Heard, not judged: Adolescents’ perspectives on quality of healthcare following self-harm

Abstract

Objectives: The study aimed to identify the healthcare attributes most valued by adolescents with lived experience of self-harm, and to explore their qualitative experiences and recommendations to inform professional training. Methods: It was a convergent mixed-methods study done at Child and Family Psychiatry Department, Mayo Hospital, Lahore; over six months from 1st January 2025 to 30th June 2025. Ten adolescents with previous history of self-harm, were recruited via convenient sampling. In the quantitative component, participants ranked five care attributes by personal importance, which was analyzed via mean rank and Borda count. Four participants additionally participated in detailed qualitative interviews which were analyzed using framework analysis. Results: The mean age of participants was 15.3 years (Range: 13-17). In quantitative sample (n=10), feeling heard and understood ranked highest (M = 2.60; Borda = 24), followed by empathy and non-judgmental attitude, clear communication, and privacy and confidentiality. Involvement in decision-making ranked last. Through qualitative interviews (n=4), the findings reinforced and deepened these priorities across five themes: therapeutic relationship and emotional safety; communication style and interaction skills; understanding the young person’s experience; support systems, agency, and recovery; and therapeutic techniques and practical interventions. Participants highlighted the harm caused by mocking or dismissive clinician behavior, and the value of calm, personalized, and play-inclusive care. Conclusions: The adolescents consistently prioritize relational and affective dimensions of care over procedural ones. These findings provide a coherent, patient-centered evidence base for designing healthcare professional training focused on adolescent self-harm.