A mixed methods analysis of youth mental health intervention feasibility and acceptability in a North American city: perspectives from Seattle, Washington

Introduction In March 2021, the Governor of Washington declared a youth mental health crisis. State data revealed high rates of youth suicide and inadequate access to services. This mixed-methods study examines youth and adult perspectives on mental health service gaps and opportunities in Seattle by assessing needs, feasibility, and acceptability of interventions to support youth mental health. Methods We interviewed 15 key informants to identify the contextual, structural, and individual-level factors that increase the risk of poor mental health and deter access to care among young people. We complimented these data with a cross-sectional 25-item survey of 117 participants in King County to assess the feasibility and acceptability of interventions for youth mental health. We conducted a deductive thematic qualitative analysis of the interviews and performed descriptive analyses of the quantitative data, using t-tests and χ 2 tests to summarize and compare participant characteristics stratified by age group. Results Qualitative informants attributed challenges to youth mental health to social and relational problems. Example interventions included creating environments that increase belonging and implementation of culturally congruent mental health services. Quantitative study participants rated all evidence-based mental health interventions presented as highly acceptable. However, youth preferred interventions promoting social connectedness, peer support, and holistic approaches to care, while non-youth preferred interventions focused on suicide, alcohol, and substance abuse prevention. Both key informants and survey participants identified schools as the highest priority setting for mental health interventions. There were no significant differences among quantitative outcomes. Conclusion Our findings highlight the need for reducing social isolation and increasing social connectedness to support youth mental health. Schools and digital tools were preferred platforms for implementation. Engaging multiple stakeholders, especially young people, and addressing cultural needs and accessibility of mental health resources are important pre-implementation activities for youth mental health intervention in a US city.