Title: Linking individual risk prediction and population level risk stratification to effective interventions for reducing self-harm in adolescents
Funder: Department of Health and Social Care

Abstract: BackgroundMental health problems in children and adolescents contribute to outcomes with long-lasting effects, such as suicidality, self-harm, violence towards others and risky behaviours. In the UK there is a large amount of unmet need in young people with mental distress. Waiting lists are long and have been growing as demand increases. Self-harm is a serious public health issue in young people, and is increasing. Self-harm is an umbrella term which captures all forms of self-injurious behaviour irrespective of intent. Predicting which adolescents are at higher risk of self-harm is an important part of case assessment and management. In addition, understanding the characteristics of young people who self-harm may help health services manage their response to the increasing numbers and complexity of such patients.For each individual, predicting the likelihood of these consequences is challenging. Nonetheless, risk assessments are a routine part of care in services. Professionals use a range of methods to assess risk, including structured risk assessment tools. However, there is no standardised method for risk assessment and many tools lack a scientific evidence-base and have poor accuracy.Accurate risk assessment tools could help professionals to base their assessments on evidence and guide the allocation of treatment in a way that is tailored to individuals. Effective tools could also inform discussions amongst health professionals and between professionals and their patients and families. They may also improve consistency of assessment between services. Aims and objectives This project proposes to model the risks and needs of adolescents who go on to experience self-harm, with the goal of making recommendations for interventions at different levels of the healthcare pathway. MethodsI will aim to build a new prognostic risk assessment tool for new or repeat self-harm in adolescents, building on similar work which has been carried out for mental health (OxRISK Self Harm) in adults, and for physical health conditions such as QRISK for cardiovascular disease. This will be followed by a model which uses machine learning techniques to segment a population of adolescents into groups of differing characteristics and stratifies their risks of self-harm. These tools with be combined with a systematic evidence review of effective interventions to improve outcomes for adolescents at risk of self-harm. Anticipated impact and dissemination If successful, the anticipated outcome is new insights that will be of value to those responsible for the care of adolescents at risk of self-harm. I propose to disseminate the findings of this project by engaging with patients, carers, and members of the public, supported by members of the public engaged in this project since its development. I will draw upon previous experience of using films as means to engage, inspire and generate debate. I will seek to publish the findings in academic journals, targeting Translations in Psychiatry, Lancet Psychiatry, and the Journal of Public Health. I will engage with clinicians and local and national population health management groups such as the Integrated Care Partnerships through workshops, presentations and blogs.

Lay abstract: Mental health problems in children and adolescents can lead to negative long-lasting effects, such as attempting suicide, other types of self-harm, violence towards others and risky behaviours. In the UK there is a large of young people with mental distress do not receive the care they need. Waiting lists are long and have been growing as demand increases. Self-harm is increasing and is a serious public health issue in young people. Self-harm is an umbrella term which captures all forms of behaviour where someone injures themselves regardless of whether they mean to harm themselves or not. Predicting which adolescents are more likely to experience self-harm is an important part of case assessment and management. In addition, understanding the characteristics of young people who self-harm may help health services manage their response to the increasing numbers and complexity of such patients.For each individual, predicting the likelihood of these consequences is challenging. Nonetheless, risk assessments are a routine part of care in services such as primary care, child and adolescent mental health services, education and child protection. Professionals use a range of methods to assess risk, including structured risk assessment tools. However, there is no standardised method for risk assessment and many tools lack a scientific evidence-base and have poor accuracy. Accurate tools to predict future risk could help health professionals base their assessments on evidence to guide the allocation of treatment in a way that tailors treatment for each individual. Effective tools could also inform discussions amongst health professionals and between professionals and their patients and families. They may also improve consistency of assessment between services.Aims and objectives This project proposes to model the risks and needs of adolescents who go on to experience self-harm. The first objective is to create a new risk prediction tool based on up-to-date methods to predict the risk of new or repeat self-harm in adolescents over the next 12 months. The second objective is to generate an understanding of how different groups of adolescents are at risk of self-harm, and how different types of services can help them.Methods The tool to predicting new or repeat self-harm will be developed with statistical techniques from electronic healthcare records of adolescents in contact with mental health services.This will be followed by using machine learning techniques to divide the population of adolescents into groups of differing characteristics, depending on their use of health-care resources and risk of being admitted to hospital for self-harm. These tools with be combined with a comprehensive review of the current evidence for approaches to improve outcomes for adolescents at risk of self-harm.Timelines for delivery I plan to complete this study within three years.Anticipated impact and disseminationIf successful, I hope to provide new insights for health professionals responsible for the care of adolescents at risk of self-harm. I propose to share the findings of this project by engaging with patients, carers, and members of the public. This dissemination will be supported by members of the public who have been engaged in this project since its development. I will use my previous experience of using films as a means to engage, inspire and generate debate. I will seek to publish the findings in academic journals, targeting Translations in Psychiatry, Lancet Psychiatry, and the Journal of Public Health. I will engage with local and national population health management groups such as the Integrated Care Partnerships, which have been established to improve healthcare services. I will also seek to establish a national network of people working to use mental health service data for population health management.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH