Goals and Reasons for Entering Inpatient Withdrawal Treatment, and Perceptions of Help Received.

OBJECTIVE: Abstinence has been the primary treatment goal for alcohol and other drug (AOD) users attending withdrawal treatment. However, other outcomes including harm reduction have also been identified. This observational study aimed to describe participants' goals and reasons for seeking inpatient withdrawal treatment and compare the needs of clients with comorbid mental health problems and those without. METHODS: Participants completed questionnaires at intake and discharge. Questionnaires assessed reasons for entering withdrawal treatment, goals, comorbidity, and perceived help received. RESULTS: The sample comprised 1746 participants (69.4% male). Participants endorsed diverse reasons for entering withdrawal treatment. The most and least endorsed reasons were "stop using" (97.9%) and "legal reasons" (43.1%). Comorbidity groups varied significantly in their endorsement of reasons for mental health, physical health, harm reduction, financial, and legal. CONCLUSION: AOD users enter withdrawal treatment with a variety of reasons and goals including harm reduction. Variations in rates of endorsement highlight the importance of identifying individual needs dependent on mental health comorbidity.

A Qualitative Study Exploring the Benefits and Challenges of Implementing Client Centred Care (CCC) in an Alcohol and Other Drug Treatment Service.

Objective: Client centered care (CCC) is strongly advocated for improving the quality of health care. The aim of the current study was to explore client and staff perspectives of a new model of CCC implemented in a residential alcohol and other drug (AOD) treatment service. Specifically, the study aimed to (i) describe the defining features of CCC, and (ii) describe the benefits and challenges of implementing CCC at the service. Methods: Participants were 18 clients and eight staff who took part in focus groups and interviews. Thematic analysis of four client focus groups and eight staff individual interviews was conducted. Results: Staff identified the defining features of CCC as flexible, comprehensive, open-minded, and inclusive. Clients and staff shared predominantly positive views on the CCC model. Shared themes included the challenge of balancing flexibility and structure, and delivering comprehensive and individualized care within the limits of staff knowledge, skills, and resources. Conclusions: Results suggest that implementing CCC across an AOD treatment setting has clear benefits to staff and clients, along with challenges that require careful consideration and planning. Future research should evaluate the effectiveness of providing guidelines that address many of the challenges associated with implementing CCC.

Exploring Continuum and Categorical Conceptualisations of Mental Health and Mental Illness on Australian Websites: A Systematic Review and Content Analysis.

It is important to explore the types of conceptualisations and causes presented in online mental health promotion given the implications that these presentations may have on mental health stigma. This study systematically reviewed 92 Australian webpages focused on either mental health, mental illness, depression, or schizophrenia, to explore the types of conceptualisations and aetiologies presented. A minority of mental health and mental illness webpages (n = 8, 8.70%) explicitly presented continuum conceptualisations, with none providing explicit categorical conceptualisations. No depression or schizophrenia webpages presented explicit conceptualisations of any kind. All four webpage foci had a greater proportion of continuum than categorical conceptualisations. Moreover, both depression and schizophrenia webpages presented many mixed conceptualisations which included both continuum and categorical messaging. Most webpages mentioned biological and social causes equally across webpage foci. These findings suggest that Australian mental health websites predominantly present continuum conceptualisations of mental health and mental illness.

Substance Use Disorder and Anxiety, Depression, Eating Disorder, PTSD, and Phobia Comorbidities Among Individuals Attending Residential Substance Use Treatment Settings.

Objective: Mental health comorbidities among individuals with a substance use disorder are common. This study provides an analysis of the prevalence, risk factors, and treatment outcomes (depression, anxiety and stress, and cravings) of individuals with comorbid depression, anxiety, posttraumatic stress disorder (PTSD), obsessive compulsive disorders (OCD), and/or eating disorders attending residential substance use treatment centers. Methods: Intake and three-month post-discharge assessments of 603 (69.3% men) people attending residential substance use treatment services were conducted using the Mental Health Screening Scale, Addiction Severity Index, Depression, Anxiety Stress Scale, and a cravings measure. Results: Anxiety disorders were common (94.5%), followed by depression (89.6%), PTSD (62.0%), OCD (33.7%), and eating disorders (21.4%). Nearly a quarter reported two comorbidities and 8.5% reported five comorbidities. Higher comorbidity levels were associated with having poorer mental health but not cravings at three-month post-discharge follow-up. Conclusions: Comorbidity is common and complex in presentations to residential substance use treatment settings. Higher levels of comorbidity are linked to poorer mental health, which remains over time.

An exploratory study of culture in treatment for Aboriginal Australian men in residential drug and alcohol rehabilitation services.

The objectives of the research are to describe the cultural activities offered in residential drug and alcohol rehabilitation for Aboriginal Australian men, along with client perceptions of the benefits associated with these cultural activities. Participants were 101 Australian Aboriginal male clients attending five residential drug and alcohol rehabilitation services in New South Wales. Participants completed a semi-structured interview and questionnaires that included the Growth and Empowerment Measure, the Aboriginal Cultural Engagement Survey, Clinical Global Impressions, and two questionnaires regarding cultural engagement while in treatment. Service users indicated that the most beneficial cultural activities offered within services were traditional art/craft, culturally-focused talks/meetings, and being on the land. Hierarchical multiple regression analysis indicated that cultural engagement in everyday life significantly predicted empowerment but not other measures of mental ill-health. The opinions of service users are presented, and recommendations are made regarding ways to enhance the effectiveness of cultural activities within drug and alcohol rehabilitation programs.

Video-consulting to address mental health needs after traumatic brain injury: evaluation of a training workshop to build capacity among psychologists.

BACKGROUND: Traumatic brain injury (TBI) can lead to significant psychological distress, but few psychologists in Australia are trained in working with this complex clinical group. Despite government funding to provide video-consulting (VC) services in Australia, uptake before COVID-19 was limited. OBJECTIVE: This mixed methods study evaluated whether training in eHealth and evidence based TBI psychological therapies increased provider uptake of VC in clinical practice, and delivery of mental health services to individuals with TBI. METHODS: Mental health professionals completed a range of self-report measures before (n = 50), after (n = 48), and four months following (n = 30) a one-day workshop. Participants' TBI knowledge, client-base and levels of access, confidence, motivation and attitudes toward VC were assessed. Knowledge did not increase after training but participants had significant increases in their confidence and motivation to using VC at follow up. Significant reductions in pragmatic barriers to using VC were reported post training and at follow up, all barrier categories indicated significant reductions. There was no significant change in clinical practice of the participants. CONCLUSIONS: Training to increase TBI knowledge requires specific assessment tools and although training appears to reduce barriers to using VC, uptake in clinical practice may require additional supervision and warrants further research.

Feasibility of a Mobile Health App for Routine Outcome Monitoring and Feedback in SMART Recovery Mutual Support Groups: Stage 1 Mixed Methods Pilot Study.

BACKGROUND: Mutual support groups are an important source of long-term help for people impacted by addictive behaviors. Routine outcome monitoring (ROM) and feedback are yet to be implemented in these settings. SMART Recovery mutual support groups focus on self-empowerment and use evidence-based techniques (eg, motivational and behavioral strategies). Trained facilitators lead all SMART Recovery groups, providing an opportunity to implement ROM. OBJECTIVE: The aim of this stage 1 pilot study is to explore the feasibility, acceptability, and preliminary outcomes of a novel, purpose-built mobile health ROM and feedback app (SMART Track) in mutual support groups coordinated by SMART Recovery Australia (SRAU) over 8 weeks. METHODS: SMART Track was developed during phase 1 of this study using participatory design methods and an iterative development process. During phase 2, 72 SRAU group participants were recruited to a nonrandomized, prospective, single-arm trial of the SMART Track app. Four modes of data collection were used: ROM data directly entered by participants into the app; app data analytics captured by Amplitude Analytics (number of visits, number of unique users, visit duration, time of visit, and user retention); baseline, 2-, and 8-week follow-up assessments conducted through telephone; and qualitative telephone interviews with a convenience sample of study participants (20/72, 28%) and facilitators (n=8). RESULTS: Of the 72 study participants, 68 (94%) created a SMART Track account, 64 (88%) used SMART Track at least once, and 42 (58%) used the app for more than 5 weeks. During week 1, 83% (60/72) of participants entered ROM data for one or more outcomes, decreasing to 31% (22/72) by the end of 8 weeks. The two main screens designed to provide personal feedback data (Urges screen and Overall Progress screen) were the most frequently visited sections of the app. Qualitative feedback from participants and facilitators supported the acceptability of SMART Track and the need for improved integration into the SRAU groups. Participants reported significant reductions between the baseline and 8- week scores on the Severity of Dependence Scale (mean difference 1.93, SD 3.02; 95% CI 1.12-2.73) and the Kessler Psychological Distress Scale-10 (mean difference 3.96, SD 8.31; 95% CI 1.75-6.17), but no change on the Substance Use Recovery Evaluator (mean difference 0.11, SD 7.97; 95% CI -2.02 to 2.24) was reported. CONCLUSIONS: Findings support the feasibility, acceptability, and utility of SMART Track. Given that sustained engagement with mobile health apps is notoriously difficult to achieve, our findings are promising. SMART Track offers a potential solution for ROM and personal feedback, particularly for people with substance use disorders who attend mutual support groups. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619000686101; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377336. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/15113.

Profiles of mental health help seeking among Australian adolescent males.

INTRODUCTION: Adolescent males are at increased risk of mental illness and are reluctant to engage in treatment. This study aims to identify subgroups of help-seeking intentions among a sample of Australian male adolescents. METHODS: A sample of 1038 male adolescent sport participants in Australia (age M = 14.69 years, SD = 1.35) reported help-seeking intentions from ten sources and from 'no one'. Latent profile analysis was conducted based on these 11 items. Identified profiles were then compared across mental health measures. RESULTS: Four latent profiles were identified: Low general help-seekers (10.5%), Moderate general help-seekers (46.8%), High general help-seekers (25.5%), High family and friends help-seekers (17.2%). Low, Moderate, and High general help-seekers had uniformly low, moderate, and high intentions to seek help from all sources, respectively. High family and friends help-seekers reported high endorsement of intentions to seek help from intimate partners, friends, parents, and other relatives, but low intentions for other sources. Low general help-seekers had lower intentions to seek help from parents compared to all other profiles. They also had significantly lower perceived family support and higher psychological distress. CONCLUSIONS: Low general help-seekers were particularly reluctant to seek help from all sources and at high risk of experiencing psychological difficulties. Their distinct profile offers potential to identify this high-risk group through the use of ratings on the parent help-seeking intentions item. Further research should investigate the predictive utility of this item on help-seeking and mental health, and should consider the influence of masculinity and previous experiences of help-seeking.

Psychotherapy and youth suicide prevention: An interpretative phenomenological analysis of specialist clinicians' experiences.

The study explored psychologists' experiences in delivering short-term psychotherapy for suicidal adolescents and sought to clarify how these experiences fit with empirically supported interventions and the interpersonal psychological theory of suicide. Semistructured interviews were conducted with 12 psychologists' who provided short-term psychotherapy in a suicide prevention programme for youth (12- to 25-year-olds). Interview transcripts were analysed using interpretative phenomenological analysis. Three superordinate themes were identified: (i) understand the experience and context of the suicidality and the importance of a formulation-based approach to engagement and individualized treatment planning; (ii) involve broad support systems, and in particular families, to help the young person reduce feelings of burdensomeness and increase safety, connectedness and belonging; and (iii) improve affect regulation and reflective functioning, important not only for the young person but also for the support system to maximize the positive impact of supports via emotional coregulation and effective problem-solving. Interventions and approaches as well as the potential underlying processes of change being targeted are discussed in light of these findings. As an example, the development of a suicide safety plan was an intervention that traversed these themes. When used as a process tool, it helped foster a collaborative, formulation, dimensional and biopsychosocial approach to treat psychopathology and suicidality and extended beyond the therapist-client dyad. Moreover, treatment needs to be extended beyond the therapist-client dyad to allow therapists to facilitate a systemic treatment response, as this was seen as a major component of interventions for suicidal youth.

The relationship between patient-centered care and outcomes in specialist drug and alcohol treatment: A systematic literature review.

Background: Patient-centered care is strongly advocated as a key for improving the quality of healthcare. Research examining the impact of patient-centered care in healthcare has concluded that there are demonstrable albeit inconsistent relationships between patient experience, quality of care, and healthcare outcomes. Knowledge of the impact of patient-centered care in the treatment of substance use disorder is limited. The aim of this review was to assess relationships between indicators of patient-centered care (satisfaction and patient-reported experience measures) and patient outcomes (substance use, psychological wellbeing, and service use) among people attending treatment for substance use disorder. Methods: A systematic electronic literature search of a range of databases was conducted with variations of the search terms 'patient-centered care', 'substance use disorders', and residential or community specialist 'treatment'. The populations, interventions and outcomes were summarized and described according to the PRISMA statement. Results: A total of 25 articles were identified, of which only five included a patient-centered indicator other than satisfaction. Indicators of patient-centered care showed a generally positive association with improved outcomes, particularly between satisfaction with treatment and substance use. Nonetheless, mixed and contradictory results were not uncommon, more so for psychological wellbeing outcomes. Conclusions: There were demonstrable relationships between patient-centered indicators and outcomes for people receiving treatment for substance use disorder. However, conclusions are limited due to underrepresentation of patient-reported experience measures. Further research in the area is needed involving comparisons of patient centered indicators with outcomes and use of patient-reported experience measures together with satisfaction. Registration number: CRD42018092829.

Substance Use and Co-occurring Physical Health Problems: File Review of a Residential Drug and Alcohol Treatment Service.

Objectives: Physical health conditions cause significant disability and mortality among people living with alcohol and other drug problems. There has been limited research on the prevalence of health problems among clinical samples of people with substance use disorders, particularly among those in residential treatment. Yet residential settings provide unique opportunity for responding to health needs. To better understand the health of people attending treatment for substance use disorders, this study conducted a file review to examine the prevalence of physical health problems as identified during routine residential care. Methods: A retrospective review of client files collected between 2013 and 2017 (N = 172) was completed at a residential treatment service in NSW, Australia. Data were extracted to examine the prevalence of physical health problems recorded at entry into treatment. Correlates of health problems were estimated using bivariate descriptive analyses and logistic regression. Results: The majority of clients in treatment for substance use had a comorbid physical health problem (80.7%). Musculoskeletal problems were the most frequently reported medical issue (38.6%). Odds for some physical health problems were related to client gender, age, and primary substance of concern. Male gender remained the strongest predictor of dental health problems when controlling for age and substance type (odds ratio [OR] = 3.60). Primary alcohol use remained the strongest predictor of nutritional deficiencies when controlling for client age (OR = 4.43). Among clients with a physical health problem and who had a treatment episode of at least 14 days (n = 110), just over half (55.5%) were referred to a health-related practitioner or service during their treatment episode. Conclusions: This study contributes to the literature by reporting on the incidence of physical health problems among people in residential treatment for substance use disorders. The high prevalence of physical health morbidity iterates the role of non-medical staff working within drug and alcohol services in the identification of client health needs. The findings support calls for systematic screening of physical health as part of routine care for substance use disorders improved integration of substance treatment and the broader primary health care system.

Improvements in psychologists' metacommunication self-efficacy, willingness, and skill following online training and a supervision exercise.

OBJECTIVE(S): Psychologists' experiences of an online training tool in metacommunication as well as an in-supervisory metacommunication exercise were examined. METHOD: A total of 101 participants completed a training tool in metacommunication and changes in self-efficacy (SE) to use metacommunication with clients, the proportion of metacommunication used in vignette-responses, and their willingness to use metacommunication in supervision were assessed pre- and posttraining and at 6-week follow-up. A total of 48 participants elected to undertake the in-supervision exercise. RESULTS: Participants reported significantly higher willingness and self-efficacy after completing the online training. They also showed a higher proportion of metacommunicative statements in their posttraining vignette responses compared with pretraining. The increase in willingness was retained at 6-week follow-up. There was an increase in self-efficacy from pre- to postonline-training, and this increased at follow-up. CONCLUSIONS: This opens the door to better developing metacommunication skills in supervisees through both online training and the metacommunication supervisory exercise. Areas for continued research are outlined.

Supervisee perceptions of the use of metacommunication in the supervisory relationship.

Objective: This study examined the use of metacommunication in supervision from supervisees' perspectives. Method: A total of 129 supervisees completed the Metacommunication in Supervision Questionnaire-MSQ, a measure devised for the purpose of this study to explore the frequency and willingness to use various forms of metacommunication in clinical supervision. Measures of the nature of the supervisory relationship (also from the supervisee's perspective) were taken to explore whether a relationship exists between the nature of supervision and supervisees' perspectives on the use of metacommunication. Results: There was general concordance between supervisee ratings of their own willingness and their perception of their supervisor's willingness to use various forms of metacommunication in supervision. There were significant differences in the reported frequency with which the different types of metacommunication are actually used. A factor analysis elicited a two-factor structure underlying the MSQ and significant correlations with measures of the nature of the supervision relationship were observed. It appears that metacommunication around difficult or uncomfortable feelings in the supervisory relationship occurs less often than other components of metacommunication. Conclusion: Future research needs to further validate the MSQ and assess whether the frequency of metacommunication in the supervisory relationship is related to metacommunication in supervisees' psychotherapy with clients.

Impact of early telephone contact on 3-month follow-up rates following residential drug and alcohol treatment: A randomized controlled trial.

Background: Routine outcome monitoring (ROM) is an important component of service provision and qualitity assurance procedures. However, a major logistical and financial challenge for organizations is successfully following up participants once they have left residential alcohol and other drug treatment. The aim of the current study was to assess the impact and effectiveness of an "early" follow-up contact and brief interview on subsequent 3-month ROM follow-up success. Methods: Participants were 800 clients attending specialist residential alcohol and other drug treatment provided by The Salvation Army. As part of routine outcome assessment procedures, all people attending these programs are asked to complete a 3-month follow-up assessment. Participants were randomly allocated either to the early contact condition (i.e., "early" 2-week follow-up contact prior to the 3-month follow-up assessment) or to the control condition (i.e., no "early" 2-week follow-up prior to the 3-month follow-up assessment). The primary outcomes were the proportion of participants who were followed up and surveyed at 3 months. Results: There were significantly higher follow-up rates at 3 months post discharge for participants in the early contact group (55.6%) compared with the control condition (46.1%). Although there were higher rates of 3-month follow-up for participants in the early contact group, rates of successful survey completion were not significantly different between the 2 groups. Conclusions: Including an early 2-week telephone call prior to the 3-month assessment increased the number of participants we were able to follow up at 3 months post discharge but did not improve the rate of survey participation at 3 months. The additional costs associated with this activity and the modest increase in follow-up rates need to be considered prior to organizations investing in these follow-up enhancement activities.

Exploring the Relationships Between Eating Disorders and Mental Health in Women Attending Residential Substance Use Treatment.

Objective: Comorbid eating disorders (EDs) and ED symptoms are highly prevalent among women with substance use disorders and may be a barrier to recovery. Higher rates of psychiatric illness are common when more than one disorder is present. Yet little is known about the rates and risk factors for EDs/ED symptoms in women attending treatment centers in Australia. The primary aim is to examine the prevalence of ED symptoms among women attending treatment centers. This study also examines past physical and sexual abuse and mental health as specific predictors of EDs/ED symptoms. Methods: Participants were 1,444 women attending residential treatment for substance use issues provided by the Salvation Army in Australia. Measures included the Addiction Severity Index, the Eating Disorder Screen for Primary Care, medication use, hospitalization, mental health, and past abuse. Results: Alcohol was the primary substance of concern for 53.3% of the women, followed by amphetamines (17.5%), and the mean age was 37.83 years (SD = 10.8). Nearly 60% of women screened positive for ED symptoms and 32% reported a previous or current ED. Women with a history of sexual abuse had significantly greater odds (1.96) of positive screening for an ED compared to those without a history of sexual abuse. Similarly, compared to women without a history of physical abuse, those who did have a history had significantly higher odds (1.59) of a positive screen for an ED. These women were also significantly more likely to have had a health care provider recommend they take medications for psychological or emotional problems in the past 30 days, χ2(1) = 8.42, p = .004, and during their lifetime, χ2(1) = 17.89, p < .001. They also had a significantly greater number of overnight hospitalizations for medical problems compared to those who screened negative, t(137) = -2.19, p = .03. Conclusions: Women with comorbid substance use issues and EDs are highly likely to have a history of past abuse. This combination of comorbidities makes treatment and recovery difficult. Increased awareness and research are required to explore integrated approaches to treatment that accommodate these vulnerabilities and improve long-term outcomes.

Healthy Recovery: A Pilot Study of a Smoking and Other Health Behavior Change Intervention for People Attending Residential Alcohol and Other Substance Dependence Treatment.

Objective: It is common for people attending alcohol and other substance dependence treatment to present with multiple unhealthy lifestyle behaviors such as high rates of smoking, physical inactivity, and poor diet. Healthy lifestyle interventions are increasing in importance in the general population, but have been underexamined within alcohol and other substance use populations. The purpose of the current study was to pilot "Healthy Recovery," a group program that primarily aimed to help people attending alcohol or other substance dependence treatment to reduce or quit smoking. The program also encourages participants to increase physical activity and to eat more servings of fruit and vegetables. Methods: The current study was conducted as a non-randomized controlled pilot trial. All participants were attending residential substance dependence treatment provided by the Australian Salvation Army. In addition to treatment as usual, participants in the treatment condition completed Healthy Recovery (n = 50) and participants in the control group completed an online depression program (n = 27). The study examined the health outcomes of participants (i.e., smoking, physical activity, fruit and vegetable intake, and symptom distress) and the feasibility of running the group sessions within the residential facilities. Results: Within-treatment effects demonstrated medium to large positive effects for reductions in smoking and increases in physical activity, servings of fruit, and servings of vegetables for people completing Healthy Recovery. When compared to the control condition, there were medium effects in favor of the Healthy Recovery condition for reductions in smoking and increases in physical activity. There was a small effect for servings of fruit and no effect for servings of vegetables. Conclusions: Results from this study demonstrated that people attending residential substance dependence treatment are willing and capable of engaging in multiple health behavior change interventions.

In limbo: A systematic review of psychological responses and coping among people with a missing loved one.

OBJECTIVE: This review explored psychological responses and coping among loved ones left behind when a person is missing. METHOD: A systematic search identified 42 studies that reported data gathered among people with a missing loved one regarding psychological symptoms and/or coping strategies. Studies were arranged according to context of disappearance: forced (a result of war/conflict, abduction, forced separation) or unclear (reason unknown)/unspecified circumstances. RESULTS: The most consistent findings for psychological symptoms were reports of depression, anxiety, posttraumatic stress, and prolonged grief reactions. When the disappearance was unclear/unspecified, people more often reported use of cognitive avoidance and continuing a bond as coping strategies. When the disappearance was forced, people more often reported use of informal support seeking. CONCLUSIONS: Further research is warranted to clarify (a) the generalizability of findings to those left behind under circumstances where the ambiguity may be greater and (b) the acceptability of various targeted psychological interventions.

Parental Authoritativeness, Social Support and Help-seeking for Mental Health Problems in Adolescents.

Adolescents experience high rates of mental health problems but are reluctant to seek professional help. Parents play an integral role in the help seeking process for their adolescent children. Parental authoritativeness and support have been identified as contributing to better mental health outcomes and a reduction in help seeking barriers in their children. The current study examined the influence of parental authoritativeness and support on help seeking intentions and behaviors in 1582 students (49% female) in 17 schools (mean age = 17.7, range 16-18). All data was available for 1032 participants across two time points collected one year apart. Concurrent indices of positive parenting were associated with greater help seeking intentions from professional sources, even when gender and psychological distress were controlled. Parental authoritativeness and parental support did not predict actual help seeking assessed one year later. The study highlights the potential role of parents in influencing help seeking and suggests further research is needed on other parent variables and the social antecedents to help-seeking.

Ahead of the game protocol: a multi-component, community sport-based program targeting prevention, promotion and early intervention for mental health among adolescent males.

BACKGROUND: There is a recognised need for targeted community-wide mental health strategies and interventions aimed specifically at prevention and early intervention in promoting mental health. Young males are a high need group who hold particularly negative attitudes towards mental health services, and these views are detrimental for early intervention and help-seeking. Organised sports provide a promising context to deliver community-wide mental health strategies and interventions to adolescent males. The aim of the Ahead of the Game program is to test the effectiveness of a multi-component, community-sport based program targeting prevention, promotion and early intervention for mental health among adolescent males. METHODS: The Ahead of the Game program will be implemented within a sample drawn from community sporting clubs and evaluated using a sample drawn from a matched control community. Four programs are proposed, including two targeting adolescents, one for parents, and one for sports coaches. One adolescent program aims to increase mental health literacy, intentions to seek and/or provide help for mental health, and to decrease stigmatising attitudes. The second adolescent program aims to increase resilience. The goal of the parent program is to increase parental mental health literacy and confidence to provide help. The coach program is intended to increase coaches' supportive behaviours (e.g., autonomy supportive behaviours), and in turn facilitate high-quality motivation and wellbeing among adolescents. Programs will be complemented by a messaging campaign aimed at adolescents to enhance mental health literacy. The effects of the program on adolescent males' psychological distress and wellbeing will also be explored. DISCUSSION: Organised sports represent a potentially engaging avenue to promote mental health and prevent the onset of mental health problems among adolescent males. The community-based design, with samples drawn from an intervention and a matched control community, enables evaluation of adolescent males' incremental mental health literacy, help-seeking intentions, stigmatising attitudes, motivation, and resilience impacts from the multi-level, multi-component Ahead of the Game program. Notable risks to the study include self-selection bias, the non-randomised design, and the translational nature of the program. However, strengths include extensive community input, as well as the multi-level and multi-component design. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000709347 . Date registered 17 May 2017. Retrospectively registered.

Unmet need for professional mental health care among adolescents with high psychological distress.

OBJECTIVES: This study reports the rate of unmet needs for professional mental health care in a large multi-state sample of adolescents. We also sought to describe barriers to professional help, informal help seeking and future help-seeking intentions among adolescents with wholly unmet needs for counselling for mental illness. METHODS: We collected measures of mental health, help-seeking and unmet needs in 1599 students (817 males and 781 females) in 16 schools (mean age = 17.7 years, standard deviation = 0.42 years). Adolescents meeting 'case' criteria for high psychological distress were classified as having no need, fully met needs, partially met needs or wholly unmet needs. Participants were asked about actual service use, perceived unmet needs, barriers to professional help, help seeking from other sources, use of self-management strategies and future help seeking intentions. RESULTS: In all, 35.7% ( n = 571) of the sample met criteria to be designated 'cases' with high psychological distress. Of these, 25.9% ( n = 148) were classified as having 'wholly unmet needs' (cases of untreated prevalence with self-perceived unmet needs), translating into 9.3% of the original sample. Compared to cases with partially met needs, adolescents with wholly unmet needs engaged in significantly less self-help, used less informal help from family/friends and reported lower future help-seeking intentions. Common barriers to care included a preference for self-management and concerns regarding stigma. CONCLUSIONS: A concerning proportion of adolescents have untreated high psychological distress with wholly unmet mental health needs. This group is rendered particularly vulnerable by low rates of access to non-professional sources of help and low engagement in self-management strategies. Further research is needed to support this vulnerable group to access needed professional mental health help.