Mental Health and Adolescents

Written by Kristina McMillan


Mental health is very prevalent in society. An individual who comes forward with their mental health issue is often rejected or isolated and so they are less likely to seek help only making their mental health worse (Bulanda et al., 2014; Walsh et al.,2011). Mental health can be defined as a broad array of activities that can directly or indirectly affect the mental wellbeing of an individual and how they are able to cope with normal stresses in life including work, family and society (Capital and Coast District Health Board, 2017). The stigma around mental health is now being advertised in the media in an effort to reduce the stigma and change people’s perceptions of mental health. There are advertisements that include John Kirwan, an ex All Black, coming forward and telling society it is okay to seek help, it is okay to come forward and ask for help. He lets people know what website to go to and even says he will guide you through it. However mental health awareness is not what it should be, particularly young adolescents and their awareness and knowledge of mental health. New Zealand has the highest rate of suicide for adolescents aged 15 to 19 (Zonneveld, 2014) and one in five adolescents will suffer from mental health (Bluhm, Covin, Chow, Wrath and Osuch, 2014; Clark et al., 2014) particularly those from socioeconomically deprived families and Maori (Clark et al., 2014; van Kessel, Milne, Hunt, and Reed, 2012). There have been improvements in the health status for adolescents in New Zealand however there is still room for improvement in their overall health and wellbeing (Zonneveld, 2014). It is necessary to improve the awareness of mental health in adolescents so major mental health illness later in adulthood can be prevented by providing early interventions (Bulanda et al., 2014; Walsh et al.,2011; Zonneveld, 2014).

This literature review aims to find out how much adolescents actually know about mental health, what affects their knowledge on mental health, the stigma around mental health and ways to improve mental health awareness in adolescents as a society and for the nursing workforce.  Can the role of a student nurse help create awareness and promote health in adolescents? This leads to the research question of, how much awareness do young adolescents have on mental health and how can their perception be changed?

  Literature Review

This literature review will be guided by the research question. Articles and studies that are related to adolescent’s mental health, mental health stigma and what actions and processes are used to help encourage mental health awareness in adolescents (Queen Mary, 2017), are reviewed. The subject will be defined as will the main themes that are presented. Multiple studies and articles that directly relate to the research question and what is reported on will be verified by multiple findings (Queen Mary, 2017). After searching through multiple articles and studies, particular literature will be found that will make a significant contribution to the literature review and the main themes will be grouped into headings to explain the reasoning for this research question (Queen Mary, 2017).

  Clinical issue

Mental health concerns and disorders are common among adolescents. Bluhm et al., (2014) found that five to nine per cent of adolescents have serious emotional disturbances and approximately 20 per cent of adolescents will suffer from a mental health disorder. Adolescents suffering from mental health can experience anything from depression and anxiety to alcohol abuse and educational underachievement (Bluhm et al., 2014). All of these illnesses can lead to significantly negative effects on academic and social function and further complication in adulthood (Bluhm et al., 2014). Adolescents are in an important developmental period of their life, they are becoming more independent from systems and their families and are learning to cope with new relationships, school responsibilities and home life (Bulanda, Bruhn, Byro-Johnson, and Zentmyer, 2014). Adolescents are learning to find out who they are as a person and having a mental illness or not knowing anything about their mental health will have a significant effect on this (Bulanda, Bruhn, Byro-Johnson, and Zentmyer, 2014).



Information relating to   Question



Young adolescents   between the ages of 12 to 18 years

Mental health issues   are on the rise in young adolescents. Support service and programs will help   early intervention and increase the knowledge and health literacy of   adolescents

EXPOSURE (intervention)

Young adolescents where   there is limited mental health literacy and knowledge about mental health and   early interventions that can be done to prevent mental illness

The literature review   focuses on young adolescent’s mental health and how it can be made easier for   them to seek help and access help.


Young adolescents who   feel they are unable to talk about their mental health and do not understand   enough about mental health.

How much knowledge do   adolescents actually have on mental health and how this can be improved and   how it can decrease the stigma around mental health.


