Square Pegs in Round Holes: How Strict Policies and Standardization of Mental Health Treatment Practices Complicate Youth Care Seeking

Public mental health practices related to treatment assignment and delivery are increasingly becoming standardized, yet little is known about which standardized practices affect youth treatment seeking. Although standardization introduces consistency in procedures, diagnoses, and treatment, and is considered beneficial to institutions and individuals for a variety of reasons (e.g., reliability of administration, predictability of outcomes), it often reduces individuals to diagnostic or symptom-specific classifiers and disproportionately affects care seeking among youth due to their marginalized position in care delivery. We conducted semi-structured interviews with 34 youth, ages 10 to 21 years, as part of the Atlantic Canada Children’s Effective Service Strategies Mental Health (ACCESS-MH) project to assess the impact of standardized care practices on youth mental health care seeking. Based on analyses using Psycho-Social Ethnography of the Commonplace (P-SEC) methodology, findings highlight the struggle of marginalised individuals (i.e., youth in need of mental health services) when trying to navigate mental health systems. Findings indicate that standardization of care can act as a barrier for youth due to shortcomings in the appropriateness and timeliness of interventions, and that treatment monitoring and the use of modalities less reliant on categorical diagnosis could help to address the negative impact. Recommendations related to policy change [e.g., treatment monitoring, the use of modalities less reliant on categorical diagnosis] are discussed. Youth hold a marginalized position in mental health care delivery due to an overreliance on caregivers and providers. Youth perspectives provide valuable insight into the ways in which standardized practices complicate their care seeking. Youth identify overreliance on diagnosis, iatrogenesis, and inadequate follow up/monitoring stemming from standardization. Increased monitoring and youth collaboration, along with transdiagnostic approaches, would address identified complications.