How identity and cannabis use shape teens’ access to mental health care

Adolescents often navigate complex psychological, behavioral, and identity-related challenges, yet many do not seek the mental health support they need. Sexual minority youth face additional identity-based barriers that further hinder access to care. A sample of 1,129 Israeli adolescents aged 16-18 (M = 17.42, SD = 1.03), including 30% who identified as sexual minorities, completed measures of mental health, substance use, suicidal ideation, and perceived barriers to care. Latent Profile Analysis (LPA) identified subgroups based on mental health and behavioral risk, and Exploratory Graph Analysis (EGA) identified latent dimensions of help-seeking barriers. Moderation analyses tested whether sexual orientation shaped associations between profile membership, perceived barriers, and help-seeking intentions. Four mental health profiles emerged: Within Normal Ranges, Emotional Struggles and Suicidal Ideation, Tobacco and E-cigarette Users, and Cannabis Users. Barriers to care clustered into three domains: Identity-Related Barriers, Accessibility and Structural Barriers, and Emotional and Internal Barriers. Higher-risk profiles reported greater barriers and lower intentions to seek help, with stronger effects among sexual minority youth. Sexual orientation moderated these associations, revealing lower help-seeking intentions among sexual minority Tobacco and E-cigarette Users but higher intentions among sexual minority Cannabis Users. Patterns of psychological distress, substance use, and marginalized identity intersect to shape adolescents' access to mental health care. Tailored, identity-affirming outreach and efforts to reduce structural and emotional barriers are essential for reaching youth who face the greatest obstacles to seeking support.