Advances in Mental Health

Promotion, Prevention and Early Intervention

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Parents’ experience of seeking help for children

with mental health problems

Erica Boulter & Debra Rickwood

To cite this article: Erica Boulter & Debra Rickwood (2013) Parents’ experience of seeking help
for children with mental health problems, Advances in Mental Health, 11:2, 131-142, DOI: 10.5172/
jamh.2013.11.2.131

To link to this article: https://doi.org/10.5172/jamh.2013.11.2.131

Published online: 17 Dec 2014.

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 Copyright © eContent Management Pty Ltd. Advances in Mental Health (2013) 11(2): 131–142.

Parents’ experience of seeking help for children

with mental health problems

ERICA BOULTER AND DEBRA RICKWOOD

University of Canberra, Canberra, ACT, Australia
Abstract: Parents play an important role in access to mental health care for children and adolescents. They are often
the first to seek professional help, yet their help-seeking experiences are not well documented. This study investigates parents’
help-seeking for children and adolescents with emotional and behavioural problems. A thematic analysis of interviews with
15 parents showed three main themes describing the help-seeking experience: Pathways to mental health care; intra- and
inter-personal influences; and the impact of service use experiences. Overall, parents needed to persist through an often
arduous process to obtain appropriate mental health care for their children. They often found it difficult to understand
the process to obtain help and encountered numerous obstacles. Greater focus on supporting parents in their critical role of
identifying mental health problems in their children and gaining early access to appropriate mental health care is needed.

Keywords: parental help-seeking, mental health problems, children, adolescents, help-seeking

C hildren and adolescents experience high rates

of mental health problems (Rothi & Leavey,
2006; Shanley, Reid, & Evans, 2008). The first
onset of mental illness often occurs in childhood
or adolescence, with half of all mental disorders
emerging before 14 years of age (Kessler et al.,
2005). In any year, around 20% of children and
adolescents will experience a mental health prob-
lem, and almost 10% will meet the criteria for a
diagnosis of a mental disorder (Rothi & Leavey,
2006; Shanley et al., 2008).
Childhood and adolescence are critical periods
in human development. The presence of mental
health problems early in life can have a negative
impact on almost every part of an individual’s
life. For example, children and adolescents with
mental health problems are at greater risk of aca-
demic failure, inter-personal conflict, alcohol and
drug problems, parent–child conflict, physical
and sexual assault, aggressive behaviour, suicide
and involvement with the justice system (Patel,
Flisher, Hetrick, & McGorry, 2007; Singer,
2009). Consequently, it is vital to identify and
effectively treat mental health problems in chil-
dren and adolescents as early as possible to pre-
vent the development of more severe forms of
mental illness and social and vocational problems.
Most children and adolescents with a need for
mental health care do not receive help for their
problems; only about 5% will receive special-
ist mental health treatment for their problems
(Shanley et al., 2008). There is a significant
‘service gap’ between the need for mental health
services and their use (Raviv, Raviv, Edelstein-
Dolev, & Silberstein, 2003). Many studies have
investigated the factors that influence access to
mental health services, and a range of barriers
and facilitators have been identified (Gulliver,
Griffiths, & Christensen, 2010; Singer, 2009).
One critical factor that has not been thoroughly
researched, however, is the influence of parental
help-seeking behaviour.
IMPORTANCE OF PARENTAL HELP-SEEKING
When children and adolescents experience
mental health problems, they first turn to family
and friends, if they seek help at all (Rickwood,
Deane, Wilson, & Ciarrochi, 2005). Rarely do
they directly seek professional health care, and
are generally reluctant to seek help by themselves
(Rothi & Leavey, 2006). Parents play a particu-
larly important role in their children’s mental
health care – they are likely to be the first to notice
the early signs of mental health problems and are
strongly motivated to get their children the help
they need.
Children and adolescents are necessarily
dependent on adults to take responsibility for
their mental health care needs, as they gener-
ally do not have the autonomy or the means
to seek help for themselves. The extent of
parental involvement depends on the age of the

