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Background A subset of adolescents with mental disorders are likely to be (share) decision making competent and hence can make their treatment engagement more effective. Treatment engagement is decisive in achieving successful outcomes. However, there are high rates of drop-out in mental health settings. Aim This study aims at identifying barriers to or facilitators of mental health care engagement among adolescents with decision-making competence in Greece. Methods Participants were adolescents in therapy for mental disorders recruited from an outpatient tertiary hospital setting. First, potential participants with decision making competence were identified. Second, 50 participants were interviewed about their perceptions of treatment. The interviews were auto-recorded. A transcription verbatim and data analysis were conducted. All the requirements of a qualitative research and ethical considerations were observed. Results All the participants highlighted their experience with facilitators rather than barriers to their treatment engagement. Facilitators included: a) positive treatment outcomes and adolescent's perceived usefulness of treatment, b) a meaningful adolescent-therapist relationship, c) family’s supportive role, d) symptoms and negative self-image, and e) developing social relationships and acceptance by peers. The participants equally highlighted the importance of getting rid of their symptoms and improve their socialization skills. Other facilitators included: achieving professional and personal goals in life, enhancing their independence and self-esteem / self-image, or even just confessing to another trustworthy person. Friends were reported as having a neutral or mild supportive role. The barriers included ineffective and unhelpful treatment, negative experiences with their therapist, relief from symptoms and mental health therapy-related stigma. Conclusion For the most part, the findings enhance prior studies. Participants highlighted facilitators rather than barriers to treatment engagement. For the most part, the findings enhance prior studies. However, we identified some nuances which might be used by therapists to enhance the adolescents’ treatment engagement. For instance, bearing in their mind that by the subsiding of symptoms adolescents are most likely to terminate the treatment prematurely and highlighting the achievement of adolescents’ future goals as well as the potential family’s enhanced well-being because of the improvement of adolescents’ mental health may contribute to reducing the attrition rate.