‘Just because we're younger doesn't mean our opinions should be any less valued’: A qualitative study of youth perspectives on a Youth Advisory Council in a mental healthcare context

Abstract Introduction Recognition of the importance of youth engagement in youth mental health and/or addiction (MHA) service design and delivery is increasing. Youth Advisory Councils embedded in MHA organizations represent one strategy that allows youth to be involved in MHA at the individual, organization and systemic levels. This level of involvement can facilitate positive outcomes for both the youth and the organization. As these councils become more common, it is important that organizations are prepared to partner with the participating youth. This study uses a descriptive qualitative approach to understand the motivations and expectations of youth with lived experience with MHA concerns who were beginning to work on a Youth Advisory Council in an MHA setting in the Greater Toronto Area. Methods Semistructured interviews were conducted with each youth, ages 16–26, on the advisory council (N = 8) to understand their motivations, expectations and goals coming into the work. Interviews were transcribed verbatim and analysed using a reflexive thematic analysis. Results Analysis resulted in five overarching themes: providing opportunities for youth learning and growth, platforming youth, empowering youth, embracing youth leadership and promoting youth‐driven change. The findings illustrate that these youth came into the Youth Advisory Council motivated to create positive change in the mental health system, take on leadership roles and had high expectations for organizational support. Our analyses provide insight for organizations planning and implementing Youth Advisory Councils in the MHA sector with the goal of best supporting youth in driving positive change across the system. Conclusion Youth want to be provided authentic opportunities for their engagement to make a difference. MHA organizations must embrace youth leadership and move towards listening to youth experience and acting on youth recommendations to enhance service design and implementation to improve access and to better meet the needs of youth utilizing these services. Patient or Public Contributions This study incorporated service users, including youth ages 16–26 with lived experience of MHA concerns who served on the Youth Advisory Council at the Family Navigation Project, Sunnybrook. Youth Advisory Council members contributed to two relevant research activities: (1) youth reviewed the draft interview guide before data collection, and their feedback was prioritized in the final version and (2) youth contributed to knowledge translation through contributing to academic conference presentations.


| INTRODUCTION
Mental health and/or addiction (MHA) issues impact an estimated 1.2 million Canadian children and youth. 1 In fact, youth mental health concerns make up the largest portion of the global health-related burden for youth. 2 The youth mental health crisis was exacerbated by the coronavirus disease 2019 (COVID-19) pandemic, with youth around the world reporting decreases in well-being and mental health deterioration. [3][4][5][6] Still, fewer than 20% of Canadian youth receive appropriate MHA treatment. 1 These figures are particularly concerning as early intervention is critical to reducing the burden of illness across the lifespan. 7 Youth engagement at the organizational level is an emerging strategy to combat the youth mental health crisis. [8][9][10][11][12] Youth engagement has been described as the process of participation of youth at the community and organization level that is made meaningful through intentional consideration of youth strengths, interests and developmental needs. 13 Meaningful youth engagement draws on Article 12 of the United Nations Convention of the Rights of the Child, which stipulates that decision-makers must solicit youth input in matters that impact them. 14 Positive youth development (PYD) has been posited as a framework for meaningful youth engagement, 15 as it takes a strength-based view towards youth and stresses the importance of creating opportunities for youth to gain skills, build relationships, become leaders and to thrive in adulthood. 16,17 There is increasing evidence of the benefits of youth engagement within healthcare organizations for both the youth and the organization through providing opportunities for participating youth to grow personally and professionally 15,[18][19][20] and encouraging the development of community-specific and contextually relevant organizational programming. 9,21,22 Youth Advisory Councils (YACs), sometimes called Youth Advisory Boards, Committees, Coalitions or Groups, represent one way that healthcare organizations can structure youth engagement to lift youth voices within healthcare systems to identify youth priorities for the MHA sector. 18,[23][24][25][26] YACs have been increasing in popularity in the healthcare field over the last two decades. 27 YACs help organizations find ways to reduce barriers and create pathways to more meaningful client engagement. 25,27 Prior research on youth engagement in MHA has evaluated youth personal and professional growth, 28,29 experiences and required work of adult facilitators and organizations 18,30 and outcomes of youth engagement such as the development of youthfriendly resources. 10 Less is known about what motivates youth to get involved at the advisory level in MHA, and what expectations youth bring into the work. Our research objectives are to explore (1) why youth want to be involved in advisory roles in MHA and (2) what they expect from the experience through analysis of interviews with eight youth beginning their work on a YAC in the MHA sector. This understanding may help MHA organizations as they develop and grow their youth engagement strategies.

| STUDY CONTEXT
The Family Navigation Project (FNP) at Sunnybrook is a nonprofit organization that provides MHA navigation support for youth aged 13-26 and their families. 31 MHA navigation programmes work through identifying pathways to and through the multitudes of MHA treatment options to help individuals and their families find appropriate care. 32

| Data collection
Each youth advisor (n = 8) completed a single semistructured interview via Zoom. The interviewer (A. Y.), who served as the organization liaison for the YAC, has a masters in social work, identifies as female, mixed race (Indigenous, White) and was 28 years old at the time of the interviews. As organization liaison, she attended all YAC meetings, bridged communication between the organization and the YAC, provided administrative assistance and was available for support as requested by YAC members. The interviewer had a previous working relationship with half of the group (former Youth Engagement Partners, n = 4) at the time of the interviews.
Interviews were conducted at the start of the first term of the YAC with some participants having participated in the YAC orientation.
Interviews were audio recorded and transcribed verbatim. Interview guides were developed by the organization liaison in partnership with youth and explored youth advisors' motivation to join the FNP YAC, their expectations coming into the work and their goals for the upcoming term.
Sample questions can be seen in Table 2. Interviews lasted on average 38 min. The interviewer completed memos after each interview to facilitate a deeper exploration of data. 40

| Data analysis
Data were analysed using reflexive thematic analysis. 41

| RESULTS
The analysis results in five overarching themes. The themes include providing opportunities for youth learning and growth, platforming youth, empowering youth, embracing youth leadership and promoting youth-driven change. The themes and their corresponding subthemes and supporting quotes can be viewed in Table 3.

| Providing opportunities for youth learning and growth
The youth shared their hopes for personal and professional learning through their participation in the YAC.

| Empowering youth
Youth advisors shared their hopes and expectations that the organization would provide support to achieve their collective goal of uplifting youth voices within FNP. This theme of empowering youth included subthemes of expectations of the organization, needed organizational support, intentional adult interaction and organizational culture. This theme highlights that the organizational setting and adult support within it must empower youth to feel informed and valued, so that they are able to provide their feedback and embrace the importance of their role.

| Comfortable environment
Youth stressed the importance of a comfortable environment for youth to be able to share authentic feedback. For example, one youth shared that having Youth Engagement Partners involved in the recruitment and interviews for the YAC showed that youth were valued at multiple facets of the initiative and helped them to feel more comfortable in the interviews.
Youth also wanted the meetings to feel informal. One youth

| Promoting youth-driven change
Youth were motivated to join the YAC, and were most excited about, the opportunity to make a positive impact on the youth MHA system.

| Outcomes
Youth shared they felt the YAC would be successful if youth were able to complete their chosen youth-driven project. Youth also shared that they felt that youth involvement within youth MHA organizations more broadly helps to improve services through using firsthand experience to guide programme improvements. Youth hoped that their participation would lead to increased youth clients at FNP, increased youth ratings of FNP as youth-friendly and more positive outcomes for youth seeking treatment such as improved mental wellness or access to culturally competent providers. In discussing their ideas for outcomes of the YAC, youth showed that they wanted tangible change. partnership. Previous research has demonstrated the value of youth-adult partnerships as a means to recognize the strengths of both youth and adults as critical in improving policy and practice. 9,46,47 In this project, youth recommended that one way they would feel valued by adults as partners on the team would be for the organization liaison to report on the ways that the YAC was having an impact at FNP in each meeting to help youth to understand the impact they were having as a group and help keep the organization accountable to the YAC. Strategies such as these should be codeveloped in youth engagement efforts to promote healthy youth-adult partnerships. This study highlights that youth recognized their own strengths, experience and leadership capacity and expected that they would be provided space to utilize these skills.

| DISCUSSION
Youth are ready to be engaged as partners in this work, and organizations should move to see them in this way.

| LIMITATIONS
Results from this study represent the views of eight YAC members at an MHA navigation organization in Toronto. It is possible that the focus of FNP on MHA navigation, rather than direct service delivery, impacted the way youth considered the scope of the project. It is also of note that measures were taken by the organization to approach the work democratically and to give youth power in the planning process. It is possible that these youth were primed to apply for this position because of this approach, and this could have skewed their motivations and expectations. However, insights from these eight youths can help to inform how other MHA organizations approach the planning and implementation of YACs to empower other youths to take on these leadership roles.
Furthermore, this study took place in the context of the COVID-19 pandemic, meaning that YAC activities took place virtually. Thus, their comments regarding the environment often referred to virtual environments, and further exploration is needed regarding how these preferences may apply to in-person settings.
Finally, while some of these youth had prior experience in youth engagement work, most of these youth were new to the experience.