Shared roads, shared risks: understanding the needs of youth with severe and enduring mental health problems

Abstract

Youth with severe and enduring mental health problems (SEMHP) represent one of the most vulnerable groups in child and adolescent psychiatry (CAP). Despite growing societal attention to youth mental health, this group often falls through the cracks of the current care system. Many disengage and become entangled in fragmented treatments, leading to feelings of helplessness among themselves, their families, and practitioners.

The DevelopRoad project examined why existing systems fail and what is required to improve care. Across four studies – systematic literature review, qualitative, and mixed-methods research - the experiences of youth, caregivers, and practitioners were explored. Findings reveal that meaningful improvement demands a shift from risk driven, fragmented approaches toward relational, recovery-oriented care. Central to this is building trust: youth, families, and practitioners need time, support, and organizational structures that enable presence, collaboration, and tolerance of uncertainty, especially in moments of crisis. Taking shared and proportionate risks is not opposed to safety; rather, it is a precondition for creating the kind of long-term safety in which trust, autonomy, and meaningful recovery can take root. For youth with SEMHP, effective care starts with presence, not just protection, and with the willingness to share the road - and the risks - together.