Exploring a new approach to preventing self-harm in psychiatric inpatient hospitals

INTERVENTION: Participating inpatient care wards across two NHS Trusts will be randomly assigned to two groups. Participants will be randomised and then take part in the same 4‐month intervention at a different time (phase one is up to month 4 and phase two from month 4 to month 8), depending on their group assignment. During the first phase months 1‐4 of the study, Group 1 will have immediate access to JITAI training and booklet. Group 2 will serve as a delayed intervention control during this phase. After 4 months, during the second phase, Group 2 will be trained and will have access to JITAI and a booklet. During this second phase, Group 1 will continue to use JITAI. Participants will be of two types‐ staff participants and patient participants. At the start of each phase staff participants within the assigned group will attend training which will provide information on the daily measures being used as well as the JITAI intervention and how they can view the data input by patients to respond. So at this time point, zero staff participants assigned to wards in group one will attend the training. Staff in group 2 will attend training before the start of phase 2‐ 4 months after the study starts. The JITAI intervention works based on daily Routine Outcome Monitoring (ROM) and when these indicate things are not going well, this triggers an intervention. The patient participant completes daily ROM using a web‐based secure survey, which asks questions about well‐being, frequency of suicidal ideation and distress levels. Ward staff review this data daily to assess changes in the patient’s well‐being and risk factors. If the feedback provided by the JITAI algorithm indicates high risk, staff will then initiate routine risk assessment and management procedures. It’s much the same as if CONDITION: Suicidal self‐harm ; Mental and Behavioural Disorders PRIMARY OUTCOME: Staff self‐evaluation of the efficacy of risk assessment will be measured using the Risk Assessment and Management Self‐Efficacy Scale (RAMSES) at the start of the trial, month 4 and month 8 SECONDARY OUTCOME: Measured at admission:; 1. The Depression Anxiety Stress Scale, DASS‐21; 2. The Health of the Nation Outcome Scales (HoNOS); 3. Quality of life enjoyment and satisfaction questionnaire (Q‐LES‐Q); 4. Alcohol Use Disorders Identification Test AUDIT‐10; ; Measured daily: ; 1. The Daily Inde X(DI‐5); 2. World Health Organisation Wellbeing Inde X(WB‐10); 3. Items from the Perceived Mastery Scale (PM); ; Qualitative interviews will be conducted with some participating staff at the end of the study to gain views on experiences of using the JITAI method in clinical practice and the barriers and enablers to this. INCLUSION CRITERIA: 1. Between the ages of 18 ‐ 65 years 2. Inpatient on one of the participating wards 3. Staff participants must be permanent members of staff 4. Staff participants must have completed all the relevant mandatory Trust risk management training 5. Staff member on one of the participating wards who have attended JITAI training