Barriers to professional mental health help-seeking and considerations for school-based interventions among Secondary School adolescents: an exploratory qualitative study

ABSTRACTProfessional mental health service use remains low among adolescents, and school-based interventions are frequently designed without consulting the young people and clinicians they are intended to serve. This exploratory qualitative study investigated the specific barriers to professional mental health help-seeking among Nigerian adolescents to inform the development of a culturally relevant school-based intervention. Following the ethical principles of the Belmont Report, a focus group discussion was conducted with ten secondary school students (aged 13–16), alongside individual in-depth interviews with two students and key informant interviews with two practicing clinical psychologists in Ibadan, Nigeria. Audio-recorded transcripts were verified and examined utilizing thematic analysis. Eight core categories emerged from the data, highlighting a limited formal understanding of mental health among youth and a prominent gap between baseline knowledge and help-seeking behaviors. While distress including depression, anxiety, addiction, and trauma was widely recognized through behavioral or academic declines, pervasive stigma and the fear of diagnostic labeling acted as dominant barriers to care, with nine out of ten adolescents refusing professional care pathways. Friends served as primary confidants, while parental spiritual beliefs heavily gatekept formal psychological interventions. Social media heavily informed adolescent self-image but introduced acute body-image concerns. Notably, one student preferred using an artificial intelligence chatbot over human contact to ensure absolute confidentiality. Participants requested foundational mental health literacy and coping skills delivered via brief, visual, interactive sessions, while clinicians anticipated systemic institutional implementation challenges regarding school leadership, funding deficits, and staffing constraints. Interventions must target social stigma and privacy constraints directly alongside conceptual awareness.