Relational dynamics and experiences of inpatient and intensive community care for children and young people: matters for service engagement and recovery

Previous research on young people's experience of inpatient services and community services has often relied on the responses of carers and relevant practitioners. As part of a wider randomised controlled trial comparing Intensive Community Care Services (ICCS) with treatments as usual (TAU) across the UK, including inpatient and generic community care models, this paper examines how young people experience these different models. Fourteen young people participated in a semi-structured visual interview study to reflect on their service experiences, with a focus on recovery journey and service engagement. A thematic decomposition analysis was conducted on the data, and specific themes relevant to satisfaction and engagement with services were examined in-depth. A central theme emerged was the importance of relational dynamics. In particular, we explored relationships with mental health professionals and the peer and family relationships that shape and impact experiences of service use and recovery. Young people shared mixed experiences with mental health services. Inpatient care and generic community services received both praises for individual staff commitment and reassuring diagnoses and containment, and criticisms such as inflexible approaches, inadequate staff attention, and untimely appointments. Relationships with support network were commonly reported to be unstable and unsustainable. On the contrary, the ICCS model was valued for the personalised approach, including beneficial home visits. The approach facilitated development and mobilisation of positive relationships in the community with the surrounding support network. The findings serve as a reminder of the significance to build trust-based relationships with young people that go beyond mental health assessment and treatment. Future research and service development should focus on resolving common systemic issues that hinder continuity of care, such as understaffing, long wait times, and high turnover.