A brief intervention for patients presenting to A&E with self-harm: The challenge of conducting research in an emergency setting
Quick-read summary
Patients who present to A&E following self-harm or a suicidal ideation are at risk of future suicide. This study sought to test the feasibility of assessing the effectiveness of a brief psychological intervention for patients presenting to A&E in crisis, delivered by mental health practitioners in psychiatric liaison teams. There were significant challenges to recruiting in the A&E context, particularly since the pandemic, which resulted in high staff workload and sickness, which resulted in the trial being stopped. Despite many logistical challenges, the need for this intervention remains, and the trial has been re-designed to enable its effectiveness to be tested.
Who is this evidence useful for?
Mental health professionals and researchers working in suicide prevention.
What is the issue?
Patients who present to A&E following self-harm or a suicidal ideation are at risk of future suicide. Hospital presentations are therefore an important opportunity for intervention, yet there are few evidence-based interventions for these patients. This study piloted a new brief intervention to support people presenting to A&E in a mental health crisis. This intervention consisted of a therapeutic psychosocial assessment in the ED, consisting of a narrative interview and personalised safety plan, and three follow-up sessions using a solution-focused approach.
Research summary.
The project had two phases:
Phase 1 assessed the feasibility of evaluating a brief intervention for patients presenting to A&E with self-harm and/or suicidal ideation. It was a non-randomised study where patients were recruited from A&E departments and followed up for 6 months.
Phase 2 was the internal pilot trial as part of a cluster randomised controlled trial to assess whether progression to the full-scale trial was warranted, based on whether we could recruit patients to meet the required sample size. Patients were recruited from A&E departments and assigned to either receive the brief intervention or usual care.
What did the research find?
Phase 1 indicated that it was feasible to recruit patients presenting with self-harm and/or suicidal ideation from A&E, follow patients up for 6-months and that practitioners delivered the intervention as intended.
Based on these findings, we progressed to Phase 2, but we fell significantly short of our recruitment target. This was due to significant logistical challenges, due to staff shifts, workload and sickness, and it was determined that the trial was not feasible in its current design. The study highlights the significant challenge in conducting clinical studies in emergency setting, which are unpredictable.
Why is this important?
There are a lack of interventions for patients presenting to A&E with self-harm. This intervention provides timely support following mental health crises. If effective, this intervention could improve care for this underserved population, which could ultimately save lives.
How were people/community groups/patients involved in this work?
A Lived Experience Advisory Panel (LEAP) provided advice on the project.
Recommendations for policy/practice
If the future trial of this intervention finds it to be effective in reducing self-harm in patients, it could brief a brief intervention that could be rolled out across A&E departments nationally.
What happens next?
This study is part of an ongoing research programme, the Assured study, led by researchers at City St George’s, University of London. The trial was re-designed to enable the intervention to be assessed, taking into account the real-world challenges of conducting a trial in the challenging A&E context. More information about the Assured study can be found here.
This part of the study was led by Dr Sally O’Keefe, Mental Health Research Fellow, NIHR Applied Research Collaboration North East and North Cumbria. Open access publication of this paper was funded by NIHR ARC NENC.
How can people get in touch with you?
Sally.O’Keeffe@newcastle.ac.uk
Follow the link below to read the full study paper
Were there any other partners involved in this work?
The Assured study is led by researchers at City St George’s, University of London, and in collaboration with experts from across the UK. The study sponsor is Devon Partnership NHS Trust.
How was this work was funded?
The study was funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference number RP-PG-0617-20004).
Assured project on X – @Assuredproject