To be able to identify   the most useful and appropriate methods and programs we can offer to young   adolescents

Can mental health be   better understood and exactly what is awareness in young adolescents. What   methods and programs work best to increase awareness.


Adolescents between the   age of 12 and 18

Adolescents between the   age of 12 and 18

(Whitehead, 2013)

  Mental health literacy in adolescents

Young people are hesitant when engaging in mental health services (Clark et al., 2014) this is due to the stigma around mental health and their own perception of their mental health. Due to their lack of knowledge of mental health and the services available, they think that nothing is wrong or that there is nothing that is going to help them (Clark, 2014). To minimise this it is important that adolescents have the most relevant and accurate mental health literacy (Bulanda et al., 2014; Walsh, Scaife, Notley, Dodsworth and Schofield, 2011). If adolescents have the ability to recognize their own or others mental health and are able to identify risk factors and causes then their attitudes towards mental health and seeking help and information will change, they will be more likely to access the services that are available (Bulanda et al., 2014; Walsh et al.,2011). They will be able to understand their mental health and their symptoms and feel that they are able to seek help without the stigma affecting how they feel about mental health (Bulanda et al., 2014; Walsh et al.,2011)

Salerno (2016) found that there is a chance of increasing adolescent’s mental health outcomes when providing mental health awareness and interventions in schools, allowing them to know where they can go for help and even being able to help their peers with their mental health. Adolescents have little knowledge about services that they have access to (Prior, 2012) except school counselling, however the stigma around using counselling services alone prevents adolescents from accessing this service (Prior, 2012). Counselling is able to provide early intervention for mental health but only if they use it, there needs to be more encouragement in accessing these services so further mental illness can be prevented (Prior, 2012). Adolescents need to see that mental health is just as important as physical health, it has a huge impact on society and individuals but they feel they are unable to talk about it (Pirie, 2016).


The stigma around mental health has a huge impact on people accessing mental health services and even their knowledge and awareness of mental health (Pirie, 2016). There is plenty of research that supports that adolescents have little to no knowledge about mental health and how stigma affects this (Alexander, 2009). The sigma around mental health affects how adolescents make decisions, their attitudes and their involvement in education (Alexander, 2009). Adolescents are hesitant from seeking the help they need, the idea of experiencing rejection from their fellow peers can cause emotional distress on its own and leaves them feeling isolated, it is easier for them to just keep quiet about their mental health and seek no help than to be cast out by their peers (Bulanda et al., 2014). There are mental health services available for anyone who needs those including services for young adolescents, however public stigma around mental illness has created negative reactions and attitudes towards those who suffer from mental illness. Because of this there is a lack of engagement in the services that are provided (Gearing et al., 2015). The negative view around mental health needs to be broken down so people feel they can come forward with how they are feeling and seek help (Gearing et al., 2015). Starting at a young age provides early intervention so addressing adolescents and encouraging mental health awareness will help them feel like they are able to address their mental health and reduce the stigma (Bulanda et al., 2014).

  Further implications on adolescents later in life

Mental health problems in adolescents can be associated with many negative outcomes including major depression, nicotine dependence, alcohol dependence or abuse, educational underachievement, suicide, early parenthood or even unemployment (Bluhm et al., 2014; Clark et al., 2014).  Patients who have psychiatric disorders in adulthood have been known to show signs of the illness before the age of 18 and early intervention in adolescent years could have prevented the illness (Bluhm et al., 2014; Bulanda et al., 2014; Clark et al., 2104). If left untreated, mental illness can have an overwhelming build up of pressure (Membride, 2016). For some people this pressure can lead to self harm or even suicide as no treatments or interventions were taken to help the individual cope with their mental illness (Madianos, Zartaloudi, Alevizopoulos and Katostaras, 2011; Membride, 2016; Zonneveld, 2014). Madianos et al., (2011) found that if mental illness is left untreated it can lead to violent behaviours, resulting in imprisonment. Adolescents that are exposed to multiple risk factors have a higher risk of developing mental health illnesses while progressing into adulthood, especially without any treatment or interventions (Membride, 2016).

