A Matter of Trust

Parents’ Attitudes Toward Child Mental Health Information Sources

  • Rebecca Bonanno SUNY Empire State College
  • Kristina Veselak Gateway Community College
Keywords: mental health literacy, child mental health, stigma, trust


Mental health problems among children and adolescents are widespread. Parents seeking information about child mental health problems and treatments face numerous barriers, including fear of stigmatization and uncertainty about where to seek help. In this qualitative study, seven parents whose children had experienced a mental health, behavioral, or emotional problem were interviewed about their attitudes and beliefs about child mental health information sources. Analysis revealed that the concept of trust was an overarching theme in parents’ pursuit and evaluation of information. Related themes included a preference for information from other parents with experience parenting a child with a mental health problem; seeking information from knowledgeable professionals with whom the parents had personal relationships; concerns about confidentiality and protection of privacy; and involvement of school personnel when seeking mental health information and help. Findings support the need for improved mental health literacy among parents and suggest that social workers should play a more active role in educating families and service providers about child mental health.


Behnia, B. (2008). Trust development: A discussion of three approaches and a proposed alternative. British Journal of Social Work, 38(7), 1425-1441.

doi: https://doi.org/10.1093/bjsw/bcm053

Bilsen, J. (2018). Suicide and youth: Risk factors. Frontiers in Psychiatry, 9, 540-544.

Boulter, E., & Rickwood, D. (2014). Parents’ experience of seeking help for children with mental health problems. Advances in Mental Health, 11(2), 131-142.

doi: https://doi.org/10.5172/jamh.2013.11.2.131

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.

doi: https://doi.org/10.1191/1478088706qp063oa

Bringewatt, E. H., & Gershoff, E. T. (2010). Falling through the cracks: Gaps and barriers in the mental health system for America's disadvantaged children. Children and Youth Services Review, 32(10), 1291-1299.

doi: https://doi.org/10.1016/j.childyouth.2010.04.021

Brown, P., Calnan, M., Scrivener, A., & Szmukler, G. (2009). Trust in mental health services: A neglected concept. Journal of Mental Health, 18(5), 449-458.

doi: https://doi.org/10.3109/09638230903111122

Bussing, R., Gary, F. A., Mills, T. L., & Garvan, C. W. (2007). Cultural variations in parental health beliefs, knowledge, and information sources related to attention-deficit/hyperactivity disorder. Journal of Family Issues, 28(3), 291-318.

doi: https://doi.org/10.1177/0192513x06296117

Christensen, M. (2013). Trust, social work and care ethics an exploration of the Luhmannian concept of trust and social work with children at risk: Relating Luhmann’s concept of trust to the ethics of care. In H. Warming (Ed.), Participation, citizenship and trust in children’s lives: Studies in childhood and youth (pp. 114-141). London: Palgrave Macmillan. doi: https://doi.org/10.1057/9781137295781_7

Collishaw, S. (2015). Annual research review: Secular trends in child and adolescent mental health. Journal of Child Psychology and Psychiatry, 56(3), 370-393.

doi: https://doi.org/10.1111/jcpp.12372

Costello, E. J., Pescosolido, B. A., Angold, A., & Burns, B. J. (1998). A family network-based model of access to child mental health services. Research in Community and Mental Health, 9, 165-190.

Daly, B. (2004). Using concept maps in qualitative research. In A. Cañas, J. Novak, & F. González (Eds.), Concept maps: Theory, methodology, technology; Proceedings from the First International Conference on Concept Mapping (pp. 191-197.) Pamplona, Navarre, Spain: Public University of Navarre. Retrieved from http://cmc.ihmc.us/cmc-proceedings/

Diviani, N., van den Putte, B., Giani, S., & van Weert, J. C. (2015). Low health literacy and evaluation of online health information: A systematic review of the literature. Journal of Medical Internet Research, 17(5), e1-16.

doi: https://doi.org/10.2196/jmir.4018

Eschenbeck, H., Lehner, L., Hofmann, H., Bauer, S., Becker, K., Diestelkamp, S., ... & Salize, H. J. (2019). School-based mental health promotion in children and adolescents with StresSOS using online or face-to-face interventions: Study protocol for a randomized controlled trial within the ProHEAD Consortium. Trials, 20(1), e1-12. doi: https://doi.org/10.1186/s13063-018-3159-5

Florida Institute for Human & Machine Cognition [IHMC]. (2019). CMap software. Retrieved from https://cmap.ihmc.us/

Franklin, C. G. S., Kim, J. S., Ryan, T. N., Kelly, M. S., & Montgomery, K. L. (2012). Teacher involvement in school mental health interventions: A systematic review. Children and Youth Services Review, 34(5), 973-982.

doi: https://doi.org/10.1016/j.childyouth.2012.01.027

Gaebel, W., Muijen, M., Baumann, A. E., Bhugra, D., Wasserman, D., Van der Gaag, R. J., ... Zielasek, J. (2014). EPA guidance on building trust in mental health services. European Psychiatry, 29(2), 83-100.

doi: https://doi.org/10.1016/j.eurpsy.2014.01.001

Goodkind, J. R., Ross-Toledo, K., John, S., Hall, J. L., Ross, L., Freeland, L., ... & Lee, C. (2010). Promoting healing and restoring trust: Policy recommendations for improving behavioral health care for American Indian/Alaska Native adolescents. American Journal of Community Psychology, 46(3-4), 386-394.

doi: https://doi.org/10.1007/s10464-010-9347-4

Harrison, M. E., McKay, M. M., & Bannon, W. M. (2004). Inner-city child mental health service use: The real question is why youth and families do not use services. Community Mental Health Journal, 40(2), 119-131.

doi: https://doi.org/10.1023/b:comh.0000022732.80714.8b

Heisler, E. (2018). The mental health workforce: A primer. Congressional Research Service Report No. R43255. Retrieved from https://fas.org/sgp/crs/misc/R43255.pdf

Joffe, H. (2012). Thematic analysis. In D. Harper & A. R. Thompson (Eds.), Qualitative research methods in mental health and psychotherapy: A guide for students and practitioners (pp. 210-223), Chichester: Wiley.

doi: https://doi.org/10.1002/9781119973249.ch15

Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231-243.

doi: https://doi.org/10.1037/a0025957

Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B., & Pollitt, P. (1997). "Mental health literacy": A survey of the public’s ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166, 182-186. doi: https://doi.org/10.5694/j.1326-5377.1997.tb140071.x

Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548-1555. doi: https://doi.org/10.1176/appi.ajp.159.9.1548

Kazdin, A. E., Holland, L., & Crowley, M. (1997). Family experience of barriers to treatment and premature termination from child therapy. Journal of Consulting and Clinical Psychology, 65(3), 453-463. doi: https://doi.org/10.1037//0022-006x.65.3.453

Kelly, M. S., Berzin, S. C., Frey, A., Alvarez, M., Shaffer, G., & O’Brien, K. (2010). The state of school social work: Findings from the national school social work survey. School Mental Health, 2(3), 132-141. doi: https://doi.org/10.1007/s12310-010-9034-5

Kerkorian, D., McKay, M., & Bannon, Jr., W. M. (2006). Seeking help a second time: Parents'/caregivers' characterizations of previous experiences with mental health services for their children and perceptions of barriers to future use. American Journal of Orthopsychiatry, 76(2), 161-166. doi: https://doi.org/10.1037/0002-9432.76.2.161

Lambert, S. D., & Loiselle, C. G. (2007). Health information-seeking behavior. Qualitative Health Research, 17(8), 1006-1019.

doi: https://doi.org/10.1177/1049732307305199

Lewis, J. D., & Weigert, A. (1985). Trust as a social reality. Social Forces, 63(4), 967-985. doi: https://doi.org/10.1093/sf/63.4.967

Lindsey, M. A., Joe, S., & Nebbitt, V. (2010). Family matters: The role of mental health stigma and social support on depressive symptoms and subsequent help seeking among African American boys. Journal of Black Psychology, 36(4), 458-482.

doi: https://doi.org/10.1177/0095798409355796

Mackintosh, V. H., Myers, B. J., & Goin-Kochel, R. P. (2005). Sources of information and support used by parents of children with autism spectrum disorders. Journal on Developmental Disabilities, 12(1), 41-51.

