Title: The ‘Listen-Up!’ Project: Understanding and Helping Looked-After Young People Who Self-Harm
Funder: Department of Health (England)

Abstract: Background. Self-harm is a sign of serious emotional distress and is still poorly understood by academics and clinicians. Significant NHS resources are required to deal with the assessment and management of self-harm. Each year approximately 200,000 episodes of self-harm are seen in general hospitals and many more hidden episodes occur in the community. Self-harm in young people appears to be increasing. This is very worrying because self-harm is the strongest predictor of eventual suicide and each suicide significantly affects many other individuals. Looked-after young people are at particularly high risk of self-harmful behaviour yet there is sparse research targeting this group. Aims in relation to the issue to be addressed. Our aim is to increase understanding of the experience of self-harm in looked-after children and adolescents (aged 11-18 years). We will investigate: 1. What factors most influence the initiation and maintenance of self-harm? (Pathways into self-harm) (Study one.) 2. Whether there are any common pathways into and out of self-harming behaviour. (Studies one and two). 3. What services and supports work or have worked in terms of coping with and/or ceasing self-harm? (Study two.) The studies will provide valuable information on what factors services should focus on to aid recovery from self-harm and is, therefore, of current policy interest. An advisory group of young people will prioritise the research agenda in order to effectively inform policy. Research plan and methods of investigation We will conduct two studies. In study one we will carry out semi-structured interviews to examine the factors that looked-after young people and carers see as instrumental in them starting and maintaining self-harmful behaviour, and whether there any common pathways into self-harm. In study two, a prospective Audio Computer Assisted Self-Interview (ACASI) study will investigate what promotes recovery from self-harm and which services and supports young people find helpful/unhelpful. In preparing this bid we consulted young people (via Harmless, a user-led service based in Nottingham) to ask them what research methods they would prefer - online surveys and face-to-face studies in neutral locations were chosen most frequently. Interpretative Phenomenological Analysis, sequence analysis and multivariate regression will be used to analyse data. We will recruit participants from CAMHS services in Nottingham and Leicester. We will also recruit young people who have self-harmed from the community via Social Services and Harmless. We will recruit control/contrast groups of participants matched for age and gender who are not looked-after, and care leavers. Case notes will be analysed where these are available. Research team Our multidisciplinary team comprises psychologists (Townsend, Clarke), psychiatrists (Sayal and Vostanis), the Nottingham self-harm nurse consultant (Armstrong), a CAMHS looked-after children manager (Pearce), the Director of an award winning user-led self-harm support service (Harroe) and a national mental health charity (YoungMinds). We have a strong track record of published work and clinical practice in relation to self-harm. We will work with an advisory group of young people who are looked-after/self-harm. Potential impact/influence on the relevant policy field, users and wider stakeholders . Self-harm and suicide prevention are major concerns for government (especially considering the current economic crisis which is likely to impact on suicide rates) and our ideas are consonant with research priorities highlighted in the two NICE guidelines on self-harm, the Royal College of Psychiatrists report on self-harm and suicide and the current National Suicide Prevention Strategy. The work here will give a much needed voice to the specific needs and concerns of looked-after young people who self-harm which is missing from current guidance. It will provide a robust evidence base on improving management and services for young people.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH