A holistic approach to adolescent suicide prevention combats stigma against mental health help-seeking

For the past five years the San Francisco Wellness Initiative (SF Wellness) has provided high school students with a holistic, coordinated system of health education, assessment, mental health counseling, and other support services through on-site school “Wellness Centers.” A premise of the program is that the deliberate bundling of physical and mental health services together in one center decreases stigma-related barriers for at-risk youth needing mental health services. We present results from thematic analyses of formative data collected in 2006 from 23 semi-structured individual interviews with students and parents from diverse cultural and socioeconomic backgrounds; 7 focus groups with Wellness staff and stakeholders; and service utilization data which support this premise. Constructs explored in the interviews and focus groups included barriers and facilitators to seeking help for factors correlated with suicide risk in adolescents (e.g., depression). Students reported that the bundling of physical and mental health services decreased perceived stigma problems because other students didn't know what services students attending Wellness Centers might be receiving. Staff reported that bundling provided a key point of accessibility – students might present with a non-stigmatized issue like a stomach ache, but still be linked to mental health services if appropriate. The use of holistic Wellness Centers, with multiple points of entry, is a promising early intervention approach to adolescent suicide prevention, serving students all along the continuum from mental health “wellness” to imminent suicide risk.