Becoming Invisible: How Mental Health Systems Erode Selfhood in Young Adults With Mental Health-Related Disabilities

Young adulthood is a critical period for identity formation, yet young adults with mental health-related disabilities often engage with care systems that erode rather than support selfhood. This qualitative study draws on critical realist metatheory, which aligns with interpretive inquiry while enabling layered explanation. Conducted in partnership with young adult co-researchers with lived experience of mental health-related disabilities from equity-deserving communities, the study treats participant narratives as situated meaning and as analytic entry points into the institutional, relational, and structural dynamics that generate persistent inaccessibility. Thirteen young adults with lived experience of mental health-related disabilities and unmet healthcare needs described extensive interactions with clinics, hospitals, and community services across Canada. Despite this, they remained unseen and unmet. Functional impairments collided with institutional demands for legibility, coherence, and compliance, producing recurring patterns of misrecognition, fragmentation, and withdrawal. Critical realism's stratified ontology distinguishes between what is experienced (empirical), what happens whether or not it is experienced (actual), and the underlying forces that generate those events (real). Through abductive and retroductive reasoning, the study identifies five explanatory clusters and presents the Rupture-Repair Roundabout, a model that illustrates how health systems can either destabilize or scaffold young adults' emerging selves. Participants described access as extractive rather than supportive, requiring strategic masking and self-erasure to remain eligible. Findings suggest that addressing unmet healthcare needs requires not only expanded services but also a structural and relational reorientation toward attuned, identity-holding care. Without this, healthcare risks functioning not as a site of healing but as a site of existential undoing.