Volume 11, Issue 2, February 2013 ADVANCES IN MENTAL HEALTH 131

 Erica Boulter and Debra Rickwood
child – the younger the child, the less likely they
are to seek help without parental involvement
(Farmer, Burns, Angold, & Costello, 1997).
Although children can access some types of ser-
vices on their own, particularly school-based
services, they must rely on the intervention of
parents to access other mental health services,
particularly private psychologists or psychia-
trists. Adolescents are better able to actively seek
out help on their own compared with children,
but still rely heavily on the intervention of adults
(Sayal, 2006). However, despite the essential
role that parents play in their children’s mental
health care, the few studies there are in this area
show that parents are often themselves reluctant
to seek out professional help (Pavuluri, Luk, &
McGee, 1996).
THE HELP-SEEKING PROCESS
Help-seeking is a process, rather than an event,
and occurs over time and does not necessarily
have a linear progression (Rickwood et al.,
2005). It is a process that is not well understood
in general, and particularly poorly explored in
relation to parents seeking mental health care
for their children. The few quantitative studies
in the area suggest that there is no uniform
way in which parents seek help for their chil-
dren (Logan & King, 2001), and parents access
both informal and formal sources of help, some-
times simultaneously (Cohen & Hesselbart,
1992; Shanley et al., 2008; Srebnik, Cauce, &
Baydar, 1996). It is unclear whether parents
go through the identified help-seeking stages
of initially recognising that there is a problem,
making a decision to seek help of one kind or
another, and actively seeking out that source of
help (Broadhurst, 2003). Network-based models
(Costello, Pescosolido, Angold, & Burns, 1998)
and the gateway provider model (Stiffman,
Pescosolido, & Cabassa, 2004), focus on mul-
tiple entrances into the mental health system,
rather than on a series of discrete stages (Singer,
2009). A study by Shanley et al. (2008) found
that parents access specialist mental health ser-
vices through multiple pathways and, consistent
with a gateway provider model, often through
teachers and the family doctor.
132 ADVANCES IN MENTAL HEALTH Volume 11, Issue 2, February 2013
FACTORS AFFECTING PARENTAL HELP-SEEKING
A number of barriers to parents seeking profes-
sional mental health care for their children have
been identified. Parents initially need to recognise
a problem before they are likely to actively seek
help. Research reveals, however, that most parents
of children with a mental health problem do not
recognise that their child has a problem (Sayal,
Taylor, & Beechman, 2003; Teagle, 2002). The
rates at which parents perceive or recognise a prob-
lem in their child varies across studies but tends to
be low, reported as 13% by Teagle (2002), 16% in
Zahner, Pawelkiewicz, DeFrancesco, and Adnopoz
(1992) and 20% in Verhulst and van der Ende
(1997). Even when symptoms of behavioural
problems are quite pronounced, the majority of
parents do not perceive a need for professional
help: 66% of parents of children who met the
diagnostic criteria for attention deficit hyperactiv-
ity disorder (ADHD) did not perceive a service
need (Bussing, Zima, Gary, & Garvan, 2003).
Not surprisingly, parents are more likely to
recognise a problem and seek help if their child
experiences severe, persistent or comorbid mental
health problems (Zwaanswijk, Verhaak, Bensing,
van der Ende, & Verhulst, 2003), particularly
when parents start to experience parental burden or
strain as a result of the severity of the child’s symp-
toms (Alegria et al., 2004; Brannan, Heflinger, &
Foster, 2003). Parents are more likely to seek help
if their child’s problem has an impact on their
own well-being and sense of competency (Farmer
& Burns, 1997). Externalising symptoms tend to
be more obvious and disruptive than internalising
symptoms, and parents have been shown to seek
help more often for adolescents with conduct
disorder and oppositional defiance disorder than
other types of disorders (Cohen, Kasen, Brook,
& Streuning, 1991). Similarly, Teagle (2002)
found that children with ADHD had the greatest
impact on families. Children with depressive or
anxiety disorders tend to be less burdensome than
children with disruptive behaviour disorders and
are, therefore, less likely to prompt parental help-
seeking (Angold et al., 1998).
Type of symptoms and parental burden can
explain the reason some studies show that parents
are more likely to recognise a problem and seek
© eContent Management Pty Ltd

