Youth Participation and Epistemic Authority in Digital Mental Health Design and Governance

Digital mental health technologies targeting young people have expanded rapidly amid growing concern about youth mental distress and the normalization of digital care. Yet despite being the primary users of such systems, young people have limited influence over how digital mental health is conceptualised, designed and governed. The paper examines digital youth mental health as a sociotechnical field and situates debates on youth agency, expertise and digital governance within contemporary concerns about participation and legitimacy. Drawing on a qualitative documentary analysis of policy frameworks, academic and professional literature, and youth advocacy and civil society materials (n = 86), the study investigates how authority, legitimacy and participation are attributed and contested across institutional domains. The analysis identifies three dominant framings of participation normative rhetoric, managed consultation and emerging epistemic authority and demonstrates how youth involvement is simultaneously invoked, constrained and instrumentalised. These dynamics reflect deeper tensions between safeguarding and autonomy, user engagement and democratic governance, and clinical expertise and lived experience. The paper argues that meaningful participation requires recognising young people as knowledge-holders and redistributing decision-making power within digital mental health design and governance processes. In doing so, the study contributes to sociological understandings of youth agency, digital governance and the politics of mental health care and highlights the need for participatory infrastructures capable of supporting youth co-governance in digital mental health.