FReSH START – Looking at new approaches for people who self-harm
Many people visit NHS emergency departments after self-harming, and repeated episodes are common. Most existing treatments focus only on stopping the self-harm. However, many people say it is more helpful to focus on building positive, meaningful personal goals. The FReSH START study is exploring whether three adapted talking therapies can improve quality of life for adults who self-harm repeatedly. Taking place across 12 NHS sites, the trial will include 630 people. Half of the participants will receive standard NHS care, while the other half will receive standard care plus up to 12 sessions of talking therapy with a trained therapist. All participants will answer questions about their wellbeing over 12 months. The aim is to find practical, effective therapies that NHS hospitals can easily offer to support long-term recovery.
At a glance
What is this study about?
Self-harm is a significant health concern across the UK, leading to hundreds of thousands of hospital visits each year. Many people who self-harm have done so before, showing that more effective long-term support is urgently needed. Traditional approaches often focus entirely on reducing or stopping the act of self-harm. However, people with lived experience have shared that they prefer therapies that help them focus on valued, positive life goals.
To address this, researchers have modified three existing talking therapies specifically for people who self-harm. Instead of requiring expensive, hard-to-access specialist clinics, these therapies are designed so they can be delivered through local NHS mental health services.
This study is a large clinical trial run by the University of Leeds and funded by the National Institute for Health and Care Research (NIHR). By comparing these therapies with usual NHS care, researchers hope to discover clear evidence on the best ways to help people build fulfilling lives and reduce future self-harm.
Key takeaways
- FReSH START is testing adapted talking therapies that focus on positive personal goals rather than just stopping self-harm.
- The trial involves 630 adults across 12 NHS sites in England.
- Participants are randomly assigned to receive either usual NHS care or usual care plus up to 12 therapy sessions.
- Everyone completes questionnaires over 12 months to see how their wellbeing changes.
- Taking part is entirely voluntary and will not disrupt your regular medical treatment.
Who may be eligible?
This study is open to adults aged 18 and over who have recently attended an emergency department (A&E) due to self-harm. To qualify, you must have self-harmed at least three times in the past year (including once in the last three months) and at least four times in your life. You also need to be registered with a GP in a participating NHS trust area.
The study might not be suitable if you are already receiving or waiting for a similar talking therapy, or if you are getting specialist treatment for an eating disorder or drug addiction.
It is also not open to people who are currently in severe crisis or experiencing active suicidal thoughts that require urgent medical intervention. Additionally, people with conditions such as schizophrenia or autism are excluded, as the therapies in this particular trial are not tailored to address those specific needs.
Could this study suit you?
Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.
- I am aged 18 or older.
- I have recently attended an A&E department because of self-harm.
- I have self-harmed at least three times in the past 12 months.
- I am registered with a GP in a participating NHS area.
- I am not currently receiving a similar talking therapy.
What does participation involve?
If you join the study, you will first meet with a researcher to discuss your health and complete five questionnaires about your wellbeing and any costs related to your care. You will then be placed by chance (like flipping a coin) into one of two groups. One group will continue with standard NHS care. The other group will receive standard care plus up to 12 sessions of talking therapy over six months. These 45-minute sessions can happen in person at an NHS clinic, over the phone, or via video call.
All participants will receive a brief monthly text message asking how they are doing and whether they have self-harmed. You will also be asked to complete follow-up questionnaires online or by post at 3, 6, 9, and 12 months. After one year, some participants may be invited to take part in an optional interview to share their thoughts on the care they received. The total study duration for each person is 12 months.
Potential risks and benefits
Locations (9)
- Leeds and York Partnership NHS Foundation TrustUnverifiedLeeds, England
- Greater Manchester Mental Health NHS Foundation TrustUnverifiedManchester, England
- Pennine Care NHS Foundation TrustUnverifiedAshton-under-Lyne, England
- Sheffield Health & Social Care NHS Foundation TrustUnverifiedSheffield, England
- Kent and Medway NHS and Social Care Partnership TrustUnverifiedMaidstone, England
- Lancashire & South Cumbria NHS Foundation Trust HqUnverifiedPreston, England
- Tees, Esk and Wear Valleys NHS Foundation TrustUnverifiedDarlington, England
- Cambridgeshire and Peterborough NHS Foundation TrustUnverifiedCambridge, England
- Gloucestershire Health and Care NHS Foundation TrustUnverifiedGloucester, England
Common questions
Can I choose whether I get the talking therapy?
No. A computer puts you into one of two groups at random. This makes sure the study results are fair and reliable.
Will my normal NHS treatment stop if I take part?
No. Everyone in the study continues to receive their usual NHS care, regardless of which group they are placed in.
What happens if I find the questions upsetting?
You do not have to answer any question that makes you uncomfortable. The researchers will also give you details of professional organisations you can contact for immediate support.
Do I have to travel for the therapy sessions?
Not necessarily. If you are placed in the therapy group, you can choose to have your sessions in person at an NHS site, over the phone, or via video call.
What if I change my mind about participating?
You are free to leave the trial at any point. Leaving will have no impact on the quality of your regular NHS healthcare.
How to find out more
- Trial Manager
Always speak to your GP or specialist before deciding to take part in a study.
Discussion
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