Title: A co-design project and early evaluation of a mobile app (Imaginator) supporting young people with reducing self-harm.
Funder: Department of Health and Social Care

Abstract: The problem. Self-harm is a behaviour that expresses a state of distress, such as being overwhelmed by feelings of anxiety, anger, despair and/or loss of control, reported by 20% of young people (YP) below the age of 25. YP who self-harm are at greater risk of suicide and more likely to have poor health and do less well in life (including family life, education and employment) compared to those who don t. Self-harm rates have been increasing over the last 10 years, however most YP who seek help (e.g. from GPs) don t receive mental health support that specifically targets how to manage this behaviour. This is because interventions available now are too long, complex and expensive to be delivered by the NHS to all those in need and to suit all YP, in particular those whose presentation is not severe when they first seek help. No intervention has been developed together with YP who identify as belonging to a minority group, even if research shows these carry higher risk of self-harm and specific needs to be considered. Our solution. Mobile apps can make it easier to reach larger numbers of YP and reduce stigma. YP prefer digital interventions that include some face-to-face human connection and this favours engagement. We propose a digital intervention called Imaginator that blends together: a mobile app three 60 mins face-to-face therapy sessions five short follow-up phone calls. Imaginator trains YP to use mental imagery (visualisation) to regulate emotions and plan positive behaviours in response to self-harm urges. It was well received and showed promising results in reducing self-harm in a pilot study with YP aged 16-25 (Di Simplicio et al., 2020). However, clinicians and YP told us that the app needs to be more personalised and varied, and to be adapted to younger teenagers too as that is when self-harm starts. Aims of the project: Co-design a new Imaginator app with YP with lived experience of self-harm including from minoritised groups. Run a small initial evaluation of Imaginator with the new app in N=15 YP with self-harm aged 12-25 recruited from mental health services in deprived areas of West London. Impact. Compared to existing apps, the new Imaginator will be unique because 1) it integrates tightly the digital technology with a brief therapist contact, supporting YP to adapt the app to their daily needs; and 2) it is individualised and personalised to suit YP from different backgrounds. Imaginator has the potential to be used across different mental health services that have little to offer at present and to double the number of YP receiving support for self-harm. Dissemination. We will co-develop a video with YP to share results and test Imaginator in a larger multi-site trial.

Lay abstract: The problem. Self-harm is a behaviour that expresses a state of distress, such as being overwhelmed by feelings of anxiety, anger, despair and/or loss of control, reported by 20% of young people (YP) below the age of 25. YP who self-harm are at greater risk of suicide and more likely to have poor health and do less well in life (including family life, education and employment) compared to those who don t. Self-harm rates have been increasing over the last 10 years, however most YP who seek help (e.g. from GPs) don t receive mental health support that specifically targets how to manage this behaviour. This is because interventions available now are too long, complex and expensive to be delivered by the NHS to all those in need and to suit all YP, in particular those whose presentation is not severe when they first seek help. No intervention has been developed together with YP who identify as belonging to a minority group, even if research shows these carry higher risk of self-harm and specific needs to be considered. Our solution. Mobile apps can make it easier to reach larger numbers of YP and reduce stigma. YP prefer digital interventions that include some face-to-face human connection and this favours engagement. We propose a digital intervention called Imaginator that blends together: a mobile app three 60 mins face-to-face therapy sessions five short follow-up phone calls. Imaginator trains YP to use mental imagery (visualisation) to regulate emotions and plan positive behaviours in response to self-harm urges. It was well received and showed promising results in reducing self-harm in a pilot study with YP aged 16-25 (Di Simplicio et al., 2020). However, clinicians and YP told us that the app needs to be more personalised and varied, and to be adapted to younger teenagers too as that is when self-harm starts. Aims of the project: Co-design a new Imaginator app with YP with lived experience of self-harm including from minoritised groups. Run a small initial evaluation of Imaginator with the new app in N=15 YP with self-harm aged 12-25 recruited from mental health services in deprived areas of West London. Impact. Compared to existing apps, the new Imaginator will be unique because 1) it integrates tightly the digital technology with a brief therapist contact, supporting YP to adapt the app to their daily needs; and 2) it is individualised and personalised to suit YP from different backgrounds. Imaginator has the potential to be used across different mental health services that have little to offer at present and to double the number of YP receiving support for self-harm. Dissemination. We will co-develop a video with YP to share results and test Imaginator in a larger multi-site trial.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH