School Matters: A Multilevel Analysis of Stigma, Supportive Relations and Adolescents' Mental Health Help-Seeking Attitudes.

Adolescence is a developmental period marked by heightened vulnerability to mental health difficulties yet help-seeking in this age group remains remarkably low. Although mental health help-seeking is increasingly recognized as a socially embedded process, prior research has largely focused on individual factors, providing limited evidence on how broader social environments shape adolescents’ mental health help-seeking. Drawing on the Network Episode Model, which emphasizes the role of social networks in shaping help-seeking, the present study examines how two aspects of schools’ social network – stigma and supportive relations – influence adolescents’ help-seeking attitudes. Accordingly, the study investigates how stigma, teacher support and classmate support at both the individual (student) and contextual (school) levels are associated with adolescents’ attitudes toward seeking help from various informal and formal sources. Data were obtained from a cross-sectional survey of 4,702 students (62.1% girls; Mage = 16.80 years, SD = 0.93) across 38 secondary schools in Flanders, Belgium. Multilevel regression analyses indicated that higher school-level public stigma was negatively associated with help-seeking attitudes, independent of individual-level personal stigma. Conversely, supportive relations, particularly with teachers, were associated with more favorable help-seeking attitudes, including toward professional services outside the school setting. These findings demonstrate that schoolwide cultures of stigma and support shape adolescents’ help-seeking in ways that extend beyond individual attitudes. They underscore the importance of fostering supportive, non-stigmatizing school environments and the influential role of teachers in promoting mental health help-seeking.