Suicide, Risk and Safety Research Unit
Suicide and Self-Harm Prevention:
The SSRU aims to provide crucial evidence to support service and training improvements, and, ultimately, to contribute to a reduction in suicide and self-harm rates. This is achieved by providing comprehensive data on suicide and suicidal behaviour in mental health patients and the wider community; making recommendations on patient safety and the quality of care; and advising services on quality improvement measures based on these recommendations. The SSRU has also pioneered improvements in the prevention of suicide and self-harm across the criminal justice system (CJS) with the introduction of some of the first clinical trials on self-harm in prisons and improving access to targeted psychological treatments for suicidal prisoners. Our current strategic goals are: continued provision of high quality data on people who self-harm; continued provision of national data on suicide in mental health patients, including UK-wide support for local areas to strengthen and adapt their suicide prevention plans and self-harm care in the community; improving patient outcomes through the application of high quality translational research; enhancing support for the development of suicide prevention strategies and community based self-harm care in the NHS and the CJS; development of interventions for the prevention of and treatment of self-harm in the community and in prisons; and developing our international work on self-harm and suicide across settings.
We have three major areas of work. These are not mutually exclusive and many leading academics and clinicians contribute to more than one.
The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH: https://sites.manchester.ac.uk/ncish/)’s database is unique internationally, providing in-depth data and analysis on over 20 years of research on patient safety across the UK. Their recommendations on suicide prevention provide health professionals, policy makers and service managers with the evidence to effectively manage change and reduce risk of suicide by service users. These recommendations have also been shown to reduce suicide rates. NCISH continue to examine the circumstances surrounding suicide in mental health patients and changes in trends over time in their UK-wide annual reports, as well as undertaking studies in the general population, currently suicide by middle-aged men. Work on suicide across the CJS provided data for the review of the self-harm and suicide monitoring system in prisons (ACCT) and has led to the development of further research on suicide prevention in community offenders.
The Manchester Self-Harm project (MaSH: https://sites.manchester.ac.uk/mash-project/) has been collecting, monitoring and analysing local self-harm data for over 20 years. As part of the Multicentre Study of Self-harm in England they are funded directly by the Department of Health and Social Care to help provide evidence and support towards aims of the National Suicide Prevention Strategy. The results of their work feed in to recommendations and clinical guidelines on the care for people who self-harm with the aim of reducing risk of self-harm and contributing to suicide prevention. The Manchester Self-Harm Project continues in its core work of monitoring self-harm rates and investigating trends and subgroups of people who self-harm. Current/recent work has looked at self-harm by people experiencing homelessness, by young people from ethnic minority groups, and by people in midlife. MaSH have also developed an online learning resource on the management of self-harm in the Emergency Department, designed to help clinicians understand why people self-harm, common risk factors, and guidance on self-harm management. In collaboration with NCISH and the GM PSTRC, MaSH are supporting local areas to improve self-harm care in the community. MaSH feeds its data into the larger Multicentre Study of Self-harm in England which has produced important academic outputs on non-fatal self-harm. The Patient Safety Translational Research mental health work stream are conducting several studies focussed on the translation of research evidence into practice.
Psychological treatments to prevent suicide and self-harm
We have pioneered the development and evaluation of novel psychological treatments specifically targeting the prevention of suicide and self-harm. We have evaluated predominantly cognitive-behaviour therapy interventions across a range of clinical groups identified to be at exceptionally high risk of suicide or self-harm. Our completed NIHR funded trials have involved community dwelling individuals experiencing psychosis, inpatients of mental health services, and prisoners. These pilot and feasibility trials have demonstrated the potential of the new interventions to offer significant clinical benefits to vulnerable individuals, thus demonstrating the need for larger scale, pragmatic evaluations of clinical and cost effectiveness. Our current projects include an MRC-EME funded multi-site trial (CARMS: https://sites.manchester.ac.uk/carms/) with individuals experiencing psychosis and suicidality, and an NIHR programme grant (PROSPECT: https://sites.manchester.ac.uk/prospect/) with suicidal prisoners. This theme includes colleagues from both the UoM and NHS whose research is shaping clinical practice across the UK and internationally.
The Medicines Safety group within the SSRU brings together a strong partnership between the University of Manchester and Greater Manchester Mental Health NHS Foundation Trust to create a centre for excellence in medication safety research across mental health settings and the CJS. We carry out research that takes forward national and international priority agendas for patient safety by better understanding the burden and underlying causes of medication safety issues with the aim of developing, testing and implementing effective and practical solutions to these challenges in clinical practice. Within the group we are committed to the growth and development of the health services research workforce within mental health care and the CJS that is reflected in our projects with front line clinical staff and PhD studentships, and to basing our work on the perspectives of service stakeholders. Our current major project focuses on the implementation and evaluation at a national level of an intervention designed to improve the safety of prescribing in the prison setting, which we envisage will influence practice nationally in the future. This intervention we have developed features the use of ‘prescribing safety indicators’ which capture potentially hazardous prescribing – these indicators were developed and tested in practice as part of our earlier SSRU work, and we are currently collaborating with a national prison health care provider to evaluate the impact of the intervention on medication safety for prisoners and on the working patterns of prison health care staff.
If you would like to contact SSRU, please email the team below:
Paula Duxbury: Paula.Duxbury@gmmh.nhs.uk
Daniel Pratt: firstname.lastname@example.org