“Into a whirlwind”: Navigating psychosis and anti-psychotic treatment among youth entrenched in an urban drug scene

Background: Co-occurring psychosis and substance use-related health concerns among youth (ages 14-24) can engender powerful intervention responses, particularly for youth experiencing entrenched poverty and homelessness. There are gaps in knowledge about the intersectionality and context of these issues, however, alongside shortcomings in pertinent intervention landscapes, which remain centered on psychiatric treatment and injunction. 

Methods: This study examines how youth entrenched in an urban drug scene in Vancouver, Canada, navigate psychosis and anti-psychotic treatment. We analyze data from 101 in-depth qualitative interviews and ethnographic fieldwork with youth, leveraging a reflexive thematic approach and perspectives from critical drug and mental health studies.

Results: Our analysis spans four themes. First, we outline the psycho-political landscape wherein youth entrenched in this urban drug scene are swept up in a nexus of anti-psychotic treatment, hospitalization, and mental health certification. Second, we characterize youths’ refusals in engaging with this landscape, and the political significance thereof. Third, we trace the stakes of slipping away as youth work to balance the demands of psychosis, intensive substance use, and psychiatric treatment and side effects under the weight of structural pressures. Finally, we discuss performing sanity under the gaze of systems as youth navigate institutionalized psychiatric treatment and surveillance.

Conclusions: Findings underscore that psychosis treatment and care with youth who use drugs ought to be grounded in mental health harm reduction and responsive toward social determinants of health. Recognizing the complex interplay between youth psychosis, substance use, and wider structural forces is critical to the advancement of more equitable interventions.