"It's About Meeting People Where They Are": A Qualitative Study Exploring Ways to Enhance Engagement with Services via Thematic Analysis of the Experiences of People Who Self-Harm, and the Healthcare Professionals Who See Them.

BACKGROUND/AIM: People presenting to healthcare services following repeated self-harm often view care as unsuited to their needs, sometimes leading to disengagement with services. The aim of this paper was to explore the experiences of service users and healthcare professionals to identify key aspects of an effective interaction. METHOD: This paper draws on qualitative data from a large-scale national UK evaluation of a novel therapeutic intervention for people who self-harm. It reports data from semi-structured interviews with 24 service users with a history of recurrent self-harm and 34 healthcare professionals, recruited from NHS Trusts across England and Wales. Reflexive thematic analysis was used to identify patterns of meaning across the dataset. RESULTS: Themes generated include (i) Meeting People Where They Are, which comprised concerns regarding perceived risk and how it can be used to ration care, how difficulties attending can be misread as disinterest or disengagement, and how flexibility can support continued engagement despite complex or unstable life circumstances; and (ii) Shame and Sensitivity in Services, which comprised accounts detailing self-censorship, shame, and fear of consequences when disclosing self-harm, alongside the importance of sensitive, nonjudgmental responses. DISCUSSION: This study contributes to international evidence calling for a more compassionate and flexible response to self-harm, focusing on long-term benefits rather than short-term results. This is essential not only for improving outcomes for individuals, but also for building mental health systems that are financially sustainable, humane, and capable of addressing the complex realities of what it is to live with self-harm.