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In England and Wales there are at least 200,000 general hospital presentations for self-harm (intentional self-poisoning or self-injury) per year. Self-harm occurs in relation to a wide range of personal problems, emotional turmoil and psychiatric disorders. It carries a significant risk of subsequent suicide and has major impacts on family members and friends. It also places pressure on busy emergency departments, wards and clinicians, as well as having major financial costs for the NHS.

The aim of the Multicentre Study of Self-Harm in England is to conduct a series of related studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. Through a multicentre collaboration the research provides representative and reliable data on self-harm in England. It contributed to the National Suicide Prevention Strategy for England (2002, 2012) and prevention and service initiative, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011.

Oxford - Suicide GrpManchester - Suicide GrpDerby - Suicide Grp

The research started as a collaboration between the University of Oxford (Principal Investigator, Professor Keith Hawton), the University of Manchester (Lead, Professor Nav Kapur), and Derbyshire Healthcare NHS Foundation Trust (Lead, Mr Keith Waters). Data for the study is being collected in these three centres in five general hospitals, one in Oxford, three in Manchester and one in Derby. Over 10 collaborating researchers were part of the research group. The project also had input from service users.

The programme of research includes 4 broad areas:

  • Epidemiology and trends in self-harm
  • Clinical management of self-harm
  • Outcome of self-harm, including repetition and mortality
  • Pharmaco-epidemiology, including drug toxicology and impacts of changes in prescribing legislation and trends

We do not provide a treatment service or advice for those in crisis. If you are in crisis or feeling suicidal we urge you to seek help from your general practitioner, through a telephone helpline service such as Samaritans (UK telephone number 116  123), or by discussing your problems with a friend or colleague. Befrienders Worldwide offers a comprehensive directory of crisis helplines worldwide. We are also not able to discuss individual cases.

The following are the specific investigations within the areas of research;

Epidemiology and trends in self-harm

    • Rates and trends in self-harm and socio-demographic and clinical characteristics of self-harm patients:
      • adults 
      • children and adolescents
      • older people


  • Rates and trends in self-harm in ethnic groups including Black (Caribbean and African), South Asian (Indian, Pakistani, Bangladeshi and Sri Lankan), Chinese and White groups
  • Alcohol and drug misuse and self-harm
  • Characteristics of frequent repeaters of self-harm
  • Impact of the recession on self-harm

Clinical management of self-harm

  • Determinants of type of hospital management following self-harm, and the relationship between management and outcome
  • Validation and refinement of a clinical screening tool to identify risk of repetition of self-harm or suicide following a self-harm episode
  • Relationship between psychosocial assessment following self-harm and subsequent repetition of self-harm, in both the short-term and longer term

Outcome of self-harm, including repetition and mortality

  • Risk of suicide following self-harm in gender and age subgroups, and changes over time
  • Risk factors for suicide 
  • Risk of death from non-suicidal causes 
  • Mortality following self-harm in
    • children and adolescents
    • older people
    • people who misuse alcohol and drugs
    • people in current psychiatric contact
    • different ethnic groups
  • Change in use of different methods of self-harm between episodes and relationship to outcome
  • Pharmaco-epidemiology, including drug toxicology and impacts of changes in prescribing legislation and trends.


  • Impact on self-harm of MHRA decision to withdraw co-proxamol
  • Comparison of size of overdoses of paracetamol in England and Ireland in relation to differing pack sizes


  • Relationship between use of specific antidepressants in self-poisoning and prescribing rates
  • Relative toxicity (lethality) of individual antidepressants
  • Trends in self-poisoning with SSRI antidepressants over time and in relation to MHRA warnings


  • Relative toxicity of individual drugs used for self-harm and suicide

Lead investigators

  • Seena Fazel (Oxford)
  • Professor Nav Kapur (Manchester)
  • Mr Keith Waters (Derby)

Research Staff


  • Keith Hawton, Director Emertus
  • Ms Deborah Casey (Oxford Monitoring System Project Co-ordinator)
  • Ms Elizabeth Bale (Research Assistant)
  • Mr John Ryall (Research Clerk)
  • Ms Fiona Brand (Research Nurse)


  • Dr Caroline Clements (Project Manager/Research Fellow)
  • Ms Harriet Bickley (Research Associate)
  • Jackie Ward (Project Administator)
  • Bradley O'Donovan (Project Administrator)


  • Ms Jennifer Ness (Research Project Manager)
  • Dr Samantha Kelly (Consultant Nurse)
  • Ms Jessica Pearson(Research Assistant)
  • Ms Phyllis Leung (Research Assistant)
  • Professor Ellen Townsend (University of Nottingham)



  • Dr Apostolo Tsiachristas
  • Prof. Andrea Cipriani


  • Dr Roger Webb
  • Dr Kevin Mackway-Jones
  • Dr Damien Longson
  • Dr Elspeth Guthrie
  • Prof Louis Appleby


Other Centres

  • Prof. David Gunnell (University of Bristol)
  • Dr. Alexandra Pitman (University College London)
  • Dr Ella Arensman (National Suicide Research Foundation, Cork)
  • Dr Paul Corcoran (National Suicide Research Foundation, Cork)