Mental health service use decision-making among young adults at clinical high risk for developing psychosis

Aim: Research has shown that young adults at clinical high risk (CHR) for developing psychosis have the capability to recognize that they have a problem and initiate mental health services, yet there is a paucity of theoretically based research examining this decision-making process. This is critical to study because there are high rates of underutilization of mental health services among these young people. The following study explored the decision-making process among young adults at CHR in order to understand mental health services utilization at a CHR clinic. Methods: Semi-structured face-to-face interviews were conducted with 30 young adults at CHR between the ages of 18 and 30, from an Eastern city in the United States. The study applied the unified theory of behaviour (UTB), a decision-making framework for health behaviour, to examine service use. Content analysis with multiple coders was used. Results: The most salient constructs discussed when participants envisioned seeking services at the clinic included attitudes or beliefs about help-seeking, social image beliefs and emotional reactions towards seeking services. Differences in UTB responses emerged depending on whether participants were engaged in clinical services and research at the time of the interview or just taking part in research follow-ups. Conclusion: When designing future interventions to increase service utilization among young adults at CHR, programs can address health beliefs such as how services at the clinic can improve symptoms, stigma and difficult emotions such as fear and shame about seeking services, and particularly among young people who are more ambivalent about seeking clinical services.