Experiences of engaging with healthcare services following a self-harm presentation to hospital of high lethality or high suicidal intent have not been examined previously, despite this subgroup of self-harm patients being at high risk of suicide. Therefore, this study addressed this issue by documenting patients' experiences of engaging with healthcare services after a high-risk self-harm (HRSH) presentation to hospital. Demographic, psychiatric and psychosocial factors associated with variations in perceptions of care received were also examined. Quantitative information was obtained by interview administered questionnaires 0-3 months following a HRSH presentation to hospital. Semi-structured follow-up interviews, conducted, 6-9 months later, provided qualitative data ( = 32). Satisfaction with aftercare varied. Positive experiences of care included "" and "" The establishment of trust in the services encouraged help-seeking and psychotropic treatment adherence. Conversely, "" and "" left some participants feeling isolated, contributing to inhibited help-seeking and resistance to psychotropic treatment. Participants with a history of self-harm and mental health service engagement were more likely to report dissatisfaction with care provided. Those who described unsupportive relationships more frequently reported repeated self-harm, alcohol misuse, and hopelessness at follow-up. Our findings show that satisfaction with services, help-seeking and treatment adherence may be improved by ensuring the consistent provision of timely, comprehensive and supportive aftercare following a HRSH presentation. Absence of these aspects of care may contribute to ongoing distress and further suicidal behavior.