Supporting Adolescents with Self-Harm (SASH) Project

Background to the SASH study

Suicide is the second-leading cause of death in young people, with nearly 1 in 10 adolescents reporting attempting suicide at some point in their lives.

The strongest predictor of suicide is self-harm. When adolescents present in crisis, there is a crucial opportunity to intervene rapidly so that self-harm does not become an established coping strategy for life, significantly increasing the risk of suicide. The period immediately following discharge from hospital is associated with the highest risk of repeat self-harm and suicide, demonstrating a need for rapid intervention.

Furthermore, previous research emphasises the need for compassionate, personalised care to break the cycle of self-harm. A promising approach to address this is a Therapeutic Assessment with safety planning and rapid follow-up contacts using a solution focused approach.

Aims

This trial aims to test the clinical- and cost-effectiveness of this approach for adolescents presenting to the Emergency Department with self-harm.

The SASH study consists of six work packages

Work package 1: Co-Design with Adolescents

• We are working with the Young People’s Network at the McPin Foundation to develop and set up this trial. We have set up a Young People’s Advisory Group (YPAG). The YPAG includes 6 young people and will meet around three times a year, to advise on all aspects of the study.

Work package 2: Trial

• We will conduct a cluster randomised controlled trial, with 18 mental health practitioners from Emergency Departments and 144 young people. The trial will test the clinical- and cost-effectiveness of the intervention. All young people will continue with their normal care and, in addition, half will receive the new approach. After 6 months we will compare whether those receiving the intervention have better mental health and quality of life, and have harmed themselves less, than those not receiving it.

Work package 3: Outcome Analysis

• The outcome analysis will focus on whether the participants who received the intervention harmed themselves less throughout the study period of 6 months, compared to those who did not receive it. It will also focus on whether they had better mental health and quality of life. If our findings show better outcomes, it offers the potential to improve outcomes for adolescents who self-harm, using an evidence-based and consistent approach.

Work package 4: Economic Evaluation

• To look into the cost-effectiveness of the intervention, we will conduct an economic evaluation. The evaluation will focus on the period from starting the intervention to the end of the follow up period at 6 months, and the costs will include resource usage to train personnel, deliver the intervention, provide other health/social care services to adolescents, costs to parents, and impact on education.

Work package 5: Qualitative Process Evaluation

• The outcome analysis will be complemented by a qualitative process evaluation to explore how the intervention was experienced by practitioners, guardians, and young people.

Work package 6: Dissemination and Impact Activities

• We will share our findings widely and explore whether the intervention could also be helpful in other settings.

• Professor Rose McCabe, Chief Investigator (City, University of London)
• Dr Sally O’Keeffe, Co-applicant (City, University of London)
• Katherine Tallent, Research Assistant (City, University of London)
• Professor Dennis Ougrin, Co-applicant (Queen Mary University of London)
• Professor Stefan Priebe, Co-applicant (Queen Mary University of London)
• Dr Yan Feng, Co-applicant (Queen Mary University of London)
• Dr Peter Martin, Co-applicant (University College London)
• Rachel Temple, Co-applicant (McPin Foundation)
• Emma Garavini, YPAG coordinator (McPin Foundation)
• Maria Long, Study coordinator and research fellow (City, University of London).

English, O., Wellings, C., Banerjea, P., & Ougrin, D. (2019). Specialized therapeutic assessment-based recovery-focused treatment for young people with self-harm: pilot study. Frontiers in psychiatry, 10, 895.

Ougrin, D., & Zundel, T. (2009). Defining self-harm. Self-Harm in Young People: A Therapeutic Assessment manual, 1, 17.

Ougrin, D., Zundel, T., Ng, A., Banarsee, R., Bottle, A., & Taylor, E. (2011). Trial of Therapeutic Assessment in London: randomised controlled trial of Therapeutic Assessment versus standard psychosocial assessment in adolescents presenting with self-harm. Archives of Disease in Childhood, 96(2), 148-153.

Ougrin, D., Boege, I., Stahl, D., Banarsee, R., & Taylor, E. (2013). Randomised controlled trial of therapeutic assessment versus usual assessment in adolescents with self-harm: 2-year follow-up. Archives of disease in childhood, 98(10), 772-776.

Ougrin, D., Zundel, T., Ng, A. V., Habel, B., & Latif, S. (2013). Teaching Therapeutic Assessment for self‐harm in adolescents: Training outcomes. Psychology and Psychotherapy: Theory, Research and Practice, 86(1), 70-85.

For more information about the SASH study, please contact:

Professor Rose McCabe, Principal Investigator: Rose.McCabe@city.ac.uk

Dr Sally O’Keeffe, Co-Investigator: Sally.OKeeffe@city.ac.uk