Title: A comparison of usual care versus usual care plus a smartphone self-harm prevention app (BlueIce) in young adolescents aged 12-17 who self-harm.
Funder: Department of Health and Social Care

Abstract: Background Self-harm, i.e. intentional self-poisoning or self-injury irrespective of motivation, is common during adolescence with up to one in six reporting at least one episode in the past year. Approximately half of adolescents who self-harm will do so more than once; cutting and overdose are the main methods used, with self-harm being associated with a range of mental health disorders and increased risk of suicide. The recent Cochrane review concluded that there is little evidence to draw conclusions on the effects of interventions for self-harm in adolescents and recommended the development and evaluation of new interventions developed collaboratively with young people. Research question To determine whether adding a smartphone self-help app (BlueIce), developed collaboratively with young people, to usual mental health care, can reduce reported self-harming incidents and improve mood. Aims and Objectives To determine the effect of adding BlueIce to usual care on (i) reported self-harm (ii) mood, anxiety, hopelessness and general behaviour and whether (3) BlueIce is acceptable and (4) cost-effectives Methods We will conduct a single blind randomised controlled trial comparing usual face to face mental health care (UC) and usual face to face mental health care plus BlueIce (UC+BI). We will recruit 172 young people aged 12-17, attending specialist Child and Adolescent Mental Health Services (CAMHS) with a history of self-harm (i.e. 2 or more episodes of self-harm over the past 12 months). BlueIce, was designed with young people to help manage or delay urges to self-harm. It includes a mood diary, menu of personalised mood lifting activities based on recommended interventions (CBT and DBT) and automatic routing to emergency numbers (Childline, 111) if self-harm urges persist. We will undertake assessments at baseline, post-intervention (12 weeks) and follow-up (6 months) with the primary outcome being self-report self-harm assessed by the Risk-Taking and Self-Harm Inventory for Adolescents (RTSHIA). Secondary outcomes include depression, anxiety, hopelessness and general behaviour, the CHU9D and resource-use questionnaire for the economic analysis and semi-structured interviews to assess acceptability. Timelines for delivery Months 1-3 recruit researchers, establish project infrastructure, liaise with CAMHS teams, secure final approvals and registrations. Months 4-24: recruitment (n=172), consent, baseline assessment, delivery of interventions. Months 7-27: 12 week assessments, data collection, coding and entry. Months 10-30: 6 month assessments, data collection, coding and entry. Months 27-33: qualitative, economic and quantitative analyses, Months 33-36: Prepare project report, papers for publication & dissemination. Anticipated Impact and Dissemination BlueIce has already met the NHS safety and security requirements and is available for use by other Trusts via the NHS app library. If proven to be effective, it can immediately be implemented in CAMHS at negligible cost to improve the mental health of young people and to offer cost savings arising from reduced emergency care following incidents of self-harm. Results will be disseminated in different formats including peer reviewed papers, conference presentations and websites to a wide audience including national and local service commissioners, clinicians and young people.

Lay abstract: Why is this important? Self-harm (intentional self-injury or poisoning) is unfortunately common amongst young people aged 12-17. Up to one in six young people report self-harming at least once during the past year. Self-harm is linked to other mental health problems such as depression, anxiety and substance misuse and with an increased risk of suicide. Nearly all self-harm happens whilst the young person is on their own. However, most have access to a mobile phone at the time they harm themselves What did we do? We talked with young people. They told us that a telephone app could provide them with help at times they were thinking of self-harming. We had workshops with young people to design, develop and produce a smartphone app, BlueIce. We tested BlueIce with 44 young people to check whether it was safe, that they liked and used it and that it helped them to manage urges to harm. Young people liked the app with three quarters telling us that their self-harm had stopped or reduced after using it for 12 weeks. What do we want to do? We want to test the effects of adding BlueIce to the usual care provided by child and adolescent mental health services (CAMHS) for young people who self-harm. We want to test whether adding this reduces self-harm, improves how they feel and results in fewer emergency contacts. . How will we do it? We will ask young people being seen by CAMHS to take part in a controlled trial. They will be allocated to usual care or usual care plus BlueIce How will we know if it is effective? We will ask young people about their self harm. We will ask them to complete questionnaires about their mood and how they feel. We will ask them about any care they have received for their self-harm such as attending Emergency Departments. We will ask them to do this at the start, after 12 weeks and at the end of the trial (6 months). We will compare the two groups to see if there are any differences in self-harm, depression, anxiety, feelings of hopelessness, general behaviour and emergency contacts and support for self-harm .

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH