Editorial: Advancing equity, diversity and inclusion through culturally sensitive collaboration and training

Welcome to the November 2024 issue of Child and Adolescent Mental Health (CAMH) Journal.

Child and Adolescent Mental Health (CAMH) is committed to advancing equity, diversity and inclusion, and improving the mental health of children and young people living in challenging circumstances. The CAMH 2024 Special Issue ‘Equity, Diversity and Inclusion in Child and Adolescent Mental Health’, included a variety of papers on this topic such as the intergenerational consequences of racism (Simela et al., 2024), the effect of socioeconomic inequalities (Pearce et al., 2024) and the impact of youth disadvantages and vulnerability on social inclusion (Renner, Rowland, Hutchinson, & Toumbourou, 2024).

To further advance knowledge on this field, the current issue includes papers evaluating other vulnerable populations, such as children and adolescents exposed to substance misuse, or suffering from substance use disorders (Carrasco-Garrido et al., 2024), and children and adolescents who are transgender or ‘gender diverse’ (Whittle, Moore, & Stallard, 2024). In the first study, Carrasco-Garrido et al. (2024) found that the nonmedical use of prescription opioids, novel psychoactive substances and other illicit psychoactive drugs was a risk factor for nonmedical use of benzodiazepines and Z-hypnotics in male and female adolescents; while the use of cannabis predicted the nonmedical use of benzodiazepines and Z-hypnotics in female adolescents only. The second study (Whittle et al., 2024) found that being transgender or ‘gender diverse’ was associated with higher rates of self-harm, poorer peer relationships, less prosocial behaviour and greater interference with friendships and leisure activities, and adverse impact in the classroom.

Mental health services need to be accessible, culturally competent and responsive to the diverse needs of all young people (McGorry et al., 2022). While significant progress has been made in understanding the mental health challenges faced by some populations of vulnerable young people, there remains a pressing need for further research and open discussions about the barriers to accessing mental health services and care. These barriers can manifest as practical challenges, including financial constraints, travel difficulties or childcare responsibilities but can also be due to systemic and structural factors. Such challenges are especially significant for those living in poverty, those with vulnerable family circumstances, individuals impacted by racism and discrimination, and those children and adolescents with neurodevelopmental conditions or learning disabilities. Research should focus on addressing these systemic barriers, with a view to developing solutions that make mental health services more accessible to all young people.

Clinical work and research should be integrated within a broad and culturally sensitive health inequalities framework. It is vital to involve young people and community members in the evaluation and decision-making process to find solutions that will actually result in an improvement in mental health outcomes. Codesign is widely recommended in mental health settings and mental health research studies as a method to develop an empathic understanding of service users and produce design solutions that meet their specific needs (Morris et al., 2024). Young people's engagement is crucial in ensuring that initiatives are grounded in lived experiences, which do lead to more relevant, practical and actionable insights. Regular focus groups and feedback sessions are instrumental in refining services to better meet the unique needs of the populations they are intended to serve. A more equitable and inclusive approach to mental health care requires both clinical and research populations to be representative of the broader community, especially vulnerable young people from underserved backgrounds.

One effective way to engage with young people is through the establishment of youth advisory groups that meet regularly to review the progress of ongoing initiatives and to address any emerging challenges. In these advisory groups, it is essential not only to hear young people's voices but also to ensure engagement with other key stakeholders that play a role in the lives of children and adolescents who may require mental health support. Specifically, working with local community leaders and organizations representing underserved or marginalized groups is essential to ensure that the initiative is genuinely inclusive and effective. Partnering with local organizations and involving community members in the design and implementation of these projects, can help to build trust and foster a more supportive environment. This, in turn, encourages young people to actively engage with services, feel confident in accessing mental health care and participate in initiatives—including research projects. This promotion of coordination, engagement and social inclusion plays a protective role on young people's mental health (Rice, Purcell, & McGorry, 2018).

To address systemic barriers that may discourage participation, such as the lack of culturally appropriate engagement strategies, it is also imperative to train mental health professionals to be both culturally competent and sensitive to the diverse backgrounds and experiences of the young people they work with. This training should emphasize the importance of understanding different cultural perspectives on mental health, recognizing how cultural norms and values influence symptom expression and help-seeking behaviours, and learning to communicate effectively across cultural and linguistic barriers. In doing so, mental health professionals can provide care that is not only effective but also respectful and responsive to the individual needs of young people from diverse backgrounds, including those who are particularly vulnerable.

In conclusion, advancing equity, diversity and inclusion in child and adolescent mental health care and research requires a sustained commitment to equity. Creating more inclusive and accessible mental health support for all children and adolescents can be achieved through collaborative efforts, community engagement, systemic changes and training initiatives to break down barriers.

G.S.P is a Joint Editor for Child and Adolescent Mental Health. The author has declared that they have no competing or potential conflict of interest in relation to this Editorial.