mental health case study questions

72 Mental Health Questions for Counselors and Patients

Is it the same as happiness?

Or is it simply the absence of mental illness?

Whether you are a professional therapist or want to help a friend in need, it helps to have some mental health questions up your sleeve.

You may not be able to diagnose someone who isn’t doing 100%, but with a little insight into their state of mind, you can play a valuable role in supporting them to get the help they need.

In this article, we’ll cover some mental health questions to ask yourself, your clients, or even your students. Read on to learn more.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises will explore fundamental aspects of positive psychology including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains:

What are mental health questions, mental health questions, 5 examples of common mental health questions for risk assessment and evaluation, 20 mental health interview questions a counselor should ask, 10 mental health questions aimed at students, 7 questions for group discussion, common mental health research questions, 9 mental health questions a patient can ask, 12 questions to ask yourself, 9 self-reflection questions, a take-home message.

Let’s start with a definition of mental health – more precisely, what it isn’t. In the article The Mental Health Continuum : From Languishing to Flourishing , positive psychologist Corey Keyes (2002) is very adamant about not oversimplifying the mental health concept, writing:

“mental health is more than the presence and absence of emotional states.”

Recapping the definition of a syndrome from the clinical literature, he then reminds us of the following:

“[a syndrome is] … a set of symptoms that occur together.”

Finally, Keyes argues that we can challenge the idea that syndromes are all about suffering. Instead, he argues that can we view mental health as:

“a syndrome of symptoms of an individual’s subjective well-being” or “a syndrome of symptoms of positive feelings and positive functioning in life.”

The right questions can give you insight into others’ wellbeing and promote the benefits of mental health .

These questions also help you:

Show your concern for someone who is struggling
Open up a dialogue about their mental state
Trigger them to reflect on their overall wellbeing
Prompt or encourage them to seek professional help if it is necessary

To get a clearer idea of these questions, let’s consider some examples.

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Where do you take a mental health conversation once you’ve opened with, “ How are you feeling? ”

For professionals, it might help to screen your client for any disorders or distress. The Anxiety and Depression Detector (Means-Christensen, Sherbourne, Roy-Byrne, Craske, & Stein, 2006) can help you assess depression and anxiety disorders, and it’s only five questions long (O’Donnell, Bryant, Creamer, & Carty, 2008).

You may want to tweak some of these questions to make them more relevant to your client.

Have you ever experienced a terrible occurrence that has impacted you significantly? Examples may include being the victim of armed assault, witnessing a tragedy happen to someone else, surviving a sexual assault, or living through a natural disaster.
Do you ever feel that you’ve been affected by feelings of edginess, anxiety, or nerves?
Have you experienced a week or longer of lower-than-usual interest in activities that you usually enjoy? Examples might include work, exercise, or hobbies.
Have you ever experienced an ‘attack’ of fear, anxiety, or panic?
Do feelings of anxiety or discomfort around others bother you?

These are just a few examples, and they are primarily concerned with identifying any potential signs of anxiety and depression. By design, they do not assess indicators of wellbeing, such as flourishing, life satisfaction, and happiness.

If you want to find out more about the latter, we have some great articles about Life Satisfaction Scales , as well as Happiness Tests, Surveys, and Quizzes and mental health exercises .

Open-ended questions are never a bad thing when you’re trying to start a discussion about mental health.

A study by Connell, O’Cathain, and Brazier (2014) suggested that seven quality of life domains are particularly relevant to a counselor who wants to open up dialogue with a client: physical health, wellbeing, autonomy, choice and control, self-perception, hope and hopelessness, relationships and belonging, and activity.

Physical health

Questions of this type were related to feelings such as agitation, restlessness, sleep, pain, and somatic symptoms. Examples of prompts to investigate this domain could include:

Tell me about your sleeping habits over the past X months. Have you noticed any changes? Difficulty sleeping? Restlessness?
How would you describe your appetite over the past X weeks? Have your eating habits changed in any way?

Wellbeing (and ill-being)

These questions looked at feelings of anxiety, distress, motivation, and energy. The ‘absence of negative feelings of ill-being,’ was understandably related to a higher perceived quality of life Connell et al., 2014). Sample prompts might include:

Could you tell me about any times over the past few months that you’ve been bothered by low feelings, stress, or sadness?
How frequently have you had little pleasure or interest in the activities you usually enjoy? Would you tell me more?

Autonomy, choice, and control

Questions about independence and autonomy were related to quality of life aspects such as pride, dignity, and privacy. Potential questions might include:

How often during the past X months have you felt as though your moods, or your life, were under your control?
How frequently have you been bothered by not being able to stop worrying?

Self-perception

Self-perception questions were related to patients’ confidence, self-esteem, and feelings of being capable of doing the things they wanted to do. Counselors might want to use the following prompts:

Tell me about how confident you have been feeling in your capabilities recently.
Let’s talk about how often you have felt satisfied with yourself over the past X months.

Hope and hopelessness

These questions ask about the patient’s view of the future, their hopes and goals, and the actions they were taking toward them.

How often over the past few weeks have you felt the future was bleak?
Can you tell me about your hopes and dreams for the future? What feelings have you had recently about working toward those goals?

Relationships and belonging

These questions consider how the client felt they ‘fit in with society,’ were supported, and possessed meaningful relationships. Examples include:

Describe how ‘supported’ you feel by others around you – your friends, family, or otherwise.
Let’s discuss how you have been feeling about your relationships recently.

The more purposeful, meaningful, and constructive a client perceived their activities to be, the better.

Tell me about any important activities or projects that you’ve been involved with recently. How much enjoyment do you get from these?
How frequently have you been doing things that mean something to you or your life?

Read our post on mental health activities to assist clients in this area.

Mental health questions for students

Other self-efficacy and life skills measures could give us a good idea of some example mental health questions for students. The following may help:

Academic self-efficacy questions for students

How much confidence do you have that you can successfully:

Complete homework within deadlines?
Focus on school subjects?
Get information on class assignments from the library?
Take part in class discussions?
Keep your academic work organized?

Mental health questions (World Health Organization, 2013)

Over the last 12 months, how frequently have you felt so worried about something that you were unable to sleep at night?
Over the last 12 months, how frequently have you felt alone or lonely?
Over the last 12 months, how often did you seriously consider attempting suicide?
Over the last 12 months, did you ever plan how you might attempt suicide?
How many close friends would you say you have?

As with all the other questions in this article, you’ll probably want to tweak and amend these items to suit your audience.

Your mental health questions answered – jacksepticeye

The catch-all term “mental health group” can refer to several different things. Mental health groups may gather together for therapy or may be more informal peer support groups. You may also find yourself part of a group that’s purely for friends, family, and carers of those whose mental health is a concern.

Whatever group you find yourself in, the World Health Organization (2017) has some suggestions that will help you create a safe and productive space.

Mental health group best practices

Everything that is said in therapy should remain confidential; nothing from the discussion should be shared outside of the group setting.

Bear in mind that not everyone in the discussion will be at the same stage. Some may be new, others may be more seasoned or regular visitors.

Recognize that people won’t necessarily get along, but they all are welcome anyway.

Try not to view peer support or group discussions as a panacea for mental conditions. While they may be a great place to get suggestions or clarity, mental health is about feeling good in more than one way. Participants or caregivers may also require coaching, counseling, or medication to feel better.

7 Group questions

What questions can we ask to get some discussion flowing in a mental health group?

You may want to start with a focus for your discussion. Ask someone to share a story, experience, or step in as a facilitator with a video about the theme at hand. If you are discussing the role of social support, for example, you may have a presentation or case study prepared on the importance of friends and family.

Once you’ve opened with your story or resource, try some of these to spark a discussion (Gruttadaro & Cepla, 2014):

How do you feel about the story you just heard? What was your first reaction? How about as the story unfolded?
What were your thoughts regarding the signs and symptoms of this mental health issue? Have you experienced any of these yourself or in someone you know?
How would you react if you noticed these in someone you care about?
How might taking action benefit you and the person you care about?
What actions could you take to help someone who is exhibiting these signs and symptoms?
What do you believe is important for anyone to be aware of if they know someone with this mental health issue?
What experiences have you had that are related to this story? What was similar? What differed?

Curious to know the top research questions related to mental health worldwide? Tomlinson et al. (2009) identified some of the key priorities for researchers to look at.

The group came up with 55 questions, and the top three topics included:

Health policy and systems research topics – e.g., How can health policy and systems research help us create parenting and social skills interventions for early childhood care in a cost-efficient, feasible, and effective way?
Cost-effective interventions for low-resource settings – e.g., How can affordable interventions be delivered in settings where resources are scarce?
Questions about child and teen mental disorders – e.g., How effective and cost-effective are school-based mental health treatments for special needs schoolchildren?

Engaging with your mental health practitioner is one of the best ways to get the most out of your check-ups. The healthcare system is changing, and gone are the days when a patient sat passively for a diagnosis or prescription (Rogers & Maini, 2016).

These days, arguably, medical dialogues place more emphasis on helping a client help themselves through information, education, and commitment to a better lifestyle. It’s good news indeed for anyone who wants to get proactive about their mental health. So what should you be asking your practitioner?

Before committing to a mental health practitioner, you’ll need to know a few things about the services they provide. Many therapists can provide psychological treatments but aren’t able to prescribe medication. You’ll need a psychiatrist or physician for that.

Bear this in mind, and consider the following questions when you’re deciding whether a provider is right for you (Association for Children’s Mental Health, n.d.; Think Mental Health, n.d.):

What is your experience with treating others with my mental health condition?
Will you be able to collaborate or liaise with my physician on an integrated care plan?
What does a typical appointment with you look like?
What treatments or therapies are you licensed to administer?
Are there benefits or risks that I should know about these therapies?
What is the general time frame in which most patients will see results?
How will I know if the treatment is having an effect?
How long does this type of treatment last?
What does research say about this type of treatment?

It is an awareness-raising campaign that encourages us to tune in early to the symptoms of mental illness.

But, of course, you can always check in with yourself as regularly as you like.

Example questions about wellbeing

The Canadian Mental Health Association (n.d.) provides some self-report questions that you can start with; these questions cover six areas and require only agree/disagree responses. Try some of these as an example:

Sense of self questions– e.g., I see myself as a good person. I feel that others respect me, yet I can still feel fine about myself if I disagree with them.
Sense of belonging questions – e.g., I have others around me who support me. I feel positive about my relationships with others and my interpersonal connections.
Sense of meaning or purpose questions – e.g., I get satisfaction from the things I do. I challenge my perspectives about the world and what I believe in.
Emotional resilience questions – e.g., I feel I handle things quite well when obstacles get in my way. I accept that I can’t always control things, but I do what I can when I can.
Enjoyment and hope questions – e.g., I have a positive outlook on my life. I like myself for who I am.
Contribution questions – e.g., The things that I do have an impact. My actions matter to those around me.

According to Rath and Clifton (2004), we each possess a metaphorical bucket representing our emotional and mental wellbeing. This imaginary bucket can be empty, full, or anywhere in between, and it undergoes a continuous process of filling (through positive interactions) and emptying (through negative interactions).

We feel energized, happy, and content when our buckets are full. When our buckets run low or empty, we can easily become negative, insecure, and defensive.

Having positive, meaningful interactions and showing kindness not only makes us feel good and fills our buckets but also fills the buckets of those around us. When our bucket is full, we are more inclined to fill the buckets of others.

However, when our bucket is running low or empty, we don’t have anything left to give to ourselves, let alone others. Therefore, it’s important to show kindness and compassion to ourselves to fill our bucket back up before we can service the buckets of others.

Elsewhere on PositivePsychology.com, we’ve written about the many potential benefits of narrative therapy . If you’re looking for some writing or journal prompts to help you get started, you can try putting your responses to these questions down on paper (Post Trauma Institute, 2019).

Have my sleeping habits changed? Do I wake up and fall asleep at regular times? When I sleep, how would I describe the quality of my rest?
How has my appetite increased or decreased recently?
Am I having trouble focusing at work or school? Can I concentrate on the things I want to do? Do I find pleasure in things that usually make me happy?
Am I socializing with my friends as much as I usually do? How about spending time with my family? Am I withdrawing or pulling away from those around me who matter?
Do I feel like I’m maintaining a healthy balance between leisure, myself, my career, physical activity, and those I care about? How about other things that matter to me?
How relaxed do I feel most of the time, out of 10? Is this the same, more, or less than usual?
How do I feel most of the time? Happy? Anxious? Satisfied? Sad?
What are my energy levels like when I finish my day? Are there any significant changes in my tiredness?
Am I having any extreme emotions or mood swings? Any suicidal thoughts, breakdowns, or panic attacks?

It may help to keep track of your responses over time and take notice of any differences in your answers. It should go without saying that the earlier you seek out any help you may need, the better. Consider reading one of these recommended mental health books if you are still unsure about seeking help.

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Mental health is not about the absence of mental illness. When we take the time to ask ourselves and others about our mental states, we can potentially make some crucial steps toward wellbeing.

As Keyes (2002) describes, we can think of our mental health as a continuum, with languishing at one end and flourishing at the other. By starting a dialogue and showing that we care, we can help each other get the help we need and potentially begin to feel better.

What questions have you asked yourself before? And what would you add to our list? Let us know in the comments below!

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

Association for Children’s Mental Health. (n.d.). Questions to ask your mental health professional about treatment options, medications, and more. Retrieved July 29, 2021 from http://www.acmh-mi.org/get-information/childrens-mental-health-101/questions-ask-treatment/
Bashir, L. (2018). Mental health among senior secondary school students in relation to life skills and self-efficacy. International Journal of Multidisciplinary Research Review, 3 (9), 587–591.
Canadian Mental Health Association. (n.d.). Check in on your mental health. Retrieved from https://mentalhealthweek.ca/check-in-on-your-mental-health/
Connell, J., O’Cathain, A., Brazier, J. (2014). Measuring quality of life in mental health: Are we asking the right questions? Social Science & Medicine , 120 , 12–20.
Keyes, C. L. (2002). The mental health continuum: From languishing to flourishing in life. Journal of Health and Social Behavior, 43 , 207–222.
Means-Christensen, A. J., Sherbourne, C. D., Roy-Byrne, P. P., Craske, M. G., & Stein, M. B. (2006). Using five questions to screen for five common mental disorders in primary care: Diagnostic accuracy of the Anxiety and Depression Detector. General Hospital Psychiatry, 28 (2), 108–118.
Mental Health America. (n.d.a). Questions to ask a provider. Retrieved July 29, 2021, from https://www.mhanational.org/questions-ask-provider/
Mental Health America. (n.d.b). Mental health screening tools . Retrieved July 29, 2021, from https://screening.mhanational.org/screening-tools
Gruttadaro, D., & Cepla, E. (2014). Say it out loud: NAMI discussion group facilitation guide. National Alliance on Mental Illness. Retrieved July 29, 2021, from https://www.nami.org/getattachment/Get-Involved/Raise-Awareness/Engage-Your-Community/Say-it-Out-Loud/Say-it-Out-Loud-Discussion-Group-Facilitation-Guide.pdf
O’Donnell, M. L., Bryant, R. A., Creamer, M., & Carty, J. (2008). Mental health following traumatic injury: Toward a health system model of early psychological intervention. Clinical Psychology Review, 28 (3), 387–406.
Post Trauma Institute. (2019). How to do a mental health check-up DIY style! Retrieved from https://www.posttraumainstitute.com/how-to-do-a-mental-health-check-up-diy-style/
Rath, T., & Clifton, D. O. (2004). How full is your bucket? Positive strategies for work and life . Gallup Press.
Rogers, J., & Maini, A. (2016). Coaching for health: Why it works and how to do it. Open University Press.
Saatchi, M., Kamkkari, K., & Askarian, M. (2010). Life skills questionnaire. Psychological Tests Publish Edits, 85 .
Singh, A. K., & Narain, S. (2014). Manual for Self-Efficacy Scale. National Psychological Corporation.
Talesara, S., & Bano, A. (2017). Mental Health Scale. National Psychological Corporation.
Think Mental Health. (n.d.). Questions to ask your GP – What to discuss. Retrieved from https://www.thinkmentalhealthwa.com.au/mental-health-support-services/how-your-gp-can-help/questions-to-ask-your-gp/
Tomlinson, M., Rudan, I., Saxena, S., Swartz, L., Tsai, A. C., & Patel, V. (2009). Setting priorities for global mental health research. Bulletin of the World Health Organization , 87 (6), 438–446.
World Health Organization. (2013). Global school-based student health survey: 2013 core questionnaire modules. Retrieved July 29, 2021, from http://www.who.int/entity/chp/gshs/GSHS_Core_Modules_2013_English.pdf
World Health Organization. (2017). Creating peer support groups in mental health and related areas: WHO QualityRights training to act, unite, and empower for mental health (pilot version) (No. WHO/MSD/MHP/17.13).

