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Objectives: In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. Methods: We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy – that is, how different needs are deemed deserving of health service attention – was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. Results: Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable. Conclusions: Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources. [ABSTRACT FROM AUTHOR]

Objective: Young people and parents want to be more active in treatment decisions. Using the Theoretical Domains Framework (TDF), which segments behaviour change into barriers and facilitators across fourteen domains, the aim of this study is to explore the barriers and facilitators to shared decision‐making (SDM) from young people and their parents' perspectives. Method: The sample comprised nine young people who presented with internalising difficulties and ten parents of young people with internalising difficulties across two sites in England. Interviews were conducted, and transcripts were analysed using a deductive thematic analysis. Results: Overall, 15 barriers to and facilitators for SDM in child and youth mental health were identified. Under capability, these included an awareness of SDM, forgetting discussions or not asking questions, clinician listening skills and communication skills. For opportunity, these included the availability of treatment options, availability of understandable resources, staff shortages, the environment being conducive to SDM, and if the school, or parents of young people, facilitated decisions. For motivation, these included whether SDM was thought to empower individuals, result in better treatment, or individuals making the 'wrong' decision, as well as whether individuals felt capable to be involved in treatment decision‐making, whether young people lacked capacity, and whether they could make decisions due to enhanced emotional states. Conclusions: Barriers and facilitators across capability, opportunity and motivation were identified. Interventions which target these barriers and facilitators may facilitate young people and their parents' involvement in decision‐making. [ABSTRACT FROM AUTHOR]