The ASsuRED Project
ASsuRED is a five year programme of research that aims to develop and test a new intervention for people who present in Emergency Departments having harmed themselves, which began in May 2019.
The title of this project is ‘ASsuRED: Improving outcomes in patients who self-harm – Adapting and evaluating a brief pSychological inteRvention in Emergency Departments’ - Assured for short.
The study will investigate how to better support people who attend Emergency Departments (EDs) who have thoughts of taking their own lives or have harmed themselves. We know that the conversation between the individual and the mental health professional they see is critically important. Although there are many examples of good care, current practice across the NHS varies widely with no research evidence to support best practice. We will adapt and test a promising new approach used in other countries and evaluate its benefits in the UK context. This will involve therapeutic assessment, safety planning and follow-up support after leaving the ED.
The project is funded by the National Institute of Health Research (NIHR) Programme Grants for Applied Research (ref: RP-PG-0617-20004), and is being led by researchers at City, University of London.
You can stay up to date with the project by visiting the Assured Study website.
Background to the ASsuRED study
Self-harm is the most important risk factor for suicide. When someone who has harmed themselves is seen in the Emergency Department, a mental health practitioner usually assesses their psychological state, social situation and needs for support. International evidence shows that training mental health practitioners in how to work therapeutically with the person and to create a personal plan for future crises, as well as following up with them after they leave the Emergency Department, reduces subsequent self-harm and deaths by suicide. We will test if this approach can help people seen in the NHS.
The aim of the ASsuRED study is to develop and test a new intervention for people who present in Emergency Departments who have harmed themselves or have thoughts of ending their life.
The Assured study consists of six work packages:
Work package 1: Developing the intervention
- Firstly, we developed a draft intervention. To do this, we carried out focus groups with people with a history of harming themselves and friends or relatives, and mental health practitioners working in Emergency Departments. We asked about their experiences of attending or working in the ED, to inform the development of an intervention that is acceptable to patients, carers and practitioners. By the end, we had a draft of the intervention manual.
Work package 2: Initial testing of the intervention
- Having developed the intervention, we tested the approach in four Emergency Departments in England. 16 practitioners received training and used the intervention with 46 patients. A control arm was piloted at one site where 5 practitioners delivered treatment as usual to 15 patients. We collected feedback from patients, carers and practitioners, allowing us to improve and refine the intervention.
Work package 3: Developing an online training package
- We developed a training package that will be used to train practitioners in Emergency Departments to deliver the intervention. The training package includes an interactive website and training videos.
Work package 4: Preparing for the trial
- We carried out work to prepare for a randomised controlled trial. We accessed Emergency Department computer records to test the best ways of identifying repeat self-harm and healthcare contacts to inform the approach that will be used in the trial in work package 5.
Work package 5: Randomised Controlled Trial to test the effectiveness of the intervention
- We will conduct a national study, a cluster randomised controlled trial, with 10 Emergency Departments and 1088 patients. The trial will test the clinical and cost effectiveness of the intervention. All patients will continue with their normal care. In addition, half will receive the new approach and half will not. After 18 months we will compare whether those receiving the new approach have better mental health and quality of life, and have harmed themselves less, than those without the approach.
- If our findings show better outcomes, it offers the potential to improve outcomes for people who self-harm and have suicidal feelings more generally, using an evidence-based and consistent approach.
Work package 6: Disseminating our research findings
- We will share our findings widely, including with members of the Zero Suicide Collaborative, and explore whether the approach could be helpful in other settings.
City, University of London:
- Professor Rose McCabe, Chief Investigator
- Dr Sally O’Keeffe, Programme Manager
- Alexandra Bakou, Trial Manager
- Katherine Tallent, Research Assistant
- Oliver Matias, Research Assistant
- Maria Safi, Research Administrator
Queen Mary, University of London:
- Mimi Suzuki, Research Assistant
- Kirsten Brown, Research Assistant
Devon Partnership NHS Trust:
- Daniel Scott, Psychology Research Practitioner
- Meredith Parkin, Senior Research Assistant
- Tanja Christensen, Research Assistant
- Zak Evernden, Research Associate
- Dr Peter Aitken, Devon Partnership NHS Trust
- Professor Vera Araujo Soares, University of Twente
- Professor Richard Byng, Plymouth University
- Professor Chris Dickens, University of Exeter
- Professor Richard Hooper, Queen Mary University of London
- Dr Domenico Giacco, University of Warwick
- Professor Navneet Kapur, University of Manchester
- Dr Will Lee, University of Exeter
- Professor Borislava Mihaylova, Queen Mary University of London
- Paul Norris, Binary Vision
- Professor Stefan Priebe, Queen Mary University of London
- Dr Peter Riou, Royal Devon and Exeter NHS Foundation Trust
- Dr Mary Ryan, PPI representative
- Professor Alan Simpson, Kings College London
- Dr Helen Smith, Devon Partnership NHS Trust
Currie, C.C., Walburn, J., Hackett, K., McCabe, R., Sniehotta, F.F., O’Keeffe, S., Beerlage-de Jong, N., & Araujo-Soares, V. (2022). Intervention Development for Health Behaviour Change: Integrating Evidence and the Perspectives of Users and Stakeholders. Reference Module in Neuroscience and Biobehavioral Psychology.
McCabe, R., Garside, R., Backhouse, A. and Xanthopoulou, P. (2018). Effectiveness of brief psychological interventions for suicidal presentations: a systematic review. BMC Psychiatry, 18(1). doi:10.1186/s12888-018-1663-5.
McCabe, R., Sterno, I., Priebe, S., Barnes, R., and Byng, R. (2017). How do healthcare professionals interview patients to assess suicide risk?. BMC psychiatry, 17(1):122.
O'Keeffe, S., Suzuki, M., Ryan, M., Hunter, J., & McCabe, R. (2021). Experiences of care for self-harm in the emergency department: comparison of the perspectives of patients, carers and practitioners. BJPsych Open, 7(5).