“I’m tired of being pulled from pillar to post”: internet forums reveal barriers to care

“I’m tired of being pulled from pillar to post”: internet forums reveal barriers to care

6 April 2020

Orygen analysis of internet forums has identified key barriers to mental health care faced by young people who have experienced trauma.

Orygen researchers completed a qualitative analysis of online discussion threads about trauma which were posted to five internet forums (two in Australia, two in the US and one in the UK) over a two-week period.

Their findings, published online ahead of print in Early Intervention in Psychiatry, were that the barriers to care fell into two categories: relational and structural.

Senior researcher Associate Professor Sarah Bendall said the forums revealed surprising insights from previously hard-to-reach young people.

“We looked at the forums because we wanted to hear the voices that we weren’t hearing: the people who don't actually come into services,” Associate Professor Bendall said.

“When we started this research paper I thought ‘Oh it might be quite dry. People will be saying the obvious things: they can’t find a psychologist, the services are too far away’, that kind of thing.

“But the forum content was really raw and powerful. It became clear to us that it was difficult to separate the structural barriers to services from the relational barriers. We think the relational element was so very important for young people with trauma exposure because often that’s what’s been damaged.”

The kinds of relational barriers Orygen researchers identified included receiving invalidating responses from professionals, and young people feeling a lack of power over the therapy process.

Many forum posts included in the qualitative analysis also highlighted frustrations with having to rebuild therapeutic relationships.

“I don’t have anything against [mental health service] it’s just that I’ll be 18 soon and then I’ll have to leave [my current service]. I just feel like by the time they get my referral I’ll get just a couple of [therapy] sessions and then I’ll have to find yet another counsellor,” one young person posted online.

“I’m tired of being pulled from pillar to post and not getting enough time to get well again.”

Another common relational barrier was reluctance to disclose past trauma.

“I have a good relationship with my counsellor and was seriously considering telling her about [past trauma] … but sadly I’ve got four sessions left and my counsellor will have to stop seeing me,” a forum post stated.

The structural barriers Orygen researchers identified related to ineffective pathways to mental health services, lack of availability of professionals, and insufficient treatment.

Difficulties navigating the care system were also common.

“I just keep hitting the wall. I am trying my hardest to get help and there is just no one here who seems to be able to offer any unless you’re well off,” one post stated.

Lead researcher Carli Ellinghaus said the findings highlighted the need for health practitioners to receive trauma-informed mental health training.

“Trauma-informed care is care that doesn’t re-traumatise young people, it means moving from a paternalistic kind of care and partnering in the young person's journey,” Ms Ellinghaus said.

“Trauma-informed care means continually checking in, discovering and listening to young people because trauma-exposed young people may not feel comfortable sharing exactly what is going on.”

The research was funded by a grant from the McCusker Charitable Foundation.

Orygen has a range of resources on dealing with trauma for young people, their families and health professionals.

If you need help now the following support services are available. If it’s an emergency call 000.