Supporting Adolescents with Self-Harm (SASH Study) – an innovative brief intervention

Suicide is the second leading cause of death in young people, and a new, more successful approach to suicide prevention is needed. The strongest predictor of suicide is self-harm. When young people present at emergency departments with self-harm, NICE recommends they receive a psychosocial assessment with a specialist mental health practitioner alongside a follow-up appointment within a week. Follow-up care after this follow-up appointment is variable, and many young people struggle to access further specialised resources and treatment.

Working alongside young people with lived experience, we developed an alternative approach to care named the SASH intervention. This involves a follow-up appointment to check in on how things have been since ED, a therapeutic assessment that involves identifying emotions, thoughts, and behaviours that contribute to distress and self-harm, and ways to break that cycle. A personalised safety plan is also developed to help young people identify alternate coping strategies. There are up to 5 solution focused follow-up sessions, which focus on identifying best hopes and preferred future, and exploring what is already working. The sessions are followed with two letters to remind young people of their safety plan and support networks.

This approach is now being trialed in three NHS Trusts across London. We have trained mental health professionals from CAMHS and crisis teams to deliver the SASH intervention. We will recruit 144 participants aged 12-19 presenting at eight EDs across London who will be allocated to either the SASH approach or care as usual. We will assess whether the intervention reduces self-reported self-harm and improves secondary outcomes (psychological distress, ED reattendance for self-harm, psychological wellbeing, resource use, experiences of attending the ED and suicide). We work very closely with the McPin foundation to ensure the voices of young people with relevant lived experience shape each aspect of the study.