Despite the greatest onset and increased frequency of suicidal or self-harm behavior occurring in adolescence, most youth affected do not receive professional care. Family-based intervention offers a promising treatment for this population, however, there is much to learn about the barriers and facilitators to effective care and the tailoring of treatment necessary to meet youth and family needs. Such insights can be sourced from a growing qualitative literature reporting the views of young people and their caregivers affected by suicidality and self-harm. This systematic review analyzes qualitative research to synthesize the perspectives of these youth and their caregivers about their needs for and experiences of professional help. Following a search of 4 databases, 35 studies were analyzed using Consensual Qualitative Research methods. Barriers to effective care were identified at individual, family, and systems levels. Young people and their caregivers experienced fractured relationships and overwhelming emotions that impeded engagement, increased young people's distress and suicidality, and reduced parenting efficacy. Systemic barriers to care included insufficient, fragmented, and inaccessible services, and stigmatizing or dismissive responses from healthcare providers. In contrast, effective professional care was timely, non-judgmental, collaborative, and included separate and joint sessions for youth and caregivers to address their individual needs and foster relationship repair. This review's findings support the value of family-based treatment that pro-actively addresses stigma and highlight the need for increased services that are structured to facilitate therapeutic engagement from crisis through recovery.