Umbrella review of psychosocial and ward-based interventions to reduce self-harm and suicide risks in inpatient mental health settings

Background: Understanding what psychosocial interventions can reduce self-harm and suicide within inpatient mental health settings can be challenging, due to clinical demands and the large volume of published reviews.

Aims: To summarise evidence from systematic reviews on psychosocial and ward-level interventions (excluding environmental modifications), for self-harm and suicide that may enhance patient safety in inpatient mental health settings.

Methods: We systematically searched Medline, Embase, CINAHL, PsycINFO, and CDSR (2013- 2023) for systematic reviews on self-harm and suicide prevention interventions that included inpatient data. Review quality was assessed using AMSTAR-2, primary study overlap via an evidence matrix, and evidence strength evaluated (GRADE algorithm). Findings were narratively synthesised, with input from experts-by-experience throughout. [PROSPERO ID: CRD42023442639]

Results: Thirteen systematic reviews (7 meta-analyses, 6 narrative), comprising over 160,000 participants were identified. Based on quantitative reviews, CBT reduces repeat self-harm by follow-up, and DBT decreases the frequency of self-harm. Narrative review evidence suggested that post-discharge follow-up, system, and ward-based interventions (e.g., staff training) may reduce suicide and/or self-harm. However, review quality varied, patient involvement was lacking, and methodological quality of trials informing reviews was predominately low. Overlap was slight (Covered Area= 12.4%).

Conclusions: The effectiveness of interventions to prevent self-harm and suicide in inpatient settings remains uncertain due to variable quality reviews, evidence gaps, poor methodological quality of primary studies, and a lack of pragmatic trials and co-production. There is an urgent need for better, co-designed research within inpatient mental health settings.