Exploring the Transition from Online Mental Health Services to Face-to-Face Support for Young Adults 18–25 Years

Abstract

Online mental health services offer programs and resources for users to better manage their mental health, where part of the process of engaging in these services involves initiatives that attempt to motivate a transition from online to face-to-face support. What can we make of those initiatives through the insight of users? This research, platforming the voices of young adults aged 18–25 years, provides valuable insights into the unique help-seeking experiences of this demographic and the effectiveness of online mental health services in facilitating a transition to face-to-face support. Using an online survey comprising of open-response and Likert scale questions, 101 participants provided qualitative and quantitative feedback. Key quantitative findings revealed 66% of participants had transitioned from online mental health services to face-to-face supports following their initial engagement. Moreover, a substantial 57.05% of participants expressed satisfaction with their online experiences. Mental health education pages were the most accessed resource by service users, with 82.18% of participants having used them. Emerging from a series of 10-point Likert scale questions, “contact with a professional” (7.58) and “receiving a referral” (9.25) were the highest rated predictors of transition, while barriers such as a “lack of motivation” and “bureaucratic complexities” were identified from qualitative data as the dominant inhibiting factors. Lastly, psychoeducation emerged as a crucial tool for empowering participants toward overcoming stigma, with the theme of trust highlighted as the most critical factor in determining the confidence of young adults attempting to transition from online to face-to-face support.

Keywords:

• Counseling
• mental health
• mental health teletherapy
• psychoeducation
• young adult

Introduction

For many young adults managing mental health concerns, seeking face-to-face support can often feel like an inconceivable task (Prizeman, Weinstein, and McCabe 2023; Achterbergh et al. 2020). As advocates from all areas of the field acknowledge, the disempowerment associated with internalized stigma is damaging the opportunities of this group from accesses support before they have even begun their journey toward recovery (Barbalat et al. 2022). The role of online mental health services may provide a solution to this barrier and engage this demographic (Pretorius, Chambers, and Coyle 2019). In a time where value and dependence on technology is seeing unprecedented growth, online services provide an innovative way for people to seek support in a comfortable environment (Burns et al. 2016). However, this format of support is not without significant limitations that suggest face-to-face support may have a stronger role in achieving long-term, sustainable recovery (Kauer, Mangan, and Sanci 2014). This research explores the factors affecting the utilization use of online mental health services among young adults aged 18–25 and analyses how it impacts their face-to-face help-seeking behaviors and experiences.

Online mental health services

Online mental health services are quickly becoming increasingly recognized as a legitimate avenue for recovery (Prizeman, Weinstein, and McCabe 2023). While still a relatively new concept, these services have flourished with the rapid growth of internet use and accessibility (Burns et al. 2016). Gowen (2013) recognizes that online services are more successful amongst young adults than any other demographic and highlights the fact that they have a substantial online presence through social media and often use the online sphere as an avenue for information and community. It is a place of familiarity, belonging, and a space they can navigate with confidence (Achterbergh et al. 2020).

The appeal and value of online services is vast. One such attribute is the unique way in which people can seek support while maintaining anonymity and avoiding the fears of social stigma (Burns, Durkin, and Nicholas 2009). Additionally, there are no limits to its accessibility, meaning users can engage with services outside of usual business operating hours, when they are most vulnerable (James 2019). However, while there is vast evidence indicating the great value in online mental health services, there is also a depth of research outlining their limitations. As Lawlor and Kirakowski (2014) highlighted, many studies investigating the impact of online mental health services found trends in the rates of users who had gone on to develop an excessive dependence on their online service as a result of frequent, long-term usage. This demonstrated that while online mental health services are very efficient at engaging those with mental health difficulties, in time they can often manifest into avoidance behaviors and replace the desire to seek face-to-face support. This is often a significant issue when considering the circumstances of users with severe mental health issues whose complex needs require medication which cannot be met by an online service (Burns et al. 2016).

