Intractable Self-harm-What Support is Effective?

Study Overview
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Brief Summary
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The aim of this project is to evaluate a novel treatment program for individuals with intractable and lethal self-harm. The main questions are: 1: Is there, in individuals with intractable self-harm, a relevant improvement in daily functioning and is this improvement related to the provided interventions? The secondary research questions are: 2. Is there, in individuals with intractable self-harm, a relevant improvement in frequency and severity of self-harm? 3. Is there, in individuals with intractable self-harm, a relevant improvement in voluntary hospital admissions? 4. Is there, in individuals with intractable self-harm, a relevant improvement in compulsary hospital admissions? 5. Is there, in individuals with intractable self-harm, a relevant improvement in the use of medication pro re nata? 6. Is there, in individuals with intractable self-harm, a relevant improvement in cost-effectiveness related to the provided interventions?

Detailed Description
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Individuals with intractable, imminent and lethal self-harm often have multifaceted psychiatric symptoms, pervasive suffering, high mortality and a reduced level of daily functioning. Severe self-harm can lead to long periods of psychiatric inpatient care which can lead to reduced autonomy and aggravated self-harm. Effects of this care remain uncertain. The Swedish National Board of Welfare has provided National specialized medical care units for severe self-harm behaviour to three Swedish hospitals. In one of this hospitals, Region Skåne, the intervention will be consultation-based. Individuals with intractable self-harm will be offered an assessment and review of all medical records which will result in a individualized intervention plan. Interventions include further assessments and supporting the existing treatment providers, families or caregivers. Recurring network-meetings will occur every three months as well as at he end of the intervention. Data collection will include self-report measures as well as information from charts and national och regional registries.

Official Title
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Svårbehandlat självskadebeteende-Vilka Insatser är Effektiva?

Conditions
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Self-harm

Intervention / Treatment
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* Behavioral: National specialized medical care unit for severe self-harm behaviour-Consultation model


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Having tried or made serious attempt to try at least two different interventions with evidence to reduce self-harm, without sufficient reduction in suffering or self-harm Exclusion Criteria: Need for translation services to complete measures or interviews Not able to complete measures or interviews

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study group<br>Individuals with current severe, imminent and lethal self-harm with a history of at least two interventions without sufficient reduction of self-harm or suffering. | Behavioral: National specialized medical care unit for severe self-harm behaviour-Consultation model<br>* Extensive assessments. Consultation and training for existing treatment providers and caregivers. Network-meetings for providers and caregivers.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The World Health Organization Disability Assessment Schedule II (WHODAS 2.0) | Level of daily functioning and disability in the domains of cognition, mobility, self-care, getting along with other people and life activities. | Monthly from baseline to endpointat 24 months and at follow-up at 36 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Five Self-harm behaviour groupings measure (5S-HM) | Indirect and direct self-harming behaviour | Weekly from baseline to endpointat 24 months and at follow-up at 36 months. | 
| The 5-level EQ-5D | Quality of life scale | Monthly from baseline to endpointat 24 months and at follow-up at 36 months. | 
| Cost effectiveness | Quantities and costs related to healthcare, municipal, social and rescue services. | Monthly from baseline to endpointat 24 months and at follow-up at 36 months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Deliberate self-harm, Suicide