A volitional helpsheet to reduce hospital-treated self-harm: a randomised trial

Abstract

Background. To investigate the efficacy of a Volitional Help Sheet (VHS) in the management of self-harm (SH). There were two research questions: (i) Does a VHS reduce the number of people who re-present to hospital with SH in the six months following an index episode of SH? (ii) Does a VHS reduce the number of SH episodes in the six months following an index episode of SH? Methods. Participants who had presented to hospital following suicidal SH were randomised into either the intervention (treatment as usual + VHS; n=259) or control (treatment as usual; n=259) arms of the trial. The VHS is a theoretically-derived brief behaviour change intervention. Two months later, they are sent out a booster VHS. Six months after randomisation, we determined whether the intervention had an effect on the number of participants who re-presented to hospital for SH and the number of re-presentations. Results. Twenty eight per cent (27.8%) of the total sample re-presented with SH in the six months following randomisation. Intention to treat (ITT) analysis (using zero-inflated statistical modelling) revealed that the intervention was associated with a significant reduction in number of SH repetitions individuals engaged in. The intervention did not reduce the number of participants who self-harmed, Discussion. The study achieved its aim in full. Taking the effectiveness and economic analyses together, we believe that the VHS offers considerable promise, however, closer inspection of the small minority of participants who are less likely to engage with the intervention is required.