Barriers to accessing and using preventive mental health services for psychosocially strained children and families in Germany: Perspectives of professionals from different sectors

Abstract

Objective

Children, young people, and families (CYF) with psychosocial strains face elevated risks for mental health problems. Preventive mental health services in health, education, and social sectors can reduce this risk, but are often underused or have waiting times. While some data on barriers to use from clients' perspectives exist, the professionals' perspective is also important, particularly for understanding barriers at the side of providers and organizations and identifying solutions. This study examines barriers to accessing and using services from the perspective of professionals in multiple sectors.

Methods

Nineteen semi-structured interviews were conducted with professionals from the health, education, and social sectors in socioeconomically disadvantaged districts of two German cities in 2024. Interviews were audio-recorded, transcribed verbatim and coded using thematic analysis.

Results

Professionals described barriers at the (1) Client level (e.g., feeling ashamed using psychosocial services), (2) Provider level (e.g., insufficient knowledge about services), (3) Organizational level (e.g., responsibility or expertise not fitting families' needs), and (4) System level (e.g., long waiting times). To address barriers, professionals suggested trust-building with families, establishing contact and collaboration with other professionals, and building one-stop-shop models of co-located services to overcome parents' time constraints when children need multiple services.

Conclusions

Professionals are key to identifying barriers to preventive mental health service access and use in psychosocially strained CYF and finding solutions. Intersectoral exchange with other professionals can increase service awareness from other institutions and guide intersectoral collaboration. Barriers must be addressed holistically across levels and sectors to effectively overcome them.