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Thank you so much for this helpful resource. As a masters student for Public Health Nursing, I found these questions helpful ice breakers for me to use for a focus-group collection strategy paper I am writing (questions were modified, of course to my topic). Thank you!

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Would like to thank the writer of this article. Used some of these questions to design a mental health survey for our website project to raise awareness about early treatment of mental illnesses. Really informative and useful to raise in-depth questions and start meaningful conversations. Thank you so much!

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Counseling Across the Lifespan: Prevention and Treatment

Student resources, case study questions.

CASE EXAMPLE

Jolanna is a 20-year-old African American woman who has come to see you at the community mental health center following a visit to the psychiatric emergency room (ER). She presented at the ER saying that she was hearing voices and needed to get back on her medication right away. She was evaluated and treated with a prescription for Geodon and given a follow-up appointment with you. Her presenting diagnosis is major depressive disorder with psychotic features.

Jolanna is the mother of two young children, ages 4 months and 3 years, and lives alone in an apartment with support from a Section 8 voucher. She started taking courses at the community college 9 months ago and has a part-time job at McDonald’s. Jolanna aged out of the foster care system at age 18 and was supported by a caseworker and transitional living program until the time she officially left the system. She currently reports some support from an aunt who visits and gives her money occasionally and from her boyfriend, Zeus, who is the father of her youngest child. She reports that he can sometimes get violent and he does not like her taking medications or getting counseling. She recently tried to reconnect with her mother but found that her mother was consumed with a substance use addiction and did not want to spend time with Jolanna or get to know her grandkids.

Jolanna tells you that she has had a long history of problems with depression starting at age 10, when she was removed from her mother’s home after being sexually abused by her mom’s boyfriend. She stated that she had been “passed around” by her mother for years and had faced things that she “just doesn’t want to talk about.” She says that her first episode of depression began after she was taken from her mother’s home and placed in foster care.

She reported withdrawing from everyone and just crying in her room for weeks. She also reported episodes of rage during which she would become aggressive and throw things around the house and scream uncontrollably. Because of these problems, she had trouble maintaining a stable placement. She was in and out of residential treatment and foster homes and had seven placements during the time she was in foster care. While in foster care, she consistently took medications for depression and aggression, but she stopped taking the medications within a month after leaving state custody. She says that she wanted to see what she was like off of medication and that she didn’t have time, between school, work, and her kids, to get to a psychiatrist appointment. She did well for a while and felt that she was managing all right without the treatment until she had her last baby 4 months ago. The baby does not sleep much and has a medical condition that requires her to make frequent visits to the pediatrician.

Jolanna began having trouble getting out of bed and felt she wasn’t caring for either of her children well. She began thinking about trying to get back on medication, but she didn’t know whom to call. When she began hearing voices telling her to kill herself, she called her aunt and asked her to take the kids so she could go to the ER. In addition to getting on the medications, Jolanna is hoping that counseling can help her to get over her past. She thinks her anger and depression are probably caused by the hard life she has had. She says that she knows that it’s time to do something about this because she wants to be a better mother and give her kids a better life than she had.

DISCUSSION QUESTIONS

What barriers can you identify that may need to be addressed in getting Jolanna engaged into treatment?
What might you do to encourage Jolanna to come back and see you again?
What problems would you like to address with Jolanna while she is seeing you?
What type of treatment might you consider for Jolanna given the evidence presented in this chapter?
What are some of the challenges Jolanna faces that are specific to her transition into young adulthood?

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Pryjmachuk S, Elvey R, Kirk S, et al. Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study. Southampton (UK): NIHR Journals Library; 2014 Jun. (Health Services and Delivery Research, No. 2.18.)

Cover of Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study.

Chapter 5 the case study.

This chapter focuses on Stage 2, the empirical – or ‘primary research’ – aspect of the study, which we conducted using the case study method. We start with an outline of the specific research methods used, after which we provide a descriptive overview of the individual case study sites; we then present our findings, organised according to a number of analytical themes.

This stage of the project was designed to inform research objectives 3 and 4, which were concerned with, respectively, the factors influencing the acceptability of mental health self-care support services for CYP and the barriers affecting the implementation of such services. In addition, as with the mapping exercise (see Chapter 4 ), this stage of the study also helps realise objective 5, which was concerned with the interface between the NHS and other service providers in the provision of mental health self-care support services for CYP.

Stage 2 was conducted as a collective case study . A case study is an empirical enquiry that focuses on a single phenomenon in its real-life context, especially useful (as in our circumstances) when description or explanation is required. 181 Collective case studies are those in which multiple cases are studied simultaneously or sequentially in an attempt to generate a broad appreciation of a particular issue. 182 Yin 181 (p. 6) defines a ‘case’ as a ‘bounded entity’, a broad and flexible definition that allows the case to be as varied as an event, an individual, a service or a policy. In this project we have defined the case as a ‘mental health self-care support service for CYP in England and Wales’.

Sampling and recruitment

A purposive sampling strategy was employed to ensure that the various dimensions of the self-care support typology we derived from the mapping exercise and systematic reviews (see Chapter 4 , Table 19 ) were reflected in our sample. Accordingly, sites were recruited to include a variety of theoretical bases (e.g. cognitive–behavioural, social learning, recovery) and platforms (e.g. face-to-face or remote, group or individual). We also recruited on the basis of organisational characteristics, such as the sector the site operated in (e.g. NHS vs. local authority vs. voluntary sector) and the site leaders (e.g. health professionals vs. other trained workers vs. volunteers). It was also important to include key characteristics of the study population; thus, the sample included sites offering condition-specific and more generic support, CYP from different age groups, and different types of location (urban, rural) across England and Wales. Using the typology and these characteristics, six potential sites were selected from our sampling frame of 33 services (delivered by 27 providers), and these were approached to participate in the study. One site declined to participate so an alternative, similar in terms of typology dimensions and characteristics to the site that declined, was invited to participate and agreed.

The six sites which agreed to participate were:

a psychotherapy group for young people aged 14–17 years who self-harm and their families, provided by the NHS in an urban area of England
a group intervention (Dina School) for children aged 5–6 years with emotional and behavioural difficulties (EBD), based on The Incredible Years 183 programme and provided in rural Wales by the voluntary sector
a parenting group for parents of children with EBD, based on The Incredible Years 183 programme and operating in rural Wales as a joint NHS/local authority initiative
a resilience-focused family support service for families of children aged 5–14 years with emerging EBD, provided by the voluntary sector (but local authority funded) and operating in an urban area of England
a national, recovery-focused online support group for young people aged up to 25 years with eating disorders
a supported online cognitive–behavioural intervention (Beating the Blues 184 ) provided to young people aged 14–30 years with depression and/or anxiety by the voluntary sector in an urban area of England.

Recruitment of participants at the case study sites was also purposive in that it was driven by the characteristics of the particular self-care model employed. Additionally, to ensure a range of relevant perspectives, the views of younger, as well as older, children, and those of parents and staff with differing roles providing the services were sought.

Regarding the recruitment of service user participants (i.e. CYP and their parents), we received valuable advice from the SAG on engaging these participants in the study. Recruitment documentation (the covering letter, participant information sheets, contact form and consent/assent forms; see Research ethics and governance below) was developed with guidance and feedback from CYP. At five of the sites, staff provided the recruitment documentation to current and ex-service users (or to their parents if they were aged 14 years or below), via the post or by handing the documentation to users when they attended the self-care support service. Participants provided their contact details using the contact form and the researcher (Elvey) telephoned them to arrange the interview. For the eating disorders online support site, the study was publicised, including contact details for the research team, on a web page listing details of current research projects wanting to recruit participants, via an e-mail distribution list of service users who were willing to be contacted about research projects, and via the site’s Twitter feed. CYP participants were eligible to participate only if they were aged between 5 and 17 years. Although two of the sites (sites 5 and 6) did not offer services specifically tailored for CYP, they were eligible for this study because they did offer services to those under the age of 18 years. Non-professional participants (i.e. CYP and parents) were offered £10 in gift vouchers as a token of thanks for their participation.

Recruitment of staff at each site was facilitated via a key contact, usually a service manager, who not only took part in the research, but also identified additional relevant staff to invite as participants. At five of the six sites, staff were provided with the recruitment documentation, either through the post or in person by the researcher; at the eating disorders site, documentation was supplied via e-mail.

Research ethics and governance

Like all empirical research conducted within a university setting, the case study was subject to ethical approval by the host institution, the University of Manchester. Moreover, because the research involved potential access to NHS sites and NHS patients, the ethical aspects of the study required consideration by the NHS National Research Ethics Service (NRES) prior to any consideration by the university. Regulations introduced by NRES in 2011 185 allowed an expedited proportionate ethical review in circumstances where a project had no material ethical issues . NRES provides a tool 186 to help researchers identify whether there are material ethical issues or not, and use of this tool suggested that our project might be eligible for such an expedited review. This turned out to be the case and a favourable ethical opinion was obtained through proportionate review in March 2012. As is the standard procedure, this favourable opinion was accepted by the University of Manchester Research Ethics Office shortly afterwards. While conducting the case study research, it was necessary, on two occasions (in September 2012 and October 2012), to inform NRES of a ‘substantial amendment’ to the ethics-approved protocol. One amendment was required because one site requested that the wording on the covering letter be modified to remove the term ‘mental health’. The other arose because another site worked predominantly with children aged 5 years, so we asked that our original lower age limit for CYP participants be reduced from 6 to 5 years. Both of these amendments NRES subsequently approved.

Ethical research is underpinned by three inter-related factors: (1) informed consent; (2) the safety of participants and researchers; and (3) the safeguarding of any data obtained during the course of the research.

Regarding informed consent, all identifiable participants received an age-appropriate participant information sheet informing them of the study’s nature and purpose. The participant information sheets and associated consent/assent forms were designed according to NRES guidance. 187 The versions specific to CYP, furthermore, were piloted with colleagues’ children, students at a local secondary school and young people with experience of mental health services, and were subsequently amended as a result of their feedback. Written consent was obtained from all adult participants. In line with NRES guidance, 187 all CYP participants aged 15–17 years provided their own written consent; parents provided written consent for children under 15 years old, although, in line with good practice, written assent was also obtained from these children. We needed to take a slightly different approach to consent for the online eating disorders support group (site 5). We were interested in postings on the site’s discussion boards – postings that were both anonymous and publicly available. As the postings were anonymous, it would have been very difficult to obtain individual consent for the use of these postings, so we obtained ‘proxy’ consent to access and use these postings from the eating disorders organisation providing the service.

Regarding the safety of participants and researchers, the principal risks identified for participants were that they might get upset during the interview or disclose information (e.g. in relation to child protection) that would require action by the researcher. Written protocols were prepared for both of these situations. Risks to researcher safety were minimised by adherence to the University of Manchester’s guidance on lone working.

Data safeguarding requires that confidentiality and anonymity issues be addressed, not only in the conduct of the research but also in the reporting and storage of any data associated with the research. To preserve anonymity, the data generated by the research were, wherever possible, stored with identifying features removed. In any case, the data were stored securely, with due regard to confidentiality and in accordance with the University of Manchester’s information governance regulations. When the data were circulated around the study team or SAG, analysed or (as is the case here) reported, we ensured that any identifying features were removed.

At each case study site, we complied with any specific research governance requirements. This included complying with NHS Research and Development requirements at the NHS sites selected.

Data collection and management

Case study research requires data from a variety of sources and, once collected, the data should be managed systematically. 181 Data were obtained through semistructured interviews, documentary review and virtual non-participant observation and, wherever possible, from all three participant categories: CYP, parents and staff.

Semistructured interviews

Semistructured interviews were used as the main data collection technique. They were conducted with staff at all six sites and with CYP and/or parents at all sites except the eating disorders online support site. Pragmatism largely dictated the way in which participants were interviewed in that they were given choices as to which approach they preferred (e.g. telephone vs. face to face; individual vs. group). Forty-two interviews involving 52 participants were conducted; 37 were conducted in person, either at the site’s premises or at the service user’s home, and five were conducted via the telephone. The majority of interviews (35/42) were individual, five were joint interviews with a child or young person plus parent, one was a group interview with a child, parent and sibling and one was a focus group of four young people. The interviews ranged in length from 10 minutes (for some of the youngest children, aged 5 and 6 years) to 1 hour and 20 minutes. Interviews were facilitated by the use of topic guides, copies of which can be found in Appendix 12 . All of the interviews were digitally audio recorded with the permission of participants and the recordings were subsequently transcribed verbatim by a professional company.

Documentary review

Where available, relevant documentary evidence was collected from each site. For sites 5 and 6, documentary evidence was obtained simply from the relevant websites of the services. More comprehensive data were obtained from the other four sites, including a referrer’s leaflet for site 1 as well as a printed self-injury ‘toolkit’ used in providing the self-care support service there; a Microsoft PowerPoint general presentation about the Incredible Years services at sites 2 and 3, and one about the funder’s strategic plan regarding these services; an information leaflet about Dina School training for teachers at site 2; and information leaflets about the site 4 service for referrers, parents and CYP. The documentary evidence largely served to provide a contextual background to, and additional understanding of, the six sites.

Virtual non-participant observation

For the eating disorders online support site (site 5), we collected the data via ‘netnographic’ non-participation observation, adopting the principles of a method designed specifically for health-care research. 188 , 189 Netnography is a form of ethnography used in the study of online behaviour, and as ethnography concerns everyday routine behaviours in a natural setting, 190 netnography was an entirely appropriate method of observing a service that operated entirely online. The service centred around discussion threads that were organised by the providers into nine boards, following themes such as ‘recovery’, ‘caring about someone’, ‘introductions’ and ‘poetry’. Two boards were excluded from the study as the content merely described how to use the boards. All postings over a 4-month period (August to November 2012) were collected from the remaining seven boards. These comprised 114 discussion threads with more than 500 individual messages, each of which was screened for relevance. The postings were copied from the website and pasted into Microsoft Word 2010 documents (Microsoft Corporation, Redmond, WA, USA) prior to analysis.

Regarding management and coding of the data, the three data sets – interview transcripts, background information about the sites (documentary evidence) and the online group postings – were imported into NVivo 10 (QSR International, Warrington, UK), computer software designed to assist in the collection, organisation and analysis of qualitative and mixed-methods data.

Data analysis

The data were analysed using the framework method, 191 , 192 which has five stages: (1) familiarisation; (2) identifying a thematic framework; (3) indexing; (4) charting; and (5) mapping and interpretation. For the interview data, familiarisation was achieved by all of the transcripts being read by the team member who conducted the interviews (Elvey; Kendal also facilitated one group interview), and through other members of the research team (Kirk; Kendal; Pryjmachuk; Catchpole) each reading a sample of transcripts. For the virtual non-participation observation data (site 5’s online postings), Elvey and Kendal undertook an analogous process in that they treated the Word documents into which the postings had been pasted as ‘transcripts’. Following familiarisation, the study’s research questions and the topic guides (see Appendix 12 ) were used to devise an initial thematic framework. Using this initial framework, data from the transcripts (including the online postings) and the background documents obtained from each site were then indexed by Elvey in order to produce an initial chart for each of the six sites. An example of such a chart is provided in Appendix 13 . These six charts were then circulated around team members and a final thematic framework was developed through an iterative process, whereby we met as a team several times to discuss the data and any emerging salient themes. As the final thematic framework emerged, the data from the six initial charts were assimilated into a single chart which was used to guide our analysis and interpretation of the case study findings. The final thematic framework is outlined in Table 22 in the Findings section of this chapter, and Appendix 14 illustrates (using one of the themes, ‘facilitating self-care support’, as an example) how data from each of the initial charts were subsequently assimilated into a single chart.

Themes and subthemes emerging from the case study data

Characteristics of the case study sites

Details of the six case study sites are summarised in Table 20 and described in detail below.

Details of the six case study sites

Site 1: self-harm psychotherapy group

This NHS service was designed for young people aged 14–17 years who self-harm; it also offered some support for the families of these young people via family support groups, and families could telephone the service and talk to staff between sessions. The service was run from an outpatient setting at an NHS mental health hospital. The service operated within a recovery-focused philosophy and was eclectic in its approach, in that the group intervention employed elements of group psychotherapy, CBT, Linehan’s dialectical behaviour therapy 193 and supportive counselling. Groups ran on a weekly basis (weekday mornings), lasted 2 hours and were led by nurses and support workers. Although the service was manualised – in that there was a specific protocol in place for how the service should be delivered – there was no limit, other than reaching the age of 18 years, to the number of weekly sessions a young person could attend. Young people were referred to the service via community or inpatient services.

Site 2: Dina School

The incredible years.

The group for children with emotional and behavioural problems (site 2) and the parenting group (site 3) were interconnected, but separate, services. Both operated as part of Webster-Stratton’s The Incredible Years programme 183 that had been adopted region-wide (across the local authority area) by the commissioning bodies in the region. The Incredible Years is an evidence-based programme, influenced heavily by social learning theory. It emphasises attachment, relationship building and emotional coaching, with a focus on children learning through play and parents and teachers spending time with children, listening to them and giving them positive feedback. The overall Incredible Years programme comprises universal and targeted (indicated) interventions, both of which were available in the region. At the time of data collection, around half of the region’s schools were Incredible Years schools. In these schools, all staff members were trained in the approach and were thus able to implement the programme universally (in a regular classroom setting, for example) or in a more targeted way.

Dina School

Site 2 was an example of a targeted intervention operating in one of the Incredible Years schools. Known as Dina School, it involved children taking part in 18 weekly, small group sessions, which took place in a room at the children’s school. The groups were facilitated by two classroom assistants, who delivered the programme as set out in the Dina School manual. The programme makes use of a dinosaur puppet called ‘Dina’ (which was also used universally in the main classroom setting) as well as two additional character puppets, ‘Wally’ and ‘Molly’. These puppets were used in role plays, demonstrations of behaviours and communication techniques and in video vignettes. Each session followed a similar format, with a review of the ‘homework’ tasks that were set at the previous session, followed by activities and games and the setting of a further homework task at the end. Parents came to collect their children at the end of the session which coincided with the end of the school day.

Site 3: parenting group

Like site 2, site 3 was a targeted programme. It was one of more than 20 Incredible Years group parenting programmes that operated in the same region as site 2, offering parent training to parents of children aged from 0 years upwards, grouped according to the children’s age. The parenting group participating in this study was for parents of preschool children, aged 2–4 years, who wanted support with their child’s behaviour or communication (e.g. being withdrawn or having tantrums that the parent found difficult to deal with). Parents could self-refer or be referred to the service. The service was provided by a voluntary sector organisation and operated from its premises, although it was commissioned and funded jointly by the NHS and local authority. Parents attended 15 weekly group sessions which were facilitated by two members of staff with backgrounds in family and youth work, and in accordance with the programme manual.

Site 4: resilience-focused family support

Site 4 was a voluntary sector family support service provided to families of children aged 5–12 years with complex emotional and behavioural needs who did not require Tier 3 CAMHS care. Some children were referred to the service because their needs were not seen to warrant CAMHS input; others had attended CAMHS and were subsequently referred to this service for the more generalised support with coping and resilience that it offered. The service is based on the Daniel-Wassell model of resilience, 194 a model with six domains – secure base, friendships, talents and interests, education, positive values and social competences – that have some affinity with the principles of recovery. Staff members work through these domains with families to identify the family’s needs and then focus on those domains where the most support is needed. The family support was delivered by a member of staff from the voluntary organisation operating the service. The staff, who had a variety of professional backgrounds including youth work, social work, psychology and nursing, met with the child and his or her parent(s) individually (sometimes together) at home and at school. As with The Incredible Years, this service was manualised with a prescribed number of sessions.

Site 5: online eating disorders discussion board

This site, operated by an eating disorders charity, consisted of online message boards for young people concerned about, or experiencing, eating disorders. The message boards were established around 6 years ago to improve access to support. Although the online eating disorders service was a ‘virtual’ service, operating entirely over the internet, the charity operating the service offered some other services for young people including a telephone helpline and a live online chat service which some message board users had also participated in. Like the self-harm service, this service operated within a recovery-focused philosophy. To post messages, users had to register on the internet site (supplying their name and e-mail address). Although the posts were moderated, they were freely available on the internet for anyone to read. The boards were organised into themes, and users posted messages that mostly described their worries about food or eating, or their experiences of living with eating disorders, as well as messages that sought support from others or offered emotional support and practical tips to others. The boards were moderated by volunteers, many of whom had experienced eating disorders themselves and some of whom had trained in relevant fields such as counselling. Although the service was open to young people up to the age of 25 years, it was eligible as a case study site because those under 18 years of age were represented in the postings. Unlike the other five sites (which were manualised to one degree or another), this service was inherently spontaneous and adaptable.

Site 6: supported online cognitive–behavioural therapy intervention

Site 6 was a charity-operated, supported online CBT service for young people with anxiety or depression aged between 14 and 30 years. Although the service was open to people up to the age of 30 years, it was, like site 5, eligible as a case study site because those under 18 years of age used the service. The service had been established by staff at the site who had had prior experience of anxiety and depression themselves. It was set up in response to a perceived gap in suitable service provision for young people and young adults and aimed to appeal to this group by being accessible and flexible. The site operated as a drop-in centre, whereby people could come without an appointment and access information and advice. Service users came to the charity’s base and worked through a specific online CBT course – Beating the Blues 184 – with a volunteer from the charity facilitating the young person through each CBT session. Like most CBT interventions, this service was manualised with a prescribed number of sessions.

Participant characteristics

Table 21 summarises the interviews conducted at each case study site. In total, 52 participants were interviewed between July 2012 and March 2013. The CYP ( n = 17) who took part ranged in age from 5 to 17 years. Of these 17 CYP, four were interviewed as a focus group (at the self-harm group psychotherapy site), and six were interviewed along with a parent, five at the family support site and one at the self-harm site. Of the 15 parents who took part, nine were interviewed individually and six along with their child. Two of the individual parent interviews at the parenting site were conducted via the telephone. The service provider staff interviewed ( n = 19) included nurses, psychologists, classroom assistants, social workers, youth workers, counsellors and lay volunteers. Three members of staff at the family support, group parenting and eating disorder sites were interviewed over the telephone. The majority of staff and family members were female; two male staff members and three fathers were interviewed. Of the six young people interviewed at the self-harm and anxiety/depression sites, half were male and half female; at the sites where younger children were interviewed, most (8/11) were male.

Participants by site and category

Although the overall quantity of data is sufficient for a case study, 195 a few observations need to be made about the relative success of our recruitment strategy across the six sites. Recruitment was relatively successful for all three participant categories across sites 1, 2 and 4, though only having one parental interview at site 1 was disappointing. Site 3’s recruitment was also reasonably successful given that parents were the target of the service and that, as they were under 5 years of age, we did not have ethical permission to interview the children. We did not attempt to recruit parents at sites 5 and 6 because the very nature of the services at these sites meant that it would be difficult to identify parents. The low numbers of staff participants at these two sites was also understandable because these services – both provided by the voluntary sector – had limited resources to employ significant numbers of staff. With site 5, we did not manage to recruit any CYP participants for interview despite advertising on the service provider’s website and through other online networks. Though disappointing, this is not an especially serious recruitment limitation as any interview data obtained would have merely augmented the CYP’s perspectives on self-care support which we obtained via the netnographic non-participation observation data.

Site 6 perhaps created the most significant recruitment issue in that we only managed to recruit one CYP participant at this site. This site was a relatively newly established service which was operated by a small organisation with one full-time member of staff. We recruited via the service manager who asked that we involve only ex-, not current, users of the service. The service manager searched the contact database and telephoned or sent information to all ex-users inviting them to participate in an interview. During the 7 months that we were in contact with the site, only eight people aged 17 years and below accessed the service. Two agreed to be contacted by the research team and subsequently participated in interviews, one of whom has since taken on a role as a volunteer providing the service.

From the analysis of the case study data, four principal themes emerged, each containing a number of subthemes. These themes and subthemes are summarised in Table 22 and discussed in more detail in the ensuing sections. At this point, however, it can be noted that the first two themes mostly provide contextual detail about, respectively, the users and providers of mental health self-care support services for CYP, whereas the remaining two focus largely on the factors contributing to the acceptability of such services.

Having a mental health problem

This theme provides some contextual detail about CYP’s and their families’ understanding of the mental health problems experienced prior to using the services at the case study sites, their understanding of self-care in the context of these problems and their experiences of any self-care support received.

Understanding the mental health problem

The conceptualisation of CYP’s difficulties specifically as mental health problems appeared to be connected to the CYP’s age. The youngest children interviewed, aged 5 and 6 years, did not describe having any mental health problems or difficulties themselves. School staff and parents tended to think that these children mainly lacked confidence or had difficulties expressing or managing their emotions. Some parents described emotional outbursts and tantrums and two described their children as being ‘unhappy’.

I had concerns about his behaviour; he would break down into quite severe tantrums that would last for 20 minutes . . . he would spit all over the seats . . . strip naked and hit and lash and kick; hurt himself, hurt me. And generally I just felt that I had this unhappy child on my hands … I couldn’t go out with him . . . So I was kind of feeling trapped in my own home because of his behaviour. Parent of younger child

Older, primary school-age children and their parents described various emotional and behavioural problems: being unsettled or disruptive at school; having emotional outbursts at home; having problems with family members or in making friends; lacking confidence; and having communication problems, especially in expressing emotions.

Me and my mum didn’t really use to get along, and not able to cope, like, and with my brother and sister, I didn’t know how to be responsible and stuff. Child

Young people – that is, older children – who had used the self-harm (site 1), eating disorders online support (site 5) and depression/anxiety (site 6) services had a wide range of experiences, from severe mental health problems and diagnosed conditions, to milder symptoms and difficulties. Some attendees at the self-harm site had been diagnosed with depression and others described feelings of low mood, anxiety and intense feelings. Staff at the self-harm group mentioned a variety of self-harm that users presented with, including cutting and burning. Some CYP attending the self-harm (site 1) and family support (site 4) services had experienced more than one type of difficulty or problem, including being bullied at school, not attending school, displaying signs/symptoms of autism, family relationship problems and misuse of alcohol and/or drugs.

Self-care and self-care support

Just as participants described a wide range of mental health problems and difficulties, their experiences of self-care and support for their problems and difficulties prior to accessing the services were also mixed. Obtaining support was sometimes related to their understanding of the specific mental health problem, as in the case of one young person who had struggled with depression over an extended period:

Interviewer: So had you had any help with your depression before you went to the centre?

Young person: No, none, not at all. I had little understanding as well, it wasn’t something that had been spoken about.

Participants generally described undertaking little self-care before coming into contact with the services. Nonetheless, some parents whose children had attended the Dina School groups (site 2) had also previously attended an Incredible Years parenting course and had used some of the approaches at home. A few parents mentioned using techniques from books or television programmes such as Supernanny . Across most of the sites, the situation for many participants was that they came into contact with the services at a point when their problems had emerged, but they had rarely engaged in self-care themselves or received support they were happy with.

With some of the older children (young people), there was some evidence that they could make rational choices regarding self-management, especially when it came to medication:

Young person: I usually forget to take it, or I intentionally go out my way not to take it, because I feel as if I don’t need it and it makes me feel different . . . I was on Sertraline, but it kept me awake and then I was on Mirtazapine and then some other things . . . I didn’t like them . . . I don’t feel as if meds help me.

Another young person: I’m on medication at the moment, because my depression has peaked at the moment . . . so it [the medication] does work.

However, these choices were not always adaptive, as in these examples of young people ‘self-medicating’ with alcohol:

Young person, interviewed in a group: I used to drink and hide in a tree to drink, because my mum wouldn’t allow it, so I used to hide and had to go in a hole and fall out of a tree regularly drinking, that’s how I coped.

Second young person in the group: Yeah. I used to think alcohol helped me, but it used to just make me worse.

Regarding the support received, there were participants at all of the case study sites with experience of accessing some form of health care or support prior to attending the self-care support service; CAMHS, social services, GPs, psychiatrists, paediatricians, school counselling services and social services were all mentioned. For example, some families had a history of contact with social services due to family situations and some parents had sought help because they were concerned that their child might have an autistic spectrum disorder. There were some reports of positive experiences, such as helpful school counsellors, health visitors and other workers:

My outreach worker who works with me to integrate into the community, because I’m, kind of, agoraphobic, I don’t like people, crowds, so he works with me to try and get me into the community. Young person

However, many negative experiences were recounted where families had felt dismissed when they raised concerns, for example, about their children’s behaviour or social understanding and had found support hard to access. The mother of one child who had previously been referred to community-based mental health services had found the care provided inadequate:

It didn’t help much, she used to just enjoy going there because I was doing all the talking, they would watch her play, so it wasn’t . . . [helping her with] expressing her feelings . . . and then it just kind of stopped, they were thinking she didn’t need it, but she’d got so much anger at the time, she wanted to leave the house . . . I was worried for her. Parent

Two settings in particular were singled out for criticism by young people: mainstream schools and inpatient hospital care. Young people had experienced bullying at school, including being bullied about their mental health problems by other students. Some had stopped attending mainstream school and were at school units and felt that staff at mainstream schools often struggled to help students who self-harmed:

They’re not trained in mental health and are only really equipped to do with stuff, like, things to do with education and . . . bullying and peer pressure . . . they’re not equipped . . . they really don’t have a clue when it comes to stuff like mental health and things like self-harm . . . I had a really bad experience with my mentor. Young person

In terms of hospitals, participants described how support for self-harm in inpatient settings focused mainly on preventing physical harm. For example, two participants reported being restrained and put into seclusion (actions which could both be seen as punitive) when staff found that they were in possession of objects which the staff thought the young people would use to self-harm. Participants had found that they could access either group ‘talking therapies’ or an individual to talk to in the units, but had found this problematic because the therapy was not suitable for them at that stage, or because staff did not spend enough time with them:

Young person, interviewed in a group: There’s people there all the time that you can talk to, [but] I think the therapy puts quite a lot more stress on you at the very beginning . . . you’re taken out of your house . . . kind of throw you in with a bunch of new people, that’s hard to deal with . . . it’s a lot harder to then feel comfortable . . . I think, I had therapy twice, it didn’t work, so they basically just left me.

Second young person in the group: [My named nurse] was on nights and then when she was on days, she didn’t speak to me anyway, that was so unhelpful. She came to my room at like half past 10 and I’d be talking about stuff and getting upset and minutes later I had to try and sleep.

Young person: Yeah I had some nights when mine was . . . on nights and the head of [name of department], so he really didn’t have time [for me].

Running throughout the narratives of the young people was a recurring sense of anxiety around accessing support. Feeling alone, not knowing where to turn for help, discomfort and worry about discussing their problems with family or friends were mentioned repeatedly. The following data extract was taken from one of the site 5 message boards:

When you realise youve got some kind of (eating disorder) what was the first thing you all did? It’s just im stuck and going nowhere, the idea of food and excercise is going round and round in my mind, having crazy thoughts in my head all the time- but i cant tell anyone or even talk about it to anyone because i could shy when it comes to spilling out information about myself . . . any help? Pleasepleaseplease . . . ALSO, if you call the youthline what do they ask you and stuff? because I really wanna call them but im scared of the reponse and over the phone (procedure). Young person, verbatim message board posting

Providing self-care support

This section explores the findings relating to staff views about providing self-care support services, their reasons for involvement, training and supervision, and the extent to which their service is integrated with other services.

Service development

Staff at the sites became involved in the services for a variety of reasons: a desire to change things or innovate on the basis of personal, often negative, experiences of mental health services; wanting to improve the evidence base for practice; and often just sheer enthusiasm to help CYP. For example, the manager of one site had been motivated to found an independent alternative to traditional ‘clinical’ approaches on the basis of personal negative experiences elsewhere:

I started to experience the onset of depression and anxiety and looked at what sort of support or help was available to me and there was nothing that I felt I would have been likely to access or appealed . . . so I . . . basically came up with a service that I would have liked to see when I was in that situation and applied for funding and got it. Service lead

At another site, the service lead had been influenced by observations from her own practice, at a time when there was a perceived ‘epidemic’ of self-harm among young people and generally insufficient support available, and when anxiety about the risk of serious harm, including suicide, was high among staff who worked with young people. The rationale behind setting up a group therapy service was that a group approach could be appropriate for young people because of the influence and importance of peer groups to this age group. Moreover, improvements in peers would be clearly visible in a group setting and so serve as a vehicle for hope and optimism in other group members.

The Incredible Years programme, on the other hand, had been adopted at two sites because of its perceived strong evidence base:

I felt really strongly that I knew that the programmes were blueprint [evidence-based] programmes . . . that met the high standards for replicability and for research . . . I really, really like the Incredible Years model. Staff member

Moreover, service development seemed to be coupled with service leads who were enthusiastic and highly motivated, even to the point of being ‘on a mission’:

So it kind of became my mission and it’s grown into the mission for the Authority to develop all of those programmes. Service lead

Across all six case study sites, the attributes of the service leads in particular were suggestive of a high level of leadership skills, in that there was evidence of innovation, planning, empathy (for CYP, parents and colleagues), motivation and communication.

Training and supervision

All of the sites except the online eating disorders site (site 5) were manualised, that is there was a specific written manual in place for how the service should be delivered. The Incredible Years sites (sites 2 and 3) and the anxiety/depression site (site 6) were guided by manuals that prescribed the topics to be covered in each session; the self-harm (site 1) and family support (site 4) services had manuals that were less prescriptive.

