Skip to main content Accessibility help
×
Home

Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial

  • Gillian Haddock (a1), Daniel Pratt (a2), Patricia A. Gooding (a3), Sarah Peters (a4), Richard Emsley (a5), Emma Evans (a6), James Kelly (a7), Charlotte Huggett (a8), Ailsa Munro (a8), Kamelia Harris (a9), Linda Davies (a10) and Yvonne Awenat (a11)...

Abstract

Background

Suicidal behaviour is common in acute psychiatric wards resulting in distress, and burden for patients, carers and society. Although psychological therapies for suicidal behaviour are effective in out-patient settings, there is little research on their effectiveness for in-patients who are suicidal.

Aims

Our primary objective was to determine whether cognitive–behavioural suicide prevention therapy (CBSP) was feasible and acceptable, compared with treatment as usual (TAU) for in-patients who are suicidal. Secondary aims were to assess the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use, cost-effectiveness and psychological factors associated with suicide.

Method

A single-blind pilot randomised controlled trial comparing TAU to TAU plus CBSP in in-patients in acute psychiatric wards who are suicidal (the Inpatient Suicide Intervention and Therapy Evaluation (INSITE) trial, trial registration: ISRCTN17890126). The intervention consisted of TAU plus up to 20 CBSP sessions, over 6 months continuing in the community following discharge. Participants were assessed at baseline and at 6 weeks and 6 months post-baseline.

Results

A total of 51 individuals were randomised (27 to TAU, 24 to TAU plus CBSP) of whom 37 were followed up at 6 months (19 in TAU, 18 in TAU plus CBSP). Engagement, attendance, safety and user feedback indicated that the addition of CBSP to TAU for in-patients who are acutely suicidal was feasible and acceptable while on in-patient wards and following discharge. Economic analysis suggests the intervention could be cost-effective.

Discussion

Psychological therapy can be delivered safely to patients who are suicidal although modifications are required for this setting. Findings indicate a larger, definitive trial should be conducted.

Declaration of interest

The trial was hosted by Greater Manchester Mental health NHS Trust (formerly, Manchester Mental Health and Social Care NHS Trust). The authors are affiliated to the University of Manchester, Greater Manchester Mental Health Foundation Trust, Lancashire Care NHS Foundation trust and the Manchester Academic Health Sciences Centre. Y.A. is a trustee for a North-West England branch of the charity Mind.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial
      Available formats
      ×

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Gillian Haddock. Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK. Email: gillian.haddock@manchester.ac.uk