Transitioning from online to face-to-face services

Research into factors that help facilitate the transition from online services to face-to-face supports identifies psychoeducation and trust as the two most significant in this regard. Psychoeducation is a term used to refer to the specific education offered to individuals carrying a mental health condition and is an approach to care that attempts to increase a person’s understanding of mental health and empower their capacity to manage their condition (Hungerford 2012). It is a method considered by Reid et al. (2010) to provide users with the opportunity to improve their emotional self-awareness and mental health literacy and develop an understanding of when it is necessary and how to seek clinical support. It is a claim supported by Kauer, Mangan, and Sanci (2014) who believe that the power of psychoeducation to challenge the stigma associated with help-seeking is substantial. However, despite the evidenced success of psychoeducation, Reid et al. (2010) found it to be an underutilized approach by mental health care services. Their recommendations promote the inclusion of psychoeducation as a key component to care across mental health services both online and face-to-face, with specific attention given to the future moderation of mobile mental health applications.

Trust is another of the consistently recognized themes found across the literature. The context of which is typically discussed in relation to either a specific service or interpersonal relationship (Gulliver, Griffiths, and Christensen 2010). The impact of trust is portrayed by Rickwood et al. (2005), who believe that for young adults, the ability to transition into a face-to-face mental health service can often hinge on the concept of trust vs fear, and as such, are likely to approach a family member or friend over a formal service. Therefore, the opportunity for online services to focus on developing a sense of trust between users and potential mental health care providers could be an important place for future investigation (Horgan and Sweeney 2010).

Methodology

Focusing on the lived experience of online mental health service users, this research used an online survey of qualitative and quantitative measures to capture an understanding of the personal lived experiences of online service users and their help-seeking journey. The survey, made up of open-ended response and Likert scaling questions, asked participants to: identify the mental health support services and programs they had engaged in during their online experience; their experience of using those support services and programs; whether those services supported their transition to a face-to-face service; and general questions concerning their overall help-seeking experience and what they believe was and/or would be most beneficial in aiding the transition process. Participants were sourced online through public social media pages, where non-paid advertisements were made on a variety of mental health support pages. With ethical considerations in mind, the survey required participants to identify as a young adult aged 18–25 and to have previously engaged with an online mental health service. The survey received 101 responses, with 44 respondents completed the questionnaire in its entirety. Of the recorded sample, 97 participants completed the survey from within Australia (89 from New South Wales; 4 from Queensland; 2 from the Northern Territory; 1 from Western Australia; and 1 from the Australian Capital Territory); 3 from Wales; and 1 from India. Ethics approval was sought and granted by the [institution redacted] Human Research Ethics Committee (H11615).

Data analysis

Thematic analysis is a process of pinpointing, examining and recording patterns that are important to the description of the phenomenon that the research aims to explore (Walter 2013; Punch 2014). It is an approach to analysis that can be partnered with phenomenology to broaden the understanding of a context premised by multiple unique experiences. Central to O’Leary’s (2004) prescription for thematic analysis, it is important to explore the potentially different ways of experiencing a phenomenon by being conscious of the range of experiences related to the phenomenon itself. Rather than simply screening for variations between experiences, which can produce fairly one-dimensional results, O’Leary’s (2004) approach focuses on what is relevant to the phenomenon between variations and is interested in identifying the sub-influences within these direct themes. This strengthens the focus of data analysis, reducing irrelevant dissimilarities and integrates the essential nature within various descriptions. This process begins with the coding of data, which involves a manual progression of screening responses for direct themes. Following this, themes are grouped based on their common associations and revisited for a second cycle of analysis, in which the researcher identifies sub-themes (O’Leary 2004). In its application to this project, the second cycle of analysis was instrumental in realizing the common trends within the various stages of recovery for online service users, allowing the data to be organized based on the period in which it was most relevant to the participants journey, the major themes relevant to each stage, and the second-cycle influences associated with each (O’Leary 2004; Walter 2013; Punch 2014). For example, stigma was perceived by young adults as one of the major inhibitors to help-seeking, and as such, saw many confronted with this challenge at the onset of their journey. Once overcoming this obstacle, participants were more likely to challenge self-stigmatising views and plan their recovery path toward face-to-face support. Relevant themes, such as “overcoming stigma” and “facilitators to transition,” were then grouped with the chronological context that they occurred, supported by the second-cycle codes beneath them.

Limitations

This research acknowledges that 72.3% of respondents who participated in this study were from within the greater Sydney region. Within this group, 46.5% were from western Sydney and 19.8% from south-west Sydney regions. This introduces complications as collecting responses from such a focused area makes results vulnerable to sampling bias (Fadem 2009). Results could potentially have socioeconomic connotations that reflect the demographics of this majority. Findings may be most relevant to service users from urban areas and exclude the experiences of those engaging online services from a rural location where only 9.9% of the sample identified as their place of residence. Furthermore, the inclusion of participants from Wales and India may have little influence on the applicability of the findings to an Australian setting given the varying social and health contexts from where these respondents originate.

Results

For most participants, using online mental health services had a positive influence on their capacity to seek face-to-face support, with 66% stating that following their initial engagement with an online service they had progressed to find face-to-face support. Of these respondents, 54.6% identified as having gone on to seek both professional and personal support; 27.3% sought support from only a professional service, while 15.2% sought personal support, and 3% selected “Other”. Moreover, 57.05% of open response comments had positive connotations regarding the use of an online service, such as:

It [going online] allows you to normalise mental health so you see it as something that is okay to seek help for.

And

I think online sites were an important part [towards seeking face-to-face support], for me at least. Jumping online was the first step I took and it was the beginning of many good choices that followed.

These quotes underscore the substantial influence that online mental health services can make among young adults seeking support for their mental health concerns in the digital age. Table 1, titled “Online Services Accessed by Young Adults,” offers a breakdown of the diverse array of online services accessed by participants and their engagement preferences:

Table 1. Online services accessed by young adults.

Answer	%	Count
Mental health education pages	82.18%	83
Narratives/stories	41.58%	42
Professional contact	31.68%	32
Online forums	30.69%	31
Portable digital media & mobile app	25.74%	26
Online clinical assessment	21.78%	22
Online treatment programs	19.80%	20
Referral	13.86%	14
Peer-network chatrooms	9.90%	10
Gaming	8.91%	9
Other: “Self-help course online”; “Mind”	1.98%	2
Total number of participants		101

In this paper, the term “online mental health service” is used as an umbrella term to encompass a wide range of online resources. It extends beyond those that are interactive and/or clinically oriented, to include static website pages that offer various resources, such as the sharing of peer narratives and mental health education materials.

Complimenting this data, Table 2, titled “Self-Reported Outcomes,” provides a quantitative analysis of these services based on a series of self-reported 10-point Likert scale questions. Reporting on the degree of improvement observed by service users across various dimensions, including self-perception, mental health literacy levels, readiness to seek help, ability to overcome barriers, and motivation to access to face-to-face support, this data provides valuable insight into the perceived impact of various online services.

Table 2. Self-reported outcomes.

	Self-perception	Mental health literacy	Readiness to seek help	Overcoming barriers	Access F2F support
Mental health education pages	6.62	7.81	6.07	6.31	5.33
Narratives/Stories	7.81	8.38	6.9	6.9	6.38
Online Forums	7.06	7.29	6.29	6.59	5.94
Peer Chatroom	7	7	8	7.67	6.67
Gaming	8.5	6.5	8.5	8	6
Referral	7.75	8	8	8.25	9.25
Professional Contact	7.42	8.33	7.33	7.67	7.58
Online Clinical Assessment	5.9	7.5	4.8	5.1	5.1
Online Treatment Programs	6.1	6.4	5.7	5.7	5.8
Digital Media & Apps	6.67	7.42	6.25	6.25	5.83

In addition to quantitative data, this research utilized first-order grouped themes derived from qualitative data, along with their corresponding second-order coded items, to establish a structured framework for analyzing the experiences of participants throughout various stages of their recovery journey. Table 3, titled “Organization of Qualitative Data,” outlines the results of the thematic analysis and the organization of data for further discussion:

Table 3. Organization of qualitative data.

First-order grouped theme	Second-order coded items	Coded items
Initial contact with online service
Psychoeducation:	Understanding mental health Reflexive Insight Measuring mental health	149
Overcoming Stigma	Reassurance Relatability Normalizing Challenging Stigma	159
Behavioral response following engagement
Facilitators to Transition	Response Guidance Empowerment Face to Face Contact Accessibility	141
Barriers to Transition	Motivation Fear Personal Challenges Bureaucratic Challenges	80
Reflection on experience
Service Relationship	Trust Comfort Consistency Transition	156

Initial contact with online services

Responses given to this research project indicate that for young adults, their initial contact with online services was typically motivated by a concern regarding their own mental health and a desire to measure those concerns. Moreover, participants expressed being drawn to online services for the accessibility and anonymity that they provide. The desire to understand a specific mental health condition better, and to measure the severity of a suspected mental health concern, was also commonly communicated by participants. They often reported feelings of isolation throughout this period but found great comfort, support, and encouragement toward taking help-seeking steps in the narratives of others. Few participants described a lack of direction at this point in their experience and found both their online and face-to-face help-seeking actions stunted as a result.

