The Manchester Self-Harm Project / Support for improving community-based care for self-harm

Support for improving community-based care for self-harm

The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) is working alongside experts from the Manchester Self-Harm Project and the Patient Safety Translational Research Centre to support NHS Integrated Care Systems across England to improve community-based services and care for people who self-harm.

This is part of a national programme of transformation funded by NHS England and NHS Improvement linked to establishing new and integrated models of primary and community mental health care across England. These new models will provide improved care for adults and older adults who self-harm in the community, as laid out in the NHS Long Term Plan.

This work is commissioned by the Healthcare Quality Improvement Partnership (HQIP), with funding from NHS England and NHS Improvement.

We will support teams in participating areas by:

  • providing broad expert knowledge of current self-harm data and research;
  • providing guidance on national guidelines and recommendations for the care of people who self-harm;
  • advising on methods of data collection to monitor and evaluate the impact of service changes for people who self-harm;
  • developing an online resource to gather useful information in an easily accessible format.

Introduction to Community Based Care for Self-Harm – YouTube links and presentation slides

Please click through the following links to access recordings of Professor Nav Kapur introducing the Community Based Care for Self-Harm project, the work being done at some of the sites we are working with, and the support available from our team.

Phase I Virtual Site Visits

Nav Kapur on Improving Community Based Care

 

Phase II Virtual Site Visits

22 February 2022

Community Based Care Virtual Site Visit (Full event)

23 February 2022

Community Based Care Virtual Site Visit (Full event)

26 April 2022

Community Based Care Virtual Site Visit (Full event)

1 June 2022

Community Based Care Virtual Site Visit

8 June 2022

Community Based Care Virtual Site Visit

Phase II Virtual Clinics

Infographics

As part of this work we co-created infographics that reflect the main themes of the community self-harm and CQUIN (psychosocial assessments) interventions developed during the project. These infographics are intended to promote and share learning; they summarise the projects’ aims, project details, and outcome measures.

Data Dictionary

We have developed a data dictionary (PDF) providing a selection of process measures that can be used to help assess change as areas implement new strategies for supporting people who self-harm.

Resources: evidence and guidance around self-harm

The following sections contain links to information on different aspects of care for people who self-harm, such as national clinical guidelines, peer reviewed journal publications, and commissioned reports.

 

Section 1: guidance on assessment care and potential treatments

Clinical guidelines on care for people who self-harm

The following clinical guidelines draw together evidence for the best ways to provide care for people who self-harm.

NICE has produced clinical guidance on both the short- and long-term management of self-harm, as well as quality standards for the care of people who self-harm:

NCISH developed a self-harm toolkit intended to be used as a basis for self-assessment by mental health care providers has been developed by NCISH and is available as a PDF online:

 

CQUIN

CQUIN stands for Commissioning for Quality and Innovation. This is a system introduced in 2009 to make a proportion of healthcare providers’ income conditional on demonstrating improvements in quality and innovation in specified areas of care.

 

Provision of good quality psychosocial assessments for patients who have self-harmed is a core clinical priority area. NHS England and NHS Improvement implemented a CQUIN indicator for psychosocial assessments for patients who are referred to liaison psychiatry services for self-harm in April 2021. The CQUIN goal is that 80% of patients referred to mental health liaison teams receive a psychosocial assessment concordant with the NICE guidelines for self-harm. The following documents provide more information, guidance, and CQUIN audit tool. For further information, please see https://future.nhs.uk/MHCQUIN/groupHome

  1. 2022/23 Biopsychosocial assessments by mental health liaison services CQUIN Guidance
  2. CQUIN Psychosocial assessment audit tool and NICE guidelines
  3. Biopsychosocial CQUIN FAQ for liaison psychiatry
Psychosocial assessments

In this section you will find guidance on psychosocial assessments. Psychosocial assessments are typically carried out by clinical staff and take into account many psychological and social factors to determine the care and support needs of people who self-harm:

 

Guidance on psychological and medical treatment for people who self-harm

The following works present information on the effectiveness of psychological and medical treatments for people who self-harm (including adults, children and adolescents):

 

Safety Planning
Risk assessments and risk scales

Research on the use of risk scales for predicting future risk in people who present to hospital for self-harm:

 

Section 2: Services for self-harm and patient experience

Research assessing services for self-harm

Guidance on the current state of services available for people who self-harm in England:

Papers:

Clinician and service user views on self-harm/mental health care

Clinician and service user views on self-harm/mental health care:

 

Section 3: Improving awareness and training.

Promoting awareness of self-harm

People who self-harm often report poor staff attitudes when they seek help, which may discourage people from seeking help in the future during times of crisis.

Guidance on competencies for healthcare and other staff working with people who self-harm. The competencies are for working with children and young people (from 8 years upwards), adults and older adults (from 18 years upwards), and the public (community and public health):

 

Staff training for self-harm

There are a number of free and paid training courses that might be helpful in raising awareness of self-harm among staff, dispelling myths and misconceptions about people who self-harm and promote improved care.

