Adolescents visiting A&E departments with self-harm are more likely to repeat self-harm and attempt suicide than matched controls. Many of these adolescents do not receive effective follow-up care, despite this being a critical time of increased risk for suicide. The Supporting Adolescents with Self-Harm (SASH) study responds to this gap by offering a rapid-response brief psychological intervention aiming to improve outcomes for young people in crisis.
How are we doing it?
We are conducting a pragmatic randomized controlled trial evaluating the clinical- and cost-effectiveness of the intervention in reducing repeat self-harm compared to treatment as usual (TAU). The trial is recruiting 144 adolescents who present to A&Es with self-harm or suicidal ideation with recent self-harm (within 1 month).
We have recruited 33 mental health practitioners from CAMHS Urgent Care Teams to take part in the study. Half of the recruited practitioners have been trained in the new SASH Intervention, whilst the other half are continuing to deliver TAU. The practitioners deliver the intervention or TAU to patients during recruitment who meet the eligibility criteria and consent to take part in the trial.
The SASH Intervention
The SASH Intervention is three to six follow-up sessions involving Therapeutic Assessment, Enhanced Safety Planning, and Solution Focused techniques:
- Dennis Ougrin’s Therapeutic Assessment (2009) is a collaborative and person-centered approach that engages young people in the evaluation of their mental health and self-harm difficulties. It prioritizes establishing a supportive alliance, exploring their narrative, and formulating a shared understanding of their self-harm.
- Enhanced Safety Planning involves a detailed discussion around the young person’s strengths and resources, their preferred coping strategies, potential barriers to using those coping strategies, and collaboratively planning how to overcome those barriers should they arise.
- The Solution Focused approach involves exploring the young person’s hopes for the future, imagining that desired scenario in detail, and then identifying the possible resources and strengths already present in achieving or working towards those hopes. Focusing on the young person’s strengths and solutions rather than problems may help refocus them on the positives rather than negatives in life and thus may be less likely to consider the path of suicide.
In a non-randomized study, Therapeutic Assessment and rapid clinical follow-up designed for adolescents presenting with self-harm have shown promising results in reducing self-harm. Therapeutic Assessment dramatically increases engagement with follow-up care which is a key mechanism for reducing future self-harm: 83% attended the first follow-up session. This is consistent with a recent systematic review in adults, whereby interventions which included therapeutic assessment, safety planning and rapid follow-ups were effective in reducing self-harm behavior in adults presenting with self-harm to the ED.
The primary outcome will be number of self-harm episodes in the last month, measured 6 months after starting the intervention, based on the young person’s self-report. We are also measuring socio-demographics; depression, anxiety and well-being scores; school attendance; experiences of care in A&E; and the therapeutic relationship as rated by the young person.
We trained the Intervention Practitioners in January 2023. Participant recruitment opened in May 2023, currently we have 16 participants recruited.
The SASH study is funded by the Kavli Trust.
The project will be led by City University of London.
- Principal Investigator: Professor Rose McCabe
- Co-Investigators: Dr Sally O’Keeffe, Dr Dennis Ougrin, Professor Stefan Priebe, Dr Peter Martin, Dr Yan Feng
- Research Fellow: Maria Long
- Research Assistants: Josh Lee & Katherine Tallent