Psychoeducation

A common trend in young adults’ recovery experience began with a desire to better understand their mental health experience. Often this meant feeling a degree of ambiguity at the onset of their mental health concerns, motivating the initiative to research online to either confirm or revoke their suspicions. As such, mental health education pages were often a point of early engagement and were nominated by 83 participants (82.2% of the wider sample) as the most utilized service. Participants explained how using information ascertained through visiting an online mental health website enhanced their ability to practice reflexive insight and gauge their mental health concerns. This experience was frequently expressed as a point of change for participants, who felt a shift in their perception toward requiring support. It is important that young adults’ capacity to exercise reflexive insight is valued and trusted. This is supported by Leary and Tangney (2012), who state that self-influence is one of the strongest precursors for behavior and that self-awareness holds great potential in triggering help-seeking actions. Moreover, as Rickwood et al. (2005) and Gulliver, Griffiths, and Christensen (2010) argue, this cohort possess an ability to practice reflexive insight by reading their emotions accurately and understanding the complexities of their issues in a way that constructively contributes to a sense of readiness for care

Findings from this research project support the role of psychoeducation in this regard, with several participants able to make the connection between their enhanced mental health literacy and their improved capacity to help-seek. For example, the following young adult, who shared:

[Mental health education pages], specifically in my case at least, in regards to the psychological and biological aspects of depression and anxiety allowed me a much deeper understanding of what I was going through. It let me understand that I wasn’t abnormal per se and that the nature of neural and psychological interactions was capable to be altered through CBT (cognitive-behaviour therapy) or mindfulness.

Contrastingly, however, a small sample of participants had a negative experience when accessing mental health education pages, having felt triggered by the content, and failing to progress into further support. In these cases, participants typically spoke of a desire to have received more direct instructions about where to go to next. This was reflected in the Likert scaling questions, where mental health education pages scored a high 7.81 out of 10 mean score in relation to improving understandings of mental health, but fell to a significantly lower 5.33 out of 10 mean score relating to whether this service was the reason they were able to transition into face-to-face supports. Nevertheless, understanding mental health was initially viewed as a priority and first concern by participants, granting significant importance to this stage of their journey.

Overcoming stigma

It is widely recognized and accepted across the literature that stigma is a major inhibiting factor for the help-seeking behaviors of young adults (Barney et al. 2006). This was reflected in the findings of this research, where one of the more common experiences reported by participants was their fear of receiving a diagnosis and the negative connotations associated with this. They reported that finding information had the potential to reaffirm the prejudices they held about themselves and trigger a sequence of negative attitudes that would disable them from moving forward. The weight of self-stigma and fear of diagnosis is reflected in the following:

I was terrified about the idea of being diagnosed with a mental health condition. I felt it would make me weak as a person and more vulnerable to bullying and put downs.

While participants spoke of enduring feelings of intense stigma prior to their help-seeking actions, they also spoke fondly of the positive outcomes they received after visiting a mental health website, as having empowered their ability to challenge those prejudices. Most significantly, narratives and stories written by others were seen to have made a meaningful impact on breaking down stigma. This was reflected powerfully in the open-response questions, where participants conveyed feelings of validation and acceptance through finding a sense of community in online forums. An expression of the positive influence that online narratives can have toward normalizing the fears of service users was demonstrated in the following story:

Simply being able to empathise and relate to the problems other people have gone through, that are plainly and so strikingly similar to my own showed me that I wasn’t alone, and that there is hope and potential for conquering the darkness.

The ability that online mental health communities have in challenging stigma and promoting healthy attitudes in relation to help-seeking was a well-established theme across the survey responses. It is a finding that is supported by Kummervold et al. (2002), who believe participation in online mental health communities increases knowledge and understanding of mental health problems. It also improves awareness of health care services available, heightens comprehension and understanding of rights and improves insight into what users could expect from face-to-face services. However, while in many ways this study supports the findings of Kummervold et al. (2002), it also found a portion of participants to have experienced feeling directionless and without support following their initial engagement. Here there was a suggestion that more concrete advice regarding steps forward would have been helpful to those who failed to reach a sense of empowerment and continued to lack confidence.

