Title: Multicentre Intervention Designed for Self-Harm, using Interpersonal Problem-Solving (MIDSHIPS) trial: A feasibility study
Funder: Department of Health (England)

Abstract: Background Around 150,000 people each year attend hospitals in England due to self-harm, many of them more than once [1]. Over 5000 people die by suicide each year in the UK, a quarter of them having attended the general hospital in the previous year because of non-fatal self-harm, so self-harm is the major identifiable risk factor for suicide [2]. People receive a variable standard of care at hospital: many are not assessed for their psychological needs and little psychological therapy is offered [3]. Despite its frequent occurrence, we have no clear research evidence about how to reduce repetition of self-harm [4]. People who have self-harmed show less active ways of solving problems, and brief problem-solving therapies are considered the most promising psychological treatments [5]. Aims We plan a randomised controlled trial to find out whether problem-solving therapy, when added to treatment as usual (TAU), reduces the rate of repeated self-harm over the next year. Problem-solving therapy has proven benefit in depression and is known to reduce hopelessness and suicidal thinking [5]. We are proposing a feasibility study; if we prove successful in recruiting and treating patients, and in following them up to identify repeat episodes of self-harm, we will apply for funding for a large trial. This application is for a study that includes only 80 people but the large trial, if it takes place, will have up to 2800 participants. The feasibility study can provide hard data on which to base assumptions and processes, and thereby position our team ready to run the main trial. Plan of Investigation Problem-solving therapy can be set out in simple manuals and is readily taught to health professionals with a mental health nursing, social work or counselling background. Patients in the active treatment-plus-TAU limb of the proposed multicentre trial will receive 4-6 one-hour weekly sessions from staff trained in the intervention by the research team and working to a manual of treatment. In the feasibility study we will: prepare the therapy manuals; train 2 therapists in the problem-solving therapy; screen patients attending hospital after self-harm for their eligibility for the trial; and establish the best methods for recruiting and delivering therapy to 60 patients. We will refine our methods for collecting the information we need about follow-up – from surveys and hospital records. Potential Impact At present, around the world, therapy is not usually offered to people who have come to hospital because of self-harm because none is known to be effective [4,6]. The absence of effective treatment is one of the main reasons why fewer than half of the people who come to hospitals in the UK as a consequence of self-harm receive an adequate psychosocial assessment of their needs [3]. Current evidence points towards effectiveness from brief problem-solving therapy but, if it is to become a routinely available treatment in the NHS, we will need clear evidence from a large, multicentre, pragmatic trial in the UK and an economic evaluation; this feasibility study paves the way towards badly needed improvement in patients’ experience and outcome after self-harm.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH