Aim <p>To meet a growing demand among youth for mental health treatment across outpatient, acute, and inpatient settings, health care organizations have adopted policies aimed at optimizing access to care and matching patient acuity with appropriate treatments. However, such policies have not sufficiently addressed youth needs, as youth are typically marginalized within the mental health system due to a disproportionate reliance on others for their care (e.g., symptom identification, treatment adherence, transportation, remuneration). To better understand the impact and effectiveness of current policies and protocols on youth care-seeking, it is crucial to obtain the perspectives of youth who have experienced complications in their care-seeking journeys.</p> Subject and methods <p>In the current study, youth participants (<i>N</i> = 34; 65% female; 10 to 21 years old [<i>M</i> = 16.44 years, <i>SD</i> = 2.46]) provided detailed perspectives through semi-structured interviews as part of the Atlantic Canada Children’s Effective Service Strategies in Mental Health (ACCESS-MH). Interviews were analyzed using the Psycho-Social Ethnography of the Commonplace (P-SEC) methodology.</p> Results <p>Results highlight the struggle in navigating the mental health system from a position on the margins of care delivery and indicate shortcomings associated with a stepped care treatment model that disproportionately benefits the system.</p> Conclusion <p>Recommendations are made with the aim of increasing youth autonomy and control in their mental health journeys and streamlining access to, and transitions between, services.</p>