help for boys than girls. Raviv et al. (2003) found
that mothers were more likely to express intentions
to seek professional help for boys than for girls. It
is suggested that boys can exhibit more disrup-
tive behaviour in childhood, which has a greater
impact on parents who are then more likely to
seek help (Zwaanswijk et al., 2003). Bussing et al.
(2003) found that while parents were equally able
to recognise symptoms of ADHD in both boys
and girls, they sought help more often for boys
than they did for girls.
Parental beliefs about the cause of their
child’s mental health problems also appear to
affect mental health service use. Parents are
more likely to seek help if they attribute their
child’s problem to stable, internal dispositional
causes (Srebnik et al., 1996), or if they perceive
their child’s behaviour as ‘deviant’ (Morrissey-
Kane & Prinz, 1999). Parents are unlikely to
seek help if they believe that their child’s prob-
lem will improve by itself (Pavuluri et al., 1996),
if they perceive their child’s problem as ‘nor-
mal’ or have an alternative explanatory model
for the symptoms (Bussing et al., 2003). This
can be particularly problematic during adoles-
cence, when parents have difficulty distinguish-
ing between ‘normal’ adolescent moodiness and
mental health problems.
Parental psychopathology appears to increase
the chance that parents will recognise a mental
health problem in their child, although recogni-
tion does not always translate into seeking help,
which depends on the parent’s own help-seeking
propensity (Zwaanswijk et al., 2003). The
mother’s own help-seeking behaviour has been
shown to have a strong impact on young peo-
ple’s service use (Cardol et al., 2005). Similarly,
Wu et al. (2001), found that mothers who had
sought professional help for their own depression
were more likely to think that their depressed
child might need help than mothers who did not
receive help themselves.
Belief in the importance of having the strength
to deal with problems oneself is a general barrier
to seeking help (Rickwood, Deane, & Wilson,
2007), and this also applies to parental help-
seeking. High levels of parental self-efficacy have
been associated with not seeking help for their
© eContent Management Pty Ltd Volume 11, Issue 2, February 2013
Parents’ experience of seeking help for children
child’s problems (Singer, 2009), as well as parental
beliefs that they should be able to deal with prob-
lems on their own (Pavuluri et al., 1996). Mothers
were shown to be more likely to refer a friend’s
child for professional help than their own, which
was attributed to fears of appearing incompetent
to deal with their own child’s problem (Raviv
et al., 2003).
Service characteristics affect mental health ser-
vice usage by parents, including the availability
and cost of services, and the attitude of mental
health professionals (Farmer & Burns, 1997;
Logan & King, 2001; Morrissey-Kane & Prinz,
1999; Srebnik et al., 1996; Teagle, 2002; Verhulst
& van der Ende, 1997; Zwaanswijk et al., 2003).
For mental health services in particular, parents’
uncertainty about the services available for their
children made it difficult for them to seek help
(Bussing et al., 2003). Mental health services are
more available in urban areas and there is sig-
nificantly less service use by children and ado-
lescents in rural and semi-rural areas (Cohen &
Hesselbart, 1992).
THE CURRENT STUDY
The aim of the current study was to gain an insight
into parents’ experiences of seeking help for their
children with mental health problems. While the
literature has investigated a range of discrete fac-
tors that affect the likelihood of parents seeking
mental health care for their children, an explora-
tion of the whole help-seeking process from the
parental perspective is lacking. Parents are often
the first ones to seek help for their children and
play an important role in service access for chil-
dren and adolescents. Understanding ways to sup-
port parents to more effectively access appropriate
mental health care for their children is essential
for effective early intervention.
METHOD
Participants
The participants were 15 parents (14 moth-
ers, 1 father) between the ages of 25–61 years
(M = 41.0, SD = 8.8). Parents with children
up to the ages of 18 years were eligible to par-
ticipate in the study if they had sought psycho-
logical help from a mental health professional
ADVANCES IN MENTAL HEALTH 133
 Erica Boulter and Debra Rickwood

(i.e., school counsellor, doctor, paediatrician, these options. Recruitment was undertaken until
psychologist) at any point in time for their maximal variation and saturation of themes was
child’s mental health problem(s). There were achieved.
no exclusion criteria. Nearly all of the partici- A semi-structured interview was used to elicit
pants were mothers with a good education and the parents’ experiences using questions that were
from a high socio-economic status. Most partici- broad in scope to attain a comprehensive account
pants were married and half of them had a self- (Rubin & Rubin, 1995). The focus of the inter-
reported mental health problem (see Table 1, for view questions was retrospective as parents had
participant characteristics). already sought help for their children. Questions
were framed around parents’ perception of the
Procedure nature of their child’s mental health problems, the
Participants were volunteers who were recruited ways the parent and family coped, the types of
via poster advertisements through local mental help that parents sought and the ways they went
health services and email to the organisers of about seeking help, and the factors that influ-
parent support groups and a community mental enced decisions to seek help.
health education group. All participants provided A trial interview was conducted with one par-
fully informed consent and ethics approval was ticipant to check the questions and process. All the
obtained from the university’s Human Research interviews were conducted by the same interviewer
Ethics Committee. Participants could with- and were held at a room in the university or the
draw from the study at any time, or choose not participant’s home. The interviews took approxi-
to answer any questions; none took up either of mately 45 minutes (range 30 minutes to 1 hour).
Interviews were recorded with a voice-recorder
and transcribed verbatim. Participants were given
TABLE 1: PARTICIPANT CHARACTERISTICS an opportunity to review the accuracy of their
Characteristics N interviews (see Fossey, Harvey, McDermott, &
Davidson, 2002). Only six participants provided
Gender
comments, which were all in the form of gram-
Female 14
matical corrections to their interview transcripts.
Male 1
Education
High school certificate 1
Analysis
TAFE/CIT certificate 2
Thematic analysis was chosen as the method to
University degree 12
analyse the data, following the guidelines proposed
Household income by Braun and Clarke (2006) to identify, analyse
<$50,000 1 and report patterns (themes) within the data and
$50,000–$100,000 7 locate themes based upon the number of times they
>$100,000 7 occur in the transcripts. Data were coded using
Marital status (current) NVivo version 8. A theme could be identified at a
Single 5 semantic or explicit level (analysis identifies themes
Married 9 within the explicit or surface meanings of the data)
De facto 1 or at a latent or interpretative level (analysis identi-
Mental health status fies or examines the underlying ideas, assumptions
(current) and conceptualisations that shape the semantic
Anxiety 5 content of data). An essentialist or realist method
Depression 2 perspective was applied, reporting the experiences,
Attention deficit 1 meanings and the reality of participants (Braun
hyperactivity disorder & Clarke, 2006). We used a reiterative compara-
No mental health 7 tive procedure to develop the themes (Miles &
problems
Huberman, 1994). The approach was inductive

134 ADVANCES IN MENTAL HEALTH Volume 11, Issue 2, February 2013 © eContent Management Pty Ltd
 Parents’ experience of seeking help for children

and data-driven, focussed on

identifying salient themes repeated
Parental
across and within transcripts Help-seeking
(Braun & Clarke, 2006).
Two tests of coding reliability
were conducted. Five transcripts
were re-coded by the same coder Pathways to
Mental
Intra and
Inter-
following completion of initial Health Care personal
Influences
coding of all transcripts to assess
consistency over time (Richards, Impact of
Service Use
2005). For a stronger indicator Parent Teacher
Experiences
Mediated Parental Others
of reliability, inter-rater reliability Mediated
Concerns Concerns
(Joffe & Yardley, 2004) was tested
by a second independent coder
coding six clean transcripts. Coding Helpful - Helpful - Unhelpful - Unhelpful -
Practical Emotional Practical Emotional
assignment was compared between Support Support Support Support
(fit) (feel) (fit) (feel)
the two independent coders using
Cohen’s Kappa coefficient, which
corrects for the number of agree- FIGURE 1: CONCEPT MAP: PARENTAL HELP-SEEKING BEHAVIOUR
ments that would occur by chance
between coders. The present Kappa coefficient was with primarily emotional problems entered the
0.76, above the level of 0.75 generally considered mental health system through both pathways,
excellent (Robson, 2002). The few discrepancies while participants who had children with primarily
were resolved through an independent researcher, behavioural problems entered through the parent
providing investigator triangulation. initiated pathway only. This seemed to be because
To report the representativeness of responses, behavioural problems were evident to parents well
four frequency levels are applied. A theme that before their children began school.
applies to all or all but one of the cases is general; a All participants reported contact with multiple
typical theme applies to more than half of the cases; services, including multiple mental health services.
a variant theme includes more than two but less Formal sources of help included psychiatrists, pae-
than half of all cases; and a theme with only two diatricians, general medical practitioners (GPs),
cases is rare (Hill, Thompson, & Williams, 1997). psychologists, teachers and counsellors. Twelve
The results from only one case are not reported. participants reported that their contact with ser-
vices was sequential rather than concurrent. Nine
RESULTS participants returned to one or more of the same
The thematic analysis revealed three main themes: services, showing a recursive pattern of contact
pathways to mental health care; intra and inter- with mental health services. This meant that it
personal influences on help-seeking choices; and took longer for participants to receive adequate
the impact of service use experiences on further help for their children. Nearly equal numbers
help-seeking. Figure 1 summarises the three main accessed both paediatricians (seven) and special-
themes and their sub-themes. ist mental health services (six). Five participants
returned to their family doctor because they found
Pathways the specialist service provider unsatisfactory or the
The participants described two distinct pathways service to be inadequate or ineffective. Subsequent
for the initiation of mental health services for chil- referrals by GPs were frequently to specialist men-
dren: the parent initiated pathway, which was typi- tal health services, rather than paediatricians.
cal (N = 10); and teacher-initiated pathway, which Persistence was essential to negotiating multiple
was variant (N = 5). Participants who had children contacts with multiple services. An example of a

