SYSTEM GUIDES AS THE KEY TO CHANGE: GROUNDED THEORY OF EXPERIENCES OF FAMILIES AND CHILDREN WITH MENTAL HEALTH ISSUES

Abstract

Introduction. Supporting children and adolescents with mental illness in the Czech Republic is hampered by a fragmented care system, long waits and weak inter-institutional coordination. From the viewpoint of social work and social medicine, a guide is crucial for continuity of care, empowerment and active participation of families.

Aim. To examine how the presence or absence of a guide shapes families’ ability to navigate services, stabilise their situation and access resources, and to propose a theory-based model underscoring the systemic importance of this role. The study was funded by the University of South Bohemia (GA JU 133/2024/S) and approved by the ZSF JCU Ethics Committee (No. 018/2023).

Materials and methods. Qualitative grounded theory study drawing on 46 in-depth interviews with children aged 11–18 with mental disorders, their parents and social workers. Open, axial and selective coding identified key meanings and relationships informing an emergent model centred on the guide.

Results. Without a guide, families reported heightened emotional distress, disorientation and stigma, exacerbated by systemic fragmentation and poor coordination. With a guide, orientation improved, parental competence strengthened, trust in services increased and continuity of care became more likely. A paradigmatic process model describes movement from crisis to stabilisation through guided support and inter-agency linkage.

Conclusions. The guide is not an ancillary add-on but a pivotal mechanism that reduces isolation, restores trust and promotes mental well-being. Institutionalising and supporting this role—together with continuity and interdisciplinary coordination—should be a priority for child mental health policy and practice in the Czech Republic.