A CO-produced Psychosocial INtervention delivered by GPs for young people who self-harm (COPING): an intervention development and feasibility study

Background Self-harm significantly affects patients, families, the public and the NHS. There is a 20% lifetime prevalence of self-harm in young people, and nearly 50%, in young people with mental illness. Young people who self-harm are at risk of future self-harm, anxiety, depression, premature death and suicide.

Presentations of self-harm in young people to general practice are increasing. After seeing their general practitioner (GP) for self-harm, 22% of young people repeat self-harm the following year.

My systematic review highlights the important role GPs have in managing young people who self-harm; and qualitative research with young people reports poor experiences of seeing GPs for self-harm. There are few guidelines and an absence of evidence-based interventions for GPs to use with young people who self-harm.

Cognitive behaviour and dialectical behaviour therapies can help reduce repeat self-harm in young people, however, these are delivered by specialists outside general practice. There is evidence GPs can deliver effective psychosocial interventions.

Young people who self-harm, families and practitioners feel interventions for GPs to use in the consultation with young people who self-harm are important.

Aim To develop a co-produced complex GP-delivered psychosocial intervention (COPING) for young people (16-25-years) who self-harm to reduce repeat self-harm, and test its feasibility in general practice.

Methods Three complementary workpackages (WP) informed by the MRC framework for developing and evaluating complex interventions.

A 'combination' approach to intervention development will be adopted through combining a theory and evidence informed (MRC) approach with a partnership (framework for coproduced public health interventions) approach, increasing likelihood of the intervention working in practice. Patients, families and key stakeholders will be involved throughout the study.

WP1 (one-14 months): Semi-structured interviews with up to 15 GPs to explore experiences of consulting with young people who self-harm, target behaviours, feasible and acceptable intervention components, and barriers and enablers to intervention implementation.

WP2 (15-31 months): Stage one: past evidence, theories, WP1 and stakeholder consultation will be drawn together to draft possible intervention components.

Stage two: two intervention design groups: 1) young people who self-harm and 2) GPs, will participate in meetings, using an action-research approach to create, refine and agree on the content, resources and delivery of COPING.

Stage three: peer-review and simulation of two COPING consultations will further refine the COPING intervention and conclude intervention development.

WP3 (32-50 months): Feasibility study of COPING across six GP practices to estimate parameters to inform the design of a larger randomised-pilot trial.

Five semi-structured interviews with young people and GPs will explore intervention acceptability and GP questionnaires will assess willingness of GPs to be involved in a subsequent trial. Mixed-methods data will be integrated.

Anticipated impact and dissemination This research will potentially lead to improved patient experience, increased GP skills and confidence, reduced distress for young people and families, lower NHS costs and reductions in self-harm, suicide and mortality in young people. Findings will potentially inform self-harm policy and guidelines, and primary care self-harm models.

Outputs will be strategically disseminated to patients, public and NHS to facilitate maximum reach and uptake.