Substance Abuse Clinical Trial
Official title:
ENGAGE - Meeting Mental Health Needs of Complex Comorbid Patients Attending A&E Following a Suicide Attempt. A Pilot Study.
Scotland has higher rates of suicide than other parts of the UK, an average rate of 15.1 per
100,000 in Scotland compared to 11.4 for England and Wales. The Scottish Government is
committed to reducing suicide by 2013. Choose Life has led to staff in services such as
Accident and Emergency (A&E) receiving recent training in suicide prevention through ASIST
and STORM.
Evidence for interventions specific to A&E setting is limited despite the fact that this is
the most likely point of first contact with health services for people at risk of this
behaviour. Brief interventions that reduce repetition of self harm have not been
particularly effective partly because of poor attendance and lack of focus on comorbidity.
We propose to pilot an evaluation of a brief focused intervention, ENGAGE (based on
MAnualised Cognitive Therapy,MACT, developed by the investigator (Kate Davidson) and Prof
Ulrike Schmidt of the Institute of Psychiatry, London) for those who present at A&E with a
suicide attempt and who have a complex presentation - a combination of substance abuse and
or personality disorder, all of which are recognized as high risk factors for suicide.
ENGAGE will specifically encourage patients to seek appropriate services to meet their
mental health needs. This pilot will allow us to assess the feasibility of a full scale
study.
This is an exploratory single centre, randomised controlled trial of a complex intervention
based on cognitive behavioural therapy principles for patients with a recent episode of
suicide and who have personality disorder/s and or substance abuse (complex comorbidity).
Patients who join the study will be randomly allocated to receive either ENGAGE CBT or
Treatment as Usual (TAU). We will compare the effectiveness of ENGAGE with TAU. The primary
outcome will be engagement with services − the number of contacts with mental health
services (e.g. drug, alcohol and CMHT) in the 3 months following the participant's
randomisation.
We will recruit 30 patients seen in the hospital by the Liaison Team with a suicide attempt
who score above the threshold for personality disorder and drug or alcohol abuse using
SAPAS,AUDIT and DAST assessments. If the patient is interested in the study a research
assistant will obtain consent and conduct a baseline interview at which full personality
disorder diagnostic status will be confirmed and further psychological measures will be
taken. The patient will be randomised to ENGAGE (CBT) or TAU and interviewed again by the
research assistant at 3 months post randomisation. The research assistant will be blind to
treatment group. Those patients randomised to ENGAGE CBT will receive 6 sessions of the
intervention from a CBT therapist. ENGAGE will help patients to identify problems, use
problem solving to help prioritise and resolve problems and motivate patients to attend the
treatment recommended by the liaison team. The ENGAGE therapist will encourage and, if
necessary, facilitate patients with substance abuse and personality disorder to engage in
the appropriate NHS services.
TAU - usual treatment is the services that patients may already be involved in or services
that the patient has been referred to following the suicide episode.
;
Allocation: Randomized, Intervention Model: Factorial Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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