Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS)
Self-Harm, Depression
About this trial
This is an interventional treatment trial for Self-Harm focused on measuring Primary care, Community settings
Eligibility Criteria
Inclusion Criteria:
- Recent episode of SH (in the past six months, self-reported)
- A score of 14 or greater on the Beck Depression Inventory-II (BDI-II) corresponding to the BDI-II score where 14-19 = mild depression, 20-28 = moderate depression, >28 = severe depression
- Aged 16 years and over (SH is especially prevalent in adolescents and young adults and often this transitional age is neglected. This study will be offering at least TAU which young people may not otherwise access. To leave 16-18 year olds out of this study may be unethical and guidance from the British Psychological Society states that people aged 16 years and over can give informed consent)
- Help-seeking, defined as attendance at GP practices or self-referral into the trial
Exclusion Criteria:
- Non-English speaking
- Diagnosed with an intellectual disability as determined by review of clinical notes - the therapy has not yet been adapted for working with this population
- Experiencing severe problems with addiction to alcohol or illicit drugs
- Actively suicidal or psychotic and/or severely depressed and unresponsive to treatment as judged by clinical team
- Unable or unwilling to give written informed consent to participate in the study
- Currently receiving talking therapy for SH
Sites / Locations
- Brownlow Medical GroupRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
No Intervention
COPESS and Treatment as usual
Treatment as usual only
COPES is a brief (4 + 1 sessions, 50 minutes) psychotherapy based on psychodynamic and cognitive analytic principles that was developed to help those struggling with SH and depression. COPES is designed to be brief and accessible, and involves working collaboratively with a client to try and identify patterns or conflicts in emotional experiences and interpersonal relationships, linked to depressed mood and acts of SH. The therapist works with the client to build a shared map or understanding of these experiences. A goal of therapy is to work towards a small number of specific "exits", representing helpful steps the client might make to improve their difficulties. Therapy would take place either in the participant's home or in a community setting (e.g. health centre or clinic) depending on preference. Safety for the therapist and/or mobility for the patient will be reviewed throughout the recruitment period. Participants in the COPES arm of the trial will also receive TAU.
The control group will receive Treatment-as usual (TAU), defined as the standard care provided to individuals struggling with self-harm (SH) as detailed within the 'Managing SH in primary care' NICE guidelines. These include: an initial comprehensive psychosocial assessment of skills and risks; co-production of a care and risk management care plan, which should include harm reduction plans, the need for between 3 and 12 sessions of psychological intervention as well as treatment for associated mental health conditions. Primary care practices in the control arm will be asked to provide information on what constitutes TAU within their organisation. This trial may enhance TAU as researchers will provide details of NICE guidance to GP practices that may not currently be following these guidelines. We will collect data regarding the acceptability of TAU for SH offered by GPs within both treatment arms.