Title: Improving help-seeking in adolescence: the importance of mental health stigma and mental health literacy.
Funder: Economic and Social Research Council

Abstract: This fellowship will facilitate the consolidation of my PhD and prepare me for the next stage of my academic career by focussing on: (1) maximising the impact of my research and developing academic and policy networks (70%), (2) preparing grant applications (20%) and (3) continuing my professional development (10%). Key objectives are: -To prepare manuscripts for publication based on my PhD thesis. -To undertake further research with young people to gain an understanding of the impact of stigma on help-seeking in rural communities. -To co-produce a range of youth-friendly dissemination materials with young people. -To develop collaborations with academic, policy and practice partners in the field of youth mental health. -To undertake training in advanced qualitative methods and co-production to support my professional development. -To prepare and submit funding applications to support my future career. 1. Maximising the impact of my research. Developing publications from my PhD. I aim to publish three manuscripts based on my PhD research. These will follow on from a paper on the effects of mental health literacy (MHL) on adolescent help-seeking, which is currently in preparation and due for submission in April 2021. 1. "Psychometric properties of the adapted Peer Mental Health Stigmatisations Scale when measuring perceived stigma from specific groups", to be submitted to Early Intervention in Psychiatry, this will detail the adaptation and validation of a known stigma scale. 2. "The influence of mental health literacy and personal and perceived stigmas on help-seeking in adolescence: A structural equation model", to be submitted to Frontiers in Psychology, this will detail a theoretical framework and empirical model linking mental health literacy, stigma and help-seeking in adolescence. 3. "Capturing adolescents' conceptualisation of 'mental health problems'" to be submitted to Child and Adolescent Mental Health, and will reflect findings from piloting of the PhD research. Conducting new research Based on qualitative research conducted during the fellowship I plan to publish a further paper which will supplement quantitative findings of the PhD by gaining a deeper insight into adolescents' experiences of stigma, and by sampling adolescents from rural areas which was overlooked in the PhD. Co-production I have published a research brief aimed at interested policy makers and researchers. However, adolescents are central to my research and an objective of the fellowship is to adopt a co-production approach to design dissemination materials that are maximally engaging for young people. Via links with my mentor's networks, I will work with schools and youth advisory groups to discuss PhD findings and co-develop a range of creative outputs. Academic engagement I aim to present at the European Association for Research on Adolescence conference, and at the International Association for Youth Mental Health conference. Further dissemination includes seminar presentations at the Institute of Health & Wellbeing at the University of Glasgow, and via Transdisciplinary Research for the Improvement of Youth Mental Public Health (TRIUMPH) video series. Stakeholder engagement I will hold two stakeholder workshops with the aim of engaging with those with the ability to inform policy. These will provide a forum to share research findings, facilitate translation into policy and practice, and ensure the research is relevant to youth mental health priorities. 2. Preparing funding applications I will develop funding proposals to be submitted to the ESRC New Investigator Grant and the Leverhulme Early Career Fellowship. 3. Continuing professional development I will engage in diverse training to achieve fellowship aims and strengthen my long-term career prospects. Training/development will include: 1) courses in qualitative analysis, 2) workshops on co-production and 3) gaining additional teaching and supervision

Lay abstract: Adolescence is a particularly vulnerable period for the development of mental health problems, with around half of all mental health problems emerging before the age of 14 (Kessler et al., 2005). Despite adolescent mental health being a public health priority there is a notable lack of help-seeking among young people. Around two thirds of adolescents do not access formal support despite showing clinical symptoms of a mental health problem (Merikangas et al., 2011). One explanation for this lack of help-seeking is stigma which is consistently noted as one of the most significant barriers to help-seeking among adolescents (Gulliver et al., 2010). Given the strong link between stigma and a lack of help-seeking, the reduction of mental health stigma among young people has been identified as a priority area for research and policy development (WHO, 2013). Adolescents who do not seek help are seven times more likely to see a worsening of mental health problems (Neufeld et al., 2017). There is therefore a clear need to improve help-seeking, and to do so, we need to better understand the impacts of stigma on adolescents' help-seeking behaviour. Results from my PhD research suggest that perceived stigma from friends and parents is associated with decreased help-seeking among adolescents aged 12-17. Therefore, it may be beneficial to consider whether information can be provided to both parents and adolescents together, to reduce perceived stigma from parents. Additionally, findings suggest that peer-led initiatives may be helpful in reducing perceived stigma from friends. However, adolescents' views have often been overlooked in the development of anti-stigma strategies, thus reducing their effectiveness (Gronholm et al., 2018). Adopting a co-production approach (i.e. where young people and researchers share power and responsibility for research) would enable young people to contribute to and shape the decisions that affect their lives. During the fellowship, a co-production approach will be adopted with young people in partner schools and via links with See Me (Scotland's national anti-stigma programme). This will build on statistical findings of my PhD by enabling young people to consider the key research findings and identify potential family and peer-based anti-stigma strategies. By working together, young people will be enabled to help shape research output based on what they believe are the key messages resulting from the PhD, and what the best methods of disseminating to young people and other key stakeholders would be. I will expand on my PhD with additional qualitative research in the form of focus groups with young people. I plan to work with schools in the rural areas, where stigma is known to be a greater barrier to help-seeking. This would further enhance our understanding of the impact of stigma on rural young people's help-seeking behaviour by bringing their own perspectives into the research process to inform and enhance our understanding of issues as they affect their lives. Research questions include: -To what extent do young people living in rural areas perceive stigma towards mental health problems to be a significant issue within their communities? -Does stigma impact on help-seeking intentions of adolescents living in rural communities? -What do adolescent in rural areas perceive as being facilitators of successful help-seeking? Findings will be used to inform my future research, and to inform work with young people in partner organisations such as See Me. Findings will make important contributions to knowledge by highlighting adolescent voices and experiences of stigma, as well as signposting solutions to stigma's negative consequences, as identified by adolescents themselves. Improving young people's mental health, as well as rural mental health, is a key part of the Scottish Government's Mental Health Strategy, 2017-2027, therefore the research will have important implications for policy development.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH