Development of a Brief Intervention for Emergency Department Attendees Presenting With Self-Harm and Co-Occurring Substance Use Problems

Prianka Padmanathan; Rachel Cohen; David Gunnell; Lucy Biddle; Emma Griffith; Katie Breheny; Matt Hickman; Nik Munien; Anish Patel; Elaine Crocker; Paul Moran

doi:10.1027/0227-5910/a000933

Development of a Brief Intervention for Emergency Department Attendees Presenting With Self-Harm and Co-Occurring Substance Use Problems

Crisis. 2023 Nov 17. doi: 10.1027/0227-5910/a000933. Online ahead of print.

Authors

Prianka Padmanathan^{1

2}, Rachel Cohen^{1

3}, David Gunnell⁴, Lucy Biddle^{1

5}, Emma Griffith^{6

7}, Katie Breheny^{1

5}, Matt Hickman^{1

8}, Nik Munien⁹, Anish Patel^{2

10}, Elaine Crocker⁹, Paul Moran^{1

2

4

5

9}

Affiliations

¹ Population Health Sciences, Bristol Medical School, University of Bristol, England, UK.
² Liaison Psychiatry, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, England, UK.
³ Welsh Government Health and Social Services Group, Social Services and Integration Directorate, Futures and Integration Division, Cardiff, Wales, UK.
⁴ National Institute for Health and Care Research Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, England, UK.
⁵ National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, England, UK.
⁶ Department of Psychology, University of Bath, England, UK.
⁷ Specialised Services, Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, England, UK.
⁸ National Institute for Health and Care Research Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, England, UK.
⁹ Liaison Psychiatry, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England, UK.
¹⁰ Liaison Psychiatry, North Bristol NHS Trust, Bristol, England, UK.

PMID: 37975217
DOI: 10.1027/0227-5910/a000933

Abstract

Background: People who present to the emergency department with self-harm and co-occurring substance use problems often have difficulty accessing effective care. Aims: To develop a brief psychosocial intervention for this population, which would be suitable for testing in a future randomized controlled trial. Methods: A modified Delphi method was used. A 34-item, 3-round, online Delphi survey was informed by a literature review and stakeholder telephone discussions (n = 17). Two panels consisting of people with lived experience (PWLE: n = 15) and people with occupational experience (PWOE: n = 21) participated in the survey. The threshold for consensus was a pooled agreement rate across the two panels of 80% or more. Results: Expert consensus was achieved for 22 items. The new intervention consists of weekly follow-up phone calls for up to 1 month, delivered by Liaison Psychiatry practitioners, in which both self-harm and substance use problems are explored and addressed, and patients are supported in accessing community services. Limitations: Some stakeholder ideas regarding intervention components could not be included as survey options due to anticipated difficulties with implementation. Conclusions: The key elements of a brief psychosocial intervention for self-harm and co-occurring substance use problems have been agreed. Feasibility testing is currently underway.

Keywords: intervention; psychosocial; self-harm; substance use; suicide.