Care pathways following disclosure of adolescent non-suicidal self-injury: a dyadic qualitative study.

Introduction: Adolescents with non-suicidal self-injury (NSSI) often move between family, school, and mental health services after disclosure, but the care pathways shaping psychiatric service engagement and continuity remain poorly understood. Methods: We conducted a dyadic qualitative study using semi-structured interviews with 20 adolescents (14-17 years) with a history of NSSI and 20 caregivers in Shaoxing, China. Reflexive thematic analysis was combined with socioecological journey mapping to reconstruct post-disclosure care trajectories across individual, family, school, and health-system contexts. Results: Analysis identified a six-stage care pathway from accumulated distress and concealed NSSI to discovery, multi-system service entry, treatment engagement, and continuing care needs. The key transition was the point at which NSSI became visible to others. Participants described post-disclosure responses as important contexts associated with more stabilizing or fragmented care trajectories. Adolescents emphasized shame, exposure, and uncertainty, whereas caregivers described fear, guilt, and difficulty identifying appropriate help. Continuity depended on emotional safety, caregiver reframing, school referral, clear service navigation, and follow-up planning. Discussion: Disclosure or discovery of adolescent NSSI is a clinically important transition that shapes subsequent psychiatric service engagement and continuity of care. Coordinated responses across families, schools, and mental health services may help transform disclosure from a crisis event into a pathway toward sustained support.