factors that increase the vulnerability of children and youth.

A Note on Ethical Considerations Ethical considerations must be taken into account when working with children and youth. These considerations include harm reduction (the benefit must outweigh the risks), informed consent, engagement of children and youth, and program design and content development competence.

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Youth & Mental Health Information The available data on the mental health challenges of children and youth in Canada is incomplete.i Despite this large knowledge gap, it is likely that a significant number of young Canadians are challenged by mental health difficulties. A large proportion of these youth do not access information that could help them.ii It has been shown that young adults in Canada experience higher rates of mental health concerns compared to other age groups, and yet have lower rates of accessing mental health services.iii

Experiences of mental health, and of information seeking, vary depending on their cultural, social and economic positioning.iv It should come as no surprise that these factors influence the ways in which youth find information and support related to mental health.

The purpose of this report is to synthesize existing knowledge on youth information seeking in order to shed light on the diverse information seeking experiences of youth, and to identify areas of interest which are relevant to improving programming that could help youth find the information they need.

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Diverse Experiences of Mental Health Many factors intersect to influence the information seeking experiences of individuals. These factors include, but are not limited to: gender,v immigration status,vi political context,vii socio-economic status.viii A central challenge encountered in compiling this report existed in representing the variety and complexity of mental health and information seeking experiences of young people, while still being able to draw conclusions that have a wider applicability. The factors that make an impact on the individual experiences of youth seeking mental health information are complex and interrelated. This makes writing about these experiences in general terms a necessarily incomplete project.

In recognizing this challenge, this knowledge synthesis report brings into focus several factors that play a role in determining the mental health related experiences of youth in Canada:

Gender and Mental Health There is considerable variation in how genders experience mental health problems, how they access information, and what their attitudes are towards help-seeking. While incidences of mental health disorders are comparable across genders, girls are more likely to use counseling services than boys, and boys have more negative views towards help-seeking.ix

Migration and Mental Health Approximately one fifth of children in Canada were born outside the country or to recently landed parents, making the influence of migration on mental health relevant to understanding youth mental health more broadly. When considering migration as an influence it is essential to look at the pre-migration experience (refugees, unaccompanied minors, immigrants) and the migrant’s legal status, since both contribute to very different pressures on how vulnerable youth are to mental health issues in the post-migration experience.x

First Nations/MĂŠtis/Inuit and Mental Health Canadian First Nations, Inuit and MĂŠtis communities experience mental health problems and consequent issues at dramatically higher rates than the rest of the Canadian population. This is connected to the legacy of colonialism, to rapid cultural change and to poor access to effective support services. Access to supportive services in particular is a challenge for many First Nations youth, particularly those living in rural and remote communities.xi

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Pathways and Barriers to mental health information

The pathways that youth choose to help them access support for their mental health vary greatly, as do the barriers that challenge youth seeking mental health information. There are a number of context-specific elements that should be kept in mind when looking at the various paths to support.

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Acess to Information Youth show varying preferences for accessing information, whether online, through telephone helplines, through peer engagement or with formal services. Many youth use informal social networks to obtain mental health information.xii

Stigma and Mental Health Stigma is one of the most significant obstacles to accessing mental health information. Stigma is complex - contextual factors play a role in the formation and reproduction of stigmatizing beliefs, in reproducing stigma, and in sharpening the blows dealt by stigma.

Peer-support can play an essential role in reducing feelings of distrust, self-stigma and isolation.xiii

Social Media and the Internet The internet and social media is a useful way of connecting youth to mental health information, particularly when concerns related to stigma are involved. There are, however, concerns about the credibility of information provided online; the available evidence suggests that young people use multiple methods for establishing the credibility of online information. Importantly, many youth feel that personalized stories provide credible sources of information.xivxv

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Case Study: Kids Help Phone Kids Help Phone (KHP) offers bilingual internet and phone-based counseling services for free to children and youth across Canada. The organization has recently expanded to offer internet-based live-chat counseling as well. Youth who access this service say they feel much more comfortable online, in part because it provides more privacy and an option to write rather than speak about difficult topics.

KHP services are disproportionately accessed by females, First Nations youth and sexual minorities, and conversations range from mental health, suicide, addiction, struggles with peer and family relationships, violence, abuse, and more.

The KHP phone service has been very effective – 87% of youth who contact KHP report a reduction in stress and 84% say they learned new methods for coping with challenges in their lives.

