<p>Treatment for youth with severe and enduring mental health problems (SEMHP) in child and adolescent psychiatry (CAP) often does not align with their needs. An emphasis on symptom reduction, which characterizes current practice, may not be suitable for these youth due to their enduring and various needs across life domains. To better match care to their needs, this study explores multiple stakeholder perspectives on the current and preferred treatment focus for youth with SEMHP in CAP. A sequential exploratory mixed-method design was used. Qualitative data from a thematic analysis of interviews (<i>n</i> = 30) informed a subsequent online questionnaire (<i>n</i> = 116), providing insight into the perspectives of youth with SEMHP, their caregivers, and CAP practitioners. We explored variations in ratings on current and preferred treatment focus within and between groups. Based on the interviews, we identified nine themes, suggesting treatment should encompass various treatment foci. Responses to the questionnaires indicated that symptom reduction should remain a focus in the CAP treatment of youth with SEMHP, and that acceptance, autonomy, underlying issues, perspective, and strengths should also be focused on. Practitioners believed they already addressed these areas, which contrasts with the experiences of youth and caregivers. Although symptom reduction is a crucial treatment focus in CAP, addressing additional themes is essential to enhance youth engagement and minimize treatment failure. Therefore, treatment must be regularly evaluated and adaptable to changing circumstances. The question remains whether CAP is the appropriate setting to address all of these treatment priorities.</p>