© eContent Management Pty Ltd Volume 11, Issue 2, February 2013 ADVANCES IN MENTAL HEALTH 135
 Erica Boulter and Debra Rickwood
parent initiated pathway involved initial contact
with a nurse, followed by the family doctor, a social
worker, paediatrician, family doctor, and finally a
psychologist. A teacher-initiated pathway com-
prised the teacher, the school psychologist, the fam-
ily doctor, paediatrician, back to the family doctor,
back to the school psychologist, and finally to a
youth mental health service. A common service was
the family doctor or GP; this is a necessary compo-
nent in the Australian healthcare system to access
specialist health services, including paediatricians
and psychiatrists, and to gain government rebates
for psychological services.
Eleven participants reported that they had first
initiated help-seeking on their own, while four
participants reported that they had sought help
with their partner. None of the participants (who
were almost all mothers) reported that their part-
ner (husband) had initiated help by himself.
Twelve participants had sought informal help
at some stage of the process, including family,
friends, parent support groups, and self-help
resources such as the internet and books. Of
these, half said they had sought informal help
before they sought formal help, and the other half
sought informal help after they had received a
diagnosis for their child.
Intra and inter-personal influences
The second theme was related to the intra and
inter-personal influences that affected parents’
decisions to seek help. Parents’ own intrapersonal
concerns had the most influence on decisions to
seek help for 10 participants, while five partici-
pants emphasised the influence of other people’s
concerns. For intrapersonal parent-generated con-
cerns there were three sub-themes: concern about
the impact of their child’s mental health problem
on the family; recognition of family vulnerability;
and recognition that their child was ‘different’.
Concern about the impact of their child’s men-
tal health problems on the family was a typical
factor affecting participants’ decisions to seek help.
Emotional impact on the family was important and
participants talked about a desire to alleviate their
frustration, guilt, stress, anxiety or fear. All par-
ticipants found it difficult to cope with their child’s
mental health problems, and 11 explicitly said not
136 ADVANCES IN MENTAL HEALTH Volume 11, Issue 2, February 2013
being able to manage their child’s problems by
themselves prompted seeking help. Participants also
talked about an escalation in their child’s behaviour
and the subsequent impact of this behaviour on their
family as a motivator to seeking help, ‘It was a lack
of coping as parents and … the family being upset
all the time’. All participants were conscious of the
need to obtain formal help for their child because of
recognition that their child was different, that their
behaviour was ‘not normal’, ‘He was really different
than the other children and his behaviour wasn’t nor-
mal at all. It was too bizarre’. Recognition of family
vulnerability had an influence on participants’ deci-
sions to seek help. Eleven participants were aware of
similar mental health problems in their family, with
statements such as, ‘I could relate to it. There was
no way that I wanted her to go through the things I
went through when I was younger’.
Inter-personal influences revealed the impact
of other people’s concerns on the decision to seek
help – expression of concern by the child her/
himself and suggestions of family, friends or the
teacher. The child’s own concerns were a variant
influence and children’s own expression of distress
triggered parental help-seeking, ‘She was really
upset about her own problems’. The suggestion
by family/friends to seek help was also reported
as prompting service utilisation. For example,
one participant said that she would have sought
help herself eventually, but the suggestions by her
family and teacher gave her a ‘push’ to do it sooner.
Another commented, ‘It was partly because his
grandparents and his teacher said things to us’.
However, sometimes informal networks were a
barrier, particularly around the families’ denial of
any mental health problems.
Impact of service use experiences
The third theme was the ongoing impact of par-
ents’ experiences with mental health services.
Nearly all participants had both positive and neg-
ative experiences and both types were influential.
Relevant experiences comprised practical support
(the fit between the service and the participant)
and emotional support (the feel between the
service and the participant).
Practical support that provided a good fit was
having knowledgeable service providers that gave
© eContent Management Pty Ltd

