Award Title: Adapted suicide safety plans to address self harm, suicidal ideation and suicide behaviours in autistic adults: an interventional single arm feasibility trial and external pilot randomised controlled trial
Funder: Department of Health and Social Care

Abstract: Aims: This study will examine how acceptable and usable adapted Safety Plans (SPs) are for autistic adults who have a history of self-harm and/or suicidal thoughts and behaviours. The findings will also help us to determine the important features to be included in a future study to assess how helpful SPs are. _x000D_
Background: Suicide is a leading cause of premature death for autistic people. Autistic people are 9 times more likely to die by suicide than non-autistic people and 66% of autistic adults report having considered suicide (UK general population rate is 17%). No research has explored suicide prevention strategies for this group. Autistic people need mental health treatments to be adapted to make them more accessible. SPs are a type of intervention to prevent people attempting suicide. They are a simple, cost-effective, potentially life-saving intervention that autistic people could find indispensable in times of crisis. Working with autistic adults we have adapted SPs to make them more suitable for them._x000D_
Design & methods: In Stage 1 we will consult with autistic adults, family members and professionals to refine our adapted SPs and research plan to ensure both are fit for purpose. We will run focus groups with: 1) autistic adults with experience of self-harm; 2) family members of autistic people who have experienced self-harm; 3) service providers who support autistic adults to discuss how the adapted SPs could be utilised in services and what training would be helpful. In this stage we will also work with local authorities, mental health and autism charities to train staff to use the SPs. In Stage 2 we will recruit 10 autistic adults through these organisations, who have experienced self-harm, with support from staff at their service provider they will develop their own SP and we will also ask them to complete some questionnaires about depression, anxiety, self-harm and suicidal thoughts/behaviours.  We will ask for feedback on the SPs and the questionnaires and use this information to further refine the SPs and our research procedures. Finally, in Stage 3 we will recruit 70 autistic adults who have experienced self-harm. These autistic adults will be allocated at random, by a computer, to use our SPs (alongside usual care), or receive only usual care. We will follow up these participants one month and six months later and ask them about self harm, depression, anxiety, and suicidal thoughts/behaviours. We will also ask the autistic adults who received the SPs and their support workers (where applicable) if they used the plans and what they thought about them. At the end of the study we will have useful information about whether the adapted SPs are acceptable and usable by autistic adults and whether the procedures are appropriate for a future study to assess how well they work._x000D_
Patient and Public Involvement: Autistic advisers have already guided the development of the SPs through a series of consultations. In the proposed study we will engage autistic people as co-investigators, researchers and members of our steering committee and advisory panel. _x000D_
Dissemination will include a series of reports written in an accessible and inclusive manner for a wide audience; a feedback event; presentations at academic meetings; papers in academic journals; presentations for multidisciplinary teams; articles for professional organisation newsletters.

Lay Abstract: Research Question: ‘Are Autism Specific Safety Plans to reduce repeat self harm, suicidal ideation and behaviours acceptable and feasible for use with autistic adults and what are the parameters for a future definitive trial?'_x000D_
Background: Suicide prevention is a national priority for UK government policy, and autistic people have recently been identified as a high-risk group in NICE suicide prevention guidelines. Closing the mortality gap between autistic people and the general population is a priority for the Department of Health’s revised “Think Autism Strategy” (2018). Autistic people are a highly disadvantaged group, which has been associated with increased risk of self harm and suicide. Our research, designed in partnership with autistic people, highlights a lack of appropriate support and treatment for autistic people experiencing self-harm, suicidal thoughts and behaviours. No suicide prevention interventions have been developed specifically for autistic people. Hence, it is crucial to address this knowledge gap, and develop appropriate interventions to prevent self-harm and suicide in autistic people. At an engagement event with autistic people, families, practitioners and researchers we identified a suicide prevention intervention for adaptation for use with autistic people, suicide safety plans (SPs). Safety plans are a simple, cost-effective, potentially life-saving intervention that autistic people could find indispensable in times of crisis. We have developed an adapted safety plan for use with autistic adults. We do not yet have systematic data on the use of the SPs.  Autistic people experience significant difficulties accessing NHS clinical services and when support is accessed it is often via third sector autism or mental health organisations. Our partners in the current project include third sector organisations where autistic people are most likely to receive support. This will be crucial to explore SPs use in non-NHS settings, where autistic people are most likely to seek support. _x000D_
Aims: to evaluate the feasibility and acceptability of the use of autism adapted safety plans for autistic adults and to undertake an external pilot to explore whether the components of a larger future definitive trial are achievable. _x000D_
Objectives:_x000D_
1. Refine our autism adapted SPs to ensure they are suitable for use with autistic adults. (Stage One)._x000D_
2. Conduct an interventional single arm feasibility trial to explore data collection tools/methods & gather information to inform the external pilot Randomised Controlled Trial (RCT) (Stage 2). _x000D_
3. Conduct an external pilot RCT of adapted SPs + treatment as usual vs. treatment as usual (Stage 3)._x000D_
Methods: Community consultation, single arm interventional feasibility trial, external pilot RCT. _x000D_
Timelines for Delivery: 34 months - Stage One 0-6 months, Stage 2 6-10 months, Stage 3 10-31 months, analysis, write-up & dissemination 31-34 months._x000D_
Anticipated impact and dissemination: Autistic people are significantly more likely to die by self-harm and suicide than the general population. Adapted SPs have significant, scalable and translational potential to close this mortality gap. We will undertake wide dissemination of the findings including reports written in an accessible and inclusive manner for a wide audience; a feedback event; presentations at academic meetings; papers in academic journals & professional newsletters; presentations for multidisciplinary teams.

Research Activity Codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health Categories: MENTAL HEALTH