As part of the ongoing work of SSHaRe NoW, we are carrying out a Delphi exercise to find consensus of research priorities in the north-west.
The methodology, known as a Delphi Study, is named after the ancient Greek temple at Delphi dedicated to Apollo, the god of divine inspirations. Originally proposed based on people’s conjecture, judgment, and inspiration, Delphi Studies gradually took the academic form for the scientific study of experts’ opinions.
The Delphi Study being conducted by SSHaRe NoW is taking opinions of a potential 148 people identified to have expertise in the field of suicide and self-harm service provision in the north-west of England.
These experts include clinicians, academic researchers, local authority workers, 3rd/voluntary sector workers, carers, students, experts by experience and others.
Why we're conducting this study in north-west England
The rates of suicide and self-harm in the north-west of England are higher than other parts of the country, and there are isolated groups or individuals who have expertise around understanding and preventing self-harm and suicide.
There are also a large number of third sector and voluntary organisations in the north-west conducting innovative work with those who struggle with self-harm and suicide (for example, James’ Place, Life Rooms, Liverpool Light, Papyrus, No secrets, MIND, CaLM, AMPARO, Hub of Hope).
Success in understanding and effectively tackling self-harm and suicide will rely on the various groups and organisations working effectively together.
Our methodology so far
In June 2017, we held the first SSHaRe NoW conference where we held thirty-minute discussions relating to suicide and self-harm in the following populations:
- children and young people
- self-harm and suicidal ideation in the community
- crisis intervention services.
The discussions explored the main issues within these populations, and looked at the gaps in our understanding, what we could do differently, and how we should begin designing future work.
The seven facilitators then reviewed the outcomes and conducted an analysis on the themes that emerged from all of the discussion tables. From this, they designed an online template questionnaire for which they obtained ethical approval from LJMU Research Ethics Committee.
To be eligible for inclusion in the study, participants met one of the following criteria:
- Conducts research in the area of suicide and self-harm;
- Experience of working in a 3rd sector organisation that supports or helps individuals struggling with suicide or self-harm (including services set-up for carers);
- Experience of working as a clinician within the NHS supporting or helping individuals with difficulties around suicide or self-harm; or
- Personal experience of difficulties associated with suicide and self-harm.
Of the participants identified:
- 21% were clinicians
- 33% were academics or researchers
- 7% worked for local authorities
- 9% worked in the 3rd or voluntary sectors
- 2% were carers
- 5% were students
- 23% did not fall into any single category.
Of the initial cohort, 19% had a history of self-harm.
Engagement of participants
An email was sent to 148 potential participants to outline the study and invite them to take part.
The email included a participant information sheet, information about the study, a link to an online survey, and a consent box to tick before taking part.
We required the informed consent of participants in order to complete the second and third round of the Delphi exercise.
After each round, participants were informed of the ranking of each research priority and asked to repeat the process.
Of the 148 potential participants, 30% engaged in Round 1, of whom 74% were female and 19% had a history of self-harm.
Of these, 50% engaged in Round 2, of whom again 74% were female, but the proportion with a history of self-harm increased to 30%.
Round 3 is ongoing.
The results so far
The first and second rounds of the study are now complete, and from these rounds we have been able to identify the top three priorities in working with some key populations:
59% of participants in Round 2 thought it is important to understand the role of trauma and difficult life events and how they impact risk of suicide and/or self-harm in offender populations.
55% of participants in Round 2 thought it is important to explore the training and support for people working with offenders (for example, level of training within particular settings, or training needs, supervision, debriefing), and to identify any areas for improvement.
50% of participants in Round 2 thought it is important to understand the barriers to accessing health/mental health services for offenders who self-harm or attempt suicide, as well as understanding what might help offenders to access these services.
Children and young people
73% of participants in Round 2 thought it is important to understand different ways to build resilience in children and young people, to help reduce self-harm and suicide.
68% of participants in Round 2 thought it is important to evaluate different interventions (for example, talking therapies, support groups, mobile/computer applications) for children and young people who self-harm to find out what is most effective.
64% of participants in Round 2 thought it is important to understand the positive and negative impact of social media on self-harm and suicide, and how social media might be used to help children and young people in distress.
Crisis intervention services
77% of participants in Round 2 thought it is important to evaluate existing services to find out what works well, what services or interventions are having the greatest impact, and if they are cost effective.
68% of participants in Round 2 thought it is important to understand how health care and other support services work together and interact to support people who are at risk for self-harm and suicide.
59% of participants in Round 2 thought it is important to understand the relationship between lack of staff/resources/ funding in health care services and the level of demand for people who self-harm.
Self-harm and suicidal ideation in the community
77% of participants in Round 2 thought it is important that training is provided to professionals who might be in contact with people who self-harm (for example, GPs, nurses, teachers, and staff at community centres).
64% of participants in Round 2 thought more research is needed on the effectiveness of postvention services in reducing self-harm, suicidal ideation, anxiety, depression, blame and grief intensity.
59% of participants in Round 2 thought it is important to understand the functions and mechanisms behind self-harm (for example, what causes people to self-harm), and to ensure that mental health services understand these causes.
What next for the SSHaRe NoW Delphi exercise?
The third round of collecting opinions for the study is now underway. We will share the results on this SSHaRe NoW webpage and in our newsletter, and will feed the specific results back to the relevant research groups once the study is complete.
The full study will be written up for publication in a peer-reviewed journal.