Table 2 Barriers to and enablers of identification, treatment and on-going engagement

Identification of mental health and/or substance use problem in a young person

• Outreach work

• Prioritisation of crisis cases at the expense of early intervention

• Activity-based engagement

• Confidentiality and consent issues, particularly around parental involvement for under 18s

• Mental health/drug awareness promotion

• Concerns around formally treating a young person for a mental health or substance use problem

• Specific training in youth mental health/substance use problems

• Experience in dealing with young people with mental health/substance use problems

• Using formal assessment tools

• Building a trusting relationship with the young person

Treatment of young person for mental health and/or substance use problem

• A holistic/collaborative approach, including high quality communication, between healthcare agencies, e.g. primary care, secondary care and community-based agencies

• Limited funding resources result in a lack of age-appropriate services

• Training for primary healthcare professionals, in particular, GPs in addressing youth mental health and substance use problems effectively.

• Crisis intervention taking precedence over early intervention

On-going engagement

• Intrinsic motivation of the young person

• If young person is attending because of external pressure

• Continued/repeated opportunities for engagement

• Unwillingness of some young people to attend counselling

• Personal achievement goals

• Transition from child to adult services

• Having the structure of school or work to continue with during treatment or return to after treatment