useful strategies and advice to help the parent
manage their child’s behaviour and mood, ‘That
was really helpful to teach her to think things
through … it’s certainly given her some strate-
gies and she really enjoyed it’. The most common
unhelpful practical experiences were being provided
insufficient support and information, which were
reported by 11 participants. Either lack of advice, or
unhelpful advice, was common, ‘And, then we went
to another paediatrician, who said that we should
be able to manage without medication, but didn’t
give us anything that was terribly helpful’.
Thirteen participants talked about the impor-
tance of a diagnosis as a helpful practical experience,
and four participants reported that it had been an
unhelpful experience when they did not receive a
diagnosis. Although some participants had concerns
about stigma and labels, for most it was important
for them to receive a formal diagnosis for their child,
‘I wanted to get an explanation and the psycholo-
gist diagnosed him … it was helpful because I guess
I needed confirmation about my son’s behaviour’.
Participants talked about their frustration about
being given the wrong diagnosis and about the
delays by mental health services to diagnose their
child with a mental illness. Some participants said
that mental health workers did not take the time to
properly explain their child’s diagnosis to them, ‘So,
we sort of felt once the diagnosis was made, it was
kind of, “Well, off you go, you’ve got your diagno-
sis”, off you go now and try to deal with it’.
There were 12 participants who mentioned that
the poor availability of services was unhelpful, and
some services were reported as inflexible, inaccessi-
ble and unresponsive to their needs, ‘We finally got
a referral, which took a long time and then when
we actually went in there, they actually said that she
didn’t have a serious enough problem to warrant
their help, and unfortunately it sort of went from
there’. Six participants reported on the helpfulness
of services that were easily accessible and flexible,
‘[the service] was helpful because one of their com-
ments was, if she won’t come to see us, she obvi-
ously needs help and we’ll come out to see her’.
Other important experiences related to the
emotional support received. All participants men-
tioned the way that the service experiences made
them feel. Three participants reported that it had
© eContent Management Pty Ltd Volume 11, Issue 2, February 2013
Parents’ experience of seeking help for children
been helpful to have their child’s problem validated
as real. Participants talked about feeling guilty and
responsible for their child’s problem and of the
enormous relief they experienced when mental
health services diagnosed their child as having a
problem, ‘So, yes, just that validation, I guess, was
probably the first most important thing’.
Many participants reported that it had been a
helpful experience when mental health workers did
not judge them, ‘You’re made to feel welcome, you
know, there’s no judgemental atmosphere in the
way that staff treat you’. Conversely, the experience
of four participants was unhelpful when workers
had been judgemental, dismissive of their con-
cerns, and particularly when mental health workers
criticised their skills as a parent, ‘It’s also difficult to
be told as a parent to go and get more skills when
you’ve done all the courses that you can find and
you’ve read all the books you think are reasonable,
and you don’t know the skills that you’re missing’.
Trustworthy workers, who developed a good
rapport with the child, had been a helpful experi-
ence for four participants. One participant said that
the mental health worker created a ‘safe place’ for
their child to be able to share his feelings with his
psychologist. Another commented, ‘My daughter
managed to actually form a good relationship with
her and has a lot of trust in her, which is some-
thing she hasn’t been able to do in the past’. Two
participants noted that the poor rapport between
the mental health worker and their child had been
an unhelpful experience, ‘I think the psychologist
started at the wrong end with her problems. She
needed to speak to her, talk to her more before she
started the relaxation techniques, I don’t know. My
daughter didn’t feel comfortable with her’.
Being included in their child’s treatment was an
important helpful experience for five participants,
‘They’ve listened to her, I think, and then if I’ve
got questions, they’ll answer my questions as well.
You know, I have the option of either going in
with her or not’. The support from workers also
helped participants to cope and provided them
with some relief from the burden of responsibility.
Another five participants noted the importance of
a sense of empowerment and hope, ‘I thought that
was extremely helpful because it sort of empow-
ered her to take charge of her problem’.
ADVANCES IN MENTAL HEALTH 137
 Erica Boulter and Debra Rickwood
DISCUSSION
We sought to gain an insight into parental help-
seeking behaviour in relation to their children’s
mental health problems, which is an area that
has not been well investigated. Parents play an
important role in their children’s mental health
as they are often the first ones to seek help for
their children. Gaining an in-depth knowledge
through qualitative methods of parents’ experi-
ences, addresses an important gap in the mental
health help-seeking and service use literature.
We found that mothers, rather than fathers, were
the primary help-seekers for their children, which
concurs with the results of other studies (Czuchta
& McCay, 2001). Only one father was recruited
for our study. There were no differences in help-
seeking between the mothers and the sole father in
our study. However, it should be understood that
references to ‘parents’ in the remainder of the dis-
cussion are references to participants (almost exclu-
sively mothers) interviewed for our study.
Parents often had to engage in an arduous pro-
cess in order to obtain help for their children. We
also found that parents had to be extremely persis-
tent to find the right mental health care for their
children. This meant that parents often had contact
with multiple health services, which was consistent
with other studies (Cohen & Hesselbart, 1992). We
found that parents had to persist for long periods
of time, often in the face of resistance from other
people. For example, it was common for parents
to encounter barriers from other family members,
such as spouses, in seeking help for their children.
Parents reported that family members were judge-
mental and critical of them and dismissive of their
concerns about their children. This made it espe-
cially difficult for parents to find help for their chil-
dren, as they often did not have the support of their
family and had to seek help on their own.
We found that parents also encountered
barriers from services to seeking help. Although
most parents had both good and bad experiences
with services, it was apparent that both the practi-
cal support (or the ‘fit’ between the service and
the parents) and the emotional support (or the
‘feel’ between the service and the parents) from
services was important to parents. Studies have
shown that parents’ experiences with services can
138 ADVANCES IN MENTAL HEALTH Volume 11, Issue 2, February 2013
either facilitate or hinder their efforts to obtain
help for their child’s mental health problems
(Anderson et al., 2006; Czuchta & McCay, 2001;
Sayal et al., 2010), which was also found in our
study. Some of the practical barriers included ser-
vices that were unavailable or inaccessible, while
emotional barriers included feeling hurt when
workers were critical of their skills as a parent.
Parents were often the first ones to recognise
a problem in their child. The emotional impact
of a child’s behaviour on the family and on their
ability to cope was one of the strongest influences
on parents’ decisions to seek help. The impact, or
burden, on families due to children’s mental health
problems has been shown to be one of the most
significant factors in parents’ decisions to seek help
for their children (Angold et al., 1998; Farmer &
Burns, 1997). In fact, the extent of burden that
parents experience is likely to influence their
awareness of the problem (Logan & King, 2001).
Parents were often aware of similar mental
health problems in themselves or their family,
which made them more likely to seek help for
their children. They could also relate to their
child’s mental health problems and did not want
their child to go through similar experiences. In
Logan and King’s (2001) study, a family history
of mental health problems has been shown to
influence parents’ ability to identify similar prob-
lems in their children. In their study, they found
that parents with a family history of mental ill-
ness may be more familiar with the symptoms of
mental health problems and may be better able to
recognise the signs of a problem in their children.
We found that parents were more likely than
teachers to initiate contact with mental health ser-
vices, and that the parent-mediated pathway was
the primary pathway to help. The other pathway
was the teacher-mediated pathway. The point of
entry for most children into the mental health sys-
tem was through the general medical sector (i.e.,
GPs), which is consistent with a gateway provider
model. However, entry into the mental health sys-
tem was dependent on the nature of the child’s
problem. Children with emotional problems
entered the mental health system through the par-
ent- and teacher-mediated pathways, while children
with emotional and behavioural problems or only
© eContent Management Pty Ltd

