Centre for Mental Health and Society

Self-harm and suicide

We have a growing portfolio of self-harm and suicide prevention research at the Centre for Mental Health and Society. A major focus of the work has been in South Asia. A close collaboration between clinical academics in Mysore, India, and the Centre has been ongoing for over 15 years. Following an identification for the need for improved self-harm surveillance data, this collaboration gained a £4.5 million MRC GCRF grant for the South Asia Self-Harm Initiative (SASHI) (2019-2024). The Chief Investigator is Prof Catherine Robinson, and the Principal Investigator for Bangor University is Prof Rob Poole. The project is unique in its focus on building research capacity for self-harm surveillance in both the UK and South Asia by bringing together academics and practitioners from psychiatry, emergency medicine, public health, and surgery. The collaboration includes UK universities of Bangor University, University of Manchester, University of Oxford; Mysore Medical College and Research Institute, and JSS University, Mysore, India; and Aga Khan University, Karachi, Pakistan. The project has led to the establishment of a self-harm register at two hospitals in Mysore, India. A self-harm register has also been established at one hospital in Karachi, Pakistan. SASHI has enabled methodological innovations in registry research, and qualitative exploration of professionals understanding of self-harm and suicide prevention. We expect to produce a manual detailing the learning from the establishment of the registries in the near future.

Professors Poole and Robinson are editors of an upcoming book with Cambridge University Press entitled “Preventing Suicide – an evidence-based approach”. This book brings together world experts in suicide prevention to produce an accessible compendium on international suicide and self-harm prevention that will be of interest to academics and practitioners. Dr Bebbington has contributed a chapter to this book that explores the interface between self-harm and other forms of violence, the inherent difficulties in differentiating between them, the common antecedents and need for an upstream preventative approach. Differentiating the intent of burn injuries is particularly challenging, and Dr Bebbington’s portfolio of burns surveillance research forms a substantial component of the self-harm and suicide prevention research completed at the Centre.

We also have a portfolio of UK-focussed self-harm and suicide prevention research. Dr Bebbington and Dr Krayer lead the Self-harm and violence presenting to emergency care registry (SaVER) service evaluation project, which has been funded by Bangor University’s Innovation and Impact Award (August 2024 – July 2025). The SaVER project brings together academics at Bangor University from the CFMHAS and CHEME, University of Manchester; as well as practitioners in BCUHB (emergency medicine, public health, and mental health); Public Health Wales; and the NHS Executive. The aim of the project to understand the utility of existing systems in BCUHB that collect data about self-harm and other forms of violence, and how these might be improved to implement a self-harm and violence registry. Workstreams include process mapping of the pathways by which patients gain emergency care in BCUHB; quantitative analysis of existing data collected in BCUHB about patients presenting with self-harm and other forms of violence; and conducting qualitative interviews to understand stakeholder needs (clinical and third sector) and experiences of use of self-harm and violence data. Public Health Wales recently commissioned the Centre to complete a scoping review of male suicide prevention, which is being led by Prof Poole and Dr Nafees.

Relevant publications:

Bebbington E, Kakola M, Majgi SM, Krishna M, Poole R, Robinson C. Exploring misclassification of injury intent: A burn register study. Burns. 2024 Sep; DOI: 10.1016/j.burns.2024.05.010

Nyakutsikwa B, Taylor P, Hawton K, Poole R, Weerasinghe M, Dissanayake K et al. Financial stress amongst people who self-harm in Sri Lanka. Archives of Suicide Research. 2024 Sept 5

Bebbington E, Kakola M, Nagaraj S, Guruswamy S, McPhillips R, Majgi SM, et al. Development of an electronic burns register: Digitisation of routinely collected hospital data for global burns surveillance. Burns. 2024 Mar; DOI: 10.1016/j.burns.2023.08.007

A, Pirani S, Bebbington E, Khan M. Suicide and self-harm by burns in Pakistan: A scoping review protocol. BMJ Open. 2024 Mar; DOI: 10.1136/bmjopen-2023-080815

Bebbington E, Ramesh P, McPhillips R, Bibi F, Khan M, Kakola M, et al. Terminology and methods used to differentiate injury intent of hospital burn patients in South Asia: Results from a systematic scoping review. Burns. 2024 Mar; DOI: 10.1016/j.burns.2023.10.008

Krayer A, Kulhari S, Sharma V, Robinson C. Pathways to Suicide among Police in Rajasthan: Perceptions and Experiences of Police Personnel. International Journal of Environmental Research and Public Health. 2023 Jan 18;20(3):1812. doi: 10.3390/ijerph20031812

Bebbington E, Ramesh P, Kakola M, McPhillips R, Bibi F, Hanif A, et al. Terminology and methods used to differentiate injury intent of hospital burn patients in South Asia: A systematic scoping review protocol. Systematic Reviews. 2023 Aug; DOI: 10.1186/s13643-023-02317-y

Bebbington E, Miles J, Peck M, Singer Y, Dunn K, Young A. Exploring the similarities and differences of variables collected by burn registers globally: Protocol for a data dictionary review study. BMJ Open. 2023 Feb; DOI: 10.1136/bmjopen-2022-066512

Bebbington E, Poole R, Kumar SP, Krayer A, Krishna M, Taylor P, et al. Establishing self-harm registers: The role of process mapping to improve quality of surveillance data globally. Int J Environ Res Public Health. 2023 Feb; DOI: 10.3390/ijerph20032647

Ramesh P, Taylor PJ, Mcphillips R, Ramanathan R, Robinson C. A scoping review of gender differences in suicide in India. Frontiers in Psychiatry. 2022 Apr 19.

Krishna M, Majgi SM, Kumar SP, Rajendra R, Heggere N, Poole R et al. A hospital-based self-harm register in Mysore, South India: Is follow-up of survivors feasible in low and middle income countries? International Journal Of Community Medicine And Public Health. 2021 Nov 1;8(11):5258-5262. Epub 2021 Oct 27. doi: 10.18203/2394-6040.ijcmph20214092

McPhillips R, Nafees S, Elahi A, Batool S, Krishna M, Krayer A et al. Knowledge, attitudes and experiences of self-harm and suicide in low-income and middle-income countries: protocol for a systematic review. BMJ Open. 2021 Jun 1. doi: 10.1136/bmjopen-2020-041645

Poole R, Robinson C. Self-Harm and Suicide: Beyond Good Intentions. University and College Counselling . 2019 May;7(2).

Rajendra R, Tiptur Nagaraj MK, Majgi S, Heggere N, Robinson C, Poole R. A feasibility study to establish a Deliberate Self-harm Register in a state hospital in southern India. British Journal of Medical Practitioners. 2015 Mar;8(1):a807.

Krishna M, Rajendra R, Majgi SM, Heggere N, Parimoo S, Robinson C et al. Severity of suicidal intent, method and behaviour antecedent to an act of self-harm: a cross sectional study of survivors of self-harm referred to a tertiary hospital in Mysore, south India. Asian Journal of Psychiatry. 2014 Dec;12:134-139. doi: 10.1016/j.ajp.2014.09.002

 

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