Factors that affect pathways to care for youth with psychotic disorders in Newfoundland and Labrador, Canada: A qualitative study.

Youth mental health has become an area of concern in Newfoundland and Labrador (NL), with psychotic disorders representing some of the most disabling forms of mental illness. Yet the pathways to care (PtC) that youth in NL use to access mental health supports remain poorly understood. This research used a qualitative approach to examine the experiences of this population in three important areas: 1) What patterns emerge in the early symptoms and behaviours of children who develop a psychotic disorder? 2) What factors influence treatment and diagnosis from the perspectives of clients and families? 3) What gaps exist in services for clients in NL living with a psychotic disorder and their families? Using a grounded theory approach, this study employed semi-structured interviews and focus groups across two phases. Phase one included participants who were: 1) clients of mental health services, nineteen or older, diagnosed with a psychotic disorder between ages 15-24, and 2) a close family member most knowledgeable about the client's history. Phase two involved interviews with caseworkers, whose professional experience added valuable context and enabled triangulation of findings. The data from this study informed the creation of categories, which developed into the concepts of the grounded theory. First, the study documented clients' developmental histories and changes that appeared with the onset of symptoms. Second, it highlighted the challenges clients and families encountered in obtaining a diagnosis, managing medications, and accessing sufficient community support. Third, it identified gaps in services from the perspectives of clients and family members, along with their recommendations for improvement. Caseworkers recognized these themes as consistent with their own experiences working with affected youth and families. This study amplifies the voices of clients and family members to illustrate PtC for NL youth living with psychotic disorders. It is intended as a resource for clinicians, caseworkers, school personnel, and policymakers to support future policy development that strengthens services, enhances care pathways, and improves outcomes for this vulnerable population.