References

Hide All
1Knapp, M, McDaid, D, Personage, M. Mental Health Promotion and Prevention: The Economic Case. Department of Health, 2011.
2National Confidential Inquiry into Suicide and Homicide by People with Mental Illness (NCISH). Annual Report. University of Manchester, 2017.
3Haw, C, Bergen, H, Casey, D, Hawton, K. Repetition of deliberate self-harm: a study of the characteristics and subsequent deaths in patients presenting to a general hospital according to extent of repetition. Suic Life-Threat Behav 2007; 37: 379–96.
4Kapur, N, Cooper, J, King-Hele, S, Webb, R, Lawlor, M, Rodway, C, et al. The repetition of suicidal behaviour: a multicenter cohort study. J Clin Psychiatr 2006; 67: 1599–609.
5Health & Social Care Information Centre. Mental Health Bulletin: Annual Report from MHMDS Returns 2013–14. 2014.
6Windfuhr, K, Kapur, N. Suicide and mental illness: a clinical review of 15 years findings from the UK National Confidential Inquiry into Suicide. Brit Med Bull 2011; 100: 101.
7Tarrier, N, Taylor, K, Gooding, P. Cognitive-behavioral interventions to reduce suicide behavior: a systematic review and meta-analysis. Behav Modif 2008; 32: 77108.
8Tarrier, N, Kelly, J, Maqsood, S, Snelson, N, Maxwell, J, Law, H, et al. The cognitive behavioural prevention of suicide in psychosis: a clinical trial. Schizophr Res 2014; 156: 204–10.
9National Institute for Health and Clinical Excellence. Self-Harm. Longer Term Management. CG133. NICE, 2011.
10Chang, NA, Stanley, B, Brown, GK, Cunningham, A. Treating the suicidal patient: cognitive therapy and dialectical behaviour therapy. In International Handbook of Suicide Prevention: Research, Policy And Practice (eds O'Connor, RC, Platt, S, Gordon, J). John Wiley and Sons, 2011.
11Tarrier, N, Gooding, P, Pratt, D, Kelly, J, Awenat, Y, Maxwell, J. Cognitive Behavioural Prevention of Suicide in Psychosis: A Treatment Manual. Routledge, 2013.
12Pratt, D, Tarrier, N, Dunn, G, Awenat, Y, Shaw, J, Ulph, F, et al. Cognitive behavioural suicide prevention for male prisoners: a pilot randomized controlled trial. Psychol Med 2015; 45: 3441–51.
13Haddock, G, Davies, L, Evans, E, Emsley, R, Gooding, P, Heaney, L, et al. Investigating the feasibility and acceptability of a cognitive behavioural suicide prevention therapy for people in acute psychiatric wards (the ‘INSITE’ trial): study protocol for a randomised controlled trial. Trials 2016; 17: 79.
14Awenat, Y, Peters, S, Shaw-Nunez, E, Gooding, P, Pratt, D, Haddock, G. Staff experiences and perceptions of working with in-patients who are suicidal: qualitative analysis. Br J Psychiatry 2017; 211: 103–8.
15Awenat, Y, Peters, S, Gooding, P, Pratt, D, Haddock, G. A qualitative investigation of psychiatric inpatients’ views and expectations of psychological therapy for suicide prevention: Implications for suicide prevention. 2018; BMC Psychiatry 2018; 18: 334.
16Haddock, G, Devane, S, Bradshaw, TJ, McGovern, J, Tarrier, N, Kinderman, P, et al. An investigation into the psychometric properties of the cognitive therapy scale of psychosis (CTS-Psy). Behav Cog Psychother 2001; 29: 221–33.
17Horvath, AO, Greenberg, LS. Development and validation of the Working Alliance Inventory. J Couns Psychol 1989; 36: 223–33.
18Osman, A, Bagge, CL, Gutierrez, PM, Konick, LC, Kopper, BA, Barrios, FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment 2001; 8: 443–54.
19Beck, A, Kovacs, M, Weissman, A. Assessment of suicidal intention: the Scale of Suicide Ideation. J Consult Clin Psychol 1979; 47: 343.
20Cull, J, Gill, W. Suicide Probability Scale. Western Psychological Services, 1982.
21Beck, AT, Weissman, A, Lester, D, Trexler, L. The measurement of pessimism: the hopelessness scale. J Consult Clinl Psychol 1974; 42: 861.
22Kay, SR, Flszbein, A, Opfer, LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261.
23Lewis, S, Tarrier, N, Haddock, G, Bentall, RP, Kinderman, P, Kingdon, D, et al. Randomised controlled trial of cognitive behaviour therapy in early schizophrenia: acute phase outcomes. Br J Psychiatry 2002; 181 (suppl 43): s917.
24Haddock, G, McCarron, J, Tarrier, N, Faragher, E, Tarrier, N. Scales to measure dimensions of hallucinations and delusions: the Psychotic Symptom Rating Scales (PSYRATS). Psychol Med 1999; 29: 879–89.
25Addington, D, Addington, J, Schissel, B. A depression rating scale for schizophrenics. Schizophr Res 1990; 3: 247–51.
26Morosini, PL, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 2000; 101: 323–29.
27Kawaka, AK, Ravicki, DA. Psychometric properties of the Personal and Social Performance scale (PSP) among individuals with schizophrenia living in the community. Qual Life Res 2008; 17: 1247–56.
28Group, W. Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998; 28: 551–8.
29Skevington, SM, Lotfy, M, O'Connel, KA. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Qual Life Res 2004; 13: 299310.
30Gilbert, P, Allan, S. The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view. Psychol Med 1998; 28: 585–98.
31Robson, P. Development of a new self-report questionnaire to measure self esteem. Psychol Med 1989; 19: 513–18.
32Ghaderi, A. Psychometric properties of the Self-Concept Questionnaire. Eur J Psychol Assess 2005; 21: 139–46.
33Endler, N, Parker, J. Coping Inventory for Stressful Situations (CISS): Manual. Multi-Health Systems, 1990.
34Herdman, M, Gudex, C, Lloyd, A, Janssen, MF, Kind, P, Parkin, D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011; 10: 1727–36.
35Schulz, KF, Altman, DG, Moher, D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010; 8: 18.
36Devlin, N, Shah, K, Feng, Y, Mulhern, B, Van Hout, B. Valuing Health-Related Quality of Life: An EQ-5D-5L Value Set for England. Office of Health Economics Research Paper 16/01. Office of Health Economics Research, 2016.
37Curtis, L, Burns, A. The Unit Costs of Health and Social Care 2016. PSSRU, 2016 (http://www.pssru.ac.uk/project-pages/unit-costs/2016/index.php).
38Department of Health. National Schedule of Reference Costs 2015–2016. Department of Health and Social Care (https://www.gov.uk/government/publications/nhs-reference-costs-2015-to-2016).
39Royal College of Psychiatrists. Second Round of the National Audit of Psychological Therapies for Anxiety and Depression (NAPT). Royal College of Psychiatrists, 2013.
40Care Quality Commission. Right Here, Right Now: People's Experiences of Help, Care and Support During a Mental Health Crisis. CQC, 2015.
41The Schizophrenia Commission. The Abandoned Illness: A Report from the Schizophrenia Commission. Rethink Mental Illness, 2012.
42Johnson, S, Paul, SW, Osborn, D, Wearn, E, Lloyd-Evans, B, Totman, J, et al. Inpatient Mental Health Staff Morale: A National Investigation. Final Report. NIHR Service Delivery and Organisation programme, 2011.
43Horvath, AO, Del Re, A, Flückiger, C, Symonds, D. Alliance in individual psychotherapy. Psychotherapy 2011; 48: 9.

Keywords

Type Description Title
WORD
Supplementary materials

Haddock et al. supplementary material
Haddock et al. supplementary material 1

 Word (39 KB)
39 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Feasibility and acceptability of suicide prevention therapy on acute psychiatric wards: randomised controlled trial

  • Gillian Haddock (a1), Daniel Pratt (a2), Patricia A. Gooding (a3), Sarah Peters (a4), Richard Emsley (a5), Emma Evans (a6), James Kelly (a7), Charlotte Huggett (a8), Ailsa Munro (a8), Kamelia Harris (a9), Linda Davies (a10) and Yvonne Awenat (a11)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *