A qualitative exploration of the lived experiences and views of users of mental health services after self-harm.

Background: Individuals at risk of suicide have low engagement with mental health services (MHS). Reasons for this include stigma about suicide, inadequate public awareness, and the difficulty in approaching MHS. Lived experiences of users of MHS might yield insights into this low engagement and improve the access to mental health interventions for users. Aim: To explore the lived experiences and views of individuals with self-harm who were users of specialist MHS in a tertiary general hospital setting. Methods: We used a qualitative study design with in-depth interviews. We included participants who had used inpatient or outpatient MHS for a self-harm attempt. We used a realist approach to thematic analysis and Results: We recruited 25 participants (16 women and nine men) between 18 and 43 years. All participants had completed a randomized controlled trial on the efficacy of telephone outreach in suicide prevention. The themes generated were the participants' inherent attitudes toward self-harm and suicide, their experiences of MHS, their perspectives on treatments that helped with suicidal ideation, and the impact of their experiences with MHS on future help-seeking. Conclusions: The user perspectives of MHS appear to be influenced by their inherent pre-existing beliefs about suicide. Users find specific interventions for suicidal ideation beneficial and healthcare infrastructural problems as challenges. Individuals with persistent difficulties after self-harm were more likely to engage with healthcare services. The study limitation was the absence of perspectives from those individuals who dropped out from MHS and other settings.