At the self-harm site (site 1), all staff running the groups were provided with the service manual and, as part of their training, they also observed groups prior to becoming a group leader. Staff running the groups met monthly for group supervision with the service lead. On its initial formation, staff at the family support service (site 4) had been trained in the resilience approach by its architects. New staff members were first introduced to the model and subsequently trained by the service’s current staff, as well as receiving clinical supervision from a psychologist. At the anxiety/depression site (site 6), training was provided by the company supplying the CBT programme and all volunteers had to work through the course before working as a volunteer; there was no formal clinical supervision in place at this site, however.

The two Incredible Years services (sites 2 and 3) were different in that, of all the sites, they had the most structured and formal arrangements for training and supervision. To deliver a programme, staff members were required to undergo formal training. Staff members were regularly supervised by local colleagues and there was ongoing monitoring from the programme base in the USA. The service lead explained why she thought the training and ongoing supervision and support were important:

We’re using an evidence-based programme and actually unless you really are delivering with fidelity we know that you can’t guarantee that you’re going to get the same results as [the] research . . . everybody who delivers the group in [area name] can be sure they’re either going to be able to work with [or get] supervision from someone who’s accredited either as a peer coach or as a mentor . . . I think that is really important in making it effective. These are hard groups to run, so it’s important ensuring that people do get the support. Service lead

Fidelity was not emphasised as strongly at any of the other sites. This is perhaps because fidelity can be in opposition to flexibility, a characteristic seen by many as a key factor in a service’s accessibility, as will become apparent when the next theme, Accessing self-care support , is discussed.

Integration with other services

As outlined earlier in the site descriptions, the two Incredible Years sites (sites 2 and 3) had been widely adopted by local commissioning bodies. These services were closely integrated with local planning and commissioning structures and with the local education, health and social services sectors. The Incredible Years services were an exception, however. None of the other services had this level of integration with health, education and social care. The family support service (site 4) was integrated in as much as it was run by a voluntary sector organisation but funded by a local authority, with clinical supervision provided by an NHS psychologist. It also had close links with special educational needs co-ordinators (SENCOs) in schools and could form part of an action plan arising from national ‘Common Assessment Framework’ 196 assessments. Staff at the family support service, however, perceived that there were overlaps between their work and that of the NHS and social services, and that they fitted into a niche between the two.

The self-harm group (site 1) was run from a NHS mental health trust, at a CAMH day service. The service is attached to an inpatient unit with residential and non-residential care and education provision. Self-harm groups using the same principles are run at other NHS locations in the region, and although these groups are integrated with other services to the extent that GPs and consultants can refer CYP to them, they are usually run as ‘standalone’ services with little integration with the NHS CAMHS provider delivering them. The eating disorders (site 5) and depression/anxiety (site 6) services were provided by charities dedicated to helping people with particular difficulties in these areas. The depression/anxiety service was run by a small, relatively new organisation which provided some other activities as well as the supported online CBT, and to some extent could be seen as an alternative, rather than a complement to, statutory services. Regarding the eating disorders charity operating at site 5, integration tended to be limited to ‘signposting’ in that message board posters often offered advice to other board users about how to access statutory services, encouraging users to overcome their anxieties in accessing such services and offering opinions about those services.

Where integration was most evident was in the referral processes at the various sites. This is discussed further in the next section.

Accessing self-care support

This theme, and the next, will present findings on the acceptability of the self-care support services, both in terms of their general accessibility (this theme) and the perceived attributes that services and their staff possess that facilitate CYP and their parents to care for themselves (the next theme). Regarding general accessibility, two key subthemes emerged from the data: one pertaining to referral and one focusing on engagement.

Referral to services

Children, young people and their families had accessed the services via a range of routes, including self-referral, signposting and referral by professionals. The self-harm (site 1), family support (site 4) and parenting group (site 3) services were well integrated into referral pathways and several CYP and parents at these sites had been referred in this way. Several postings on the eating disorders message boards (site 5) mentioned being ‘signposted’ to the board by health professionals, including psychologists and doctors. The parenting group (site 3) and anxiety/depression (site 6) sites encouraged self-referral and publicised their services; some parents had found out about the service through leaflets in their child’s school bag, or through a friend. The anxiety/depression site was advertised through posters and leaflets in shops and bars as well as through presentations at schools and Sure Start centres. At Dina School (site 2), staff at the school had approached the parents of children who they thought would benefit from the service and asked these parents for consent to include their children in the group. Schools were a common source of referrals for the family support service (site 4) and two children who participated in the study had been referred by school staff, one by a SENCO and one by a school nurse. The young person interviewed at the anxiety/depression site (site 6) had self-referred to this service following a presentation at school; in interview, the service manager expressed disappointment that no school nurses had made referrals to the service.

One family who had attended the family support service recalled a long wait (around 2 years) from becoming aware of the programme to the time when they started receiving the support. Waiting times were not cited as a problem, however, by other study participants.

Building and maintaining engagement

In building engagement with health-care services, one of the first barriers to overcome can be the physical access to services. The participants at all of the case study sites seemed to encounter few physical barriers to access, though it should be added that we did not recruit those with probably the best information about barriers to access – ‘dropouts’ from the services – to our sample. For the physically provided services, none of the CYP or parents reported particular problems with travel to the sites. The virtual eating disorders support site could be accessed via the internet at any time, although messages were only uploaded when staff members were available at the service to moderate them (until 20.30 on weekdays and until the afternoon on Saturdays). The Incredible Years services (sites 2 and 3) covered a large rural area and were provided in convenient venues across the region. The young people at the self-harm group site (site 1) were all at school or college and often had to miss school or college to attend the service, though none of the young people interviewed raised this as an issue. These young people were mostly brought by car to the service by their parents. There were several examples of staff working to make services convenient to attend, or taking the service to the families. For example, staff at the family support service (site 4) worked with families in their homes and with children at school. The parenting group (site 3) was generally provided in a group setting but could be run by staff on an individual basis at people’s homes if necessary:

Staff member: It’s very different to a traditional service where you might send out an invitation and if the parents don’t come then . . . they might say that you might not be able to access the service. With Incredible Years it’s more about going out and getting the parents really. So it’s about awareness raising, training lots of agencies who know about the programme . . . but [also] offering really nice coffee and biscuits. If parents miss a session, [it’s] really important that they have the hand-outs. So, if it’s possible, the leader goes and visits them at home.

Another staff member: Recently we’ve had a case [where] mum . . . is not ever there physically when we turn up for our appointment . . . so our worker . . . she’ll go to the child’s nursery . . . to try and catch mum at a drop-off, just to have that initial face-to-face engagement because we were mindful that this is a mum who is surrounded at the moment by professionals who are all breathing down her neck, and we wanted to make sure that mum had a fair view of where we were in that process, what our role is and that we’re not scary monsters who are trying to trip her up.

Flexibility in service provision seemed to be a key in not only building, but also maintaining, engagement with CYP and their families. As a member of staff at the family support service (site 4) outlines:

It’s looking at each case on an individual basis and thinking about what are the reasons for disengagement, why haven’t they engaged, is this a language issue, did they not understand when the appointment was, is it that the intervention isn’t working for them . . . It’s quite involved; but we don’t just do a kind of, if you don’t pitch up we send you a letter and then if you don’t pitch up again we bin you off to be picked up by some other agency – we will attempt always to get an answer. And then if it’s just that it’s not working, well, then we’ll have a conversation about that and let’s work it out. Staff member

Another example of the flexible nature of the services was the between-session support that the sites offered. At the self-harm (site 1), family support (site 4) and parenting group (site 3) sites, support in addition to the scheduled sessions was available, including staff being available to parents over the telephone if they wanted to make contact. Staff at these sites emphasised that they worked hard to engage people in the services and to maintain engagement once a supporting relationship had been established. However, a participant who provided clinical supervision at one of the sites provided an alternative perspective on this, suggesting that it was possible to be overly flexible in that, for example, always bringing the service to a family’s home could potentially discourage independence:

I think, the fact that they [the organisation] go out and work with families in their local area, either at home, or in schools . . . that’s really important . . . something that families will like [but] if you’re going to visit somebody at home then . . . how do you evaluate their motivation to change? Because . . . if you’re at home and somebody comes to see you then actually you don’t necessarily need to do anything to engage, other than sit and nod and make the right noises . . . but if you’ve actually got to physically leave the house and go somewhere, then that suggests that your motivation might be greater to engage . . . it’s trying to get the match between that initial buy in to the service [and maintaining engagement]. Staff member (from outside the organisation)

Some staff expressed an awareness of working with parents who were used to being highly monitored by statutory services and said this could sometimes be a challenge when working to engage parents initially. A school-based member of staff, for example, who had referred several children to the service observed:

You do have the odd family who you refer who don’t engage. And it’s very sad really . . . it’s usually . . . parents who have already got to the point of social services . . . [people think] oh, don’t get social services involved, they’ll take my children from me. And once social services are involved . . . they’re breathing down your neck all the time then, aren’t they? I mean, they’re popping in and out of your house all the time, they’re watching your every move, very intrusive. Staff member

Facilitating self-care support

This theme explores the perceived attributes that services and their staff possess that facilitate CYP and their parents to care for themselves. Key facilitators of mental health self-care support for CYP appear to be organisations and staff that are welcoming; a skills focus whereby CYP and parents are taught relevant self-care skills and then given the chance to practise these skills; opportunities for peer support; and the provision of time and attention.

Welcoming staff; welcoming organisations

Positive staff attitudes appeared to be particularly important. At every site (apart from the online eating disorders service), service users spoke spontaneously and positively about the staff running the service, using adjectives such as ‘nice’, ‘lovely’, ‘good’ and ‘thoughtful’ to describe them. Listening to CYP, allowing them to tell their own story and treating them with empathy and compassion, was also important. This was mentioned particularly by parents at the family support service (site 4) and the young people at the self-harm service (site 1), who liked the manner of the staff and contrasted this with previous, negative experiences at other services. Young people using the self-harm (site 1) and anxiety/depression (site 6) services in particular emphasised the importance of being able to trust staff in order to talk to them openly:

You have to feel comfortable talking to that person, if you don’t like them, then you’re not going to feel comfortable, so you’re not going to engage with them at the level that’s needed to help [you] recover. Young person

At several sites, CYP and parents perceived staff as wanting to understand and help them and felt that they were treated with care and compassion:

The service worker talked to me as if he’d been there before . . . went out of his way for me. Young person

It wasn’t just a job to her. Parent of a younger child

Knowing that the service would accept people for who they were and be open to hearing about their problems was an important attribute of the case study sites operated by voluntary sector organisations. Being non-judgemental or offering non-judgemental support was a particularly positive aspect:

You could be honest and say, ‘This is what my child has done’, and you weren’t judged. Parent of a younger child

Indeed, contrasts were sometimes drawn with other statutory or conventional health and social care services perceived (unfairly or not) as being judgemental. A worker who referred into the family support service noted:

You’ve got to the point where this has become . . . crisis time: ‘We’ve got a plan here in front of us, you will do this, you will do this, you will do this’ . . . whereas with [site name] it’s not, ‘you will do . . .’ it’s ’these are the suggestions that we can make, that will make things better for you’. So it’s not as judgemental, well, social services aren’t judgemental, I suppose, but it might feel like they are . . . I hear in lots of groups that I go to . . . ‘you’re all judging me, that I’m this, you’re judging me on that’. Staff member

A similar feeling was expressed in an interview with a young person at another site:

Young person: [With the general practitioner (GP) and] even with CAMHS sometimes . . . it seems a bit like I’m being judged, or it doesn’t seem like they’re there for me in the way that I’d like, but it was different with [site name], like, it definitely felt a lot more welcoming.

Interviewer: Okay. Is it the people at the GP and CAMHS? Or is it more general?

Young person: I think, it’s more the method, like, I mean, it’s just all about a feeling, it feels like if I’m at the doctors . . . it becomes a thing that I’m ill, or there’s something wrong with me . . . you still sit there and you feel like you’re being judged . . . it definitely affects your confidence when you’re trying to answer, like, the questions, like, confidently and with, like, full honesty . . . I don’t know, like, when I saw my GP I didn’t tell him the whole truth, just because I didn’t feel that comfortable.

Organisational features of the sites were also important in determining how welcoming a service was. In the earlier Service development and Building and maintaining engagement subthemes, we discussed how the service leads appeared to have a high level of leadership skills, and described how staff often worked hard to make services convenient to attend, or took the service directly to the families. There were also some comments about the premises that the services were delivered from. At two of the voluntary sector sites, staff explained that particular efforts had been made to ensure that the physical surroundings were attractive to young people, featuring, for example, bright colours and soft furnishings or having music playing. On the other hand, CYP at one site commented that the rooms in which the groups were held were somewhat small. The physical features of the premises, however, were overshadowed by spontaneous references that CYP and parents made to the welcoming ambience. Indeed, there was often blurring between organisational and individual staff attributes: ‘welcoming’, ‘friendly’ and ‘non-judgemental’ were used by CYP and parents to describe both the staff and the general atmosphere or ambience of the service, often in contrast to other services they had experienced.

Activities to build skills for self-care

The use of skill-building techniques and opportunities to practise such skills in their daily lives was considered an important feature of all six services. Children, young people and parents outlined a variety of practical activities and techniques, including games and exercises, which they had used in formal sessions (in vitro) as well as at home and in school (in vivo). Fittingly, given the nature of this study, most of these activities and techniques were designed to assist the participants in managing (self-managing) the CYP’s condition or problems. For example, in the self-harm group (site 1), young people were supported in devising coping strategies other than self-harming; in site 2, children practised communication skills at home that they had learnt at Dina School; and in the family support group (site 4), families were encouraged to action plan and set goals. For younger children in particular, a large proportion of their narratives consisted of their recollections of the various games and activities in which they had taken part. The youngest children stated that they had gone to Dina School to learn things and that they got ‘prizes’ (plastic chips) for doing well at the activities there:

Interviewer: And what did you get a chip for?

Child: When I’m doing stuff nice.

Many of these activities focused on identifying thoughts and emotions or on learning techniques to relieve anxiety or calm anger. These had been introduced by staff at the sites and also practised by children outside the sessions. The older primary school-aged children seemed to have more insight into the purpose of the activities and techniques:

We used to do these words about temper and then after that to calm me down we used to play a few games. Child

The parents who were interviewed also seemed to appreciate practical techniques and talked at length about implementing these at home. Reward systems including sticker charts were mentioned frequently, along with techniques designed to help children manage tasks and express their feelings:

I think it is important to have a task and try and complete it and stuff. Young person

I think she is responding well to positive rewards . . . she loves the reward charts . . . I give her a sticker just on her T-shirt if she’s done something really nice. Parent of younger child

And from an interview with another parent:

Interviewer: Are there any things in particular that you find helpful?

Parent of younger child: Well there was the words on the fridge . . . the fridge magnets spelling out, ‘I’m not happy’, ‘I’m . . .’

Child: ‘. . . sorry’.

Parent: ‘Sad’, ‘I’m sorry’ and . . .

Child: ‘I love you’.

Parent: ‘I love you’, yeah. We did that for a while. We lost all the pieces, like, we did it for a while.

Some games and techniques were ‘prescribed’ as part of the manual or workbook for the course. However, most of the activities allowed some personalisation such as tailoring rewards to the individual child. For example, staff at the family support service (site 4) found out what children were interested in or enjoyed and then looked for local activities or clubs they could join, such as football or the Boys’ Brigade. At the self-harm site (site 1), young people put together their own ‘tool boxes’ of distraction techniques, memorabilia and keepsakes that helped them reduce urges to self-harm. The service also provided support for caring for wounds that arose from cutting, and advice on ways to camouflage scars, with an organisation specialising in this visiting the group.

I’ve got this thing called a tool box in my room that I put all my different distraction techniques inside so, like, if I’m having a bad day, even if I’m not having a bad day . . . I could use the different things. And different things work at different times, so one time, like, writing out your feelings might be enough, or drawing might be enough, but sometimes you have to use a range of things to minimise that urge and sometimes nothing works, but . . . at least I’ve tried. Young person, interviewed with parent

The programmes delivered at sites 2 and 3 (the Incredible Years sites) and site 6 (the anxiety/depression support service) were supplemented by videos for participants to watch that contained vignettes or examples of role plays to augment the situations or techniques that the programmes considered. These were criticised repeatedly by staff and service users for being outdated and participants disliked that they had been filmed in the USA as they would have preferred British accents. One service user found them ‘idealised’ in that the actors looked too ‘perfect’ and suggested that videos featuring real people, not actors, would be more helpful.

Sharing experiences and peer support

Although a key aspect of all of the services at the case study sites was introducing CYP and their families to stock tools and techniques to help them care for themselves, an important aspect of skills building was supporting CYP and parents to discover self-care techniques for themselves. Often, this happened with the support of their peers, especially in the sites operating group-based approaches where other group members could play a key role in generating ideas or giving feedback. For example, children in the Dina School groups (site 2) took part in role plays and other interactions that helped them to think through how they could handle things that children might find difficult, such as sharing:

[Using a puppet to act out] snatching a book, [then discussing], is that kind?, is that unkind? . . . then after a while you’d get them to bring their problems in, you know, if you have a problem on the yard [playground], you know, if someone’s not listening to you, or doesn’t want to play, well, eventually they would come up [and talk about it with the group]. Staff member

Similarly, users of the online support service (site 5) frequently exchanged tips and techniques. Postings on the message boards often included users sharing self-care tips and suggestions with each other, and describing various relaxation or distraction techniques and activities such as reading, knitting, writing, drawing and exercising:

Listening to music is a huge relaxation thing for me, also drawing/writing – either a story, poetry or in a journal. Do you enjoy reading? To begin with i didnt have much concentration for reading, but now I am really enjoying reading again, and i find if i start reading after a meal when i am anxious that I can get lost in the book, and before i know it half an hour has passed. I’ve also tried knitting, but i’m a bit of a perfectionist so that didnt go so well. Hope you are ok, and that some of these tips may help you. Verbatim message board posting

The following were taken from two other sites:

They discuss coping strategies, like, they’ll say, like, if you get the urge to self-harm, what do you do? And they, sort of, come up with, ‘well, I’ll go and do this, I’ll go and put my favourite music on, my film, go for a walk, walk the dog, talk to my mum’ . . . and I do think it’s very beneficial. Staff member

I enjoyed the discussion. And what was nice is the feedback we gave each other . . . Because I think, that does you good, to have other people sometimes go, no, you’re good at that or why don’t you try this or why don’t you try that? . . . because you put it into practice with other people, it works better than you just reading books. Parent

Although the sharing of practical tips and techniques was an important element of peer support, the sharing of the experiences among CYP and parents was perhaps more beneficial. As discussed in the first theme, Having a mental health problem , some participants had not talked about their difficulties with other people prior to coming into the services and had felt alone with their problems. Staff members and attendees at several sites talked about the emotional benefit of being in a group with people who had had similar experiences, in that people who had previously felt isolated with their problems, or uncomfortable about seeking help for them, felt less alone:

It was actually amazing really; firstly because you realise that what your child was doing was normal and that all the other children were doing the same things. Parent of younger child

I think they listen more to their peers, their peers is pivotal, isn’t it, in adolescence, so I think the peer groups are very important, and that sense of belonging is good. And often . . . I’ve found that every single youngster who attends a group, is excluded from some aspect of their life, either from their family or from a peer group, because they’re bullied or they bully or, you know, they don’t fit somehow . . . So I guess being together with other young people helps you feel, you know, you’re not on your own with this. Staff member, another site

As well as receiving support from others, satisfaction gained from feeling that they had helped others was also important to some participants:

It was good for [my daughter] to see that she had helped other people, she liked that; that helped her as well. Parent of older child

As well as perceiving that the sharing of experiences was helpful, staff and parents felt that having a mixture of experiences and people at different stages of illness or recovery within a group provided additional benefits. The self-harm and parenting groups brought together people from different social groups who would normally not socialise together, but who had experienced similar problems, and this seemed to be helpful in terms of giving people a wider perspective on their problems, or perhaps developing empathy:

[They] have a good understanding of each other’s needs . . . it runs well because it’s a mixture . . . they’re all at different stages of their recovery . . . we’ve got young people who have been established for a long time and . . . have almost recovered, others are at the stage of contemplating, sort of, change and in the process of recovery and some that are not ready to change. And that’s, as I say, a very supportive group . . . those that are almost recovered, they do get and understand where [those who are less recovered] are coming from. Staff member

Very heterogeneous . . . you’d have youngsters in local authority care, and then you’d have very upper middle class young people, who were anxious about exams and stuff like that. And that actually works as well, because kind of sometimes it’s good to see people in other situations . . . you thought your situation was really bad, but actually, there’s people who are worse off, and something about that kind of gratitude about what you have got. Another staff member, same site

The participant quoted below, who described herself as ‘middle class and educated’ seemed to agree that this could be a benefit:

It sounds awful, but people that you might not necessarily have mixed with before, because you wouldn’t have had the chance, and got to know them . . . different social spheres . . . all of that’s broken down . . . [there can be perceptions that] . . . some backgrounds are better, supposedly, than others. And actually, you know, one of the mums in particular, who hadn’t got any further education . . . was just a fantastic mum. Whenever we’d . . . learn a new principle, when we’d feed back the next week, her and her partner had discussed it, and had both tried it . . . And it was nice to hear about other people, and there is a range of us, you know, people with partners, people without. Parent of younger child

The ‘sharing experiences’ aspect of peer support was complemented by others including the social aspect and what might be termed an ‘empowerment’ aspect. Regarding the social aspect, service users at the self-harm (site 1) and parenting (site 3) sites enjoyed attending the groups and especially liked the social aspect of getting to know others in the group. The parenting course (site 3) had an arranged ‘buddy system’ where parents were paired up and encouraged to telephone each other between sessions to talk about how they were getting on with their tasks or exercises, and some of these parents also reported forming friendships and continuing to meet socially after the programme had finished. From the focus group:

Young person 1: I prefer group talks, like, talking in groups, instead of taking medication . . . [at first] I was an inpatient so I was really struggling and . . . just having the support off people in the group was what I needed.

Young person 2: We’re good for each other!

Young person 3: We just, like, support people with what’s been going on in their week, and stuff, and it’s nice, because we’re like a little family.

Young person 4: We are like a family aren’t we?

The social benefit of groups was also reported by the staff member at the eating disorders message board service (site 5):

[T]he message board is a really good place to start forging links with other people in a very safe and supported way and it helps to build their confidence . . . when they suggest something to somebody [and they] come back and say, ‘that was really good, I did that and it really worked for me’ [they] make very strong bonds with each other. Staff member

Some of the group activities also appeared to help empower the CYP. For example, the self-harm groups (site 1) helped participants develop empathy by encouraging the young people to take it in turns to chair the group. Each group began with each member giving an update on how his or her week had been, and a role of the chair was to ensure that each person contributed. Staff observed that some young people in the group seemed unhappy or annoyed when they would have preferred not to contribute but the chairperson still asked them to share their experiences with the group. The staff member who described this thought that this could help young people to appreciate the difficult task that staff sometimes faced in encouraging young people to engage in ‘talking therapies’, and that sometimes encouraging someone to contribute in a group, even if they seemed not to want to, could help develop empathy and leadership skills in the young person.

Although our data demonstrate that peer support is beneficial, the risk of ‘contagion’, or triggering self-harm or problems with eating, was perceived as a key challenge by staff at the self-harm (site 1) and eating disorders (site 5) sites. Staff at both of these services saw risks in group work and worked actively to manage such risks. Unlike the parenting site (site 3), where parents were ‘buddied’ with another parent and encouraged to support each other between sessions, young people at other sites were discouraged from having contact outside of the service. At the self-harm site, young people were actively discouraged from meeting outside the group and, at the online site, interaction was controlled through moderation of the message board postings. This involved screening and editing posts to ensure that they did not contain contact information.

Some people who had attended the self-harm groups (site 1) and parenting courses (site 3) remembered feeling nervous about attending their first session. As it was the first time they had attended anything of that nature, they were unsure what to expect and were nervous about having to talk about their difficulties in front of other people. They felt that groups were only helpful for people who were at a stage of their illness or recovery where they were ready to attend a group. Our interviewees had all settled into the groups and had positive experiences, but they thought that the group setting would not be suitable for everyone; some people simply would not want or choose to discuss their problems in a group setting. Staff at the self-harm group identified managing dominant personalities as a further challenge that they had to be aware of, in order to make sure that all group members had a chance to participate during each session.

Time and attention

Giving CYP time and attention appeared to be a valued characteristic of the services. At four of the six sites, participants valued simply spending time with children, especially when this involved enjoyable activities. A key principle of Dina School (site 2) and the parenting course (site 3) was giving children positive attention. The Dina School groups allowed for each child to receive more attention than would be possible in a regular class. Parents felt that their children enjoyed being in the group and that the environment was more realistic than the regular classroom for them to learn about talking about their feelings. Parents who attended the parenting course found that setting time aside for their children was helpful, including scheduling time to play with them and also having activities together as a reward for good behaviour, and reported that their children were calmer. At the family support service (site 4), a worker described how during school holidays, instead of having appointments with children at their school, she had collected them from home and brought them to the centre, and had been surprised by how much they enjoyed this:

Often I’ll go and pick the children up and bring them here, which they just think is the best thing in the world . . . it’s not that exciting, but it’s just something different . . . that’s what some of them say. Staff member

Participants of different ages seemed to enjoy positive attention, perhaps away from a school or the clinical or home environment:

Another thing as well that sticks in my mind about the group is when [staff member] actually took us out once into town . . . as a group . . . just to do something nice, instead of being stuck in a small room that’s quite clinical . . . it was good. Young person

At one site, young people recalled their experiences of being inpatients, when some staff would come to talk to them, but often at inappropriate times or not for long enough. At another, family members of younger children appreciated project workers talking to the children themselves.

I think that young people often really have appreciated the fact that someone has taken the time to listen to them and hear their side of the story. Staff member

An older sibling of one of the children at the same service singled out the way that the project worker had helped her brother to understand his behaviours and the emotions attached to them, and what might affect these:

When [child’s name] used to get angry we used to talk to him and try and calm him down . . . but we never used to speak to him about why he got angry . . . I think because [project worker’s name] spoke to him and broke it down into steps that he could understand . . . and then she used to ask him stuff about his friends and his family. Sibling

Although CYP and parents appreciated the time and attention that staff at the sites gave them, staff mentioned that operational constraints sometimes prevented them from providing as much time as they would have liked. The manuals for the Incredible Years services (sites 2 and 3, Dina School and parenting groups) were prescriptive, with themes and associated activities being set out for each session. However, although staff at these sites liked the fact that all the materials for the sessions, and also the letters to send home to parents, were provided (as this made the course easy to deliver), they felt that there was too great a volume of material, and that they had often had to leave out certain aspects in order to complete the sessions on time.

Sometimes it was hard to keep their attention, because we’ve got a programme to deliver and it’s quite a lot to fit into those 2 hours, so sometimes [we] would look at it before and think we’re never going to fit all that in so we’d think, right, we won’t do that activity today, we’ll do that next week and try to fit in an activity where they’d be moving a bit more and try to adapt it a little bit. Staff member

Both CYP and parent participants at several sites mentioned that they would have preferred more sessions or time with the service – a statement also echoed by staff at some sites – but financial constraints prevented this from occurring. In particular, staff at one of the voluntary sector sites outlined how a scheduled 15-week programme had to be reduced to 12 weeks because of financial and resource restraints.

Now we have this 12-week programme and it used to be a bit more like 15 weeks and we used to be able to be a bit more flexible with what each different family needed . . . I feel I used to do a lot more . . . therapeutic work with the young people and creative work, and some of that has had to be cut because we’re having to be a bit more focused on where we need to get to, which is a bit of a shame . . . I used to do a lot more kind of crafty things . . . than I feel that I’ve got the time to really do now. Staff member

Summary of the case study findings

This chapter has presented the findings derived from 52 interviews with children, young people, parents and staff, some documentary evidence and over 500 message board postings at six case study sites.

The aim of this stage of the project was to investigate the acceptability of mental health self-care support services for CYP and the interface between mental health self-care support providers, the NHS and other service providers in the statutory, private and voluntary sectors.

A common feature across all the case study sites was the perceived accessibility of the services provided. The self-care support services appeared to offer convenient locations and appointment times, maintained engagement with between-session support, and were staffed by people who were caring and compassionate. Given that self-care support necessarily requires an agent – a professional or lay person to provide that support – it was reassuring to witness passionate, motivated, welcoming, non-judgemental and child-centred staff at all six sites. Where barriers were mentioned, they tended to be discussed in the context of other, sometimes competing, services (including standard NHS and local authority services) rather than with reference to the services at the six sites. These barriers could be seen as criticisms of the other sites and were broadly related to inflexibility: applying (stigmatising) diagnoses and labels, rather than seeing the child or young person as a person needing help and support; being dismissive of, or failing to appreciate, the concerns that CYP and their families might have about having a ‘mental health problem’ or accessing services; adhering rigidly to manualised interventions without questioning the readiness of CYP and their families to self-care or the intervention’s suitability to the CYP; and affording them little choice in their (self-)care.

Taking all of the participants’ perspectives – CYP, parents and staff – into account, we can speculate on some of the key elements of effective mental health self-care support for CYP. From the case study data it seems that, in addition to flexibility, effective mental health self-care support services for CYP seem to be built on straightforward access; positive staff and organisational attributes that are non-judgemental and welcoming; the provision of time and attention; the chance to learn and practise skills relevant to self-care; and systems of peer support which include opportunities to share experiences and practical tips.

If there is an overall constraint, it is regarding the interface with other services. The case study sites cut across the NHS, other statutory providers and the voluntary sector, yet there was no clear pattern of how well these providers worked together, if at all. In the two Incredible Years sites, there was a seamless integration of the health, social care and education sectors; yet in another site (the family support group), even though there was ‘nominal’ integration between health, social care and education, the service preferred to see itself as a ‘niche’ not quite fitting into any of these domains. In the other sites, there was either no visible integration or somewhat erratic integration or, as in the case of one site, an almost defiant refusal to integrate demonstrated by the setting up of an alternative, rather than complementary, service. Where the interface between the sectors worked best was in relation to referral: though only a few services had extremely well-integrated referral pathways, all had some degree of interface, even if it was as simple as merely signposting into, or out of, the self-care support service, or using networks among the sectors to promote self-referral to the service.

Included under terms of UK Non-commercial Government License .

Cite this Page Pryjmachuk S, Elvey R, Kirk S, et al. Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study. Southampton (UK): NIHR Journals Library; 2014 Jun. (Health Services and Delivery Research, No. 2.18.) Chapter 5, The case study.
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55 research questions about mental health

Last updated

11 March 2024

Reviewed by

Brittany Ferri, PhD, OTR/L

Research in the mental health space helps fill knowledge gaps and create a fuller picture for patients, healthcare professionals, and policymakers. Over time, these efforts result in better quality care and more accessible treatment options for those who need them.

Use this list of mental health research questions to kickstart your next project or assignment and give yourself the best chance of producing successful and fulfilling research.

Why does mental health research matter?

Mental health research is an essential area of study. It includes any research that focuses on topics related to people’s mental and emotional well-being.

As a complex health topic that, despite the prevalence of mental health conditions, still has an unending number of unanswered questions, the need for thorough research into causes, triggers, and treatment options is clear.

Research into this heavily stigmatized and often misunderstood topic is needed to find better ways to support people struggling with mental health conditions. Understanding what causes them is another crucial area of study, as it enables individuals, companies, and policymakers to make well-informed choices that can help prevent illnesses like anxiety and depression.

How to choose a strong mental health research topic

As one of the most important parts of beginning a new research project, picking a topic that is intriguing, unique, and in demand is a great way to get the best results from your efforts.

Mental health is a blanket term with many niches and specific areas to explore. But, no matter which direction you choose, follow the tips below to ensure you pick the right topic.

Prioritize your interests and skills

While a big part of research is exploring a new and exciting topic, this exploration is best done within a topic or niche in which you are interested and experienced.

Research is tough, even at the best of times. To combat fatigue and increase your chances of pushing through to the finish line, we recommend choosing a topic that aligns with your personal interests, training, or skill set.

Consider emerging trends

Topical and current research questions are hot commodities because they offer solutions and insights into culturally and socially relevant problems.

Depending on the scope and level of freedom you have with your upcoming research project, choosing a topic that’s trending in your area of study is one way to get support and funding (if you need it).

Not every study can be based on a cutting-edge topic, but this can be a great way to explore a new space and create baseline research data for future studies.

Assess your resources and timeline

Before choosing a super ambitious and exciting research topic, consider your project restrictions.

You’ll need to think about things like your research timeline, access to resources and funding, and expected project scope when deciding how broad your research topic will be. In most cases, it’s better to start small and focus on a specific area of study.

Broad research projects are expensive and labor and resource-intensive. They can take years or even decades to complete. Before biting off more than you can chew, consider your scope and find a research question that fits within it.

Read up on the latest research

Finally, once you have narrowed in on a specific topic, you need to read up on the latest studies and published research. A thorough research assessment is a great way to gain some background context on your chosen topic and stops you from repeating a study design. Using the existing work as your guide, you can explore more specific and niche questions to provide highly beneficial answers and insights.

Trending research questions for post-secondary students

As a post-secondary student, finding interesting research questions that fit within the scope of your classes or resources can be challenging. But, with a little bit of effort and pre-planning, you can find unique mental health research topics that will meet your class or project requirements.

Examples of research topics for post-secondary students include the following:

How does school-related stress impact a person’s mental health?

To what extent does burnout impact mental health in medical students?

