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 full 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.
This study, funded by the National Institute for Health Research (NIHR) [Programme Grants for Applied Research, Grant Reference Number RP-PG-0617-20004], is being led by researchers at City, University of London
You can stay up to date with the project by visiting our blog.
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 will consist of six work packages:
Work package 1: Developing the intervention
- Firstly, we will develop a draft intervention. To do this, we will carry out focus groups with people with a history of harming themselves and friends or relatives, and mental health practitioners working in EDs. We will ask 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 of Year 1, we will have a draft of the intervention manual.
Work package 2: Initial testing of the intervention
- Having developed the intervention, in Year 2 we will then test the approach in four Emergency Departments in England. Sixteen practitioners will use the intervention with up to six patients each. We will collect feedback from patients, carers and practitioners, allowing us to improve and refine the intervention.
Work package 3: Developing an online training package
- In Year 2, we will develop a training package that will be used to train practitioners in Emergency Departments to deliver the new intervention. This face-to-face training package will include an interactive website and training videos.
Work package 4: Preparing for the trial
- In Year 2, we will carry out work to prepare for a randomised controlled trial. We will access Emergency Department computer records to test the best ways of identifying repeat self-harm and healthcare contacts. This approach will subsequently 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 22 Emergency Departments and 1386 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.
The core team for the ASsuRED project are based at City, University of London:
Professor Rose McCabe, Principal Investigator
Dr Sally O’Keeffe, Programme Manager
Dr Jennifer Hunter, Research Fellow
Dr Clara Bergen, Research Fellow
Mimi Suzuki, Research Assistant
Carmen Wright, Research Administrator
Dr Peter Aitken, Devon Partnership NHS Trust
Dr Vera Araujo Soares, Newcastle University
Professor Richard Byng, Plymouth University
Professor Chris Dickens, University of Exeter
Professor Sandra Eldridge, Queen Mary University of London
Dr Domenico Giacco, Queen Mary University of London
Professor Navneet Kapur, University of Manchester
Dr Will Lee, University of Exeter
Professor Borislava Mihaylova, Queen Mary University of London
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
Dr Melanie Smuk, Queen Mary University of London
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.