'They really want to find some kind of box they can put you in': how young people with severe mental health problems and complex needs talk about their past treatment in traditional child and adolescent mental health services - a critical discourse analysis.

Challenges in child and adolescent mental health services (CAMHS), including complex and fragmented services, are well documented, particularly to young people with severe mental health problems and complex needs. Research on young people's experiences of CAMHS is scarce. Especially studies on young people who have dropped out of CAMHS and/or transitioned to alternative services are lacking. This article addresses the following research question: Which discourses can be identified when young people with severe mental health problems and complex needs enrolled in Youth Flexible Assertive Community Treatment (Youth Flexible ACT) articulate their past treatment in CAMHS, and contrast it with their current treatment? We conducted a qualitative study using semi-structured interviews with 12 participants aged 15 to 19, recruited via convenience sampling from three Youth Flexible ACT teams in Norway. The interview data were analysed using a Fairclough-inspired critical discourse analysis (CDA), where discourse is understood as a particular way of understanding and talking about the world, and language is seen as a social practice rather than an individual activity. We identified three dominant discourses when the young people talked about conventional services/CAMHS in Norway: a biomedical, a paternalistic and a neoliberal. The findings suggest that treatment in CAMHS is shaped by a market-oriented understanding of mental health (neoliberal discourse), a medical model that reduces complex problems to medical terms (biomedical discourse), and a lack of user participation (paternalistic discourse). The findings indicate a gap between what young people see as helpful, the aims outlined in guidelines and the young participants' descriptions of CAMHS. The lack of user involvement and the unequal power balance need to be actively addressed with concrete practices that support more equal participation. The findings highlight the need for more differentiated treatment pathways for this group of young people, enabling timely, tailored support and reducing the risk of ineffective initial interventions. Our findings indicate that the framework in CAMHS is poorly suited to the needs of this group. In contrast, differently organised services, such as Youth Flexible ACT, may offer an alternative by providing a coherent framework for holistic, integrated and person-centred care.