Title: A pilot study to investigate the feasibility and acceptability of a cognitive behavioural suicide prevention therapy for people in acute psychiatric wards
Funder: Department of Health (England)

Abstract: Background Suicide is the most serious outcome of mental illness [18,19, 20], resulting in approximately 6000 deaths annually. Rates of suicide are high in the North West of England [3], particularly Manchester [20]. The impact of suicide is far reaching, affecting family, friends and healthcare staff. The associated health economic burden is also significant [9,17,19,21,22]. Further, attempted suicide and feelings of suicidality are re-current experiences for many individuals [14,15,16,17] contributing to significant personal distress and placing significant pressure on NHS services. Suicide prevention is therefore an important public health issue and NHS priority as reflected in major policy directives across the UK [6,7,8,10,18]. Fourteen percent of suicides occur in acute psychiatric settings [4,6,16,18]. Arguably, these deaths are the most preventable [4,23,30] given the patients’ close proximity to services. Targeted suicide prevention initiatives such as CBSP therapy are ideally suited for these vulnerable patients. Aims This feasibility/pilot study will investigate clinical and contextual issues about which further information is required to design and implement a rigorous high quality definitive trial to evaluate the efficacy and cost-effectiveness of a psychological suicide prevention therapy (CBSP), which has not previously been applied in acute psychiatric ward settings. The study comprises of three phases:- The Service User Reference Group will be involved throughout all phases and their input will be continuously monitored collecting data that will be used for planning the service user involvement strategy for the definitive study. Phase 1 This phase will be based on qualitative methods including semi-structured interviews, focus groups, process mapping and observational work. i) Research team (including SURG) training needs analysis. ii) Advertise study with staff information presentations and flyers. iii) Identify usual ward routines & typical patient journeys. iv) Elicit staff and patient views (feasibility and acceptability). v) Refine selection of outcome measures in consultation with SURG. Phase 2 The second phase is a pilot RCT comparing CBSP with treatment as usual (TAU). Assessments will be at:- i) Baseline ii) Week 6 of therapy / TAU iii) Six months follow-up Phase 3 The third phase is largely qualitative using interviews and focus groups to assess:- i) Views of staff of CBSP delivery, ii) Patient perceptions of therapy process, iii) Potential benefits of CBSP in acute settings, iv) Problems and solutions with CBSP in acute settings, On completion of phase 3 the cost analysis will be finalized and dissemination activities will commence. Potential benefits to patients and the NHS are as follows: Reduction or elimination of repeated suicidal crises / attempts, improved family and social relationships, reduced stress, better social support networks. 2. Mental health gains by prevention / reduction of mental distress and disability associated with suicidality, - reduced fear, anxiety, panic, depression, guilt, shame, hopelessness, confusion, defeat, entrapment, isolation and failure. Improved quality of life / reduced disability - enjoyment of life / work and productivity / purposeful activity / social functioning. Increased life-expectancy - repetitious suicide attempts increases risk of premature death by suicide [24]. Enhanced ‘patient experience’ - a DH quality indicator [25]. Substantial carer quality of life & health gains . – reduced threat of bereavement, reduced carer stress and better family relationships [26]. Improved public health gains . - reduced stress and distress associated with suicide will have positive preventative effects on many physical illnesses (eg. cardiac, auto-immune) [27] Health economic benefits to the NHS of lower costs with more effective treatment resulting in lower resource utilization [28]. 9. Benefits to psychiatric staff include reduction of stress arising from caring for suicidal crises with consequences of improved job satisfaction, reduced staff-sickness and reduced job turnover [29,30,31].


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