Abstract
Background
Transitions between sectors represent a critical aspect in patient flow. Young people with mental health difficulties are particularly vulnerable in these transitions. This study evaluates the development of an intersectoral bridging model designed to support transitions from youth psychiatric care to civil society actors.
Methods
The study employed an iterative, participatory design integrating qualitative data and co-creation with diverse stakeholders. Data consisted of semi‑structured interviews with youths and relatives and field observations. Two participatory system mapping workshops were conducted with relatives and stakeholders from psychiatry care, municipalities, and civil society actors to identify transition barriers and design solutions.
Results
Findings show varied recovery status among youths at discharge, indicating differing needs for post–treatment support. Relatives were found to be key stabilizing actors but often strained following prolonged involvement in care trajectories. Cross-sectoral challenges included inconsistent communication between sectors and limited shared situational awareness regarding youths’ treatment pathways. The new bridging model was developed to integrate 1) strengthened relational ties across sectors, 2) flexible, individualized transitions, and 3) earlier and repeated introduction to civil society actors. Together, these elements form a relational infrastructure that supports young people’s movement between sectors and supports recovery beyond clinical treatment.
Conclusions
This study demonstrates that the participatory co-creation process was valuable in addressing key challenges in transitions from youth psychiatry to civil society incorporating perspectives from diverse stakeholders. By combining flexibility, sustained relational support, and early community‑based engagement, the model strengthens continuity across sectors and supports recovery beyond clinical care for vulnerable young people.
Key messages
• The participatory co-creation process was valuable in developing the intersectoral bridging model and in incorporating perspectives from diverse stakeholders.
• Combining flexibility, cross-sector relationships, and early civil society involvement, the transition model supports recovery beyond clinical care for young people with mental health difficulties.