behavioural problems, entered through the parent-
mediated pathway. A possible explanation for this is
that behavioural problems manifest themselves more
clearly than emotional problems, which increases
the chance that parents will become aware that their
children have these problems and recognise that they
are in need of formal help (Logan & King, 2001).
There was considerable variability across fami-
lies in terms of the sequence of contact with ser-
vices. Most contact with services was sequential,
rather than concurrent, which was consistent with
Farmer, Burns, Philips, Angold, and Costello’s
(2003) study. There was also a recursive pattern
of contact with mental health services in which
parents returned to one or more of the same ser-
vices, showing that parents were persistent in their
efforts to obtain help for their children.
All parents sought formal, but not informal
help, for their children’s mental health problems.
Parents often sought informal help after they had
received a diagnosis for their child. However, only
a few sought informal help before they had sought
formal help. This is contrary to most studies
which suggest that parents are more likely to seek
informal help before they seek formal help (Cauce
& Srebnik, 1990). However, one other study on
maternal help-seeking behaviour also found that
mothers reported few contacts with informal sup-
port before they sought formal help (Singer, 2009).
One possible explanation that may account for
this difference is that, as the current study did not
directly question or probe parents about the different
types of help they had sought, the parents may not
have considered that it was necessary to mention any
informal help that they had sought for their children
or considered that it even constituted a form of help.
Another possible explanation may be that the high
level of education, affluence and awareness of men-
tal health problems amongst parents in the current
study may have made it more likely that they would
have initially sought formal help rather than informal
help. In a study on parental help-seeking behaviour,
Czuchta and McCay (2001) found that there was a
relationship between uncertainty and level of educa-
tion: as there was an increase in the level of paren-
tal education, there was a decrease in the degree of
uncertainty. The researchers suggest that an increase
in parental education is associated with an increase
© eContent Management Pty Ltd Volume 11, Issue 2, February 2013
Parents’ experience of seeking help for children
in awareness about mental illness and knowledge
of appropriate treatment resources. Furthermore, a
number of parents in the current study had a self-
reported mental health problem, which suggests they
may have had experiences with mental health services
for the treatment of their own mental health prob-
lems. This may have then made parents more knowl-
edgeable and more likely to seek formal help, rather
than informal help, for their own children.
Limitations and implications for
future research
Our study is limited mostly by the considerable
range of mental health problems experienced by
children and adolescents and the consequently wide
range of potential mental health service experiences.
This was confirmed by the wide variety of behav-
ioural help-seeking pathways reported by the par-
ents who participated in our research. Nevertheless,
common patterns were evident, despite diversity of
behaviour. This is the value of qualitative research:
regardless of different quantitative experiences
(i.e., behavioural) the perceptual experiences were
often shared. A more pertinent limitation was
homogeneity of the participant group, which com-
prised mostly mothers from a higher socio-economic
status demographic in one location in Australia.
Experience of health service use is clearly related to
socio-demographic characteristics and the different
health system contexts in different countries. Again,
it may be that the perceptual experience of parents
transcends different health care systems – and that
the commonalities are more relevant than the sys-
tem-specific experience. Our results provide a point
of comparison with an Australian experience that
researchers in other countries may want to explore.
Our research ended up reporting the experience
of mothers, rather than fathers, as it is mothers
who are most likely to seek mental health care
for their children – this is likely to be a common
phenomenon world-wide. Nevertheless, the expe-
rience of fathers in this space should be explored.
Do men have a different experience negotiating
the mental health care system? As there was only
one father included in our study, we do not know,
and this is an area for future research.
We sought to examine the help-seeking pro-
cess for parents with children who had a range of
ADVANCES IN MENTAL HEALTH 139
 Erica Boulter and Debra Rickwood
emotional and behavioural problems. Qualitative
studies have recently begun to investigate the
parental help-seeking process for children and
adolescents with different mental health prob-
lems, such as schizophrenia (Corcoran et al.,
2007; Czuchta & McCay, 2001) and disruptive
behaviours (Arcia, Fernandez, Jaquez, Castillo, &
Ruiz, 2004). These studies suggest that different
pathways may exist for different mental health
problems, which indicates the need to investigate
parental help-seeking behaviour for a wide range
of mental health problems. It also suggests that
additional studies still need to be done on specific
populations in order to understand the influence
that different mental health problems have on the
parental help-seeking process (Singer, 2009).
We did not explore parents’ explanatory frame-
works for their children’s mental health problems.
This is likely to be a relevant factor in determining
whether a mental health service response is sought.
As with young people themselves, parents are also
likely to seek help only when they deem profes-
sional care to be necessary and effective within
their attributional framework.
As we used a retrospective design, it is pos-
sible that parents did not experience the pathway
in exactly in the same way that they remembered
it. This suggests the need to do further studies to
follow parents over time while they seek help for
their children in order to accurately identify the
help-seeking process and pathway. A prospective
design would also address some of the limitations
in the design of the current study.
CONCLUSION
Our study provides further insight into the per-
spectives of parents as help-seekers for their chil-
dren’s mental health problems. It highlights the
important role that parents play in mental health
care, the perseverance required to overcome the
barriers they experience, and the importance of
a good ‘fit’ and ‘feel’ with services to facilitate
engagement. A greater focus on the help-seeking
needs of parents is needed. If parents are not
supported to seek and find appropriate help for
children with emerging mental health problems,
essential effective early intervention is unlikely to
be achieved.
140 ADVANCES IN MENTAL HEALTH Volume 11, Issue 2, February 2013
ACKNOWLEDGEMENT
We would like to express our gratitude to Rex
DeCruz and Nicola Palfrey for their constructive
comments and to Kerry Thomas for her help with
some of the data analysis. We would like to thank the
participants for their generosity with their time and
for the courage to share their personal stories. Your
persistence and conviction to seek help for your chil-
dren is an inspiration to all parents. We would like to
express our gratitude to the staff at headspace and the
Psychology Clinic at the University of Canberra, the
ADHD Support Group, MIEACT and the Autism
Asperger’s Group for their help with the recruitment
of participants. We would like to acknowledge the
contribution of the Audrey Fagan Scholarship.
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Received 09 July 2012 Accepted 21 September 2012

