Exploring Mental Health Barriers Among At-Risk Adolescents: An Integrative Analysis of Self-Reports and School Nurses’ Perspectives

In modern society, adolescents experiencing mental health problems are increasing. This study aims to identify barriers to mental health care at the individual, family, school, and staff levels among at-risk adolescents, employing a mixed-methods approach. Given the ethical and practical constraints of engaging at-risk adolescents directly, the study quantitatively analyzed responses to the AMPQ-III-I survey from 47 runaway adolescents, while conducting interviews with eight school nurses serving as proxy informants. The at-risk adolescents were found to be in a state of mental health crisis characterized by somatization, self-harm, excessive digital media use, and peer imitation. Within the family environment, they experienced communication gaps with adults, concerns about mental health stigma, and the risk of disengagement from home and school. Despite experiencing physical and emotional difficulties that hindered their ability to focus on academic work, schools tended to deprioritize mental health, and these adolescents reported notably low utilization of professional counseling. School nurses, although well-positioned to identify at-risk adolescents, expressed barriers such as excessive workload and a lack of communication among teachers. These findings suggest that, to support the growing and intensifying population of at-risk adolescents, an urgent shift in awareness and the alleviation of barriers within the family–school–staff ecosystem is required.