Behavioral response following engagement

Results from this study indicate that in the help-seeking experiences of young adults, the journey from online to face-to-face support is imbued by a range of factors. Key facilitators to transition were consistent throughout responses, where a need for guidance and planning support was perceived to be an integral part at this stage of their journey. Conversely, the range of barriers to transition were vast and contextual, suggesting that the challenges faced are multiple and often subjective to the experience of the individual.

Facilitators to transition

As participants saw their knowledge of mental health improving, their capacity to practice reflexive insight into their own conditions grew. Echoed in the following narrative, where psychoeducation played a significant role in supporting the service user to recognize their need for face-to-face support:

For me it was simply learning that there was a problem by taking a questionnaire, after this I searched for a better understanding of my condition (dysthymia, major depressive episodes, generalised anxiety/social disorders) and realised that there were ways I can restructure my life so as to minimise the prevalence, and perhaps even silence these symptoms of the disease. The more I learned the more I understood that it was something that I could not do alone, and that seeking professional help shouldn’t be seen as embarrassing, if anything it is to be seen as courageous.

Conversely, some participants expressed extreme difficulty in planning their help-seeking actions and experienced feelings of uncertainty toward making a transition to face-to-face support. The desire for direct response guidance was seen as important in this regard, as suggested in the following response:

I think recommending people to go and see someone. Not just saying you would really benefit from seeing someone but actually telling them how. A lot of us would be afraid and overwhelmed and having someone who is educated in the matter who has already developed a trust in the patient, telling them exactly how they would be able to seek the help they need, would be a good way of turning an online service into a face-to-face.

The importance of direct response guidance was further demonstrated in the Likert scale results regarding the value of online referral, where two Likert scale questions regarding the value of online referral and whether receiving a referral helped to over-come barriers to face-to-face support scored an extremely high 8.25 and 9.25 out of 10, respectively, indicating just how effective online services can be as a gateway into face-to-face support.

Another key facilitator for engaging with face-to-face support was access to an online mental health professional. For those who had connected with this form of support, all spoke highly of the outcomes following their sessions. Responses suggested a direct improvement in their overall mental health, as well as aiding their transition toward formal face-to-face services. Moreover, data produced through Likert scales confirmed that online professional contact had positive outcomes on their ability to overcome barriers to face-to-face help-seeking, where there was a mean score of 7.33 out of 10 in response to this question.

Interestingly however, while participants described positive experiences in their online service usage, comments were consistently made throughout the study suggesting a preference toward face-to-face support. For those who were able to make a transition, they cited the benefits of face-to-face contact as being one of the most significant factors in their recovery journey. While for often those who were not able to, they typically discussed a desire to reach out to face-to-face supports but expressed an inability or unawareness of how to do so. These findings indicate that the role of online services could be most significantly utilized in their ability to empower users to overcome their personal obstacles relating to self-stigma, making transition plausible through direct response guidance and the planning of recovery. These statements are supported by the research of Horgan and Sweeney (2010), who found that 79.4% of of their sample stated they would prefer face-to-face support, despite 75% of Kummervold and colleague’s (2002) sample finding it easier to discuss their mental health problems online. These statistics show that while young adults desire face-to-face support, they often feel incapable or uncomfortable in doing so—it is here where online services can make their impact as a transitional tool.

Barriers to transition

Obstacles preventing or deterring young adults from successfully transitioning from online to face-to-face support were vast. It was clear during the analysis of responses that people experience challenges in a variety of ways, making it difficult to deduce concrete conclusions regarding key barriers. However, some common trends that influenced a range of participants have been identified. These were: issues related to self-motivation, fear of disclosure and the stigma attached to this, personal challenges, and bureaucratic and logistical challenges.

Motivation was consistently cited by participants as a difficult barrier to overcome in their help-seeking experience. Correlations between those who possessed motivational struggles with the accounts of a failed transition into face-to-face supports were clear. Responses regarding the efforts of online services to address this issue were split. Some reported experiencing a sense of empowerment attached to their online engagement and as such were able to alter their perception and overcome the barrier. However, an equal group of participants revealed being unable to continue their search for support due to the severe lack of motivation and an unsuccessful effort to challenge the issue. These results are supported by research conducted by Bradley, Robinson, and Brannen (2012) who found a comprehensive link between a lack of motivation and readiness for care, declaring it as a key stimulant in the help-seeking experience.

