Title: A CO-produced Psychosocial INtervention delivered by GPs for young people who self-harm (COPING): an intervention development and feasibility study
Funder: Department of Health and Social Care

Abstract: Background Self-harm significantly affects patients, families, the public and the NHS. There is a 20% lifetime prevalence of self-harm in young people, and nearly 50%, in young people with mental illness. Young people who self-harm are at risk of future self-harm, anxiety, depression, premature death and suicide. Presentations of self-harm in young people to general practice are increasing. After seeing their general practitioner (GP) for self-harm, 22% of young people repeat self-harm the following year. My systematic review highlights the important role GPs have in managing young people who self-harm; and qualitative research with young people reports poor experiences of seeing GPs for self-harm. There are few guidelines and an absence of evidence-based interventions for GPs to use with young people who self-harm. Cognitive behaviour and dialectical behaviour therapies can help reduce repeat self-harm in young people, however, these are delivered by specialists outside general practice. There is evidence GPs can deliver effective psychosocial interventions. Young people who self-harm, families and practitioners feel interventions for GPs to use in the consultation with young people who self-harm are important. AimTo develop a co-produced complex GP-delivered psychosocial intervention (COPING) for young people (16-25 years) who self-harm to reduce repeat self-harm, and test its feasibility in general practice. Methods Three complementary workpackages (WP) informed by the MRC framework for developing and evaluating complex interventions. A 'combination' approach to intervention development will be adopted through combining a theory and evidence informed (MRC) approach with a partnership (framework for coproduced public health interventions) approach, increasing likelihood of the intervention working in practice. Patients, families and key stakeholders will be involved throughout the study. WP1 (one-14 months): Semi-structured interviews with up to 15 GPs to explore experiences of consulting with young people who self-harm, target behaviours, feasible and acceptable intervention components, and barriers and enablers to intervention implementation. WP2 (15-31 months): Stage one: past evidence, theories, WP1 and stakeholder consultation will be drawn together to draft possible intervention components. Stage two: two intervention design groups: 1) young people who self-harm and 2) GPs, will participate in meetings, using an action-research approach to create, refine and agree on the content, resources and delivery of COPING. Stage three: peer-review and simulation of two COPING consultations will further refine the COPING intervention and conclude intervention development. WP3 (32-50 months): Feasibility study of COPING across six GP practices to estimate parameters to inform the design of a larger randomised-pilot trial. Five semi-structured interviews with young people and GPs will explore intervention acceptability and GP questionnaires will assess willingness of GPs to be involved in a subsequent trial. Mixed-methods data will be integrated. Anticipated impact and disseminationThis research will potentially lead to improved patient experience, increased GP skills and confidence, reduced distress for young people and families, lower NHS costs and reductions in self-harm, suicide and mortality in young people. Findings will potentially inform self-harm policy and guidelines, and primary care self-harm models. Outputs will be strategically disseminated to patients, public and NHS to facilitate maximum reach and uptake.

Lay abstract: BackgroundSelf-harm, usually by medicine overdose or cutting, affects young people, their families and friends, and society. It costs the NHS 162 million a year. 20% of young people have self-harmed, rising to nearly 50% in young people with mental illness. Young people who self-harm experience further self-harm, distress, anxiety and depression. Self-harm is the strongest risk factor for suicide. The leading cause of death in young people is suicide and over half of young people who die by suicide have previously self-harmed. Within the NHS, the GP is the most frequently contacted health professional after a young person has self-harmed. Following a first GP consultation, 22% of young people self-harm again within one year. The risk of suicide is highest during the first six months after self-harm. So, the GP consultation provides a crucial opportunity for early intervention to reduce further self-harm, suicide risk and death. My previous research has shown that although GPs have an important role in managing self-harm in young people, some young people who self-harm report poor experiences with their GP, and would like more time and support. However, there are no effective interventions that exist for GPs to use with young people who self-harm. Research has shown that approaches to cope with distress, problem-solving and controlling one's emotions can help reduce repeat self-harm. I aim to develop and pilot an intervention, called 'COPING'. It will be delivered by GPs over two consultations with young people 16-25 years to reduce repeat self-harm. The COPING intervention will be produced in equal partnership with young people who self-harm and GPs, and is the first study of its kind. It will include training for GPs to use the intervention with young people. The COPING intervention will be tailored to young people who self-harm and GPs, and will be tested in general practice. Methods I propose three linked studies: Study 1: Interviews with up to 15 GPs to understand current clinical practice for self-harm in young people and gain thoughts on acceptable and realistic elements for COPING. Study 2: The findings from study 1, past research and speaking to stakeholders will help me develop COPING with GPs and young people. During face-to-face meetings, we will agree on COPING's content, resources and delivery. I will then simulate consultations with GPs and patient actors to refine COPING. Study 3: To examine whether it is possible to do a large study within general practice to test the use of COPING by GPs with young people who self-harm. Using interviews, questionnaires and other data collected, I will assess whether GPs and young people think the COPING intervention is acceptable, practices are interested to take part, young people who self-harm can be identified and recruited and GPs are willing to take part in a future larger study.COPING will be improved based on this feedback. Patient and public involvement Young people who self-harm, their families, practitioners and the public have said this research is needed and have influenced this proposal, such as the 'COPING' name. They will continue to be involved throughout all stages of the study including project oversight, shaping study documents, writing interview questions, developing COPING and sharing findings. Dissemination I will present findings at national and international conferences, and publish academic papers, public summaries and policy briefings. Young people, families, charities, practitioners, commissioners, policymakers and media will be invited to a public event to hear findings, and infographics will be shared on social media. COPING has the potential to improve patient experience, increase GP confidence and skills, lower NHS costs and reduce self-harm, suicide and death in young people.

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