Extrait

Background and study aims Economic recessions are usually characterised by rises in unemployment, debt and increased home repossession. They are also often accompanied by increases in the rate of of suicide and self-harm. Evidence of the impact of the 2008 global economic recession on suicide has been steadily growing, with studies showing that rates of suicide have increased, particularly amongst men and in countries and areas with the highest rises in unemployment. Many countries have responded to the recession with a series of austerity measures and there is population-level evidence of the negative impact of these on health and suicide rates in Europe. Data from an earlier stage of the study team’s National Institute of Heath Research (NIHR) funded research into the impact of the recent recession on self-harm and suicide in England, has highlighted that vulnerable individuals commonly experience difficulties navigating the benefits system and in accessing available sources of welfare and debt advice. This was especially the case for people with pre-existing mental health problems and whose self-harm was precipitated by financial, employment, benefits or housing problems arising from financial difficulties. There is very little information about suitable approaches to help people in this situation. The aim of this study is to conduct a small study looking at the effectiveness of a “navigator”-based program to help these people to navigate the benefits system to access available sources of welfare and debt advice, in order to see if a large scale study would be feasible. Who can participate? Adults who have self-armed or present to the hospital emergency department in acute distress in the context of financial, employment, benefits, and housing and associated problems arising from financial difficulties What does the study involve? Potentially eligible patients are identified and recruited by members of the liaison psychiatry team at the Bristol Royal Infirmary (BRI). If the patient agrees to contact with the researcher and navigator service, consent is taken by the clinician and patient details are then passed on to the researcher and HOPE Worker. Participants are then randomly allocated to one of two groups. Those in the first group receive one session with a HOPE worker assessing the participant’s economic and mental health needs, checking benefits entitlements and signposting to appropriate services, plus providing relevant written materials. Those in the second group receive up to six hour-long sessions with a HOPE worker assessing the participant’s economic and mental health needs, checking benefit entitlements and guiding and signposting to appropriate services. Maintaining contact with the participant, making telephone calls, opening correspondence, and attending appointments with the participant if necessary to ensure attendance. The HOPE worker provides practical support and use motivational interviewing techniques (a method which works on helping and encouraging a person to become motivated to change behaviour) in their work with the client. The aim of the service is to support clients through a period of acute distress to a level where the situation initiating their self-harm is resolved. At the end of the study, the number of participants who took part are recorded to find out if a larger study would be feasible. What are the possible benefits and risks of participating? Participants distressed due to financial difficulties (but not reaching the criteria for secondary mental health care) will be receiving a navigator service to help them access support that is not currently on offer. No matter which group they are allocated to they will benefit from receiving guidance and support to help them move out of the crisis that precipitated their hospital admission. The aim of the intervention is not just to move people on from their situation but to help them feel more confident about managing future financial, employment or benefit difficulties. Participants may not be happy about being allocated to the no-treatment group and not the enhanced service. To address this, people in this group will still be offered a signposting session; a service not currently available to people in their situation. Participants who receive the enhanced navigator service may find the support too intrusive and/or inconvenient. Participants will be reminded at every session that participation is entirely voluntary and they are able to withdraw at any point without prejudicing further treatment (outside of the study). The follow-up interview may cause distress by asking questions about the participants’ current or past situation. The research team has considerable experience of interviewing suicidal/distressed individuals have procedures to safeguard patient well-being Where is the study run from? Bristol Royal Infirmary (UK) When is the study starting and how long is it expected to run for? April 2015 to September 2017 Who is funding the study? National Institute for Health Research (UK) Who is the main contact? 1. Dr Maria Barnes (scientific) [email protected] 2. Professor David Gunnell (scientific) [email protected]

Critère d'inclusion

• Specialty: Mental Health, Primary sub-specialty: Study not assigned to a MH Clinical Studies Group; UKCRC code/ Disease: Mental Health/ Unspecified mental disorder

Liens

• isrctn