Saini, P, Hunt, A, Taylor, P, Clements, C, Mills, C, Kvamme, K, Tahir, N, Mulholland, H, Kullu, C, Hann, M, Duarte, R, Watts, A, Guthrie, E and Gabbay, M (2023) Acceptability and feasibility of a Community Outpatient Psychotherapy Engagement Service for Self-harm: COPESS a mixed methods study. Project Report. National Institute for Health and Care Research.

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Abstract

Background: Self-harm refers to any intentional self-injury or self-poisoning, with or without the intention to end one’s life. People who self-harm are at high risk of suicide, and often experience a range of social and mental health issues as well as considerable emotional distress. Around 70% of people who self-harm also experience symptoms of depression. There is very little help available from health and mental health services designed specifically for people who self-harm, and many receive no help at all. Most self-harm happens in the community but there have been very few attempts to develop self-harm specific services in community settings, such as GP practices. Readily accessible brief talking therapies show promise in helping people who self-harm, but further evaluation of these approaches is needed. The Community Outpatient Psychological Engagement Service for Self-Harm (COPESS) is a brief talking therapy intervention for depression and self-harm. Objectives: The objectives were to assess the feasibility of conducting a trial of the COPESS intervention in a community setting in relation to participant recruitment, data collection, the acceptability of the intervention and retention in treatment and study. Design: A mixed-method study, using a single-blind randomised controlled trial (RCT), assessing the acceptability and feasibility of the COPESS intervention for people with depression who self-harm, and purposefully collected qualitative data. Setting: GP practices in Northwest England. Participants: Individuals aged >16 years who had depression and self-harmed in previous six months. Interventions: The COPESS intervention is a psychological ‘talking’ therapy designed to help people who self-harm. It is made up of a short course of sessions with a therapist, that are available quickly after self-harm has been identified by that person’s GP. People were randomised 1:1 to receive either COPESS plus treatment-as-usual (TAU) or TAU alone. Main outcome measures: The primary outcome was the feasibility and acceptability of COPESS for people in the community with self-harm and co-existing depression. Secondary outcome measures were assessed at baseline, with follow-up assessments occurring at 1- month, 2-months and 3-months. Results: Findings indicated that COPESS was both acceptable and feasible, with all progression criteria being met. Fifty-seven people were recruited into the trial. Fifty-five were then randomly allocated to receive either the COPESS therapy (28 people) or treatment as usual only (27 people). Primary care staff and COPESS therapists based in a 3 mental health trust reported the intervention fitted and complemented existing services, and patients reported that they favoured the rapid, self-harm focused, person-centred approach of the intervention. The response to the therapy was very positive, with most participants attending all sessions. There were early indications that receiving COPESS may lower levels of depression, general distress and urges to self-harm compared to treatment as usual. Qualitative interviews were completed with participants, therapists, and primary care staff and feedback was positive about the COPESS intervention. Limitations: Due to the COVID-19 pandemic the COPESS intervention was delivered remotely only, therefore the experiences of the patients in the feasibility trial may not be representative of therapy delivered in person. Furthermore, the pandemic and associated disease control measures (i.e., lockdowns) may have had a general impact on outcomes, including recruitment into the study (both GP surgeries and participants), and experiences of participants and therapists. Conclusions: All progression criteria were met supporting further evaluation of the intervention in a full-scale clinical effectiveness trial. COPESS has potential as a brief primary-care based intervention for those struggling with self-harm. Future work: Further work involving stakeholder engagement is needed to refine the delivery of the intervention across multiple sites and conduct a full-scale efficacy trial. Trial registration: NCT04191122. Funding details: This project was funded by the National Institute for Health and Care Research (NIHR200543) Research for Patient Benefit Programme.

Item Type:	Monograph (Project Report)
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Psychology (from Sep 2019)
Publisher:	National Institute for Health and Care Research
SWORD Depositor:	A Symplectic
Date Deposited:	15 Nov 2023 11:47
Last Modified:	20 Aug 2024 14:42
URI:	https://researchonline.ljmu.ac.uk/id/eprint/21734

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