Gender/sex has an influence on MHL levels among youth. Studies show that females are more likely to have increased levels of MHL regarding generalized anxiety disorders compared to males due to high prevalence (12–14). Similarly, a cross-sectional study with 1,207 Australian youth participants demonstrated that females are significantly more likely to identify depression than males (15). Young females have also consistently reported high rates of psychological distress compared to young males (16).

Hegemonic masculine ideals discourage vulnerability, weakness, or emotional expression (17). While expressions of masculinity are diverse, adolescent males with perceptions of traditional masculine norms are more likely to have a greater risk of mental health issues risks and reduced help-seeking behaviors (18). Similarly, the rates of psychological distress among adolescent males have recently risen substantially (29%) compared to the rates in 2018 (20%) (19). Improving MHL in young men may help in providing more knowledge and awareness of mental illness, benefiting mental health outcomes.

Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) youth face detrimental health challenges and are extremely vulnerable to mental health problems in the heteronormative society. A systematic review by Wilson and Cariola (20) analyzed 34 qualitative studies and found that being victims of marginalization, isolation and rejection and phobic behavior is linked with negative mental health outcomes such as self-harm, depression, and suicidality. The authors also found a need for more supportive schools and social environments for LGBTQI+ youth. While studies related to MHL levels of sex and gender minority youth are scarce, it can be established that more research needs to focus on providing necessary support and resources in improving MHL.

Geographic location can factor toward an individuals health in many ways. For example, the Prevalence of mental illness is higher among the youth living in rural areas than youth living in metropolitan areas and higher levels of barriers to necessary treatment (1). A systematic review by Gulliver et al. (21) reported that, out of the 13 qualitative studies, four qualitative studies showed a lack of accessibility due to time, transport and costs as a prominent barrier in seeking the necessary professional help among the youth living in rural areas.

Marshall and Dunstan (22) conducted a vignette short film based study with 122 participants (49 males and 73 females) from the age range of 12–18 years and examined that rural adolescents show low levels of MHL compared to metropolitan adolescents. Conversely, the study reported that the recognition of mental illness such as depression was similar among rural and metropolitan adolescents. The authors also found that rural adolescents showed low awareness of the available mental health professional help compared to metropolitan adolescents. Moreover, in association with gender/sex disparities, Marshall and Dunstan (22) also found that there is a gender difference exist concerning MHLlevels among rural adolescents compared to metropolitan adolescents. The authors also found that MHLlevels of rural adolescent males are less than rural adolescent females.

Promoting MHLamong parents and educators are an indirect way of improving MHLamong the youth population of Australia. Youth with parents with mental illness are at more risk of developing mental illness than youth who have parents without mental illness (23). Being the caregiver of a parent with mental illness can impede the development of the child. While not all children have adverse effects, some young people build better resilience, better understanding and knowledge about mental illness. Improving the MHLof the youth of a parent with mental illness is beneficial in building and improving positive coping strategies for better mental health (24). Subsequently, youth with adequate levels of MHLare more likely to have better mental health knowledge, confidence in recognizing their mental health status and symptoms, which promotes better mental health outcomes (10).

Furthermore, Johnco and Rapee (25) found that parental depression literacy strongly influenced their parental response to an adolescent with depressive symptoms. The authors also found that poorer depression literacy of parents was associated with low support, more overprotective and distressed/withdrawn response. In contrast, parents with adequate depression literacy are more likely to support and promote positive responses toward the depressed youth. Moreover, improving parents' depression literacy was also beneficial toward the parents with managing their depressive symptoms (25).

Schools and educators are a great way of providing adolescents with a safe, supportive environment to improve their MHLas they spend most of their time in school. For example, a cluster randomized trial by Jorm et al. (26) provided mental health first aid training to middle school teachers in seven schools in South Australia to evaluate the mental health knowledge and their ability to help students with their mental health problems. After 6 months of follow-up, the authors found that the training increased teachers' mental health knowledge, changed their beliefs, and improved their ability to help students with mental health problems; however, the effects were not significant. An indirect effect noted in the study was that students reported receiving more mental health information from their teachers due to the training. Conversely, Uribe Guajardo et al. (2) found that MHFA trained teachers and responsible adults showed significant improvements in knowledge regarding youth mental health problems (p < 0.01) and significantly increased levels of confidence in helping youth with mental health problems (p < 0.001). Thus, it demonstrates teachers' key role in improving mental health knowledge to adolescents in school settings.

Culture influences many aspects of mental health, mental illness and the ways people access help toward improving their mental health status. While Australia is a major multicultural hub, other countries such as United States, South Korea and Europe are also some of the popular migrant destinations among migrant communities. Culturally and linguistically diverse (CALD) youth are more vulnerable to mental illness (2). Culture and religion surround most values and beliefs of CALD communities. Although there are generally positive influence of such culturally and religiously rich contexts, in most situations, changes that occur due to transitioning from a strong cultural influence to new social structure may result in varied negative impacts toward levels of mental health among the youth populations.

Furthermore, shame and stigma strongly influence the attitudes and behaviors of being closed off regarding mental ill-health and psychological distress and not seeking necessary help among CALD youth (27). Consequently, the patterns of shame and stigma create added stress for young people going through psychological distress. Thus, increased levels of MHLmay help CALD youth navigate their perceptions and beliefs which aids in better mental health.

Increasing levels of CALD communities in Australia necessitates culturally relevant health services. While this is not the case for all care providers, CALD communities are more selective in picking their health care provider due to this reason. Additionally, Cultural competency among healthcare providers facilitates help-seeking behaviors among the youth (27). In addition, Cross and Singh (28) examined the importance of cross-cultural communication among CALD clients and Mental health care providers. The authors found that being culturally sensitive and having good cultural communication aids in gaining the client's trust and building rapport.

A qualitative study by Valibhoy et al. (29) found that many young refugees are unaware of the available services. They believe that the threshold for entering the services is severe mental illness. Additionally, cultural mistrust of the western mental health services, especially with refugee communities with complex mental health needs, deters from seeking professional mental health help (27). Furthermore, in a systematic review by Gulliver et al. (21), out of 13 qualitative studies, five qualitative studies showed negative perceptions toward mental health professionals, with issues relating to confidentiality and trust (“I am afraid counselor will pass information about me to other people”) and a preference of self-reliance (“prefer to handle myself”) over seeking professional help among the youth population.

A qualitative study by Colucci et al. (30) found that service providers understanding of ethnocultural backgrounds, migration pathways, possible trauma, and considerations of cultural interpretations of health and illnesses are instrumental in engaging refugee youth in mental health services. Moreover, implementing measure to improve MHL among the refugee youth were more likely to facilitate better access and engagement with mental health services.

Refugee youth participants in a mixed-method study by Posselt et al. (31) reported a need for more activities to promote mental health awareness and knowledge among their communities which will aid in better MHL among them. In Addition, the service providers interviewed in the study acknowledged the need. They added that limited funding to such measures is a barrier in implementing mental health awareness programs in the area. Consequently, Reducing the mental health service disengagement and facilitating appropriate measures to improve MHL is crucial in improving mental health outcomes among the CALD youth (18).

According to Wright et al. (33), while the ability to recognize and label a mental disorder may not be sufficient in determining the appropriate help, it may indicate good mental health literacy. Ratnayake and Hyde (14) investigated the relationship between MHL and help-seeking intentions among senior high school students. The Melbourne based study involved senior high school student participants (n = 32, 22 females and 10 males). The authors found no indication of a relationship between MHL and help-seeking intentions in the study. The authors claim that this could be due to the study's small sample size and the homogeneity of the participants or inclusion bias. Conversely, some studies found increased MHL levels resulting in improved help-seeking intentions among the youth (34, 35).

Previously identified themes of gender disparities linked with variations to help-seeking attitudes among the youth. Particularly, Males are more likely to have reduced help-seeking attitudes than females (18). Moreover, even though Ratnayake and Hyde (14) found no evidence of gender difference and help-seeking, the authors found that young males were more likely to seek professional mental health help from a doctor or a general practitioner (GP) than young females.

No doubt the enforced lockdown restrictions due to COVID-19 have resulted in strong adverse effects on the mental health and wellbeing of the youth population of Australia. Such effects are mostly related to low levels of social connectedness, the uncertainty of the future, disruptions toward young people's education and employment. Such disruption of the norms may have negatively influenced the level of MHL and support these young people would have otherwise received. According to Headspace mental health survey (2020), at the early stages of the COVID-19 pandemic, the results indicated that 74% of participants reported that their mental health has declined due to COVID-19 outbreak in Australia. The survey results also indicate that 86% of participants had negative impacts to their mood, wellbeing, and sleep due to the COVID-19 pandemic. Subsequently, the survey also demonstrated that young people have been engaging in many self-care and coping strategies such as talking to friends, significant other, family and engaging in hobbies to maintain and improve their mental health and wellbeing. Similarly, Li et al. (39) found that adolescents with pre-existing mental illness experienced heightened levels of psychological distress and greater levels of loneliness and sleep disturbances due to the COVID-19 pandemic compared to adolescents without a pre-existing mental illness. It is observed that adequate levels of MHL help engage in positive self-care and coping strategies (24).

The young population of Australia have experienced adverse impacts on their mental health during the early months of the pandemic (40). The above prospective study also examined increased levels of depression and anxiety symptoms since the COVID-19 pandemic started. However, the study results show no significant changes in help-seeking from mental health professionals due to the enforced COVID restrictions. Conversely, Headspace mental health survey (2020) results indicate that the participants who engaged in help-seeking from health professionals found the help to be beneficial in managing their mental health. Thus, it can be established that improving MHL among the youth may help reduce the long-term impacts to their mental health due to COVID-19 and the enforced lockdowns.