C A L L F O R PA P E R S
Mixed Methods in Genders & Sexualities Research
A special issue of International Journal of Multiple Research Approaches – Volume 7 Issue 3
ISBN 978-1-921980-23-7 – December 2013
Editors: Lisa Jean Moore (Purchase College, SUNY, Purchase NY, USA), Damien W Riggs (Flinders University, Adelaide SA,
Australia) and Cirus Rinaldi (Deviance and Social Change, Faculty of Political Sciences, University of Palermo, Italy)
DEADLINE FOR PAPERS: 1ST MARCH 2013
Section 1: Epistemological background for Section 3: Challenges and emerging issues:
research on genders and sexualities: • Queer methodologies
• Historical and philosophical perspectives • Intersectionality studies
• Interdisciplinary domains, postdisciplinary domains: Gay & • Ethical issues (Role of participants, researcher and team based
Lesbian studies; Transgender studies; Queer studies approaches, clients and users)
• Mainly quantitative content analysis and related approaches • Analytical issues
• Mainly qualitative content analysis and related approaches • Reporting information
Section 2: Theoretical issues and planning
stages for multiple approach: Section 4: Mixed methods and evaluation
Examples of studies using multiple approaches for intervention and research with under-represented
which have attempted diverse groups:
• Sampling strategies • Sexual education
• Data formats • Sexual minorities rights
• Sequencing of data sets • Disability studies and sex
• Integration of data sets • Children
• From qualitative to quantitative designs • Pornography
• From quantitative to qualitative designs • Sex work/sex workers
• ‘Born to be mixed’
http://mra.e-contentmanagement.com/archives/vol/7/issue/3/call/
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