  Factors influencing mental health

Clark et al., (2014) and Bulanda et al., (2014) found that people living in lower socioeconomic areas or had a lower socioeconomic status were more likely be at risk of mental illness. This is due to the lack access and support to mental health facilities and the affordability of the services (Bulanda et al., 2014; Brown, Stoffel and Munoz, 2010; Clark et al., 2014). Lack of education and knowledge on mental health can be associated with mental health issues later in adulthood (Bulanda et al., 2014; Brown, Stoffel and Munoz, 2010; Clark et al., 2014). Membride (2016) found that there are multiple factors that can influence the mental health of an adolescent. These include having a learning disability, chronic physical ill health, having a parent that suffers from mental health, physical, emotional or sexual abuse and living with domestic abuse or parental breakdown (Membride, 2016). A study done by Dury (2016) around Chronic Obstructive Pulmonary Disease (COPD) found that those who suffer from COPD are more likely to develop an anxiety disorder or depression due to their symptoms and feeling as thought they are helpless. If this is left untreated, it can potentially lead to an increase in physical disability and decrease the use of health care (Dury, 2016).


It is wrongly perceived by society that mental health is rare and this makes it difficult for people to come forward and talk about their problems (Pirie, 2016). There is a high need for early intervention and awareness in young adolescents, with only 20 percent of children and adolescents that need mental health services are actually accessing them (Langley, Santiago, Rodríguez and Zelaya, 2013). Programs need to be developed and workshops need to be put into schools (Bulanda et al., 2014) this will reduce the stigma and improve mental health awareness allowing young adolescents to access the help that they need with their mental illness and not feel rejected or isolated from their peers (Bulanda et al., 2014; Langley et al., 2013; Pirie, 2016).

With the right treatment and support people are able to manage their mental health or identify that they have mental health problems before they have a highly negative effect on their wellbeing (Pirie, 2016). Having school based services will increase the mental health awareness and quality of mental health care but the implementation of these services is important to ensure positive outcomes for adolescents (Langley et al., 2013). Without successful implementations the services will result in poor outcomes or inconsistent use (Langley et al., 2013). A plan needs to be set out and followed, Langley., et al (2013) found that due to the multiple layers in a school system it is important for all of the school services to develop and engage in the need for mental health awareness. That includes the parents and families, mental health providers, district and school administrators and the students (Langley et al., 1013). By doing so, the mental health awareness will increase overall in not only the adolescents but everyone they have contact with during their school period (Langley et al., 2013). The stigma around mental health will decrease and adolescents will be able to freely talk about their mental health issues without the fear of rejection (Langley et al., 2013). Langley et al., (2013) found that both parent and teacher engagement in adolescent mental health helped improve the quality and use of the mental health services provided. By engaging and exploring parental concerns and beliefs, barriers were able to be identified such as parental language and parental perception of discrimination (Langley et al., 2013) and they were able to work hand in hand with teachers and mental health services to reduce the barriers and build relationships to encourage the engagement of the adolescents and their families (Langley et al., 2013).

The New Zealand Prime Minister has created some programs and activities in schools, online and in community to improve the mental health and wellbeing of young adolescents (Ministry of Health, 2015). These activities include Lifehack: a youth approach to wellbeing, school based case studies, youth mentors and training in youth mental health (Ministry of Health, 2015). Having programs that create more awareness for adolescents provides them with stronger coping skills and can improve their communication with others (Health and Wellness Resource Centre, 2008)

  Nurse’s role

There is a gap in mental health between what we know and what we do (Sandström, Willman, Svensson, and Borglin, 2014; Zonneveld, 2014). Nurses are the front line providers of health promotion and illness care (Baskaran, 2012; Rosvall and Nilsson, 2016). By promoting mental health awareness and care to adolescents it will increase the knowledge and understanding they have on mental health (Baskaran, 2012; Rosvall and Nilsson, 2016). Further screening needs to be done to identify possible mental health illness in adolescents and management of mental health illnesses needs to be encouraged (Baskaran, 2012; Rosvall and Nilsson, 2016). It is important that nurses receive appropriate training and knowledge of the mental health services that are available before they are able to make judgement on others mental health (Baskaran, 2012; Rosvall and Nilsson, 2016). Examples of what a nurse can do to help an individual who is suffering from mental health include, self management through sleep hygiene, encouraging a healthy diet and more exercise, referring an individual to psychological therapy or counselling, providing ongoing support and ensuring that there is ongoing monitoring (Zonneveld, 2014).

As a student nurse it is expected that we take the opportunities to take part in appropriate training to increase our personal knowledge and awareness of mental health so when we are out on clinical or even when we have become registered nurses, we are able to screen and identify possible mental health issues and provide early intervention for patients to reduce the possibility of negative outcomes (Baskaran, 2012;Rosvall and Nilsson, 2016). Cleary, Horsfall and Jackson (2011) found that supplying the appropriate education to student nurses resulted in more mental health awareness, this included access to mentoring programs, teaching programs and access to role models to develop skills and also develop teaching skills to promote health to patients and society.


The mental health awareness of adolescents and nurses is low and needs to be increased (Baskaran, 2012; Clark et al., 2014; Rosvall and Nilsson, 2016; Sandström, Willman, Svensson, and Borglin, 2014). Young adolescents are hesitant in engaging in the mental health services provided because of the stigma that is associated with mental health (Clark et al., 2014). They feel as if nothing is wrong with them or there is nothing that will help them and if they do seek help they fear being rejected by their peers and becoming isolated (Bulanda et al., 2014). If the mental health awareness of adolescents is increased they will be able to identify mental health and causes to them or their peers and encourage the mental health services to be used (Clark et al., 2014; Bulanda et al, 2014; Pirie, 2016).  Mental health is wrongly perceived as rare and so people are not able to come forward with their illness or access the services available (Clark et al., 2014; Pirie, 2016). To reduce this, awareness of mental health needs to be promoted in schools and society so people are able to see it is more common than they think and it is okay to seek help. (Baskaran, 2012; Mental Health Foundation, 2017; Rosvall and Nilsson, 2016). To promote mental health awareness in the school system, all parts of the school system need to engage in health promotion, this includes teachers, mental health providers, families and parents, administrators and students (Langley et al, 2013). By doing this barriers can be identified and overcome to help with the most appropriate and positive encouragement of mental health (Langley et al, 2013). Nurses play a key role in promoting awareness of mental health, they are able to provide early intervention of mental health issues by being able to screen for signs and symptoms and help encourage adolescents and society to engage in the services available and seek help (Baskaran, 2012; Rosvall and Nilsson, 2016; Zonneveld, 2014). Nurses are also able to promote health and help with physical issues to reduce the stress on an individual’s mental health (Baskaran, 2012; Rosvall and Nilsson, 2016; Zonneveld, 2014).


Alexander, T. (2009, February). Mental Health, a Friend, a Home, a Job. Retrieved from


Baskaran, M. (2012). Effectiveness of Structured Teaching Programme on Nursing Students Regarding Care of Alcoholics. International Journal Of Nursing Education, 4(2), 40-42.


Bluhm, R., Covin, R., Chow, M., Wrath, A., & Osuch, E. (2014). 'I Just Have to Stick with It and It'll Work': Experiences of Adolescents and Young Adults with Mental Health Concerns. Community Mental Health Journal, 50(7), 778-786. doi:10.1007/s10597-014-9695-x


Bulanda, J. J., Bruhn, C., Byro-Johnson, T., & Zentmyer, M. (2014). Addressing Mental Health Stigma among Young Adolescents: Evaluation of a Youth-Led Approach. Health & Social Work, 39(2), 73-80.


Brown, C., Stoffel, V. C., & Munoz, J. P. (2010). Occupational Therapy in Mental Health : A Vision for Participation. Philadelphia, US: F.A. Davis Company. Retrieved from


Capital and Coast District Health Board. (2017). Definition | Mental Health Services. Retrieved from


Clark, T. C., Johnson, E. A., Kekus, M., Newman, J., Patel, P. S., Fleming, T., & Robinson, E. (2014). Facilitating Access to Effective and Appropriate Care for Youth With Mild to Moderate Mental Health Concerns in New Zealand. Journal Of Child & Adolescent Psychiatric Nursing, 27(4), 190-200. doi:10.1111/jcap.12095


Cleary, M., Horsfall, J., & Jackson, D. (2011). Mental Health Nursing: Transitions From Practice Roles to Academia. Perspectives In Psychiatric Care, 47(2), 93-97. doi:10.1111/j.1744-6163.2010.00280.x


Dury, R. (2016). COPD and emotional distress: not always noticed and therefore untreated. British Journal Of Community Nursing, 21(3), 138-141. doi:10.12968/bjcn.2016.21.3.138


Gearing, R., MacKenzie, M., Ibrahim, R., Brewer, K., Batayneh, J., & Schwalbe, C. (2015). Stigma and Mental Health Treatment of Adolescents with Depression in Jordan. Community Mental Health Journal, 51(1), 111-117. doi:10.1007/s10597-014-9756-1


Health and Wellness Resource Center. (2008). Retrieved from


Langley, A., Santiago, C. D., Rodríguez, A., & Zelaya, J. (2013). Improving implementation of mental health services for trauma in multicultural elementary schools: stakeholder perspectives on parent and educator engagement. Journal Of Behavioral Health Services & Research, 40(3), 247-262. doi:10.1007/s11414-013-9330-6


Madianos, M., Zartaloudi, A., Alevizopoulos, G., & Katostaras, T. (2011). Attitudes Toward Help-Seeking and Duration of Untreated Mental Disorders in a Sectorized Athens Area of Greece. Community Mental Health Journal, 47(5), 583-593. doi:10.1007/s10597-011-9404-y


Membride, H. (2016). Mental health: early intervention and prevention in children and young people. British Journal Of Nursing, 25(10), 552-557.


Mental Health Foundation. (2017). Mental Health Foundation of New Zealand. Retrieved from


Ministry of Health. (2015). Youth Mental Health Project | Ministry of Health NZ. Retrieved from


Pirie, G. (2016). Raising Awareness of the Social Issues Around Mental Health. Podiatry Now, 19(11), 32-33


Prior, S. (2012). Young people's process of engagement in school counselling. Counselling & Psychotherapy Research, 12(3), 233-240. doi:10.1080/14733145.2012.660974


Queen Mary. (2017). Planning and Carrying Out a Literature Review: Introduction to Planning and Carrying Out a Literature Review. Retrieved from


Rosvall, P., & Nilsson, S. (2016). Gender-based generalisations in school nurses' appraisals of and interventions addressing students' mental health. BMC Health Services Research, 161-8. doi:10.1186/s12913-016-1710-1


Sandström, B., Willman, A., Svensson, B., & Borglin, G. (2014). Mapping attitudes and awareness with regard to national guidelines: an e-mail survey among decision makers. Journal Of Nursing Management, 22(7), 884-893. doi:10.1111/jonm.12061


Salerno, J. P. (2016). Effectiveness of Universal School-Based Mental Health Awareness Programs Among Youth in the United States: A Systematic Review. Journal Of School Health, 86(12), 922-931. doi:10.1111/josh.12461


Walsh, J., Scaife, V., Notley, C., Dodsworth, J., & Schofield, G. (2011). Perception of need and barriers to access: the mental health needs of young people attending a Youth Offending Team in the UK. Health & Social Care In The Community, 19(4), 420-428. doi:10.1111/j.1365-2524.2011.00991.x


Whitehead, D. (2013). Identifying research ideas, questions, statement & hypotheses. In Z. Schineider, D. Whitehead, G. LoBionda-Wood, & J. Haber. Nursing and midwifery research methods and appraisal for evidence-based practice (4th ed.). (p.57-76) Sydney, Australia: Mosby/Elsevier


van Kessel, K., Milne, D., Hunt, K., & Reed, P. W. (2012). Understanding inpatient violence in a New Zealand child and adolescent psychiatric setting. International Journal Of Mental Health Nursing, 21(4), 320-329. doi:10.1111/j.1447-0349.2011.00789.x


Zonneveld, R. (2014). A one-stop shop for Wellington youth. Kai Tiaki Nursing New Zealand, 20(7), 28-29.