How can GPs help young people engage with treatment for mental health issues?

The first contact a young person has with a health professional about a problem with their mental health can be critical in helping them to engage with treatment and recovery.

How can GPs help young people engage with treatment for mental health issues?

For more on this topic please see Mental health and young people: opportunities to empower and engage

This MedicineWise News has been prepared by Dr Iain Macmillan, Dr Rachel Tindall and Ms Lucy Mahoney from headspace (Frankston, Victoria) and Barwon Health. The article reflects their perspectives and experience working with young people presenting with psychological distress, depression,  anxiety and other mental health issues.


Key points

  • Mental health problems in young people are extremely common. More than 50% of young people will experience some form of mental ill health by the age of 25.
  • Early intervention with effective support and treatment is essential to reduce potential chronicity of mental illnesses. 75% of adult mental health disorders have their onset before the age of 25.
  • Personal connections between the young person, their supports and the health professional, a focus on the person's needs rather than their diagnosis, and shared goals are essential for good engagement.
  • Regular, scheduled follow-up sessions can be very helpful as they demonstrate to the young person that you are invested in their wellbeing.
  • Evidence-based treatments are available, but not equally readily accessible for young people. Work with the young person to determine most suitable treatments based on their needs and preferences and to optimise meaningful engagement.

Young people have experienced an extraordinarily difficult time over the past few years, with the COVID-19 pandemic, wars, disruption to their education, and environmental threats such as bush fires, droughts, and floods. Climate change is a major source of anxiety, and many young people are experiencing symptoms of anxiety and depression.1 

Iain Macmillan, consultant psychiatrist

Mental health is a key component of overall health and wellbeing and a national health priority area.2,3 The majority of mental health problems start in childhood and adolescence. More than 50% of young people will experience some form of mental ill health by the age of 254-6, with 75% of adults with a mental health disorder experiencing the onset of the problem before the age of 25 years.7

The high prevalence of mental health problems, their negative impact on educational, occupational, and social functioning, as well as quality of life, and their significant financial and societal cost, emphasise the need for optimising the management of mental health in young people.2,8

Helping young people to navigate and successfully participate in management and treatment for their mental health issues can be complex, and time-consuming. It is also highly rewarding - improving their current and long-term wellbeing and engagement with society, as well as reducing the risks of substance abuse, depression and suicidal attempts.9 Mental health disorders can lead to life-long social and economic disadvantage. This can be prevented by effective, early treatment. In this article, we address some of the steps GPs can take to help young people engage with support and plan management options to meet their needs and goals.10

Meet Jordan

Jordan is 17, in Year 11 at a local school. Their parents are worried, as Jordan’s performance at school has been deteriorating, and they have lost interest in playing soccer, which they used to enjoy. Jordan struggled with the online schooling required during COVID-19 lockdown and has been spending more and more time isolated in their bedroom.

Since school returned to face-to-face teaching, Jordan’s attendance has been poor and they have had great difficulty concentrating on their work. They are uncomfortable going to crowded places and seem to be avoiding any direct social contact with their friends. Their (supportive) parents have arranged for them to see their GP.

Jordan’s first appointment with their GP is important. It presents an opportunity for them to feel heard, and to learn that recovery is possible.


What can help make a positive first meeting?

The first contact Jordan has with a health professional can be critical in their longer-term engagement with treatment and services. It is crucially important to build initial rapport, seek to understand the young person’s primary needs and develop a collaborative plan for ongoing contact.11

Ideally, first contact should focus on engagement in a non-stigmatising setting, with a view to early intervention and prevention.12,13 Ways to make Jordan feel comfortable may include:

  • Show them they are valued as an individual. For example, the GP could ask Jordan their preferred pronouns, how they wish to be addressed and learn about their hobbies and future plans. This information can be used to discuss how the problems Jordan is experiencing are stopping them from doing what they enjoy and wish to achieve.
  • Consider the situation from the young person's perspective. What they see as their primary problem may be different to what is observed by the GP, or what their parents see, and may be a source of disagreement. In Jordan’s case for example, is it their low mood, conflict with friends, or fears about getting COVID-19 that is the primary concern?
  • Establish recovery goals. Ask Jordan what would need to change for them to feel ok again. They may say something like “I just don’t want to feel sad and scared all the time”. Ask curious questions around what this would look like.
  • Find common elements which can be drawn together to create a shared goal. With a focus on understanding Jordan’s needs, support can be targeted, such as linking in with a psychologist to discuss their low mood or providing education on how to reduce COVID-19 risks. These targeted ‘wins’ can help establish trust, give Jordan and their parents hope, and support the GP getting to know Jordan.
  • Use objective measures of severity, such as rating scales for anxiety and depression, which can be done collaboratively. These can be very helpful in planning and monitoring response to treatment.