McGorry, P. D., Purcell, R., Goldstone, S., & Amminger, G. P. (2011). Age of onset and timing of treatment for mental and substance use disorders: Implications for preventive intervention strategies and models of care. Current Opinion in Psychiatry, 24(4), 301-306. doi: https://doi.org/10.1097/yco.0b013e3283477a09

Mendenhall, A. N. (2012). Predictors of service utilization among youth diagnosed with mood disorders. Journal of Child and Family Studies, 21(4), 603-611.

doi: https://doi.org/10.1007/s10826-011-9512-x

Mendenhall, A. N., & Frauenholtz, S. (2013). Mental health literacy: Social work’s role in improving mental health. Social Work, 58(4), 365-368.

doi: https://doi.org/10.1093/sw/swt038

Mendenhall, A. N., Fristad, M. A., & Early, T. J. (2009). Factors influencing service utilization and mood symptom severity in children with mood disorders: Effects of multifamily psychoeducation groups (MFPGs). Journal of Consulting and Clinical Psychology, 77(3), 463-473. doi: https://doi.org/10.1037/a0014527

Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L.,...Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980-989. doi: https://doi.org/10.1016/j.jaac.2010.05.017

Miller, L., Musci, R., D’Agati, D., Alfes, C., Beaudry, M. B., Swartz, K., & Wilcox, H. (2019). Teacher mental health literacy is associated with student literacy in the Adolescent Depression Awareness Program. School Mental Health, 11(2), 357-363. doi: https://doi.org/10.1007/s12310-018-9281-4

Möllering, G. (2001). The nature of trust: From Georg Simmel to a theory of expectation, interpretation and suspension. Sociology, 35(2), 403-420.

doi: https://doi.org/10.1017/s0038038501000190

Moses, T. (2010). Being treated differently: Stigma experiences with family, peers, and school staff among adolescents with mental health disorders. Social Science & Medicine, 70(7), 985-993. doi: https://doi.org/10.1016/j.socscimed.2009.12.022

Murray, B., & McCrone, S. (2015). An integrative review of promoting trust in the patient–primary care provider relationship. Journal of Advanced Nursing, 71(1), 3-23. doi: https://doi.org/10.1111/jan.12502

O’Connell, M. E., Boat, T., & Warner, K. E. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities (Vol. 7). Washington, DC: National Academies Press. doi: https://doi.org/10.17226/12480

Oh, E., Mathers, M., Hiscock, H., Wake, M., & Bayer, J. (2015). Professional help seeking for young children with mental health problems. Australian Journal of Psychology, 67(3), 187-195. doi: https://doi.org/10.1111/ajpy.12072

Olfson, M., Druss, B. G., & Marcus, S. C. (2015). Trends in mental health care among children and adolescents. New England Journal of Medicine, 372(21), 2029-2038. doi: https://doi.org/10.1056/nejmsa1413512

Oliver, J. M., Reed, C. K., Katz, B. M., & Haugh, J. A. (1999). Students’ self-reports of help-seeking: The impact of psychological problems, stress, and demographic variables on utilization of formal and informal support. Social Behavior and Personality: An International Journal, 27(2), 109-128. https://doi.org/10.2224/sbp.1999.27.2.109

Perou, R., Bitsko, R. H., Blumberg, S. J., Pastor, P., Ghandour, R. M., Gfroerer, J. C.,...Parks, S. E. (2013). Mental health surveillance among children – United States, 2005–2011. Morbitity and Mortality Weekly Report, 62(2/Supplement), 1-35.