Readiness for care was influenced both positively and negatively across a variety of ways by online mental health services. While psychoeducation practices embedded in mental health education pages were viewed to have positive outcomes toward readiness for care, one place of major concern was online treatment programs which were unanimously reviewed poorly by participants. The poor review of this medium for support was accurately reflected in the open-response answers, where just 1 of the 10 participants who identified as having used this type of service acknowledged having found the service helpful. Comments regarding the ineffectiveness of these programs judged the content and material provided to be both demotivating and uninspiring.

Bureaucratic and logistical challenges were commonly identified by respondents to create unnecessarily complicated obstacles. Overcoming issues such as affordability and navigating the complexities of the health sector were frequently cited within these responses to be harshly overwhelming. Some of these issues are raised by the following respondent, who voiced their concerns:

Obstacles are often just the stress of finding time to meet with a doctor, affording appointments, filling in forms etc. Bureaucracy was ultimately more challenging for me than opening up to people.

Additionally, many reported experiences of high stress resulting from a lack of access to professionals, both online and face-to-face. This was demonstrated in the experiences of the following participant, who stated:

Engaging in contact with a professional via online chat was really unhelpful. The lack of available professionals to speak to was a major issue. Definitely deterred me from using that kind of avenue to seek support.

Other participants told narratives of how defeated they had felt trying to maneuver their way into face-to-face services after overcoming real challenges to get themselves to the point of feeling ready to transition. The contrasting responses of this sample compared to those who had received a direct referral and reported a very positive experience, perhaps reinforces the benefits of direct guidance in transition.

The connotations of fear were consistent throughout the study and generally spoken of in the context of disclosure and the stigma that is attached to this. A common theme associated with fear and the transition to face-to-face services was the difficulty to trust professionals with sensitive information. Many participants consistently expressed feeling intimidated by the thought of sharing personal stories with a stranger, such as the following:

It’s quite difficult personally going from seeking help behind a screen and having more privacy to speaking face-to-face with someone. It makes me feel a lot more vulnerable and scared that it will be used against me so I guess I would need to find someone I fully trust.

This experience is well captured by Gulliver, Griffiths, and Christensen (2010), who in their literature review investigating the perceived barriers and facilitators to mental health help-seeking, found over half of documents addressing this topic cited trust as a key finding. Furthermore, Rickwood, Deane, and Wilson (2007) and Rickwood et al. (2005) believe people show much higher help-seeking intentions when they have gone through a secure relationship or are approaching a trusted resource. Reiterated by participants of this study, who spoke of the positive influence that trusted interpersonal relations had over their face-to-face help-seeking experience.

Reflection on experience

Establishing and maintaining trusted relationships between service and their user was highlighted throughout the survey responses with vital importance. This was most evident in the open response question asking participants what they found did/or would find most helpful in transitioning from an online service to a face-to-face support, where trust and relationships were by far the most recorded theme throughout.

Service relationship

Trust in professionals within both an online and face-to-face context was cited by participants as both a key facilitator and potential barrier to their face-to-face help-seeking efforts. Examples of how relationships acted as an enabler was often provided in the narratives of successful transitions, where participants spoke about the role that a key facilitator had within that process. Often this experience explained an associated sense of comfort and confidence toward approaching a significant interpersonal relationship or role model, as opposed to an unknown professional. They spoke meaningfully about their vulnerability during this moment, where it was often the first time they had disclosed their concerns in person. Typically, responses highlighted the importance of a strong relationship in assisting and encouraging them to seek professional support.

This narrative is consistently found across the literature, where many researchers have documented trends in help-seeking behaviors that see people initiate help-seeking with a close friend or family member before approaching a formal service (Lane et al. 2023; Lane 2024). However. while it may be more common to experience trust with an established personal relationship, this does not exclude online relationships with service providers. Many participants of this study spoke very highly of the connections they were able to make with others online and how pivotal these relationships had been in their recovery journey. They spoke of their desire to retain their online relationships during their transitional period and of how consistent contact with a referring professional would provide ongoing self-assurance. This was often due to the benefits of having an established trusted relationship guiding a search for professional support, where the complexities of navigating the system can be an overwhelming experience. As this respondent advocates:

Remaining in contact with the same person who referred me online for consistency would be a major key in terms of helpfulness.