How does chronic school stress impact a student’s physical health?

How does exam season affect the severity of mental health symptoms?

Is mental health counseling effective for students in an acute mental crisis?

Research questions about anxiety and depression

Anxiety and depression are two of the most commonly spoken about mental health conditions. You might assume that research about these conditions has already been exhausted or that it’s no longer in demand. That’s not the case at all.

According to a 2022 survey by Centers for Disease Control and Prevention (CDC), 12.5% of American adults struggle with regular feelings of worry, nervousness, and anxiety, and 5% struggle with regular feelings of depression. These percentages amount to millions of lives affected, meaning new research into these conditions is essential.

If either of these topics interests you, here are a few trending research questions you could consider:

Does gender play a role in the early diagnosis of anxiety?

How does untreated anxiety impact quality of life?

What are the most common symptoms of anxiety in working professionals aged 20–29?

To what extent do treatment delays impact quality of life in patients with undiagnosed anxiety?

To what extent does stigma affect the quality of care received by people with anxiety?

Here are some examples of research questions about depression:

Does diet play a role in the severity of depression symptoms?

Can people have a genetic predisposition to developing depression?

How common is depression in work-from-home employees?

Does mood journaling help manage depression symptoms?

What role does exercise play in the management of depression symptoms?

Research questions about personality disorders

Personality disorders are complex mental health conditions tied to a person’s behaviors, sense of self, and how they interact with the world around them. Without a diagnosis and treatment, people with personality disorders are more likely to develop negative coping strategies during periods of stress and adversity, which can impact their quality of life and relationships.

There’s no shortage of specific research questions in this category. Here are some examples of research questions about personality disorders that you could explore:

What environments are more likely to trigger the development of a personality disorder?

What barriers impact access to care for people with personality disorders?

To what extent does undiagnosed borderline personality disorder impact a person’s ability to build relationships?

How does group therapy impact symptom severity in people with schizotypal personality disorder?

What is the treatment compliance rate of people with paranoid personality disorder?

Research questions about substance use disorders

“Substance use disorders” is a blanket term for treatable behaviors and patterns within a person’s brain that lead them to become dependent on illicit drugs, alcohol, or prescription medications. It’s one of the most stigmatized mental health categories.

The severity of a person’s symptoms and how they impact their ability to participate in their regular daily life can vary significantly from person to person. But, even in less severe cases, people with a substance use disorder display some level of loss of control due to their need to use the substance they are dependent on.

This is an ever-evolving topic where research is in hot demand. Here are some example research questions:

To what extent do meditation practices help with craving management?

How effective are detox centers in treating acute substance use disorder?

Are there genetic factors that increase a person’s chances of developing a substance use disorder?

How prevalent are substance use disorders in immigrant populations?

To what extent do prescription medications play a role in developing substance use disorders?

Research questions about mental health treatments

Treatments for mental health, pharmaceutical therapies in particular, are a common topic for research and exploration in this space.

Besides the clinical trials required for a drug to receive FDA approval, studies into the efficacy, risks, and patient experiences are essential to better understand mental health therapies.

These types of studies can easily become large in scope, but it’s possible to conduct small cohort research on mental health therapies that can provide helpful insights into the actual experiences of the people receiving these treatments.

Here are some questions you might consider:

What are the long-term effects of electroconvulsive therapy (ECT) for patients with severe depression?

How common is insomnia as a side effect of oral mental health medications?

What are the most common causes of non-compliance for mental health treatments?

How long does it take for patients to report noticeable changes in symptom severity after starting injectable mental health medications?

What issues are most common when weaning a patient off of an anxiety medication?

Controversial mental health research questions

If you’re interested in exploring more cutting-edge research topics, you might consider one that’s “controversial.”

Depending on your own personal values, you might not think many of these topics are controversial. In the context of the research environment, this depends on the perspectives of your project lead and the desires of your sponsors. These topics may not align with the preferred subject matter.

That being said, that doesn’t make them any less worth exploring. In many cases, it makes them more worthwhile, as they encourage people to ask questions and think critically.

Here are just a few examples of “controversial” mental health research questions:

To what extent do financial crises impact mental health in young adults?

How have climate concerns impacted anxiety levels in young adults?

To what extent do psychotropic drugs help patients struggling with anxiety and depression?

To what extent does political reform impact the mental health of LGBTQ+ people?

What mental health supports should be available for the families of people who opt for medically assisted dying?

Research questions about socioeconomic factors & mental health

Socioeconomic factors—like where a person grew up, their annual income, the communities they are exposed to, and the amount, type, and quality of mental health resources they have access to—significantly impact overall health.

This is a complex and multifaceted issue. Choosing a research question that addresses these topics can help researchers, experts, and policymakers provide more equitable and accessible care over time.

Examples of questions that tackle socioeconomic factors and mental health include the following:

How does sliding scale pricing for therapy increase retention rates?

What is the average cost to access acute mental health crisis care in [a specific region]?

To what extent does a person’s environment impact their risk of developing a mental health condition?

How does mental health stigma impact early detection of mental health conditions?

To what extent does discrimination affect the mental health of LGBTQ+ people?

Research questions about the benefits of therapy

Therapy, whether that’s in groups or one-to-one sessions, is one of the most commonly utilized resources for managing mental health conditions. It can help support long-term healing and the development of coping mechanisms.

Yet, despite its popularity, more research is needed to properly understand its benefits and limitations.

Here are some therapy-based questions you could consider to inspire your own research:

In what instances does group therapy benefit people more than solo sessions?

How effective is cognitive behavioral therapy for patients with severe anxiety?

After how many therapy sessions do people report feeling a better sense of self?

Does including meditation reminders during therapy improve patient outcomes?

To what extent has virtual therapy improved access to mental health resources in rural areas?

Research questions about mental health trends in teens

Adolescents are a particularly interesting group for mental health research due to the prevalence of early-onset mental health symptoms in this age group.

As a time of self-discovery and change, puberty brings plenty of stress, anxiety, and hardships, all of which can contribute to worsening mental health symptoms.

If you’re looking to learn more about how to support this age group with mental health, here are some examples of questions you could explore:

Does parenting style impact anxiety rates in teens?

How early should teenagers receive mental health treatment?

To what extent does cyberbullying impact adolescent mental health?

What are the most common harmful coping mechanisms explored by teens?

How have smartphones affected teenagers’ self-worth and sense of self?

Research questions about social media and mental health

Social media platforms like TikTok, Instagram, YouTube, Facebook, and X (formerly Twitter) have significantly impacted day-to-day communication. However, despite their numerous benefits and uses, they have also become a significant source of stress, anxiety, and self-worth issues for those who use them.

These platforms have been around for a while now, but research on their impact is still in its infancy. Are you interested in building knowledge about this ever-changing topic? Here are some examples of social media research questions you could consider:

To what extent does TikTok’s mental health content impact people’s perception of their health?

How much non-professional mental health content is created on social media platforms?

How has social media content increased the likelihood of a teen self-identifying themselves with ADHD or autism?

To what extent do social media photoshopped images impact body image and self-worth?

Has social media access increased feelings of anxiety and dread in young adults?

Mental health research is incredibly important

As you have seen, there are so many unique mental health research questions worth exploring. Which options are piquing your interest?

Whether you are a university student considering your next paper topic or a professional looking to explore a new area of study, mental health is an exciting and ever-changing area of research to get involved with.

Your research will be valuable, no matter how big or small. As a niche area of healthcare still shrouded in stigma, any insights you gain into new ways to support, treat, or identify mental health triggers and trends are a net positive for millions of people worldwide.

Get started today

Go from raw data to valuable insights with a flexible research platform

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Latest articles

Patient Case #1: 27-Year-Old Woman With Bipolar Disorder

Theresa Cerulli, MD
Tina Matthews-Hayes, DNP, FNP, PMHNP

Custom Around the Practice Video Series

Experts in psychiatry review the case of a 27-year-old woman who presents for evaluation of a complex depressive disorder.

EP: 1 . Patient Case #1: 27-Year-Old Woman With Bipolar Disorder

Ep: 2 . clinical significance of bipolar disorder, ep: 3 . clinical impressions from patient case #1, ep: 4 . diagnosis of bipolar disorder, ep: 5 . treatment options for bipolar disorder, ep: 6 . patient case #2: 47-year-old man with treatment resistant depression (trd), ep: 7 . patient case #2 continued: novel second-generation antipsychotics, ep: 8 . role of telemedicine in bipolar disorder.

Michael E. Thase, MD : Hello and welcome to this Psychiatric Times™ Around the Practice , “Identification and Management of Bipolar Disorder. ”I’m Michael Thase, professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania.

Joining me today are: Dr Gustavo Alva, the medical director of ATP Clinical Research in Costa Mesa, California; Dr Theresa Cerulli, the medical director of Cerulli and Associates in North Andover, Massachusetts; and Dr Tina Matthew-Hayes, a dual-certified nurse practitioner at Western PA Behavioral Health Resources in West Mifflin, Pennsylvania.

Today we are going to highlight challenges with identifying bipolar disorder, discuss strategies for optimizing treatment, comment on telehealth utilization, and walk through 2 interesting patient cases. We’ll also involve our audience by using several polling questions, and these results will be shared after the program.

Without further ado, welcome and let’s begin. Here’s our first polling question. What percentage of your patients with bipolar disorder have 1 or more co-occurring psychiatric condition? a. 10%, b. 10%-30%, c. 30%-50%, d. 50%-70%, or e. more than 70%.

Now, here’s our second polling question. What percentage of your referred patients with bipolar disorder were initially misdiagnosed? Would you say a. less than 10%, b. 10%-30%, c. 30%-50%, d. more than 50%, up to 70%, or e. greater than 70%.

We’re going to go ahead to patient case No. 1. This is a 27-year-old woman who’s presented for evaluation of a complex depressive syndrome. She has not benefitted from 2 recent trials of antidepressants—sertraline and escitalopram. This is her third lifetime depressive episode. It began back in the fall, and she described the episode as occurring right “out of the blue.” Further discussion revealed, however, that she had talked with several confidantes about her problems and that she realized she had been disappointed and frustrated for being passed over unfairly for a promotion at work. She had also been saddened by the unusually early death of her favorite aunt.

Now, our patient has a past history of ADHD [attention-deficit/hyperactivity disorder], which was recognized when she was in middle school and for which she took methylphenidate for adolescence and much of her young adult life. As she was wrapping up with college, she decided that this medication sometimes disrupted her sleep and gave her an irritable edge, and decided that she might be better off not taking it. Her medical history was unremarkable. She is taking escitalopram at the time of our initial evaluation, and the dose was just reduced by her PCP [primary care physician]from 20 mg to 10 mg because she subjectively thought the medicine might actually be making her worse.

On the day of her first visit, we get a PHQ-9 [9-item Patient Health Questionnaire]. The score is 16, which is in the moderate depression range. She filled out the MDQ [Mood Disorder Questionnaire] and scored a whopping 10, which is not the highest possible score but it is higher than 95% of people who take this inventory.

At the time of our interview, our patient tells us that her No. 1 symptom is her low mood and her ease to tears. In fact, she was tearful during the interview. She also reports that her normal trouble concentrating, attributable to the ADHD, is actually substantially worse. Additionally, in contrast to her usual diet, she has a tendency to overeat and may have gained as much as 5 kg over the last 4 months. She reports an irregular sleep cycle and tends to have periods of hypersomnolence, especially on the weekends, and then days on end where she might sleep only 4 hours a night despite feeling tired.

Upon examination, her mood is positively reactive, and by that I mean she can lift her spirits in conversation, show some preserved sense of humor, and does not appear as severely depressed as she subjectively describes. Furthermore, she would say that in contrast to other times in her life when she’s been depressed, that she’s actually had no loss of libido, and in fact her libido might even be somewhat increased. Over the last month or so, she’s had several uncharacteristic casual hook-ups.

So the differential diagnosis for this patient included major depressive disorder, recurrent unipolar with mixed features, versus bipolar II disorder, with an antecedent history of ADHD. I think the high MDQ score and recurrent threshold level of mixed symptoms within a diagnosable depressive episode certainly increase the chances that this patient’s illness should be thought of on the bipolar spectrum. Of course, this formulation is strengthened by the fact that she has an early age of onset of recurrent depression, that her current episode, despite having mixed features, has reverse vegetative features as well. We also have the observation that antidepressant therapy has seemed to make her condition worse, not better.

Transcript Edited for Clarity

Dr. Thase is a professor of psychiatry at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania.

Dr. Alva is the medical director of ATP Clinical Research in Costa Mesa, California.

Dr. Cerulli is the medical director of Cerulli and Associates in Andover, Massachusetts.

Dr. Tina Matthew-Hayes is a dual certified nurse practitioner at Western PA Behavioral Health Resources in West Mifflin, Pennsylvania.

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Children's mental health case studies
Food, health and nutrition
Mental wellbeing
Mental health

Explore the experiences of children and families with these interdisciplinary case studies. Designed to help professionals and students explore the strengths and needs of children and their families, each case presents a detailed situation, related research, problem-solving questions and feedback for the user. Use these cases on your own or in classes and training events

Each case study:

Explores the experiences of a child and family over time.
Introduces theories, research and practice ideas about children's mental health.
Shows the needs of a child at specific stages of development.
Invites users to “try on the hat” of different specific professionals.

By completing a case study participants will:

Examine the needs of children from an interdisciplinary perspective.
Recognize the importance of prevention/early intervention in children’s mental health.
Apply ecological and developmental perspectives to children’s mental health.
Predict probable outcomes for children based on services they receive.

Case studies prompt users to practice making decisions that are:

Research-based.
Practice-based.
Best to meet a child and family's needs in that moment.

Children’s mental health service delivery systems often face significant challenges.

Services can be disconnected and hard to access.
Stigma can prevent people from seeking help.
Parents, teachers and other direct providers can become overwhelmed with piecing together a system of care that meets the needs of an individual child.
Professionals can be unaware of the theories and perspectives under which others serving the same family work
Professionals may face challenges doing interdisciplinary work.
Limited funding promotes competition between organizations trying to serve families.

These case studies help explore life-like mental health situations and decision-making. Case studies introduce characters with history, relationships and real-life problems. They offer users the opportunity to:

Examine all these details, as well as pertinent research.
Make informed decisions about intervention based on the available information.

The case study also allows users to see how preventive decisions can change outcomes later on. At every step, the case content and learning format encourages users to review the research to inform their decisions.

Each case study emphasizes the need to consider a growing child within ecological, developmental, and interdisciplinary frameworks.

Ecological approaches consider all the levels of influence on a child.
Developmental approaches recognize that children are constantly growing and developing. They may learn some things before other things.
Interdisciplinary perspectives recognize that the needs of children will not be met within the perspectives and theories of a single discipline.

There are currently two different case students available. Each case study reflects a set of themes that the child and family experience.

The About Steven case study addresses:

Adolescent depression.
School mental health.
Rural mental health services.
Social/emotional development.

The Brianna and Tanya case study reflects themes of:

Infant and early childhood mental health.
Educational disparities.
Trauma and toxic stress.
Financial insecurity.
Intergenerational issues.

The case studies are designed with many audiences in mind:

Practitioners from a variety of fields. This includes social work, education, nursing, public health, mental health, and others.

Professionals in training, including those attending graduate or undergraduate classes.

The broader community.

Each case is based on the research, theories, practices and perspectives of people in all these areas. The case studies emphasize the importance of considering an interdisciplinary framework. Children’s needs cannot be met within the perspective of a single discipline.

The complex problems children face need solutions that integrate many and diverse ways of knowing. The case studies also help everyone better understand the mental health needs of children. We all have a role to play.

These case has been piloted within:

Graduate and undergraduate courses.

Discipline-specific and interdisciplinary settings.

Professional organizations.

Currently, the case studies are being offered to instructors and their staff and students in graduate and undergraduate level courses. They are designed to supplement existing course curricula.

Instructors have used the case study effectively by:

Assigning the entire case at one time as homework. This is followed by in-class discussion or a reflective writing assignment relevant to a course.
Assigning sections of the case throughout the course. Instructors then require students to prepare for in-class discussion pertinent to that section.
Creating writing, research or presentation assignments based on specific sections of course content.
Focusing on a specific theme present in the case that is pertinent to the course. Instructors use this as a launching point for deeper study.
Constructing other in-class creative experiences with the case.
Collaborating with other instructors to hold interdisciplinary discussions about the case.

To get started with a particular case, visit the related web page and follow the instructions to register. Once you register as an instructor, you will receive information for your co-instructors, teaching assistants and students. Get more information on the following web pages.

Brianna and Tanya: A case study about infant and early childhood mental health
About Steven: A children’s mental health case study about depression

Cari Michaels, Extension educator

Reviewed in 2023

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Suicide Risk: Case Studies and Vignettes

Identifying warning signs case study.

Taken from Patterson, C. W. (1981). Suicide. In Basic Psychopathology: A Programmed Text.

Instructions: Underline all words and phrases in the following case history that are related to INCREASED suicidal risk. Then answer the questions at the end of the exercise.

History of Present Illness

A heavy drinker, he has been unemployed from his janitorial job for the past three months because of his drinking. He acknowledges feeling increasingly depressed since being fired, and for the past two weeks has had insomnia, anorexia, and a ten pound weight loss. He indicates he wanted to die, had been thinking of suicide for the past week, planned the overdose, but had to “get drunk” because “I didn’t have the guts” [to kill myself]. He is unhappy that the attempt failed, states that, “nobody can help me” and he sees no way to help himself. He denies having any close relationships or caring how others would feel if he committed suicide (“who is there who cares?”). He views death as a “relief.” His use of alcohol has increased considerably in the past month. He denies having any hobbies or activities, “just drinking.”

Past Psychiatric History

Hospitalized in 1985 at Pleasantview Psychiatric Hospital for three months following a suicide attempt after his fourth wife left him. Treated with ECT, he did “pretty good, but only for about two years” thereafter.

Social History

An only child, his parents are deceased (father died by suicide when client was eight years old; mother died of “old age” two years ago). Raised in Boston, he moved to Los Angeles at twenty-one and has lived here since. Completed eighth grade (without any repeat) but quit to go to work (family needed money). Has never held a job longer than two years, usually quitting or being fired because of “my temper.” Usually worked as a laborer. Denies any physical problems other than feeling “tired all the time.” Currently living on Social Security income, he has no other financial resources. He received a bad conduct discharge from the army after three months for “disobeying an order and punching the officer.” He has had no legal problems other than several arrests in the past two years for public intoxication. Married and divorced four times, he has no children or close friends.

Mental Status Examination

Thought processes were logical and coherent, and no delusions or hallucinations were noted. Theme of talk centered around how hopeless the future was and his wishes to be dead. There were no thoughts about wishing to harm others.

Mood was one of depression. He was oriented to person, place, and time, and recent and remote memory was intact. He could perform simple calculations and his general fund of knowledge was fair. His intelligence was judged average.

Diagnostic Impression

drug overdose (Valium and alcohol)
Dysthymic Disorder (depression)
Substance Use Disorder (alcohol)

Questions for Exercise

You have interviewed the client, obtained the above history, and now have to make some decisions about the client. He wants to leave the hospital.

Is he a significant risk for suicide?
discharging him as he wishes and with your concurrence?
discharging him against medical advice (A.M.A.)?
discharging him if he promises to see a therapist at a nearby mental health center within the next few days?
holding him for purposes of getting his psychiatric in-client care even though he objects?
Discuss briefly why you would not have chosen the other alternatives in question #2.

Identifying Warning Signs Case Study: Feedback/Answers

The client is a 65-year-old white male , divorced , living alone , admitted to the hospital in a near comatose condition yesterday because of an overdose of approximately thirty tablets of Valium, 5 mgm, combined with alcoholic intoxication. The client was given supportive care and is alert at the present time. A heavy drinker , he has been unemployed from his janitorial job for the past three months because of his drinking. He acknowledges feeling increasingly depressed since being fired, and for the past two weeks has had insomnia and a ten pound weight loss . He indicates he wanted to die, had been thinking of suicide for the past week, planned the overdose, but had to “get drunk” because “I didn’t have the guts” [to kill myself]. He is unhappy that the attempt failed , states that, “ nobody can help me ” and he sees no way to help himself. He denies having any close relationships or caring how others would feel if he committed suicide (“who is there who cares?”). He views death as a “relief.” His use of alcohol has increased considerably in the past month. He denies having any hobbies or activities , “just drinking.”

Hospitalized in 1985 at Pleasantview Psychiatric Hospital for three months following a suicide attempt after his fourth wife left him . Treated with ECT, he did “pretty good, but only for about two years” thereafter.

An only child, his parents are deceased ( father died by suicide when client was eight years old; mother died of “old age” two years ago). Raised in Boston, he moved to Los Angeles at twenty-one and has lived here since. Completed eighth grade (without any repeat) but quit to go to work (family needed money). Has never held a job longer than two years , usually quitting or being fired because of “ my temper .” Usually worked as a laborer. Denies any physical problems other than feeling “tired all the time.” Currently living on Social Security income, he has no other financial resources . He received a bad conduct discharge from the army after three months for “disobeying an order and punching the officer.” He has had no legal problems other than several arrests in the past two years for public intoxication. Married and divorced four times , he has no children or close friends .

65 y.o. W/M, short, thin, grey-haired, unkempt, with 2-3 day-old beard, lying passively in bed and avoiding eye contact. His speech was slow and he did not spontaneously offer information . Passively cooperative. Little movement of his extremities. His facial expression was sad and immobile. Thought processes were logical and coherent, and no delusions or hallucinations were noted. Theme of talk centered around how hopeless the future was and his wishes to be dead . There were no thoughts about wishing to harm others. Mood was one of depression . He was oriented to person, place, and time, and recent and remote memory was intact. He could perform simple calculations and his general fund of knowledge was fair. His intelligence was judged average.

Is he a significant risk for suicide? Yes. The client presents a considerable suicidal risk, with respect to demographic characteristics, psychiatric diagnosis and mental status findings.
Discuss briefly why you would not have chosen the other alternatives in question #2. The client appears to be actively suicidal at the present time,and may act upon his feelings. Nothing about his life has changed because of his attempt. He still is lonely, with limited social resources. He feels no remorse for his suicidal behavior and his future remains unaltered. He must be hospitalized until some therapeutic progress can be made.

Short-Term Suicide Risk Vignettes

*Case study vignettes taken from Maris, R. W., Berman, A. L., Maltsberger, J. T., & Yufit, R. I. (Eds), (1992). Assessment and prediction of suicide. New York: Guilford. And originally cited in Stelmachers, Z. T., & Sherman, R. E. (1990). Use of case vignettes in suicide risk assessment. Suicide and Life-Threatening Behavior, 20, 65-84.

The assessment of suicide risk is a complicated process. The following vignettes are provided to promote discussion of suicide risk factors, assessment procedures, and intervention strategies. The “answers” are not provided, rather students are encouraged to discuss cases with each other and faculty. Two examples of how discussions may be facilitated are provided.

37-year-old white female, self-referred. Stated plan is to drive her car off a bridge. Precipitant seems to be verbal abuse by her boss; after talking to her nightly for hours, he suddenly refused to talk to her. As a result, patient feels angry and hurt, threatened to kill herself. She is also angry at her mother, who will not let patient smoke or bring men to their home. Current alcohol level is .15; patient is confused, repetitive, and ataxic. History reveals a previous suicide attempt (overdose) 7 years ago, which resulted in hospitalization. After spending the night at CIC and sobering, patient denies further suicidal intent.

16-year-old Native American female, self-referred following an overdose of 12 aspirins. Precipitant: could not tolerate rumors at school that she and another girl are sharing the same boyfriend. Denies being suicidal at this time (“I won’t do it again; I learned my lesson”). Reports that she has always had difficulty expressing her feelings. In the interview, is quiet, guarded, and initially quite reluctant to talk. Diagnostic impression: adjustment disorder.

49-year-old white female brought by police on a transportation hold following threats to overdose on aspirin (initially telephoned CIC and was willing to give her address). Patient feels trapped and abused, can’t cope at home with her schizophrenic sister. Wants to be in the hospital and continues to feel like killing herself. Husband indicates that the patient has been threatening to shoot him and her daughter but probably has no gun. Recent arrest for disorderly conduct (threatened police with a butcher knife). History of aspirin overdose 3 years ago. In the interview, patient is cooperative; appears depressed, anxious, helpless, and hopeless. Appetite and sleep are down, and so is her self-esteem. Is described as “anhedonic.” Alcohol level: .12.

23-year-od white male, self-referred. Patient bought a gun 2 months ago to kill himself and claims to have the gun and four shells in his car (police found the gun but no shells). Patient reports having planned time and place for suicide several times in the past. States that he cannot live any more with his “emotional pain” since his wife left him3 years ago. This pain has increased during the last week, but the patient cannot pinpoint any precipitant. Patient has a history of chemical dependency, but has been sober for 20 months and currently goes to AA.

22-year-old black male referred to CIC from the Emergency Room on a transportation hold. He referred himself to the Emergency Room after making fairly deep cuts on his wrists requiring nine stitches. Current stress is recent breakup with his girlfriend and loss of job. Has developed depressive symptoms for the last 2 months, including social withdrawal, insomnia, anhedonia, and decreased appetite. Blames his sister for the breakup with girlfriend. Makes threats to sister (“I will slice up that bitch, she is dead when I get out”). Patient is an alcoholic who just completed court-ordered chemical dependency treatment lasting 3 weeks. He is also on parole for attempted rape. There is a history of previous suicide attempts and assaultive behavior, which led to the patient being jailed. In the interview, patient is vague regarding recent events and history. He denies intent to kill himself but admits to still being quite ambivalent about it. Diagnostic impression: antisocial personality.

19-year-old white male found by roommate in a “sluggish” state following the ingestion of 10 sleeping pills (Sominex) and one bottle of whiskey. Recently has been giving away his possessions and has written a suicide note. After being brought to the Emergency Room, declares that he will do it again. Blood alcohol level: .23. For the last 3 or 4 weeks there has been sleep and appetite disturbance, with a 15-pound weight loss and subjective feelings of depression. Diagnostic impression: adjustment disorder with depressed mood versus major depressive episode. Patient refused hospitalization.

30-year-old white male brought from his place of employment by a personnel representative. Patient has been thinking of suicide “all the time” because he “can’t cope.” Has a knot in his stomach; sleep and appetite are down (sleeps only 3 hours per night); and plans either to shoot himself, jump off a bridge, or drive recklessly. Precipitant: constant fighting with his wife leading to a recent breakup (there is a long history of mutual verbal/physical abuse). There is a history of a serious suicide attempt: patient jumped off a ledge and fractured both legs; the precipitant for that attempt was a previous divorce. There is a history of chemical dependency with two courses of treatment. There is no current problem with alcohol or drugs. Patient is tearful, shaking, frightened, feeling hopeless, and at high risk for impulsive acting out. He states that life isn’t worthwhile.

Vignette Discussion Examples

Vignette example 1.

Twenty-six year old white female phoned her counselor, stated that she might take pills, and then hung up and kept the phone off the hook. The counselor called the police and the patient was brought to the crisis intervention center on a transportation hold. Patient was angry, denied suicidal attempt, and refused evaluation; described as selectively mute, which means she wouldn’t answer any of the questions she didn’t like.

Facilitator: How high a risk is this person for committing suicide? Low, moderate or high? Student Answer 1: Maybe moderate because the person is warning somebody, basically a plea for help. Facilitator: Okay, so we have suicidal talk. That’s one of our red flags. What else? She said she might take pills, so we didn’t know if she does have the pills. So she has a plan. The plan would be to take pills, but we don’t know if we have means. Student Answer 2: High. She’s also angry. I don’t know if she’s angry often. Facilitator: A person in this situation who is really thinking about killing themselves tends not to deny it. They tend not to deny it. There are exceptions to everything, but most of the time, for some reason, this is one of the things where people tend to mostly tell you the truth. If you ask people, they tend to tell you the truth. It’s a very funny thing about suicide that way. That’s certainly not true about most things. If you ask people how much they drink…But, “Are you thinking about killing yourself?” “Well, yes.” If you ask a question, you tend to get a more or less accurate, straight answer. Student question: Is that because it doesn’t matter anymore? If they’re going to die anyway, who’s going to care about what anybody thinks or what happens? Facilitator: My hypothesis would be, when someone is at that point, they’re talking about real, true things. They’re not into play. This is where they are. If they’re really looking at it, then they’re just at that place. What’s to hide at that point? You don’t have anything to lose. It’s a state of mind. And then if you’re not in that place—it’s like, how close are you to the edge of that cliff? “I’m not there. I know where that is, and I’m not there.” “If you get there, will you tell me?” “Yeah, I’m not there.” So, people have a sense—if they’ve gotten that close, they know where that line is, and they know about where they stand in regard to it, because it’s a very hard-edged, true thing.

Twenty-three year old white male, self-referred. Patient bought a gun two months ago to kill himself and claims to have the gun and four shells in his car. Police found the gun but no shells. Patient reports having planned time and place for suicide several times in the past. States that he cannot live anymore with his emotional pain since his wife left him three years ago. This pain has increased during the last week, but the patient cannot pinpoint any precipitant. Patient has a history of chemical dependency but has been sober for 20 months and currently goes to AA.

Facilitator: How high a risk is this person for committing suicide? Low, moderate or high? On a scale from 0 to 7 (7 being very high). Student Answer 1: High. On a scale of 0 to 7? Student Answer: Six. Student Answer 2: I would say three. I think it would be lower because if he’s already bought the gun two months ago and he’s self-referring himself to get help, he wants to live. He has not made peace with whatever, and he’s more likely not give away his things, and he’s going to AA meetings. I think it’s lower than really an extreme…I would say a three or four. Student Answer 3: I would say a four or five, moderate. Student Answer 4: About a five..several times and hasn’t followed through, tells me he doesn’t really want to follow through with it. Facilitator: And there are no shells, right? So we can see some of the red flags are there, but some of them aren’t. He’s still sober… Student: He has a support group. Student: He’s not using, though he bought a gun—so that’s a concern. There is a lot there. Student: He may not have the shells so he doesn’t have the opportunity to. So does that make him more…? Student 2: Think I’ll change mine to a five. Facilitator: So the mean was 4.68, so 5 was the mode. If we’re saying this is a moderate risk, what things would we look for that would make this a high risk? Student: Take away AA. Student: If he falls off the wagon, he goes right to the top. Student: And if he finds the shells. Facilitator: Because it probably is not that hard to find shells. All these stores around here, you can get shells quicker than you can get a gun, so he’s only a five-minute purchase away from having lethal—in contrast to not having the gun. Student: Could there be a difference in the time? Let’s say his wife left him just four to six months ago rather than three years. Would that be something that would be more serious? Facilitator: Yes, or if his wife just left him. So, say his wife left him a month ago that would bump it up. So that’s unresolved. That’s taking a person that was worried and that’s pushing him higher. Student: It also raises the homicide rate. Facilitator: Yes, because these tend to be murder-suicides. How often have we seen that? Murder-suicide is a big deal. If she won’t be with me, she won’t be with anybody.

141 Case Studies: Real Stories Of People Overcoming Struggles of Mental Health

At Tracking Happiness, we’re dedicated to helping others around the world overcome struggles of mental health.

In 2022, we published a survey of 5,521 respondents and found:

88% of our respondents experienced mental health issues in the past year.
25% of people don’t feel comfortable sharing their struggles with anyone, not even their closest friends.

In order to break the stigma that surrounds mental health struggles, we’re looking to share your stories.

Overcoming struggles

They say that everyone you meet is engaged in a great struggle. No matter how well someone manages to hide it, there’s always something to overcome, a struggle to deal with, an obstacle to climb.

And when someone is engaged in a struggle, that person is looking for others to join him. Because we, as human beings, don’t thrive when we feel alone in facing a struggle.

Let’s throw rocks together

Overcoming your struggles is like defeating an angry giant. You try to throw rocks at it, but how much damage is one little rock gonna do?

Tracking Happiness can become your partner in facing this giant. We are on a mission to share all your stories of overcoming mental health struggles. By doing so, we want to help inspire you to overcome the things that you’re struggling with, while also breaking the stigma of mental health.

Which explains the phrase: “Let’s throw rocks together”.

Let’s throw rocks together, and become better at overcoming our struggles collectively. If you’re interested in becoming a part of this and sharing your story, click this link!

Case studies

April 4, 2024

My Journey from Loneliness and Isolation to Creating an Online Haven for Seniors

“When one is home alone, all day, with nothing to do, nobody to speak with, stuck with their thoughts both good and bad, it’s easy to slip back into a depressive state. Feeling unneeded, unwanted, no happiness, no joy, no reason to get out of bed – just suffering with “the blahs”.”

Struggled with: Depression Loneliness

Helped by: Self-improvement Social support

April 2, 2024

Surviving a Workplace Shooting and Navigating PTSD, Insomnia With Marathons and Prayers

“My symptoms began immediately following a workplace shooting on Saturday, November 28, 2015, and were exasperated due to the activity of the company, the criminals, and the cops. The company treated me as if I were a criminal, the criminals attempted to kill me three additional times, and the cops (Houston Police Department Organized Crime Unit) treated me as if I was a thorn in their flesh.”

Struggled with: Depression Insomnia PTSD Stress

Helped by: Exercise Religion Treatment Volunteering

March 28, 2024

How The Support of Others Helped Me Heal After a Mental Breakdown

“I do not recommend having a breakdown when trying to raise boys. I would cry, eat all the time, and feel like my brain was full of fuzz. I could barely function. There was that day when I got home from taking the kids to school, and thought to myself that if there was a gun in the house, someone else would have had to pick them up from school that day.”

Struggled with: Depression Divorce Stress

Helped by: Journaling Social support Therapy

March 26, 2024

Journaling and Therapy Helped Me After Surviving a Car Accident and a Late Pregnancy Loss

“I vividly remember one day a few months after getting hit by the car when I wondered if my life would ever feel peaceful, pain-free, or joyful again. I was simply getting in and out of the passenger seat of a vehicle, my whole body gripped with pain and stiffness when I experienced a flash of fear that my health would never improve.”

Struggled with: Chronic pain Depression Grief PTSD

Helped by: Journaling Therapy

March 21, 2024

From the C-Suites to the Streets and Back – Overcoming Addiction, Anxiety, Depression and PTSD

“Over the past decade, I have struggled with substance abuse immensely leading to anxiety, depression, and PTSD. After losing thirteen corporate jobs and ending up homeless, beaten up, and absolutely broken on the streets I have finally come to terms with my situation and am finding a path towards long-term sobriety and happiness.”

Struggled with: Addiction Anxiety Depression PTSD

Helped by: Mindfulness Rehab Religion Self-improvement Social support

March 19, 2024

My Journey to Self-Compassion Amidst Depression, Anxiety and Suicidal Thoughts

“This suicidal edge coupled with stress, anxiety, and loneliness made me stop working as a human being. In just two months I had spiraled down into the darkest hole which has ever existed for me. There didn’t exist Marina anymore, merely a depressive and neurotic copy of her, who was unable to laugh and sleep.”

Struggled with: Anxiety Depression Panic attacks Stress Suicidal

Helped by: Self-acceptance Self-improvement Therapy

March 14, 2024

How EMDR Therapy Helped Me Navigate Childhood Trauma and Rediscover Myself

“As my anxiety levels grew, I turned to alcohol and then combined that with Vicodin to fend off the bad feelings. I would drink to the point of blacking out on a regular basis, sometimes never knowing how I got home.”

Struggled with: Abuse Addiction Bullying Childhood CPTSD

Helped by: Reinventing yourself Therapy

March 12, 2024

How Self-Care and My Infrared Sauna Blanket Help Me Navigate CPTSD and Fascia Pain

“I’m sure that other people around me knew that I was struggling, but I only shared this with a couple of people. People in my immediate physical ecosphere didn’t offer up any kind of empathy either. In fact, the exact opposite. Which I think made the condition even worse.”

Struggled with: Chronic pain CPTSD

Helped by: Journaling Meditation Self-Care

March 8, 2024

Therapy Helped Me Overcome Depression and Better Cope With Chronic Health Conditions

“I clearly remember feeling like I was stuck deep down at the bottom of a dark hole where I could barely breathe. It was especially disturbing because I didn’t care if I stayed down there and never saw light again. Looking back, I realize that my severe depressive episode had been building for years, but I didn’t really notice it.”

Struggled with: Anxiety Chronic pain Depression

Helped by: Mindfulness Self-Care Self-improvement Therapy

March 5, 2024

How Sobriety, Therapy, and Self-Care Help Me Navigate BPD and Bipolar Disorder Better

“I used to have a mindset of: “poor me” – “I’m just a victim” and “none of this is my fault”. Eventually, I knew I had to change that narrative to one of control. I had to take accountability for the things that I could change, and be honest about the things I was doing that were making everything worse.”

Struggled with: Anxiety Bipolar Disorder Borderline Personality Disorder Depression Suicidal

Helped by: Exercise Religion Self-Care Self-improvement Social support Therapy

State Resources

National Resources

Nursing Organizations

MNWC Initiatives

Maryland Nursing Workforce Center

NextGen NCLEX

Faculty Case Studies

The purpose of this project was to develop a repository of NextGen NCLEX case studies that can be accessed by all faculty members in Maryland.

Detailed information about how faculty members can use these case students is in this PowerPoint document .

The case studies are in a Word document and can be modified by faculty members as they determine.

NOTE: The answers to the questions found in the NextGen NCLEX Test Bank are only available in these faculty case studies. When students take the Test Bank questions, they will not get feedback on correct answers. Students and faculty should review test results and correct answers together.

The case studies are contained in 4 categories: Family (13 case studies), Fundamentals and Mental Health (14 case studies) and Medical Surgical (20 case studies). In addition the folder labeled minireviews contains PowerPoint sessions with combinations of case studies and standalone items.

Family ▾

Attention Deficit Hyperactivity Disorder - Pediatric
Ectopic Pregnancy
Febrile Seizures
Gestational Diabetes
Intimate Partner Violence
Neonatal Jaundice
Neonatal Respiratory Distress Syndrome
Pediatric Hypoglycemia
Pediatric Anaphylaxis
Pediatric Diarrhea and Dehydration
Pediatric Intussusception
Pediatric Sickle Cell
Postpartum Hemmorhage
Poststreptococcal Glomerulonephritis Pediatric
Preeclampsia

Fundamentals and Mental Health ▾

Abdominal Surgery Postoperative Care
Anorexia with Dehydration
Catheter Related Urinary Tract Infection
Deep Vein Thrombosis
Dehydration Alzheimers
Electroconvulsive Therapy
Home Safety I
Home Safety II
Neuroleptic Maligant Syndrome
Opioid Overdose
Post Operative Atelectasis
Post-traumatic Stress
Pressure Injury
Substance Use Withdrawal and Pain Control
Suicide Prevention
Tardive Dyskinesia
Transfusion Reaction
Urinary Tract infection

Medical Surgical ▾

Acute Asthma
Acute Respiratory Distress
Breast Cancer
Chest Pain (MI)
Compartment Syndrome
Deep Vein Thrombosis II
End Stage Renal Disease and Dialysis
Gastroesphageal Reflux
Heart Failure
HIV with Opportunistic Infection
Ketoacidosis
Liver Failure
Prostate Cancer
Spine Surgery
Tension Pneumothorax
Thyroid Storm
Tuberculosis

Community Based ▾

Mini Review ▾

Comprehensive Review
Fundamentals
Maternal Newborn Review
Medical Surgical Nursing
Mental Health Review
Mini Review Faculty Summaries
Mini Review Training for Website
Mini Reviews Student Worksheets
Pediatric Review

Mental Health and Psychiatric Nursing NCLEX Practice Questions Nursing Test Bank (700+ Questions)

Mental Health & Psychiatric NursingTest Banks for NCLEX RN

Welcome to your ultimate NCLEX practice questions and nursing test bank for mental health and psychiatric nursing. For this nursing test bank, test your knowledge on the concepts of mental health and psychiatric disorders. This quiz aims to help students and registered nurses grasp and master mental health and psychiatric nursing concepts.

Mental Health and Psychiatric Nursing Test Banks

In this section, you’ll find the NCLEX practice questions and quizzes for mental health and psychiatric nursing. This nursing test bank set includes 700+ practice questions divided into comprehensive quizzes for mental health and psychiatric nursing and a special set of questions for common psychiatric disorders. Use these nursing test banks to augment or as an alternative to ATI and Quizlet.

Quiz Guidelines

Before you start, here are some examination guidelines and reminders you must read:

Practice Exams : Engage with our Practice Exams to hone your skills in a supportive, low-pressure environment. These exams provide immediate feedback and explanations, helping you grasp core concepts, identify improvement areas, and build confidence in your knowledge and abilities.
You’re given 2 minutes per item.
For Challenge Exams, click on the “Start Quiz” button to start the quiz.
Complete the quiz : Ensure that you answer the entire quiz. Only after you’ve answered every item will the score and rationales be shown.
Learn from the rationales : After each quiz, click on the “View Questions” button to understand the explanation for each answer.
Free access : Guess what? Our test banks are 100% FREE. Skip the hassle – no sign-ups or registrations here. A sincere promise from Nurseslabs: we have not and won’t ever request your credit card details or personal info for our practice questions. We’re dedicated to keeping this service accessible and cost-free, especially for our amazing students and nurses. So, take the leap and elevate your career hassle-free!
Share your thoughts : We’d love your feedback, scores, and questions! Please share them in the comments below.

Recommended Resources

Recommended books and resources for your NCLEX success:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Saunders Comprehensive Review for the NCLEX-RN Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.

Saunders Q & A Review for the NCLEX-RN® Examination This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.

NCLEX-RN Prep Plus by Kaplan The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.

Illustrated Study Guide for the NCLEX-RN® Exam The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.

NCLEX RN Examination Prep Flashcards (2023 Edition) NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.

37 thoughts on “Mental Health and Psychiatric Nursing NCLEX Practice Questions Nursing Test Bank (700+ Questions)”

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This site is helpful. Good job 👏 Thank you Nurseslabs

After completing the quiz, results do not populate and there is no rationale as you go through each question, so you cannot learn.

Hello, after the quiz, click on the “Quiz Summary” button then “Finish Quiz” button. It should give you the option to review the questions and the rationales (by clicking “View Questions”).

I really love this website because it is really helping me for my Nclex review 👍🏽👍🏽👍🏽❤️

I am content with this website. I adhere to this website when I prepare my nursing school care plans, study for tests, and find new information. Thank you for helping me through the struggle.

I never thought practicing the content of the Psychiatric Nursing questions here would help me succeed in my certification exam. Now, I am a Psychiatric Mental Health -Board Certified (PMH-BC). Thank you for preparing those questions, it is a great site for reviews.

Congratulations! :)

I am in doubt of 43rd question of anxiety disorder question asking the side effect of Ritalin- the correct answer here is increased attention span and concentration. This is actually the therapeutic effect of this medication. As far as I know, the main side effect is sleeplessness. therefore, this medication should be given before noon to avoid sleeping problems. please check and let me know too thank you

We’re working on a way to have the questions printed.

Please install print option very fast,it exam time,we have not enough time to right all these questions,ln 2020 there is easy to print all the questions in pdf format.

You can print these questions or the webpage by clicking on the Quiz Summary > Finish Quiz > View Questions > Then go to File > Print > Save as PDF.

I’m studying for my psych certification and I have to say, I’m impressed by and love the 700 of psych questions with rationales. The only downside is that it doesn’t save your progress so if you can’t finish the test in 1 sitting, you have to start all over again. That’s the only annoying part, but I love this website.

Hi! Thank you that I found this website. This is very helpful. I was able to open the test or practice test before but when I click the start again I cant go through it.

Very very good Great questions with rational a lot of love this website again and again thank

I’m preparing to take NCLEX-RN this year, but I need to practice more in Phycology as I have a hard time in it. I found the NursesLab web site very helpful and I want to practice more, however, I cant open the practice question test bank. Kindly help. Thank you

Please what are the score projection needed on this test to assure success in the nclex. Thanks you for your incredible work.

This site is of great help to us who are going to take the NCLEX RN exam. Thank you

It is quite helpful rather than reading a text book. This help to get use of how the questions should be tackled.

Thank you a million to all Nurseslabs who made this content. Much helpful.Blessings.

I am using this site to prepare for my NCLEX RN examination. I am pleased with my success with the questions and still learning more. I will return to say thank you again to Nurseslabs as soon as I sit my exams as I believe I will pass at my first and only sitting. Thanks for putting this up.

Good luck, Debby!

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Thank you! ☺️

Really so useful and helpful collection of questions Thank you alot ..and waiting for more creativity ❤️❤️

This is a great website & I appreciate all of the practice quizzes so much! I did want to point out that it seems like the substance abuse quiz starts being about depression and mania halfway through? It’s just confusing because the questions completely stop addressing substance abuse at all.

Thank you so much 🙏 wonderful site. Helps me tremendously

I see you’re a Game of Thrones fan. Great quizzes.

Hi Nurseslabs,

Thank you for providing such helpful question banks.

May I clarify the question in number 65, is it asking for the therapeutic effects or side effects of RITALIN? thank you!

This helped me in reviewing my class. Thank you and God bless.

Thank you so much, it was very much educative.

Thank you so much

We are writing exams on Monday and I want you to help me get some questions both theories and objectives because l don’t where she will set her questions from .The course is Mental Health Assessment and Therapies

Next Generation NCLEX Case Study Sample Questions

One of the big changes on the Next Generation NCLEX exam is a shift toward case studies. Case studies often require a deeper level of critical thinking, and understanding diseases on a more in-depth level (especially the pathophysiology) will make these types of questions easier to answer.

In this article, you’ll be able to watch a free video to help you prepare for the new Next Generation NCLEX case study format. Nurse Sarah will walk you step-by-step through each scenario and help you understand how to use critical thinking and nursing knowledge to answer these types of questions.

Next Generation NCLEX Case Study Review Questions Video

NGN Case Study Sample Questions and Answers

First, let’s take a look at our case study summary below:

Case Study Summary:

A 68-year-old male is admitted with shortness of breath. He reports difficulty breathing with activity, lying down, or while sleeping. He states that in order to “breathe easier,” he has had to sleep in a recliner for the past week. The patient has a history of hypertension, myocardial infarction (2 years ago), and cholecystectomy (10 years ago). The patient is being transferred to a cardiac progressive care unit for further evaluation and treatment.

Question 1 of 6: The nurse receives the patient admitted with shortness of breath. What findings are significant and require follow-up? The options are listed below. Select all that apply.

To answer this first question in the NGN case study, let’s look at the information provided in the nursing notes and vital signs tabs provided:

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This question is asking us to identify findings that are significant and require the nurse to follow-up. In other words, what is presenting that we can’t ignore but need to investigate further.

Therefore, let’s comb through the nursing notes and vital signs to see what is abnormal and requires follow-up.

First, the patient arrived to the room via stretcher. That’s fine and doesn’t necessarily require follow-up.

Next, the patient is alert and oriented x 4 (person, place, time, event). This tells us that the patient’s neuro status is intact so far. Therefore, the shortness of breath isn’t affecting the patient’s mental function yet (we have enough oxygen on board right now for brain activity).

However, the nurse has noticed the shortness of breath with activity and talking, which should not normally happen. This tells us something is wrong and is significant enough to require follow-up. We want to know why is this happening, is it going to get worse, etc.

The patient’s weight and vital signs were collected (this is good). Weight is 155 lbs. and BMI is within a healthy range (doesn’t tell us too much but may be useful later). The patient is also connected to a bedside monitor, so they need to be monitored constantly like on a progressive care unit.

The monitor shows sinus tachycardia . This is significant because it seems the patient’s shortness of breath is causing the heart to compensate by increasing the heart rate to provide more oxygen (hence the lungs may be compromised).

Then we find out that the lungs are indeed compromised because crackles are heard in both lungs , and this may be why our patient is short of breath. This is significant (could the patient have pulmonary edema?)

Then we find out the nurse has noted an S3. This is an extra heart sound noted after S2. And what jumps out to me about this is that it is usually associated with volume overload in the heart like in cases of heart failure . However, S3 may be normal in some people under 40 or during pregnancy, but that’s not the case with our patient based on what we read in the case summary.

Therefore, based on everything I’m reading in this case study, I’m thinking this patient may have heart failure, but we need those test results back (especially the echo and chest x-ray, and hopefully a BNP will be in there too).

We are also told that the patient has an 18 gauge IV inserted (which is good thing to have so we can give medications if required), orders have been received, labs drawn, and testing results are pending.

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Now let’s look at the “Vital Signs” tab above, and ask yourself what is normal vs. abnormal for this patient (adult male).

The heart rate is high at 112 (tachycardia), and should normally be 60-100 bpm (see heart rhythms ).
Blood pressure is higher than normal (normal is 120/80), which indicates hypertension.
Oxygen saturation is 94% (this is on the low side as we’d normally want around 95% or higher, and the patient is on 4 L nasal cannula, which tells us the lungs are not okay).
Respiratory rate is increased (26 breaths per minute)…normal is 12-20 breaths per minute.

Based on the information we were provided, I’ve selected the answers below. These findings are significant and definitely require follow-up by the nurse.

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When answering these NGN case study questions, it’s helpful to think of the ABCDE (airway, breathing, circulation, etc.) as all of these fall into that category. If we don’t follow-up on the shortness of breath, crackles, respiratory rate, o2 saturation (94% on 4 L nasal cannula), the respiratory system can further decline.

In addition, the sinus tachycardia, S3 gallop, and hypertension could indicate fluid overload in the heart. This may cause the heart to tire out and lead the lethal rhythm. On the other hand, temperature, pain, weight, and BMI are not abnormal and do not require follow-up.

See the Complete Next Generation NCLEX Case Study Review

Each question in the case study builds on the previous question. To see how these questions evolve based on the patient’s condition and labs, watch the entire Next Generation NCLEX Case Study Review video on our YouTube Channel (RegisteredNurseRN).

NCLEX Practice Quizzes

We’ve developed many free NCLEX review quizzes to test your knowledge on nursing topics and to help you prepare for the Next Generation NCLEX exam.

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