Relationality, Reciprocity, and Respect: Two-Eyed Seeing As a Lens for Constructivist Grounded Theory In Youth Engagement In Mental Health

Background: Youth engagement in mental health and addictions (MHA) care has gained considerable momentum, yet the theoretical frameworks guiding this work remain predominantly rooted in Western epistemologies. Frameworks such as Positive Youth Development and Youth-Adult Partnerships have advanced the field, but their capacity to support youth is limited when Indigenous knowledges are absent from their foundations. Indigenous communities across North America have long practiced meaningful youth partnership, grounded in values of relationality, reciprocity, and respect, and these longstanding epistemologies have much to offer the MHA sector broadly. This study responds to a significant gap in the literature: the absence of Indigenous methodological frameworks in research examining youth engagement in mental health systems. Drawing on Two-Eyed Seeing (Etuaptmumk), pioneered by Mi'kmaq Elders Albert and Murdena Marshall, this study argues that Indigenous Knowledge Systems are not only relevant but necessary for ethical and rigorous research in youth engagement.

Methods: This study employs constructivist grounded theory guided by Etuaptmumk as an integrative framework. Etuaptmumk, which honours both Indigenous and Western ways of knowing together and in their fullness, was applied at every stage of the research process, from study design and recruitment through to data collection, coding, and theoretical development. This integration allowed the researcher to remain grounded in participant voices while drawing on Indigenous Knowledge Systems, including Anishinaabe Grandfather Teachings, to theorize emerging categories. Semi-structured interviews were conducted with 12 youth advisors aged 16 to 29 from historically marginalized communities, participating in advisory work across Ontario mental health organizations, as well as 6 adult facilitators.

Results: Youth advisors consistently expressed a desire to be genuinely heard, to contribute at a pace that allowed for relationship-building, and to exercise meaningful leadership rather than fulfill a symbolic advisory role. When relationality, reciprocity, and respect were absent from advisory structures, youth reported feeling tokenized and disengaged, significantly limiting the potential for systemic change. Analysis through a Two-Eyed Seeing lens illuminated the ways in which Indigenous values of intergenerational responsibility and community accountability were either present or conspicuously absent in advisory structures. Importantly, these findings resonated across youth from diverse backgrounds, not only Indigenous youth, suggesting that Indigenous epistemologies offer broadly applicable principles for ethical youth engagement in MHA care.

Conclusions and Implications: This study makes three interconnected arguments for social work research. First, Indigenous methodologies are legitimate, rigorous, and necessary, and their absence from MHA research constitutes an epistemic gap with consequences for practice and policy. Second, research in engagement spaces must structurally account for time dedicated to relationship-building and reciprocity, rather than treating these as peripheral. Rushed timelines and extractive research designs reproduce the very power imbalances that community-based research seeks to dismantle. Third, youth collaborators must be meaningfully heard and appropriately compensated for their knowledge. Reciprocity and ethical co-design are not optional enhancements but baseline requirements for research that claims to center youth voice. Together, these findings call on social work researchers to move beyond tokenistic inclusion and toward methodological frameworks that are holistic, relationally grounded, and genuinely informed by Indigenous knowledges.