Pragmatically, the idea of consistent online contact with a referring professional is difficult, and concerns over how resources can accommodate for this on a wide scale are valid. Fortunately, however, some participants spoke of having experienced consistency in their online professional contact and reported receiving a personalized approach to their care as having a positive impact on the development of their self-efficacy and confidence. This involved frequent discussions with the same professional online over a period leading up to their face-to-face help-seeking actions. A similar experience was shared by the following:

I did an online course to understand and improve my mental health where I spoke to a psychologist once a week. This was very helpful and I liked the fact that it was over the phone/online so it was very easily accessible. It also helped bridge the gap and eased the process of going face-to-face.

Many young adults identified online support services as helping to build their capacity to move to face-to-face support by breaking down the barriers, fear and intimidation preventing their access to professional services. They highlighted that being informed about the service, what they did, what they could expect and the professional they would have contact with before the first face-to-face meeting was helpful. Receiving this information and support instilled a sense of awareness about the professional service and eased the high levels of anxiety relating to access. Some participants identified this process to be a precursor to receiving an online referral.

In reflection upon their overall help-seeking journey, participants frequently spoke of their preference for face-to-face support. Often this position was a direct result of the barriers that interacting online had toward establishing trust in relationships. One example of the limitations to online services and the advantages of face-to-face support was shared in the following statement:

You can read the other person and to hear them say comforting words which is a lot more reassuring than reading them on a web page. Words are just words, but when you have things like eye contact and comfortability and trust, it is a lot easier to feel better.

Rickwood et al. (2005) believe there are multiple reasons underpinning users preference for face-to-face support and why people are most likely to approach a friend or family member. Their study points to the consistency in access that personal supports provide and trust that these relationships carry. By contrast, formal help-seeking would involve an exchange of personal information with a stranger, which is outlined by respondents in this study as an anxiety inducing factor.

The ability for online services to challenge these notions is valuable. Accessibility is high and users can engage anonymously, undercutting fears of revealing personal information. For moderators of online services, understanding how they can best facilitate the development of a trusted relationship with clients should be of principle importance. This suggestion is supported by a dominant view across the literature which acknowledges the essential nature that trust and relationships have within the help-seeking experiences of young adults (Migliorini et al. 2023).

Future research

In acknowledging and validating the views of participants, it is recommended that further research investigating how direct response guidance and psychoeducation can better facilitate users’ transition to face-to-face support be explored. Moreover, the need for research seeking to understand how trust in professional face-to-face services can be developed within an online context would be of significant benefit. This study emphasizes the potential of these areas, believing that further understanding of how these concepts can be practically applied to service provision would increase the overall effectiveness of online services and their function as a pathway into face-to-face support.

Conclusion

It is crucial to remember that although many young adults in this study expressed a preference for face-to-face support, many faced substantial barriers in accessing it. This research demonstrates that online mental health services can be a useful intermediary in addressing this gap, as evidenced by the 66% of participants who transitioned from online mental health services to face-to-face supports following their initial engagement. Moreover, a substantial 57.05% of participants expressed satisfaction with their online experiences, indicating the positive impact that online platforms in meeting the varied needs of their users. In terms of resource preferences, 82.18% of participants identified as having accessed mental health education pages, with qualitative data relating to these resources reiterating the importance of psychoeducation in challenging self-stigmas and enhancing individuals’ self-regulation abilities.

Likert scale results provided additional insight into the factors influencing young adults’ experiences. Notably, “making contact with a professional” (7.58) and “receiving a referral” (9.25) were the highest rated predictors of transition, with barriers such as a “lack of motivation” and “bureaucratic complexities” emerging from qualitative data as significant inhibitors. Lastly, the concept of “trust” was cited as a central theme throughout the help-seeking seeking journey, with participants consistently emphasizing its vital role in shaping their confidence and comfort levels toward transitioning to face-to-face support. This finding highlights the essential nature of trust within the context of mental health support and the imperative for online service to prioritize efforts in fostering trust with their service users across all stages of their help-seeking experience.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Notes on contributors

Sam Lane

Sam Lane, PhD, Honours ([email protected]) School of Social Sciences, Western Sydney University, Liverpool, Australia.