Cognitive AppRoaches to coMbatting Suicidality

What is CARMS?

CARMS (Cognitive AppRoaches to coMbatting Suicidality) is a new psychological talking therapy for people who experience or have experienced psychosis and suicidal thoughts or feelings. The therapy aims to reduce suicidal thoughts and behaviours.

The CARMS project is concerned with finding out if this new therapy is effective. In order to do this, we are inviting people to join us in a study comparing two different treatments which are, usual mental health services or usual mental health services plus the CARMS therapy.

Why is this project important?

Mental health problems are common and an increasing number of people require support. Around one in four people will experience a mental health problem at some stage during their lifetime.

About one in 13 people will experience psychosis (a term used to explain experiences such as hallucinations, hearing voices or having thoughts or beliefs that are different to what other people experience), some of whom will experience suicidal thoughts, urges and attempts.

Who are we recruiting?

We are recruiting people who:

  • are 18 or over
  • have experience of psychosis
  • have experience of suicidal thoughts and/or behaviours in the past three months
  • are under the care of a mental health services clinical team (community or inpatient)
  • are English-speaking, only because the therapy is delivered in English

We are not recruiting people who have an organic brain disorder, dementia, bipolar disorder, or who cannot speak English.

How to take part

If you would like to take part in this project, please contact our Trial Manager, Charlotte Huggett, on 0161 271 0729.

You can also ask somebody from your mental health team to contact us on your behalf if you would like to know more.

We will need to speak to your mental health team as well as you and may need to ask you some questions to make sure the project would be helpful and appropriate for you.

How to make a referral

If you are a care co-ordinator, clinician or support worker and know someone who you think might be appropriate for this project and might like to take part you can contact our Trial Manager, Charlotte Huggett, on 0161 271 0729 after having discussed it with the person concerned.

We will require consent to contact the person you are referring and may need to ask you some questions to make sure the study is the right fit for them.


The CARMS project team works in collaboration with a group of service users who called themselves the CARMers group. The members include a group of about 7 or 8 people of various ages, who have lived experience of suicidal ideation and/or suicidal behaviour and in some cases also experience of psychosis.

The CARMers group have liaised with the project team and provided a valuable contribution since prior to the official study start date (back in January 2017). The group meets approximately every 1-2 months with the project leaders, alongside providing input in between meetings.

The CARMers have contributed to and guided the development of various study documentation, such as, recruitment and treatment allocation leaflets, the participant information sheet, consent forms and this website. They are involved in training all of the research assistants involved with the study by conducting role plays and providing feedback. The CARMers have also contributed to the analysis of the CARMS qualitative studies. They are regularly provided with study progress updates and are actively involved with coming up with dissemination ideas.

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How was the CARMS therapy developed?

The CARMS therapy is based on work which shows that positive self-appraisals (evaluations of our own strengths and weaknesses) may be important for reducing suicidal thoughts and behaviours. This might be a key source of resilience.

The CARMS therapy specifically targets managing emotions, social isolation and social skills, which can trigger and maintain suicidal thoughts and behaviours. It involves practical techniques.

Supporting research for CARMS

Prior to CARMS, three pilot studies were completed to assess the effectiveness of the therapy.

The first pilot study

The first pilot study looked at the extent to which the suicide-focused talking therapy could reduce suicidal thoughts and feelings in people in the community with mental health problems on the schizophrenia spectrum.

Twenty-five people received our talking therapy plus their usual treatment. Twenty-four people received their usual treatment alone. Those who received the additional talking therapy had reduced levels of suicidality.

In addition, other research was also conducted with participants who received our talking therapy. Two main findings were identified. One reflected the acceptability of the therapy and the other reflected that people felt that they were in recovery from suicidal thoughts and feelings as a result of therapy.

Read the published findings here.

The second pilot study

The second pilot study assessed whether our suicide-focused talking therapy reduced suicidal behaviours in male prisoners in the north-west of England. Results showed that more than half of those who were in the treatment group had clinically significant recovery level by the end of therapy (six months) compared to a quarter in the control group.

Read the published findings here.

The third pilot study

The third, and most recently completed, pilot study assessed the acceptability and feasibility of our suicide-focused talking therapy in psychiatric in-patient settings. As with the previous two pilot studies, the therapy was found to be acceptable to participants and feasible to deliver.

Read the published findings here.

What happens when someone decides to take part?

We will ensure for potential participants that the project is appropriate for them. If they meet the inclusion criteria, a research assistant will arrange to meet with them over several sessions to explain more about the project, get their consent and conduct an informal interview including questionnaires.

Participants are then randomly allocated by chance to one of two groups.

The first group will continue with their usual treatment and care plan they receive from their mental health team and will not be offered CARMS therapy.

The second group will continue with their usual treatment and care plan they receive from their mental health team and will be offered CARMS therapy.

We do not know if the therapy is effective or makes any difference to suicidality at this stage.

That is what the research is desgined to find out.

Participants will meet with research assistants 6 months and 12 months after the initial meeting to complete the same interview and questionnaires as at the beginning. This is to assess whether there has been any change over time.

What happens for you as a participant?

Step 1: Meet with a researcher

Find out about the study and see if its is a good fit for you.

Step 2: Sign a consent form
At least 24 hours after the inital meeting, meet again with a researcher and sign the consent form if you want to take part. These 24 hours allow a little time to reflect on whether you wish to take part or not.
Step 3: Talk to a researcher

If you decide to take part, you will talk to a researcher for about two hours. Questions will be asked about your mental health, thoughts, feelings and related experiences. You can take breaks and don’t have to answer all the questions in one go. These researchers have been trained to conduct interviews sensitively.

Step 4: You are randomly allocated to a treatment group

You will be randomly allocated to ONE of the treatments below. Each person is put into a group by chance by a computer. The only difference between the two groups is the offer of up to 24 CARMS talking therapy sessions. 

Group 1 You will receive your usual treatment from your mental health service, e.g. care co-ordinator, psychiatrist. – and ALSO – You will meet with a researcher for an assessment in 6 and 12 months’ time. This assessment will take about two hours.

– OR –

Group 2 In addition to usual treatment, you will receive up to 24 CARMS talking therapy sessions with a psychological therapist. You will usually arrange to meet once a week. You can stop these sessions at any point. – and ALSO – You will meet with researcher for an assessment in 6 and 12 months’ time. This assessment will take about two hours.


Who is involved in CARMS?

The project is a joint collaboration between:

The project team consists of psychologists, therapists, research assistants and administration support. The project team collaborate with a service user group called the CARMers. The co-Principal Investigators are Dr Patricia Gooding and Prof Gillian Haddock from the Division of Psychology and Mental Health at the University of Manchester.


This project is funded by the Efficacy and mechanism Evaluation (EME) Programme, an MRC and NIHR partnership.

CARMS butterflyThank you for taking the time to find out more about the CARMS Project.

For additional information or to discuss referrals or any concerns, please contact our trial manager, Kamelia Harris, on 0161 271 0729.