Preventing Conflicts. SAFEapp, a training tool for staff and patients.

Title: Preventing Conflicts: SAFE-app assisting people who self-harm

Background
Self-harm is increasingly prevalent at mental health services. This challenging behaviour creates conflicts and the use of restrictive practices, such as mechanical restraints. There is a need to implement training tool in order for staff members to help people who self-harm and at the same time avoid escalating the risk of selfharm and the (sometimes) following use of restrictive practices


Aim
The aim of this study was to avoid conflicts by co-creating customized interventions that could replace the self-harming behaviour with less damaging behaviour. The interventions had to be helpful for staff and the people who had first-hand experience with the self-harm.

Method
A Co-operative Inquiry (Co-I) work group from a mental health trust included: service users (3); interdisciplinary staff members from both in- and outpatient settings (6); an engineer (1); and researchers (3). The Co-I was carried out in four stages: 1) generating ideas and deciding research focus through a future workshop, 2) preparing two interventions in repeated workshops, 3) testing the interventions in real life, and 4) evaluating the interventions through a questionnaire and focus groups. Reflexive processes helped the inquiry group to modify the interventions.

Results
The Co-I produced a mobile application: SAFE. This app’s target group is people who self-harm and their formal and informal carers (friends, family, health-care professionals and others). Users experienced the interventions as helpful on the primary level, however it was found difficult to use in escalated situations.

Discussion
The area of research is relatively young. People who engage in self-harm experience different reasons for hurting themselves. The Safe-app can provide learning for friends, family, health-care professionals and others. The interventions must be tested in a broader population.

Conclusion
Producing interventions grounded in the experience of people engaging in self-harm was rewarding for participants and developed innovative practical skills and changes. Personalized interventions targeting people who self-harm requires changes to traditional practices.
Three learning outcomes:
Insights in how:
• Co-I is helpful in co-creating interventions replacing self-harming behaviour with less damaging behaviour
• an app can be co-created in a co-designed venture between different professions and users
• people with self-harming behaviour experienced the interventions as helpful

References
Heron, J., Reason, P., 2006. The Practice of Co-operative Inquiry: Research “with” rather than “on” people, in: The Handbook of Action Research. SAGE Publications Ltd, London.
Lockwood, J., Daley, D., Townsend, E., Sayal, K., 2017. Impulsivity and self-harm in adolescence: a systematic review. Eur. Child Adolesc. Psychiatry 26, 387–402. https://doi.org/10.1007/s00787-016-0915-5
Witt, K., Spittal, M.J., Carter, G., Pirkis, J., Hetrick, S., Currier, D., Robinson, J., Milner, A., 2017. Effectiveness of online and mobile telephone applications ('apps’) for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis. BMC Psychiatry 17, 297. https://doi.org/10.1186/s12888-017-1458-0