Despite current inclusion discourses in Germany, specific groups of children and adolescents with mental health problems are identified by healthcare services as “too difficult to manage”, creating varied exclusion processes. In this study, the term young-system-survivors is used for destigmatization purposes. While occupational science discourses suggest that social inclusion should be addressed at the level of social structures, institutions, and norms, local social policies limit German healthcare practitioners from engaging with young-system-survivors to address both complex social and health issues. Using a critical dialogical approach, this study explored how occupational therapists envision inclusive practices promoting young-system-survivors participation in Germany. The data were collected through individual dialogical interviews and two focus groups with eight German occupational therapists and analysed using reflexive thematic analysis. The findings are presented as one overarching theme: The struggle of young-system-survivors to have real opportunities, composed of three subthemes a) Affirming a client-centred stance and continuity, b) Creating possibilities by addressing context-specific demands, and c) Reflecting and enacting advocacy. The findings illustrate how the participants reflect on their fundamental humanistic stance and their occupational perspective to demand a more socially responsive practice. Inspired by scholars developing the epistemologies of the south, this study draws on the concept of Social Occupational Therapy to widen the prospect of establishing multidimensional aspects of social inclusion and calls for collaborative practices to foster the visibility and consideration of young-system-survivors.