The promotion of youth participation in healthcare and welfare services has gained global attention, particularly for those with complex care needs. In 2020, Sweden took a major step toward strengthening youth participation by incorporating the UN Convention on the Rights of the Child (UNCRC, 1989) into national law. Yet, challenges remain in translating these commitments into practice. In mental health care, user involvement is recognized as essential, but structural barriers often limit its realization. Adolescents in psychiatric inpatient care frequently report low participation in treatment decisions, highlighting the need for models that enhance agency and engagement.

This dissertation examines youth participation in Swedish Child and Adolescent Psychiatry (CAP), focusing on the relational dynamics between adolescents, parents, and staff. It explores Patient-Initiated Brief Admission (PIBA), an intervention enabling adolescents to independently initiate short enrollments, thereby promoting autonomy and care accessibility. Grounded in recovery-oriented practices, the dissertation delves into how youth participation is operationalized and understood to influence recovery among adolescents with complex mental health problems. Two theoretical frameworks – epistemic injustice (Fricker, 2007) and ecological systems theory (Bronfenbrenner, 1979) – serve as the main analytical lenses. Epistemic injustice is applied to analyze the credibility and knowledge hierarchies in psychiatric inpatient care, particularly how young people’s lived experiences are valued in clinical decision-making. Ecological systems theory offers a multi-level perspective on participation, considering the broader socio-structural and institutional influences shaping interactions in psychiatric inpatient care.

The research comprises four interrelated qualitative studies: a scoping review of youth recovery literature (study I), and three interview-based studies exploring staff experiences with the implementation of PIBA (study II), staff perspectives on balancing parental involvement with adolescent autonomy (study III), and the views of adolescents and parents on participation during PIBA enrollment and its influence on recovery (study IV).

The findings indicate that youth recovery is a relational and non-linear process, shaped by trust, agency, and identity development. They point to the importance of care environments that can adjust to adolescents’ evolving needs. The results further highlight systemic barriers, including credibility deficits and the ‘admission game’ phenomenon, which can undermine trust and restrict genuine involvement. Staff face challenges in balancing protection and participation, especially where parental involvement is believed to complicate adolescents’ autonomy. While PIBA appears to offer potential for enhancing participation and fostering autonomy, its effectiveness seems dependent on trust-based collaboration among adolescents, parents, and staff, as well as on adequate staff knowledge and support.

Ultimately, the dissertation highlights youth participation as a dynamic, context-sensitive process influenced by supportive ecological systems and balanced with protective structures. It suggests that youth participation in psychiatric inpatient care is shaped by integrated approaches aligning provision, protection, and participation – the three pillars of the UNCRC. Strengthening adolescents’ credibility as knowledge holders appears important in addressing epistemic injustice. Revisiting care models to support collaborative decision-making and integrate recovery-oriented principles with participatory practices emerges as valuable. These insights contribute to developing participatory, recovery-oriented mental health care, with implications for staff training, improved communication, and flexible, youth-centered approaches that support adolescents’ active roles in their recovery.