Young People's Perceptions of Signposting in a Digital Mental Health Helpline: Mixed Methods Analysis of Cross-Sectional Data.

Background: Mental health problems are prevalent among young people aged 16 to 24 years. With the health care system prioritizing severe cases, most young people wait months before accessing professional support. One-to-one helplines offer alternative and accessible mental health services for young people with emotional support, psychoeducation, and signposting. Signposting empowers young people to access long-term support beyond a brief helpline session. However, young people often choose not to access the signposts. Despite its importance, there is a dearth of existing research examining signposting via digital mental health helplines for young people. Objective: Using cross-sectional survey data from The Mix, a UK charity supporting young people aged 25 years or younger, this study conducted a mixed methods analysis of their multichannel (webchat, email, telephone, and web-based contact form) helpline survey between February 2020 and October 2023. Methods: The analytic sample included 296 participants who collectively received 872 signposts (approximately 872/4500, 19% of signposts provided during the survey collection period), of which 822 with complete outcome data were included in the statistical models. Multinomial logistic regressions were conducted to examine whether young people's use and perceived usefulness of the signposts they received differed across modes of delivery and their demographic characteristics (gender, ethnicity, and age). Qualitative thematic analysis of 106 open-ended responses from 97 participants was also examined to illuminate why young people found signposting helpful and how it could be improved. Results: In the overall model, which included all predictors, webchat users identifying as White, women, and aged 16-19 years were significantly more likely to use and find signposts helpful than to perceive them as unhelpful (odds ratios [OR] 0.28, 95% CI 0.17-0.46; P<.001), not intend to use them (OR 0.13, 95% CI 0.07-0.26; P<.001), or only plan to use them later (OR 0.29, 95% CI 0.18-0.46; P<.001). Thematic analysis of open-ended responses revealed that young people found the choice of signposts relevant and appreciated how signposting was integrated with emotional support. Young people also felt more hopeful after being signposted and gained both clarity and insight into the support available. However, they also noted challenges, such as feeling overwhelmed or encountering outdated signposts. Conclusions: Given the increasing reliance on digital mental health services, ensuring that signposting remains accessible, relevant, and tailored to diverse user needs is essential. By optimizing signposting strategies, helplines can empower young people to seek appropriate long-term support, ultimately improving mental health outcomes.