Depression and anxiety in young people

Depression and anxiety can often present differently in young people, compared to what a GP might typically see in adults.13-15 Young people often describe their distress through how their symptoms are impacting their life, and their ability to function. Many diagnostic categories are based on observations of older people with established illnesses and are not necessarily relevant to young people who are starting to develop symptoms.

How depression or anxiety might present in a young person:13, 15, 16

  • Feeling anxious, panicky or on edge most of the time
  • Increase in physical symptoms with no medical causes identified (eg, generally feeling unwell, headaches, racing heart, muscle tension, hands shaking)
  • Withdrawing from, or avoiding situations (eg, school, socialising)
  • Intrusive thoughts
  • Feeling irritable, sad or depressed most of the time
  • Having thoughts of being worthless
  • Inability to concentrate affecting school, work or capacity to enjoy conversations
  • Lethargy, lack of motivation and lack of enjoyment in previously enjoyed activities
  • Thinking that life is not worth living – sometimes even about suicide
  • Harming self (eg, cutting, burning)
  • Changes to sleep and appetite

GP relationships as essential connections

Successful engagement is not an outcome to be met, instead, it is a dynamic process that benefits from consistent reflection and attention.

Rachel Tindall, mental health nurse lead

When young people reach out for help, they describe the importance of connecting with someone who cares about them.5 This is often demonstrated through continuity of care, following through on actions and remembering small personal details about them.

Research by Tindall et al (2018) explored experiences of help-seeking for first episode psychosis among young people, their care-givers and health professionals.12 Findings from this qualitative study demonstrated how important the relationship between a young person and their GP can be for them to access help.

“[GP] actually made me feel a lot better about going to speak to someone because I think she really cared. And my GP she always texts me and so we have a really good relationship too. I think she pushed me to get help.”

Conversely, young people also described how they feel when realising a health professional appeared to be out of their depth.

“[GP] wasn’t very helpful. She kind of just was like ‘Right. I don’t know how to handle you, but I know that the mental health place can’. So, she just called them and made me wait for a few hours . . .And then she sent me home I’m pretty sure, and I saw them the next day, I think. It felt horrendous. I felt really like upset.”

What can help create a connection when the patient is a young person?

  • Connect relationally. Young people often report being more able to open up to health professionals who connect with them person-person, with humour, or over shared interests.
  • Where possible, slow down, make eye contact with the young person and be present.
  • Demonstrate an interest in the young person, book in regular appointment times and remember details about them as a person.
  • Be aware of stigma, self-stigma and shame, and the impacts this could have on the young person’s capacity to open up.
  • Ask the difficult questions about risks and vulnerabilities in a caring manner, whilst acknowledging and parking one’s own anxieties. Sometimes, reframing a “Risk Assessment” as a “Safety Assessment” can be helpful.
  • Take a needs-based and strengths-based approach rather than a diagnostic approach. Focus on their specific symptoms and problems, as this helps them feel listened to, and it allows the GP time to undertake a more longitudinal assessment.
  • Ask about their ways of coping – many young people are very resilient and helping them to use their own strategies can empower them.
  • If caregivers are involved, keep them informed of the help-seeking process and talk with the young person about the level of personal information they would like shared with their caregivers.

Accessing care

Honouring the wisdom of the young person and their own understanding of what's happening for them is important. It empowers them to feel like they have a role in their own care rather than feeling like they're being told what's "wrong" with them.

Lucy Mahony, youth peer support worker

Ideally support should be financially accessible, with a choice of evidence-based treatments, and include opportunity for family support and engagement. A young person should feel able to speak to someone, to express their discomfort or distress with the experiences they are having, long before their symptoms increase in intensity. However, there are a number of potential barriers (person-, environment- or service-related) that a young person such as Jordan might need to overcome before they can access mental health services, or treatment (Box 1). In some cases, GP knowledge of the health care system, or of available local services, may be able to help address barriers affecting access to care.

