Research recommendation(s) from an individual piece of guidance

Research recommendations coming out of this guidance

• Effectiveness of training:- For healthcare professionals who work with people who self-harm, does the provision of training in assessment and management improve outcomes compared with no additional specialist training?
  A well-powered randomised controlled trial should examine the effectiveness of training. Researchers should consider the format and length of training. The outcomes chosen should include both healthcare professionals' and service users' evaluation of the training, and the effect on subsequent knowledge, attitude and behavioural changes. It should include longer-term follow-up of 12 months or more.
• Clinical and cost effectiveness of psychological therapy:- with problem-solving elements for people who self-harm:- For people who have self-harmed, does the provision of a psychological therapy with problemsolving elements, compared with treatment as usual, improve outcomes? What is the differential effect for people with a past history of self-harm, compared with people who self-harm for the first time? This question should be answered using a well-conducted randomised controlled trial. Consider six sessions of psychological therapy with problem-solving elements, delivered immediately after discharge for the index episode of self-harm. The therapist should be trained and experienced in working with people who self-harm. Participants' history of previous self-harm, methods used and psychiatric history should be noted. Primary outcomes should include both hospital-reported and self-reported repetitions of self-harm. Other important outcomes, such as quality of life, depressive symptoms, service users' experience and adverse events (for example, distress or exacerbation of symptoms associated with therapy) should be included. The study design should take into account the complex motives that underpin self-harm. Studies need to be large enough to determine the intervention's costs and cost effectiveness.
• Clinical effectiveness of low-intensity/brief psychosocial interventions for people who self-harm:- For people who self-harm, does the provision of potentially cheap low-intensity/brief psychosocial interventions, compared with treatment as usual, improve outcomes? This question should be answered using a well-conducted randomised controlled trial. Consider using a variety of approaches, including postcards, emergency cards, phone calls, or the use of electronic media in community mental health settings. The outcomes should include service users' engagement and experience, and hospital-reported and self-reported repetitions of self harm. Other important outcomes, such as quality of life, depressive symptoms and adverse events (for example, distress or exacerbation of symptoms associated with contact with services) should be included.
• Observational study exploring different harm-reduction approaches:- What are the different approaches to harm reduction following self-harm in NHS settings?
  A study should be carried out to investigate the different approaches to harm reduction following self-harm currently in use in NHS settings. This could use survey methodology with all, or a selected sample of, mental health service providers. Audit data should be used to provide a preliminary evaluation of potential utility. Promising interventions might be tested in small-scale pilot randomised controlled trials, which use frequency and severity of self-harm, and standard measures of distress and psychological symptoms, as outcome measures. Other outcomes such as quality of life, service users' experience and adverse events should be included.