Feasibility and acceptability of a Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS): A randomised controlled trial

Background: Self-harm is widespread and often occurs in the community without resulting in hospital presentation. Individuals with depressive symptoms are at elevated risk. There are limited self-harm interventions designed for community, primary care settings. The Community Outpatient Psychological Engagement Service for Self-Harm (COPESS) is a brief talking therapy intervention for self-harm based in community settings.

Aim: To assess the feasibility of evaluating the COPESS intervention in a community setting in relation to participant recruitment, retention, data collection, and the acceptability of the intervention.

Method: A mixed-method approach, using a single-blind randomised controlled trial (RCT) design with 1:1 allocation to COPESS plus Treatment-As-Usual (TAU) or TAU alone, was used. Adults with depressive symptoms and self-harm in the past 6 months were recruited from GP practices. Secondary outcome measures were assessed at baseline, 1-month, 2-months, and 3-months after randomisation.

Results: Fifty-five people were randomised (out of an initial target of 60). Retention rates at follow-up assessments were high (>75%). Attendance by all participants for all therapy sessions was high (93%). At three months there were trends towards lower levels of self-harm urges, depressive symptoms, and distress in the COPESS group compared to control. Fidelity to the manualised COPESS therapy was moderate to high.

Conclusion: All progression criteria were met supporting further evaluation of the intervention in a full-scale efficacy/cost effectiveness trial. These findings add to the growing evidence base supporting the utility of brief psychological interventions for self-harm. COPESS has potential as a brief primary-care based intervention for those struggling with self-harm.