Box 1: Potential barriers a young person may experience that can impact their ability to access mental health care

Lack of awareness about mental illness and support options

Shame, stigma or self-stigma

Differing cultural understandings of mental illness

Lack of cultural safety

Lack of infrastructure (internet, hardware) to facilitate online treatment

Language barriers

Logistical and geographical barriers, including lack of transport to onsite appointments

Difficulty attending scheduled appointment times, especially when mental health symptoms are impacting motivation, sleep and energy levels

Long waiting lists impacting motivation to seek help

Poor experiences during previous help-seeking episodes (eg, attending an emergency department, involvement of police, use of the Mental Health Act)

Young people do not always engage well with more traditional medical/clinic-based approaches to treatment. They may fall victim to the “gaps” that exist between primary and specialist services (Figure 1), or between child/ adolescent, and adult services, which have very different origins, and approaches to treatment, as well as set thresholds for treatment.17 The recent development of more specialist Youth Mental Health services is intended to help bridge these gaps, but may not be available in all areas.

Figure 1.  Anecdotal experience of person trying to access mental health system. 
(Adapted from Twitter – author unknown)


What treatments can help a young person experiencing depression and/or anxiety?

Current evidence supports a staged approach to treatment.13 For young people, especially those with milder presentations, effective first-line treatment could include providing information, suggesting dietary and lifestyle modifications, and encouraging increasing physical activity and exercise.13, 18

For presentations of mild to moderate anxiety or depression CBT has demonstrated benefits and is considered appropriate first line treatment.13,19 Depending on the young person’s personal preferences and needs, interpersonal therapy and non-directive supportive therapies are other evidence-based options for psychological support.19 If there are known waiting periods for accessing psychology or other therapies, work with the young person to explore interim approaches. These could include online mental health programs and resources that can help the young person start to understand their symptoms and distress, while providing some initial support.20

Other useful management strategies can be providing youth-friendly information on mental health and discussing the pros and cons of different treatment approaches.

If symptoms of depression or anxiety are severe, or psychological treatment is not possible or not effective, then use of a medicine may be an option. Any use of medicines should be a thoughtful decision made jointly with the young person (and where appropriate their parents or other carer). “Start low and go slow” is a good approach, reviewing the patient regularly to assess their response to, and tolerance of, any drug treatment (Figure 2).

SSRIs, for example, are more effective in moderate to severe depression and anxiety, but risk increasing suicidal thoughts and actions in young people. Increasing doses above the “standard” dose does not result in increased efficacy, but may lead to increased numbers dropping out of treatment due to side effects.21

Other antidepressants, such as SNRIs, or tricyclics and tetracyclics (mirtazapine) are not recommended for young people (particularly those under 18yrs), other than perhaps in specialist practice, due to potential worsening of outcomes.

Figure 2. Algorithm describing approach to selecting a medicine to trial, if required. (References are available at

In Australia: If you or someone you know needs help, contact Lifeline on 13 11 14 or or the Suicide Callback Service on 1300 659 467 or

In New Zealand: If you or someone you know needs help, contact Lifeline NZ on 0800 543 354 or or the Suicide Crisis Helpline on 0508 828 865 or


Resources and further information


Contributing authors

Iain Macmillan

Iain is a psychiatrist who has been working in the field of youth mental health and early intervention since 2003. He is consultant to the headspace Early Psychosis team in Frankston, Victoria. He is a member of the RANZCP Bi-national Committee of the Section for Youth Mental Health.

Lucy Mahony

Lucy is a youth peer support worker with the Frankston headspace Early Psychosis team. She works with young people to help them find meaning in their experiences and navigate the system. As a Recovery Educator with headspace Discovery college, Lucy draws on her lived experience to help codesign and deliver mental health courses for youth.

Rachel Tindall

Rachel is a mental health nursing lead, working on the codesign and implementation of mental health services at Barwon Health, Victoria. Her PhD, completed in 2020, focused on understanding how young people, their caregivers and their clinicians experience engagement with, and disengagement from, public mental health services.



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