Browsing by Author "Miller, David"

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    A system not their own: Investigating organizational barriers and facilitators to mental health care access among youth
    (University of New Brunswick, 2025-02) Miller, David; Ronis, Scott
    Onset of mental illness predominantly occurs in adolescence, with epidemiological trends continuing to show that youth represent the greatest comparative year-over-year increase in mental illness onset among age cohorts (Canadian Institute for Health Information, 2022; Raballo & Poletti, 2020). Despite being most likely to experience the onset of psychopathology, 40% of youth with a mental illness are unable to access appropriate supports (Canadian Institute for Health Information, 2015, 2022; Mental Health Commission of Canada, 2016). Barriers stem from constraints in the accessibility and availability of services and are exacerbated by youths’ positions within overarching care systems (de Haan et al., 2013, 2018; Gouliquer & Poulin, 2005). Youth face challenges related to their lack of autonomy, and they disproportionately rely on caregivers and providers for symptom identification and treatment adherence (Birleson & Vance, 2008; Iyer et al., 2015; Wittevrongel et al., 2024). Despite their reliance on adults, 60% of youth endorse receiving little support from others when accessing care (Canadian Institute for Health Information, 2022). As such, it is crucial to obtain youth perspectives to determine ways in which their limited agency affects help seeking in a primarily service-provider-controlled health system. Thirty-four semi-structured interviews were collected as part of the Atlantic Canada Children’s Effective Service Strategies Mental Health (ACCESS-MH) project (ACCESS-MH, 2014), a large-scale multi-site qualitative research project examining barriers and facilitators to mental health treatment among youth in Atlantic Canada. Interviews were analyzed using the Psycho-Social Ethnography of the Commonplaces (P-SEC) methodology to highlight the impact of systemic policies and protocols on youth mental health journeys. Complications to access stemming from provincial mental health policies or protocols were coded as “Organizational Moments” (OMs). Two OMs comprise individual manuscripts in this thesis to allow for in-depth analysis of specific complications, coping strategies, and schematic shifts encapsulating the way youth made sense of the barriers to care. Findings provide a contextual perspective of the unique barriers youth face that stem from stepped-care treatment models, standardized care approaches, and legal nonautonomy.