Major national study aims to help young people to overcome the cycle of self-harm

Each year, hundreds of young people deliberately hurt themselves. Now a national study will examine the best techniques for preventing young people from self-harming again.

The £4.5m study, led by the University of Leeds and NHS Leeds, will establish whether a regime of family therapy is an effective interventional technique for these young people.

Funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme, the project involves 15 NHS organisations and three universities and will work with more than 800 young people and their families.

Professor David Cottrell, Dean of Medicine at the University of Leeds, is leading the trial. He says, “Currently services use a range of different treatment approaches but we don’t have enough evidence to know which is the most effective.

“We know there is a link between self-harm and difficulties in family relationships and communication. However, there just isn’t enough evidence of the effectiveness of the therapies used to help these young people, though smaller studies have indicated that family therapy could be an effective technique in reducing further episodes of self-harm in adolescents.

“We are delighted that the NIHR HTA programme has agreed to fund what is one of the largest studies of child and adolescent mental health ever to be conducted in the UK. Through this study we’ll be looking at whether the “whole family” approach, which focuses on the relationships, roles and communication patterns between family members, will enable families to work with young people to help them manage crises and emotional situations more effectively.

“It’s concerned with what goes on between people, as much as what goes on in someone’s head.”

The Leeds-run trial will be the largest and most comprehensive of its kind and will give agencies involved in the care of young people a definitive, evidence-based insight into the effectiveness of this intervention in reducing further episodes of self-harm. Participants in the seven year trial will be 11 - 17 year olds who have self-harmed more than once and have required hospital admission for their injuries – though those diagnosed with severe depression or other serious mental illness will not be asked to take part.

It is hoped that the results of the trial, which begins in early 2009, will inform the development of consistent, safe and effective services for young people who self-harm across the UK.

“It’s about helping young people to deal with their distress – and giving them the mechanisms for coping in a better way than self-harm.”

It is estimated that 10-15% of young people in the UK have self-harmed.

The study will be conducted in three research hubs: Yorkshire, Greater Manchester and London with the University of Leeds and NHS Leeds acting as lead investigators. Services in Bradford, Wakefield, Huddersfield, Halifax, York, Greater Manchester, and parts of South West and North London serving a total population of 8.1 million will also collaborate.

Self-harm is when someone deliberately hurts or injures him or herself. In this study self-harm is defined as any form of non-fatal self-poisoning or self-injury, (such as cutting, taking an overdose, hanging, self-strangulation, jumping from a height, and running into traffic), regardless of motivation or the degree of intention to end life. Existing treatment programmes for young people vary widely across the country and include different forms of cognitive behavioural therapy, counselling and problem-solving therapies.

During the trial, family therapy will be delivered by specially trained therapists using a research-based and clinically tested manualised approach. Half of those who agree to take part in the study will be randomly selected to receive “treatment as usual” – the treatment programme currently offered – and the other half will receive a dedicated programme of family therapy. Each family undergoes a six-month course of family therapy or treatment as usual with regular follow-up over 18 months to determine whether there is any difference in the effectiveness of both treatment approaches in reducing repeat incidents of self-harm. Both groups will be treated in the service local to where they live and will receive approximately eight sessions of treatment.

About the University of Leeds/ NHS Leeds
The University of Leeds is one of the largest higher education institutions in the UK with more than 30,000 students from 130 countries. With a total annual income of £450m, Leeds is one of the top ten research universities in the UK and a member of the Russell Group of research-intensive universities.

NHS Leeds is one of the largest NHS trusts in the country with a budget of £1 billion a year and serving a population of over 720,000 people. The organisation is responsible for commissioning and providing NHS services for the people of Leeds.

About the NIHR HTA
The funding has been provided by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme, visit www.hta.ac.uk/ to view the full project details. The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with over 440 issues published to date. The journal’s 2007 Impact Factor (3.87) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the HTA website.

The HTA programme is coordinated by the NIHR Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.

The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk