Listening to the voices in four Scottish adolescentmental health units: young people, their carersand the unit cultures.

Serious mental health problems among young people are increasing in Western countries. Involving young people in their mental health care, and working in partnership with them during the treatment process, is a primary concern of all mental health services; their parents have also been promised a role within the healthcare team. Research into the process and outcomes of hospitalisation of young people in specialist mental health units is complex and therefore limited. Qualitative investigations into the experiences of young people as users of these services are few. Using ethnographic methods, this study explored the experiences of young people and their carers (both parents and staff) regarding treatment and participation in decision-making in four Scottish adolescent inpatient or day-care mental health units. The findings suggest that the young people (n = 18) valued the personalised relationships they developed with staff and peers, and that when these relationships were empowering, they facilitated both treatment and participation in care. However, the findings also show that parents (n = 16) and staff members (n = 21) were sometimes disempowered, which impaired the overall participative nature of the units. Unit culture was identified as an important factor influencing the effectiveness of young people’s and parents’ involvement. Drawing on concepts from the related academic field of pastoral theology to interpret the findings, the study concludes with a conceptual framework outlining what is required for a unit to become more participative. This theoretical framework adds significant insights to existing knowledge regarding participation in adolescent mental health units. It emphasises relationships characterised by justice and care among all stakeholders as central to successful participation, highlighting the importance of humanistic and ethical considerations in user and carer involvement.