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 χ2 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported in part by funding from Pivotal Ventures and Rural India Supporting Trust to citiesRISE (MS and MH). PYC, TC, ISC, and CGK were supported in part by funding from Pivotal Ventures through a sub-contract with citiesRISE. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The research study received approval from the University of Washington Human Subjects protocols STUDY00007988 and STUDY00008904. Qualitative research participants received a study information sheet and provided verbal informed consent (adults) or assent without parental consent (participants under age 18). Consent for quantitative survey participants was embedded in the online survey participants under the age of eighteen assented without parental consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data cannot be shared publicly because of privacy and confidentiality assurances included in the consent/assent documents for study participation. Given the sensitivity and regional specificity of some of the data, the participants did not consent to use of their data for additional research purposes.