How to meet the needs of youth with severe and enduring mental health problems: A qualitative study to barriers and facilitators in treatment

•Lack of epistemic trust is a key barrier in treatment of youth with enduring problems.•All participants experienced feelings of hopelessness due to the treatment process.•Crisis management in youth’s high risk behavior leads to fragmented care.•Perceived accountability by practitioners increases pre-existing barriers.•Youth need to experience autonomy in treatment to regain trust despite their behavior.