City Research Online

Abstract

Purpose
Adolescent mental health need is high in Aotearoa New Zealand, yet engagement of private psychologists with adolescents is limited. This study examined how private psychologists decide whether to accept adolescent referrals within a mixed public and private mental health system.

Method
Semi structured interviews were conducted with 14 purposively sampled private psychologists across three practice groups. These comprised those seeing 12 to 19 year olds, those with an adults only focus, and those who accepted adolescents selectively. Data were analysed using reflexive thematic analysis.

Results
Willingness to accept adolescent referrals reflected the interaction of interest and feasibility appraisals. Interest was shaped by comfort, perceived fit, interpretations of adolescent reluctance, and beliefs about therapeutic leverage. Feasibility appraisals filtered interest through judgements about whether adolescent work could be delivered safely and sustainably in private practice, including competence and scope concerns, system fragmentation, limited consultation and escalation options, and business viability. These appraisals were associated with conditional engagement strategies such as age thresholds and caseload limits.

Conclusions
Willingness to accept adolescent referrals was appraisal-based and potentially modifiable. Improving access may require both supporting interest formation and strengthening feasibility conditions, including consultation and escalation pathways across sectors.

Publication Type:	Article
Additional Information:	© 2026 The Royal Australian and New Zealand College of Psychiatrists
Publisher Keywords:	adolescent mental health, private practice, psychologists, mental health workforce, referral acceptance
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > HD Industries. Land use. Labor R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry R Medicine > RJ Pediatrics
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:	Symplectic Administrator

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