The Manchester Self-Harm (MaSH) Project is a clinical audit and research project established at the University of Manchester and forms part of the Centre for Mental Health and Risk. The purpose of the MaSH Project is to inform local services about self-harm presentations to the Emergency Department (ED) and to contribute to national research. Studies published using local data collected as part of the multicentre study.
Clements, C., Jones, S., Morriss, R., Peters, S., Cooper, J., While, D. & Kapur, N (2014). Self-harm in bipolar disorder: Findings from a prospective clinical database. Journal of Affective Disorders 173, 113-119. Link to the paper.
People with bipolar disorder are thought to be at high risk of engaging in suicidal behaviours, including self-harm. How that risk presents, and which people with bipolar disorder are most at risk remains in question. We looked at data on all people with a primary diagnosis of bipolar disorder who presented to hospitals in Manchester following self-harm (n=103). These people were compared to people without bipolar disorder who had also presented to hospital following self-harm (n=515). People with bipolar disorder repeated more often, and sooner, than other people who self-harmed. They were also more likely to have a history of previous self-harm and to be in contact with psychiatric services at the time of the self-harm presentation.
Conclusions: In this study we found that people with bipolar disorder who self-harm have a higher risk of repetition than people who self-harm more generally. These results suggest that good quality monitoring and responsive management of symptoms by psychiatric services could help to reduce self-harm in people with bipolar disorder.
Chang, S., Steeg, S., Kapur, N., Webb, R., Yip, P. & Cooper, J (2015). Self-harm amongst people of Chinese origin versus White people living in England: a cohort study. BMC Psychiatry 15(1), 79. Link to the paper.
There has been little previous research on self-harm among people of Chinese origin living in the UK, although this population has grown substantially in recent years and China is now the largest source of international students at UK universities. Using a study cohort of people presenting to hospital following self-harm in Manchester, we compared self-harm rates in people of Chinese ethnic origin (n=45) with rates in White people (n=7,111). Our study showed that people of Chinese origin in the UK had less than one fifth the incidence of self-harm compared with White people, and incidence was particularly low amongst men in this ethnic group. Compared with White people, people of Chinese origin who self-harmed were younger and more often female and students. They were more likely to describe relationship problems as a precipitant for self-harm. They were also more likely to self-injure but less likely to self-poison with drugs.
Conclusions: In this study we found lower rates of self-harm in people of Chinese ethnic origin than in White people. Future research is required to understand this low incidence, and to investigate whether this masks hidden episodes within the community, potentially due to less help-seeking or more barriers to accessing services. Healthcare professionals need to be aware of the risk characteristics of people of Chinese origin who self-harm.
Murphy, E., Kapur, N., Webb, R. & Cooper, J (2011). Risk assessment following self-harm: comparison of mental health nurses and psychiatrists. Journal of Advanced Nursing, 67, 127-39. Link to the paper.
Specialist psychosocial assessments following self-harm are carried out by either mental health nurses or psychiatrists. An essential component of this is an assessment of the risk of self-harm repetition. We compared nurses’ and psychiatrists’ risk assessments and found them highly similar in terms of their ability to predict which patients would subsequently repeat self-harm. They were also in strong agreement regarding the risk factors they used to inform their assessments. However, they differed markedly in terms of the aftercare they recommended. Psychiatrists were over 5-times as likely to request psychiatric inpatient admission, whereas nurses more frequently made outpatient referrals.
Conclusions: The results of this study on risk assessment support the provision of nurse-led assessment services. However, the referral differences between doctors and nurses have important implications for equity of patient care. Multidisciplinary approaches to risk management training may help to reduce variations in referral practices.
Oude Voshaar, R., Cooper, J., Murphy, E., Steeg, S., Kapur, N. & Purandare, N (2011). First episode of self-harm in older age: a report from the 10-year prospective Manchester Self-Harm project. J Clin Psychiatry, 72, 737-43. Link to the paper.
Older people who self-harm are more likely to die by suicide than the younger age groups. There is very little research on older people who self-harm, particularly if it is their first attempt. When we compared the risk of repetition of first-ever self-harm in later life (55 years and over) to first-ever self-harm in middle age patients (35-54 years) we found older people were less likely to repeat although repetition was more often fatal amongst the older group. Their circumstances suggest higher suicidal intent at the time of self-harm in older people. An important factor in repetition in older people was physical health problems, whereas psychiatric characteristics had little impact on the risk of repetition in old age.
Conclusions: High suicidal intent and different predictors of repetition in first-ever self-harm in older age highlight the need for age-specific interventions beyond the scope of psychiatric care alone, and include rehabilitation programmes for those who present with self-harm precipitated by a physical disease.
Murphy, E., Steeg, S., Cooper, J., Chang, R., Turpin, C., Guthrie, E. & Kapur, N (2010). Assessment rates and compliance with assertive follow-up after self-harm: cohort study. Arch Suicide Res, 14, 120-34. Link to the paper.
After presenting to hospital with self-harm, some patients are either not offered an assessment, or do not attend offered assessment or treatment. We studied a specialist self-harm team who assertively follow-up these patients in their homes. Rates of assessment, offers and completion of therapy ranged from 50% to 60%. These results may reflect some of the challenges of engaging this patient group. However, of those offered therapy, 73% attended at least one session. Attendance was higher for clients who had more depressive symptoms and who were also receiving treatment with their GP.
Conclusions: People who leave hospital without assessment may be a difficult to engage group. Primarily, emergency departments should aim to assess patients while they are still in hospital. Subsequently, specialist community self-harm teams may provide a means for following-up those who leave without assessment.
Dickson, S., Steeg, S., Gordon, M., Donaldson, I., Matthews, V., Kapur, N., & Cooper, J (2011). Self-Harm in Manchester 2008-2009. The Centre for Suicide Prevention: The University of Manchester. Link to the report.
Dickson, S., Steeg, S., Donaldson, I., Matthews, V., Healey, M., Cooper, J., Kapur, N., & Murphy, E. (2009). 'Self-Harm in Manchester' (01:09:05-31:08:07). Manchester: The University of Manchester.
Studies by the MaSH Project prior to 2008 are listed in full at the following link.