Free online training on the management and care of people who self-harm who attend the emergency department, with background information on self-harm and examples of patient experiences of care:

 Training packages

  • STORM provides bespoke training packages for suicide prevention and self-harm mitigation.
  •  Harmless provides support, information, and training about self-harm to people who self-harm, their friends, families and professionals, promoting health and recovery by increasing awareness and skill in intervention.

Although not self-harm specific, some organisations provide training courses focused on suicide prevention which include elements that may also be relevant to self-harm.

 

Section 4: Research on self-harm.

Statistics about people who self-harm

How have rates of self-harm changed over time and who is most likely to self-harm?

 

Characteristics of self-harm by age-group

  1. Children and young people

  1. Adults (including people in midlife)

  1. Older people

Self-harm in older adults

This infographic summarises published statistics about self-harm in older adults. It uses data from three sources: the Multi-centre Study for Self-Harm in England, the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) and the NIHR Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC)/UK Clinical Practice Research Datalink (UK CPRD).

Self-harm in older adults infographic

Self-harm in older adults data sources

The Greater Manchester Suicide Prevention & Bereavement Support Programme campaigns to improve older people’s mental health: https://shiningalightonsuicide.org.uk/olderpeople/

Suicide and mortality following self-harm

People who self-harm are at much higher risk of going on to die by suicide compared to people in the general population:

 

Self Harm in primary care
Self-harm and COVID-19

Early evidence of the impact of COVID-19 and associated health management measures (eg national and local lockdowns) on self-harm and mental health:

 

Section 5: Patient and public involvement

Patient involvement/ co-design

Helpful links on patient involvement and co-design. Some of these links are about research, but will be useful for quality improvement projects.

Involve

Knowledge Base 

UK Standards for Public Involvement

Standards for Public Involvement (2019)

The Kings Fund

The Kings Fund-Experienced based co-design (EBCD) tool kit

Patient involvement

National Institute of Healthcare Research (NIHR) helpful websites

What is Patient and Public Involvement in health and social care research?

PPI (Patient and Public Involvement) resources for applicants to NIHR research programmes

NIHR Guidance on co-producing a research project

NHS England Involvement Hub

Get Involved

NHS Improvement Leaders’ Guide- involving patients and carers- General Improvement Skills

Experienced based design approach tool kit

HQIP Patient and public involvement in quality improvement

Patient and public involvement in quality improvement

National Institute for Health and Care Excellence (NICE)

Patient and public involvement policy

Mind

Co-design – deciding together

Section 6 : additional information

Brochures and pamphlets

Coping with self-harm – A guide for parents and carers (2016)
Young people who self-harm – A guide for school staff (2018)
Keep Safe (2015)

Third sector organisations (selected, national)

Harmless: National service for self-harm;  Email: info@harmless.co.uk; Phone: 01158800280

Self-Injury Support; Email: tessmail@selfinjurysupport.org.uk; Helpline: 0808 800 8088; Office/ Admin number; 0117 927 9600; Text support: 07537 432444

Battlescars, survivor led charity for people who self-harm: Email: info@battle-scars-self-harm.org.uk; Phone: 0741 0380747

Papyrus– for people under 35; Various contact details

Life Signs, Self-Injury Guidance & Support Network; Email: hello@lifesigns.org.uk

Rethink mental Illness; Phone: 0121 522 7007

SANEline

Mind

SANE:  Email: sanemail@sane.org.uk 

 

People working on the project

We would like to thank all the staff and expert advisors who are working with us on this project.

Expert Reference Panel

We would like to particularly thank our Expert Reference Panel who have helped guide the development and implementation of this project.  They are:

 

  • Mette Isaksen – Samaritans, Lead for self-harm research
  • Emily Cannon – Quality Improvement Coach, National Collaborating Centre for Mental Health
  • Raili Frost – Senior project manager, NHS England
  • Karen Lascelles – Nurse Consultant Oxford Health NHS Foundation Trust
  • Caroline Harroe – CEO Harmless
  • Ketan Sonigra – Clinical lead intensive case management, Principal Forensic Psychologist, South London and Maudsley NHS Foundation Trust (SLAM)
  • Faraz Mughal – Academic GP, NIHR Doctoral Fellow, Keele University
  • Declan Meehan – Clinical/operational Manager, Greater Manchester Mental Health Foundation Trust
  • Amanda Thompsell – Consultant older age psychiatrist, Royal College of Psychiatrists
  • Javed Rehman – Expert by experience, MS4MH-R
  • Fiona Naylor – Expert by experience, MS4MH-R
  • Stephen Barlow – Expert by experience, MS4MH-R
  • Liz Monaghan – Expert by experience, MS4MH-R
Core Staff

Our core staff work at the University of Manchester in the Centre for Mental Health and Safety.  They are:

 

The University of Manchester