ASSURED: A brief psychological intervention for people who attend ED for self-harm/suicidal thoughts

Mimi SUZUKI1, Alexandra BAKOU1, Sally O'KEEFFE2, Rose MCCABE1

1Centre for Mental Health, City University of London, London, United Kingdom
2Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom

Introduction: Self-harm is a key risk factor for suicide. Annually, 200,000 presentations of self-harm are treated in hospital Emergency Departments (ED) in England. Risk for suicide is highest shortly after hospital presentation for self-harm. Interventions after this critical period represents an important opportunity for suicide prevention. However, there are limited services available for this group. To address this problem, the ASSURED programme aims to develop and test a psychological intervention for people shortly after presenting to ED for self-harm and/or suicidal thoughts in England. 



Method: To develop the intervention, we systematically reviewed literature on brief interventions for people who self-harm; conducted focus groups and interviews with staff and people who have lived experience of attending ED for self-harm and/or suicidal thoughts; and consulted experts in the field of suicide prevention and experts by lived experience. ASSURED is currently testing the clinical and cost-effectiveness of the intervention in 10 hospitals across England through a pragmatic randomised controlled trial (RCT) with a sample of 620 patients. The primary outcome is reduced re-attendance to ED and secondary outcomes include improved suicidality, psychological wellbeing, social outcomes, experiences of attending ED, and suicide.  



Results: A rapid intervention following presentation to ED was developed. The intervention consists of therapeutic assessment and enhanced safety planning, three solution-focused sessions, and three letters. Currently, 290 participants across 10 hospitals in England have been recruited and recruitment is ongoing. Preliminary findings from interviews with staff delivering the intervention and people receiving the intervention will be discussed in this presentation. 



Conclusion: Conducting an RCT in ED context in England has led to several pragmatic challenges. The study team have adapted the trial methodology and study procedures to ensure the viability of this project. Early feedback from staff and patient participants suggests positive reception of delivering and receiving the intervention.