Projects relating to Self-Harm

Associated projects: completed

A multi-centre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England


Every year in England there are over 4,000 suicides and 140,000 people go to hospital following self-harm ('attempted suicide').

The aim of this programme of research is to carry out a series of linked studies, the purpose of which is to:

  • improve the management of self-harm
  • reduce the incidence of suicide
  • provide reliable data to evaluate the impact of the National Suicide Prevention Strategy for England (2002)

Duration of the project


Funding body

NIHR Programme Grant

Members of the project

Professor David GunnellPrincipal investigator
Professor K HawtonPrincipal investigator
Professor Nav KapurPrincipal investigator
Dr Jayne CooperPrincipal investigator
Mr Iain DonaldsonResearch Secretary

There are four overlapping components to the programme:

1. A study of the management of self-harm in 32 English hospitals that aims to determine which aspects of care affect the risk of repeat self-harm

A comparison of the management (e.g. levels of assessment and admission) and outcome of self-harm in 32 hospitals across England to determine which aspects of care affect the risk of repeat self-harm and assess whether improvements in services have followed recent NICE guidance. This study is a follow-up of a study we originally conducted in 2001-2.

2. The development and piloting of contact-based interventions aimed at reducing the risk of self-harm after hospital discharge and A and E attendance for self-harm

The development and piloting of interventions based on the provision of “emergency support cards” and/ or regular contacts by letter, phone or e-mail in the year after receiving specialist mental health care. The aim of these interventions is to reduce the risk of subsequent self-harm. The cards will list telephone contact numbers and other sources of support in the event of a crisis.

3. An evaluation of the impacts on population health and suicide of recent regulations on the prescribing of co-proxamol and the purchase of paracetamol, and the impact of other prescribed medicines on suicide

  1. Evaluation of the impact of national legislation restricting the prescribing of co-proxamol on its use in self-harm.
  2. Investigation of whether the 1998 restrictions on paracetamol sales are set at an appropriate level, whether the guidelines are being complied with, and the long-term impact of the legislation, including possible effects on gastrointestinal bleeds due to increased use of other analgesics.
  3. Evaluation of relative toxicity of antidepressants taken in overdoses and implications for regulatory activity and prescribing.

This research is based on national mortality data and data collected within the Multicentre Study of Self-harm in England project being carried out in Oxford, Manchester and Derby.

4. An assessment of the reliability of national suicide data for measuring the impact of the National Suicide Prevention Strategy and other influences on national suicide rates

A review of Coroners’ records from 12 districts in England to determine the extent to which national suicide rates, and time trends in suicide, may be over- or under-estimated when they are based on deaths given suicide and “open” verdicts by coroners (as is currently the case). Such information is critical to assessing the impact of the Suicide Prevention Strategy.


  • Biddle, L., Cooper, J., Owen-Smith, A., Klineberg, E., Bennewith, O., Hawton, K., ... Gunnell, D. (2013). Qualitative interviewing with vulnerable populations: Individuals' experiences of participating in suicide and self-harm based research. Journal of Affective Disorders, 145(3), 356-362. DOI: 10.1016/j.jad.2012.08.024. Publication link: adf2d33c-d4d1-4039-9ceb-d2169af833d5 | PubMed:23021191
  • Cooper, J., Steeg, S., Bennewith, O., Lowe, M., Gunnell, D., House, A., ... Kapur, N. (2013). Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England. BMJ open, 3(11), [e003444]. DOI: 10.1136/bmjopen-2013-003444. Publication link: 5f3f8f67-0e24-435c-8e4c-1409f323e630 | PubMed:24253029
  • Gunnell, D., Bennewith, O., Simkin, S., Cooper, J., Klineberg, E., Rodway, C., ... Kapur, N. (2013). Time trends in coroners' use of different verdicts for possible suicides and their impact on officially reported incidence of suicide in England: 1990-2005. Psychological Medicine, 43(7), 1415-1422. DOI: 10.1017/S0033291712002401. Publication link: ab76a8a5-ae4e-4448-a0e6-4cbd9036484f | PubMed:23113986
  • Gunnell, D., Hawton, K., Bennewith, O., Cooper, J., Simkin, S., Donovan, J., ... Kapur, N. (2013). A multicentre programme of clinical and public health research in support of the National Suicide Prevention Strategy for England. Programme Grants Appl Res, 1(1). DOI: 10.3310/pgfar01010. Publication link: a0a691d6-aa4b-4b04-826b-18d9483783c4
  • Kapur, N., Cooper, J., O'Connor, R. C., & Hawton, K. (2013). Non-suicidal self-injury v. attempted suicide: New diagnosis or false dichotomy?British Journal of Psychiatry, 202(5), 326-328. DOI: 10.1192/bjp.bp.112.116111. Publication link: 7c8cb82c-e455-4b84-9327-543cd4f014c2 | PubMed:23637107
  • Kapur, N., Cooper, J., Bennewith, O., Gunnell, D., & Hawton, K. (2010). Postcards, green cards and telephone calls: Therapeutic contact with individuals following self-harm. British Journal of Psychiatry, 197(1), 5-7. DOI: 10.1192/bjp.bp.109.072496. Publication link: e64c9bfa-7342-4432-908b-7aa55e027b0c | PubMed:20592425