The CO-produced Psychosocial INtervention delivered by GPs for young people who self-harm-Intervention Development (COPING-ID) study

Problem

Self-harm in young people is an international public health concern and reducing rates a key priority. In high-income countries young people often seek help for self-harm from General Practitioners (GPs). GPs have a key role in the management of self-harm, but some GPs describe lacking confidence treating young people. There are currently no effective interventions for GPs to offer young people (16-25 years) after self-harm. There is evidence that cognitive behaviour and dialectical behaviour type interventions can reduce self-harm repetition, however these have only been tested in specialist care settings. We developed, in partnership with young people with lived experience of self-harm and GPs, a brief psychosocial intervention (COPING) to be delivered in general practice.

Approach

COPING’s development was guided by the UK Medical Research Council’s framework for developing and evaluating complex interventions. A combination development approach was adopted across two stages. Stage one was a semi-structured interview study with GPs in England about their clinical management of self-harm and views on future COPING components and implementation. Data were analysed thematically and mapped onto the Capability, Opportunity, and Motivation (COM-B)-Behaviour change framework. Stage two adhered to Behaviour Change Wheel steps and included an evidence search, stakeholder consultation, behavioural analyses of target behaviours, co-production, and prototyping of COPING. The study’s patient and public involvement group contributed to the design of stage one, interpretation of interview data and on potential elements of the COPING intervention.

Findings

Fifteen GPs were interviewed; 8 female and 7 male (age range 32-52 years). Most GPs described having the physical and psychological capability to help young people not self-harm, but some GPs felt doing so was emotionally tiring. GPs stated COPING needed to be practical and simple for GPs to use daily. Analyses of target behaviours were mapped onto six intervention types: education, training, enablement, incentivisation, environmental restructuring, and modelling. Six young people aged 16-25 with lived experience and 5 GPs participated in 3 online co-production workshops to design COPING. Members ranked/scored 42 behaviour change techniques (BCT). The final COPING draft consists of 8 BCTs and is a personalised treatment guide for GPs to use with young people across two consultations.

Consequences

This study has co-produced a GP-led intervention for young people after self-harm. The COPING intervention has the potential to benefit young people, their families, and the NHS. COPING is currently being tested in a feasibility study to assess whether a main trial in NHS general practice is justified.