Exploring adolescents' and stakeholders' perceptions of online and school-based mental health provision.

Background: Adolescents' engagement with online mental health support (e.g., apps, social media) may affect their engagement with traditional support, including in schools. However, research has typically considered engagement with online- and school-based mental health support separately meaning the mesosystemic interaction between the two is overlooked. Using co-produced exploratory qualitative methods, the present study explored adolescents' and adult stakeholders' perceptions of how and why adolescents engage with school-based and online mental health support, the interaction between these two modalities, and the associated risks and opportunities.

Methods: A youth advisory board (n= 4; Age = 18-25) co-created data collection methods, ethics procedures, and data analysis. For the main phase of data collection, 27 adolescents (Age M = 15.42, SD = 1.58, Range = 12-18, Girls = 73.1%, White = 84.6%) with mental health difficulties who had engaged with online support while at school were recruited from across England. Participants chose to participate in an interview (n = 10) or focus group (n = 17, 5 groups). In addition, interviews were conducted with 12 adult stakeholders who worked in fields related youth mental health.

Results: Data was analysed using template analysis resulting in four themes; (a) Support is abundant, but accessing what you need when you need it is tough,(b)Human connection is vital and can be achieved in diverse ways,(c) Striving for autonomy and control, (d) Navigating credibility and trust across contexts. Conclusions: Different types of support met adolescents' needs in different ways, and each offered relative strengths and weaknesses. Findings highlight how adolescents value autonomy and choice when engaging with support, using multiple different sources of support in complementary and self-directed ways to meet their needs. Several challenges were identified across settings, which could be overcome through increased collaboration. This improved collaboration has potential to improve the quality of support available to adolescents.