Understanding the experiences related to mental health amongst 16 – 24 year olds who feel under represented; a narrative inquiry study

Background: The majority of mental illnesses emerge before the age of 25. It is well established that those who are most vulnerable and most in need of mental health support are least likely to access services or take part in research. Aims: Adopting an intersectional lens, this research aims to elicit the experience regarding mental health of young people who feel under represented Method; People aged 16 – 24, living in England, who were currently experiencing or had experienced poor mental health in the preceding year were recruited from both NHS waiting lists (in Oxford, Sheffield, Cornwall and Liverpool) and nationally on social media and via charities. 248 people completed an online questionnaire, of which 117 took part in an initial screening call and 81 were interviewed. Unstructured interviews that adopted a narrative inquiry approach were conducted either in person or on online, and audio recorded then transcribed verbatim. Data were analysed using a combination of thematic and framework analysis. Young people with relevant lived experience consulted on the implementation of the research and recruitment, and peer researchers contributed data collection and data analysis. Results: Participants engaged with unstructured narrative inquiry interviews, often anchoring their experiences either in their schooling, or in a series of adverse childhood events. Three overarching themes were extracted from the data; the impact of connection, (in)validation, proactively coping and preventive opportunities. These themes highlighted the variation in health literacy and how mental health experiences are understood, as well as whether existing services were experienced as accessible and helpful. Participants were proactive with adopting coping mechanisms in the absence of support and identified times of transition as providing an opportunity for improved support. Discussion: There are implications for policy and practice in how mental health is talked about and recognised amongst young people. It is important that young people are empowered to talk about their experiences, and that attempts to seek help or access care are not met with invalidation. Times of transition (particularly around schooling) are opportunities where support could be better offered in a preventative way. Strengths -Large diverse set of lived experience data -Youth-led involvement strategy for implementing the research programme-Inclusive and intersectional approach -Open methodology that enabled participants to set agendaLimitations -Ability to represent large diverse data set within existing analytic frameworks-Unstructured narrative interview methods potentially challenging for some neurodivergent people and those with communication needs.