Perry, Y., Petrie, K., Buckley, H., Cavanagh, L., Clarke, D., Winslade, M.,...Christensen, H. (2014). Effects of a classroom-based educational resource on adolescent mental health literacy: A cluster randomised controlled trial. Journal of Adolescence, 37(7), 1143-1151. doi: https://doi.org/10.1016/j.adolescence.2014.08.001

Pescosolido, B. A. (2013). The public stigma of mental illness: What do we think; what do we know; what can we prove? Journal of Health and Social Behavior, 54(1), 1-21. doi: https://doi.org/10.1177/0022146512471197

Pescosolido, B. A., Jensen, P. S., Martin, J. K., Perry, B. L., Olafsdottir, S., & Fettes, D. (2008). Public knowledge and assessment of child mental health problems: Findings from the National Stigma Study-Children. Journal of the American Academy of Child & Adolescent Psychiatry, 47(3), 339-349.

doi: https://doi.org/10.1097/chi.0b013e318160e3a0

Reardon, T., Harvey, K., Baranowska, M., O’Brien, D., Smith, L., & Creswell, C. (2017). What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. European Child and Adolescent Psychaitry, 26(6), 930-936. doi: https://doi.org/10.1007/s00787-016-0930-6

Reinke, W. M., Stormont, M., Herman, K. C., Puri, R., & Goel, N. (2011). Supporting children's mental health in schools: Teacher perceptions of needs, roles, and barriers. School Psychology Quarterly, 26(1), 1-13. doi: https://doi.org/10.1037/a0022714

Rickwood, D., Deane, F. P., Wilson, C. J., & Ciarrochi, J. (2005). Young people’s help-seeking for mental health problems. Ausralian E-journal for the Advancement of Mental Health, 4(3), 218-251. doi: https://doi.org/10.5172/jamh.4.3.218

Rickwood, D., & Thomas, K. (2012). Conceptual measurement framework for help-seeking for mental health problems. Psychology Research and Behavior Management, 5, 173-183. doi: https://doi.org/10.2147/prbm.s38707

Shanley, D. C., Reid, G. J., & Evans, B. (2008). How parents seek help for children with mental health problems. Administration and Policy in Mental Health and Mental Health Services Research, 35(3), 135-146. doi: https://doi.org/10.1007/s10488-006-0107-6

Smith, C. (2004). Trust and confidence: Making the moral case for social work. Social Work and Social Sciences Review, 11(3), 5-15.

doi: https://doi.org/10.1921/17466105.11.3.5

Stiffman, A. R., Pescosolido, B., & Cabassa, L. J. (2004). Building a model to understand youth service access: The gateway provider model. Mental Health Services Research, 6(4), 189-198. doi: https://doi.org/10.1023/b:mhsr.0000044745.09952.33

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2018). SAMHSA is announcing up to $210 million for Project Aware State Education Agency grants [press release]. Retrieved from https://www.samhsa.gov/newsroom/press-announcements/201804091100.

Thom, D. H., Hall, M. A., & Pawlson, L. G. (2004). Measuring patients’ trust in physicians when assessing quality of care. Health Affairs, 23(4), 124-132.

doi: https://doi.org/10.1377/hlthaff.23.4.124

Tustin, N. (2010). The role of patient satisfaction in online health information seeking. Journal of Health Communication, 15(1), 3-17.

Verhaeghe, M., & Bracke, P. (2011). Stigma and trust among mental health service users. Archives of Psychiatric Nursing, 25(4), 294-302.

doi: https://doi.org/10.1016/j.apnu.2011.02.001

Walsh, A. M., Hamilton, K., White, K. M., & Hyde, M. K. (2015). Use of online health information to manage children’s health care: A prospective study investigating parental decisions. BMC Health Services Research, 15, 131-141.

doi: https://doi.org/10.1186/s12913-015-0793-4

Whitley, J., Smith, J. D., & Vaillancourt, T. (2013). Promoting mental health literacy among educators: Critical in school-based prevention and intervention. Canadian Journal of School Psychology, 28(1), 56-70.

doi: https://doi.org/10.1177/0829573512468852

Zwaanswijk, M., Verhaak, P. F., Bensing, J. M., Van der Ende, J., & Verhulst, F. C. (2003). Help seeking for emotional and behavioural problems in children and adolescents. European Child & Adolescent Psychiatry, 12(4), 153-161.

doi: https://doi.org/10.1007/s00787-003-0322-6