Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS): A feasibility trial

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

1D.5

Presenter:

Pooja Saini

Twitter:

@poojaliverpool

Co-authors:

Dr Pooja Saini, Anna Hunt, Dr Peter Taylor, Catherine Mills, Dr Caroline Clements, Helen Mulholland, Dr Cecil Kullu, Dr Mark Hann, Dr Rui Duarte, Dr Felicity Mattocks, Dr Else Gurthie, Dr Mark Gabbay

Author institutions:

Liverpool John Moores University

Problem

People who self-harm (SH) are at high risk for future suicide and often suffer considerable emotional distress. Depression is common among people who SH and may be an underlying driver of SH behaviour. Readily accessible brief talking therapies show promise in helping people who SH, but further evaluation of these approaches is needed. The Community Outpatient Psychological Engagement Service for Self-Harm (COPESS) is a brief talking therapy intervention for depression and SH. This study aims assess the feasibility of conducting a trial of the COPESS intervention in a community setting in relation to participant recruitment and retention.

Approach

This study was a mixed-method evaluation of a single-blind randomised controlled trial (RCT) will determine the acceptability and safety of the COPESS intervention, for people with depression who self-harm. People were randomised 1:1 to receive either COPESS plus treatment-as-usual (TAU) or TAU alone. Individuals aged >16 years who had depression and self-harmed in previous six months were included. Recruitment took place via GP practices.

Findings

57 participants were randomised to receiving the COPESS intervention and TAU (n=28) or TAU only (n=27). The trial was not designed or powered to calculate effect sizes. However, the levels of change reported for participants with frequency and intensity of urges to self-injure over the past seven days (-2.9 vs -1.2), levels of depression (-10.8 vs -2.4) and psychological distress (-8.3 vs -2.4) all decreased more for those in the intervention group compared to those in the TAU group. Findings indicated that COPESS was both acceptable and feasible to deliver within community settings. Primary care and COPESS therapists based in a mental health trust reported the intervention fitted and complemented existing services, and patients reported that they favoured the rapid, self-harm focused, person-centred approach of the intervention. Qualitative interviews were completed with participants, therapists, and primary care staff.

Consequences

All progression criteria were met supporting further evaluation of the intervention in a full-scale clinical effectiveness trial. The findings of this trial support further evaluation of the COPESS intervention to reduce urges and frequency of self-harming behaviours, depression, general distress and to help improve emotional regulation. Given the encouraging findings from recent reviews of brief psychological interventions for self-harm, a full trial of COPESS is an urgent priority.

Submitted by:

Pooja Saini

Funding acknowledgement:

This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR200543). The funding body had no role in the design of the trial or in writing this manuscript. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health Research or of the Department of Health and Social Care.