The difference in the rate of use between males and females, and the interest that KHP users have in remaining anonymous makes KHP an excellent illustration of the same trends we discovered in the literature on the information seeking behavior of young people.xvi

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Case Study: Mindyourmind Mindyourmind (MYM) is a mental health program that is organized around principles of youth engagement. MYM engages youth, adults and the professionals who serve them in the development of relevant, reliable mental health resources with the goal of helping youth to access the right information, in the right format, at the right time. The success of MYM’s programming demonstrates the benefits of using diverse strategies to engage youth in mental health-related programming.

MYM’s programming also challenges assumptions about the role that expert adult knowledge should play in youth information-seeking. While clinical information and the support of adults is important, youth who are engaged in the creation and delivery of programming bring unique assets, experiences, and insights which can help organizations share information in much more effective ways.xvii

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conclusion This knowledge synthesis report attempts to shed light on the information-seeking experiences of youth, and on the ways in which youth find, engage and understand mental health information This report highlights the diverse experiences of youth with mental health challenges. The academic literature shows that the factors influencing the mental health experiences of youth are very diverse.

For some youth, multiple factors such as gender, age, geographic location, ethnic background, and legal status interact to shape experiences of mental health and of help-seeking.

The complexity and diversity of mental health and information seeking experiences should be taken into account when developing mental health programming. This means that mental health information should be provided in various formats in order to take the different needs of youth into account.

There is convincing evidence of the importance of engaging youth in the creation of spaces and activities that support the development of mental health knowledge. This can include the creation of mental health resources, as well as engaging youth in developing strategies for disseminating mental health information. This will serve to increase youth mental health literacy and the capacity of youth to recognize disorders and risk factors and to seek the necessary and relevant support.

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policy checklist This checklist has been designed to help you implement the recommendations from the CYCC Network’s knowledge synthesis report Information-Seeking Behaviour of Young People & Mental Health. You can use it to guide your organizations programs and policies to help young people access the mental health information they need.

1)

Engaging youth in developing strategies for sharing mental health information can have benefits for all stakeholders. Youth engagement can create more effective methods of creating and sharing information, service professionals can benefit from youth input, and youth who are directly engaged can develop skills and capacity. The ways that youth use technology change rapidly and engaging youth in developing strategies to take this into account can be especially beneficial.

Our organization engages youth in developing and maintaining strategies for disseminating mental health information.

Our organization continuously engages youth in order to update our strategy for information dissemination as technology trends change.

Our understanding of how youth use technology is based upon what youth tell us about how they use technology.

2)

It is important to design and disseminate mental health information strategically. Experiences of mental health information seeking vary according to gender, socio-economic position, legal status and geographic location.

Our organization tailors the ways in which we provide mental health information to the experiences of the young people that we target.

The information we provide is available in a variety of formats/distributed using different methods in order to reach as many youth as possible.

3)

Stigma is one of the largest obstacles to connecting youth with mental health information. Stigma shapes how youth understand mental health and shapes if/how youth search for mental health information.

Our programming addresses the role that stigma plays in mental health information seeking.

Our programming is organized to respond to the impact of stigma on information seeking.

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4)

Mental health literacy is related to stigma and affects how/whether a young person will access mental health information. Mental health literacy is important for everyone, not just those who experience mental health difficulties.

Our programming enhances the mental health literacy of the youth it engages.

Our organization shares mental health information with the wider population.

Our approach to mental health literacy challenges stigmatizing behavior.

The information we provide helps youth to understand mental health and mental illness.

The information we provide helps youth to understand how mental health and illness are experienced by others.

5)

Social media can be a powerful tool for connecting young people with mental health information. Young people trust information shared by sources they find reputable, and many find learning from the stories of others to be productive. Social media can also present challenges: cyber-bullying and exposure to triggering materials can have negative mental health outcomes.

Our organization uses social media to engage with youth who are seeking mental health information.

The information our organization provides is credible in the eyes of the youth we provide it to.

Our programming helps develop the ability of youth to engage critically with information they receive from social media.

6)

Policies and procedures may need to change to reflect the experiences and learnings of every organization.

Our organization will reflect on and learn from our experiences as we implement the above recommendations for working with vulnerable young people. We will review our practices and procedures regularly and revise them when needed.

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References Davidson, M., Manion, I., Davidson, S., & Brandon, S. (2006). For youth by youth: innovative mental health promotion at Youth Net/ Réseau Ado. Vulnerable Children & Youth Studies, 1(3), 269–273.

i

Cunningham, C., Walker, J.,. Eastwood, D., Westra, H., Rimas, H., Chen, Y., Marcus, M., Swinson, R., Bracken, K., & The Mobilizing Minds Research Group , Journal of Health Communication (2013): Modeling Mental Health Information Preferences During the Early Adult Years: A Discrete Choice Conjoint Experiment, Journal of Health Communication: International Perspectives, 18(1), 1-28.

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xii Rasmussen-Pennington, D. M., Richardson, G., Garinger, C., & Contursi, M. L. (2013). “I Could Be on Facebook by Now”: Insights from Canadian Youth on Online Mental Health Information Resources. Canadian Journal of Information and Library Science, 37(3), 183–200. xiii Abdullah, T., Brown, T. (2011). Mental illness stigma and ethno cultural beliefs, values, and norms: An integrative review, Clinical Psychology Review, 1(31), 934–948.

Raghavendra, P., Newman, L., Grace, E., & Wood, D. (2013). “I could never do that before”: effectiveness of a tailored Internet support intervention to increase the social participation of youth with disabilities. Child: Care, Health and Development, 39(4), 552–561.

xiv

Marcus, M., Westra, H.A., & the Mobilizing Minds Research Group. (2012). Mental Health Literacy in Canadian Young Adults: Results of a National Survey. Canadian Journal of Community Mental Health, 31(1), 1-15.

iii

iv Viruell-Fuentes, E., Miranda, C., Andulraham, S. (2012). More than culture: Structural racism, intersectionality theory, and immigrant health. Social Science & Medicine 75(1), 2099 – 2106.

xv

Shoveller, J., Knight, R., Davis, W., Gilbet, M., Ogilvie, G. (2012).

Online Sexual Health Services: Examining Youth’s Perspectives.

Canadian Journal of Public Health, 103(1), 14-18.

v Ferguson, D., Woodward, Lianne. (2002). Mental Health, Educational and Social Role Outcomes of Adolescents with Depression.

Arch Gen Psychiatry, 1(59), 225-231.

xvi

Kids Help Phone. 2012. Caring for the future. Retrieved from: http://org.kidshelpphone.ca/media/83992/impactreport2012en.pdf Halsall, T., Garinger, C. & Forneris, T. (in press). mindyourmind: An overview and evaluation of a web-facilitated mental health program that applies empowerment strategies for youth. Consumer Health on the Internet.

xvii

Khanlou, N. (2009). Immigrant Mental Health Policy Brief. Strategic Initiatives and Innovations Directorate (SIID) of the Public Health Agency of Canada. Retrieved from: http://w.ocasi.org/downloads/Immigrant_Mental_Health_Policy_Brief_Final.pdf vi

vii Antiss, H., Ziaian, T. (2010). Mental health help-seeking and refugee adolescents: Qualitative findings from a mixed-methods investigation. Australian Psychologist, 45(1), 29–37. viii Alicea, S., Pardo, G., Conover, K., Gopalan, G., & Mckay, M. (2012). Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools. Clinical Social Work Journal, 40(2), 175–186. ix Cheung, A. (2007). Mental Health Service Use Among Adolescents and Young Adults With Major Depressive Disorder and Suicidality.

La Revue Canadienne de Psychiatrie, 54(2). x Georgiades K, Boyle MH, Fife KA. (2012). Emotional and behavioral problems among adolescent students: the role of immigrant, racial/ethnic congruence and belongingness in schools. Journal of Youth and Adolescence, 42(9):1473-92. xi Kirmayer, L. J., Brass, G. M., & Tait, C. L. (2000). The mental health of Aboriginal peoples: transformations of identity and community.

Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 45(7), 607–616.

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Find this report and more online This summary document is one of seven reports of its kind. Please go to our website to view these summaries or to find the full reports that give an in depth review of evidence and a full list of references on these topics.

This document should be referenced as follows: CYCC Network (2014). Information-Seeking Behaviour of Young People & Mental Health.

Retrieved from: http://cyccnetwork.org/info-seeking

Funding for the CYCC Network is provided by the Networks of Centres of Excellence

Get in touch 6420 Coburg Road PO Box 15000 Halifax, NS, B3H 2Z8 Canada

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phone: 902.494.4087 email: cycc@dal.ca www.cyccnetwork.org

Information-Seeking Behaviour of Young People & Mental Health