Strengthening the quality of child and youth mental health care (CAYMH) is a priority across the WHO European Region (Hall et al. 2026). One core element of this is to enhance data collection and research (WHO, 2025). There is increasing evidence that inputs from people with lived experience improve the quality and relevance of research (Hawke et al., 2023). Youth engagement in the research process for CAYMH is becoming increasingly common with varying levels of involvement. According to Hart's (1992) ladder of participation, involvement can range from 'non participation' (i.e. manipulative, decorative, or tokenistic) to varying degrees of 'participation' (including assigned but informed, consulted and informed), with child or youthled participation with shared decision-making power representing the highest level.In this commentary, we define 'youth leadership' as this highest level of participation; participation which allows decision-making to be done by those most affected by outcomes across project phases. Youth leadership has demonstrated positive outcomes for young people, including empowerment, emotional regulation, self-efficacy, and skill development (Checkoway, 2011;Donohoe-Bales et al., 2025). Despite these benefits, many participatory approaches for youth participation in CAYMH research remain tokenistic, lacking real decision-making power. The authors of this commentary have drawn on their collective youth lived (SMH, PF, AS, NA) and professional (HB, JH, LL, JB) expertise to highlight challenges related to youth participation and 'lived experience'.We urge institutions to go beyond 'tokenistic' youth advisory roles to embed youth leadership with formal decision-making authority, thereby improving research quality, ethical norms, and legitimacy.There are many challenges for implementing youth leadership from the organisational perspective. Youth leadership can be viewed as too risky, time-consuming, or complex, particularly within mental health contexts where safeguarding is a priority (McCabe et al., 2023). Additional barriers include legal challenges of including minors, unclear roles, inadequate resourcing, hierarchical decision-making, a lack of clear institutional guidance, or organisational norms that do not yet view youth leadership as legitimate or influential (McCabe et al., 2023;Ocloo & Matthews, 2016).While these concerns are legitimate, we argue that there are ways to overcome these challenges. Funders and donors can ensure that youth leadership is a prerequisite for approving any projects. Government decision-makers can integrate youth leadership in policy and guideline documents, enabling youth voices to shape decisions at all levels. Organisations can include funds for youth leadership in all budgets related to CAYMH. Budgeting considerations include youth leadership roles with real authority and decision-making power, 38 governance structures that include youth membership, capacity-building for all the 39 on how to implement safe youth leadership, fair remuneration for youth leaders, developing
Harrington et al. (Tue,) studied this question.