MR1135 - Manchester self-harm project - Mortality and suicide after self-harm- a cohort study

The University of Manchester (UoM) requires demographic and mortality data for use in the Manchester Self-Harm project (MaSH) and the Multicentre Study of Self-Harm in England. The core remit of these projects are to monitor self-harm presentations to general hospitals and to investigate associated risks, such as death by suicide. This work is funded directly by the Department of Health and Social Care, and feeds into the National Suicide Prevention Strategy for England.

The data will be processed under General Data Protection Regulation Article 6 (1) (e) “processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller” and General Data Protection Regulation Article 9 (2) (i) “processing is necessary for reasons of public interest in the area of public health, such as protecting against serious cross-border threats to health or ensuring high standards of quality and safety of health care and of medicinal products or medical devices, on the basis of Union or Member State law which provides for suitable and specific measures to safeguard the rights and freedoms of the data subject, in particular professional secrecy;)” The purposes under this Agreement explains this lawful basis is applicable because the University of Manchester’s work falls under public health and is classed as audit.

Additionally, for processing a special category of personal data (concerning health) for the Multicentre Study of Self-harm in England, the lawful basis is: General Data Protection Regulation Article 9 (2) (j) “processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject”.

The University of Manchester acknowledges there are moral and ethical issues raised by this proposed dissemination so therefore UoM will ensure safeguards are in place such as data security measures. These data are essential for informing health care provisions and allocation of resources in local and public health suicide prevention strategies. The Manchester Self-Harm Project has been collecting and processing sensitive identifiable data for 25 years, and operates to the highest standards of data security, as evidenced by section 251 approval, the published NHS data security and protection toolkit, project and system-level information and security management policies, as well as compliance with all local IG requirements.

The University of Manchester Information Governance office are aware of the work and available for support if/when required.

The civil registration mortality and demographics data from NHS England will enable the Project to establish risk of suicide following self-harm, identify sub-groups who are particularly at risk (of suicide and other causes of early mortality), and help healthcare services provision and direct resources to the most appropriate places to help reduce suicide in England, in line with the goals of the national Suicide Prevention Strategy.

The Manchester Self-Harm (MaSH) Project was established in 1997 as a stand-alone self-harm monitoring study. At the time, people who attended hospital for self-harm accounted for some of the highest rates of people being admitted to hospital beds in English NHS Trusts, and investigation of this group was of great interest. The original funding for this project came from local sources, including Manchester City Council, and four local acute NHS Trusts. The success of the study led to a number of extensions beyond the original funding period that enabled the study to continuously collect data on self-harm in the City of Manchester from 1997 onwards.

From April 2012 the Manchester Self-Harm Project has been funded directly from the Department of Health budget, under the umbrella of the Multicentre Study of Self-harm in England. However, the Manchester Self-Harm project continues to be a separate project with a separate identity and continues to audit self-harm in Manchester and to conduct studies and produce outputs focused on the Manchester-based cohort. The University of Manchester also collaborates with the other sites in the Multicentre Study.

Self-harm is a major public health problem, with in excess of 200,000 presentations to hospital emergency departments in England each year. As well as looking at changes in rates of self-harm over time; identifying sub-groups who are at high risk for self-harm, and looking at what type of care is the most effective for people who self-harm, an important part of the Manchester Self-Harm Project’s work is following-up people who presented to hospital emergency departments for self-harm to see what happened to them afterwards. Based on work conducted by the Manchester Self-Harm Project at the University of Manchester and by the Multicentre Study of Self-harm in England, there is evidence to show that self-harm is one of the strongest predictors of future completed suicide. People who attend hospital for self-harm are also around fifty times more likely to die by suicide than people in the general population. Self-harm is also associated with increased risk of dying early by any cause, including natural causes, with an average loss of around 20 to 30 years of life.

The Manchester Self-Harm Project follows up individuals who present to hospital with self-harm to find out what happens to them after they are discharged. It is important that the Manchester Self-Harm Project maintains access to mortality follow-up data in order to continue investigating patient outcome after self-harm, to track this data over time to identify increases/decreases in deaths after self-harm, and to identify any factors that could be useful in developing interventions to help reduce self-harm and prevent suicide.

The data subjects in the Manchester Self-Harm Project are individuals who presented to one of three general hospitals in the City of Manchester following self-harm.

The aims of the Manchester Self-Harm project are to monitor rates of suicide following self-harm in Manchester; to investigate risk factors pertinent to the local area, and to input directly into local clinical services and suicide prevention strategies. The Manchester Self-Harm Project can also look at how risk varies over time which allows identification of when risk of suicide might be at its highest for people who self-harm.

Mortality and demographic data is required to establish risk of suicide following self-harm. There is no alternative source for mortality data at the individual level, which is required for this work.

Furthermore, to be sure of exact matching and to avoid bias in the data, the University of Manchester need to be sure that individuals are being matched correctly (there is a particular issues with people who self-harm being members of vulnerable groups who do not always give consistent identities, spelling of names etc). Therefore, the University of Manchester require identifiable data, including confirmation of name and NHS number as well as the details of mortality e.g. date of death, ICD-10 cause codes and/or cause of death text.

As an ongoing follow-up study, updates are required for the whole cohort until an individual is excluded from follow-up e.g. by death or by notification of emigration.

Data has only been requested for individuals who attended hospitals in Manchester, however individuals may not be resident in Manchester, or may move to other locations over-time while follow-up is still ongoing.

Detailed mortality data is essential to meet the primary purposes of the Project. The majority of identifiable data returned e.g. name, NHS number, will be identical to the data submitted by the Project to initiate the link (the University of Manchester already hold the identifiable details of these individuals) and are only requested in return to ensure that linkage has been accurately undertaken, as this is essential for the validity of any subsequent analyses.

In 2022, UoM successfully applied for National Data Out-Out exemption from the Confidential Advisory Group which means the UoM will receive data on all eligible individuals regardless of whether they have expressed an National Data Out-Out. The approval was based on several factors

1. Patient safety – loss of data will reduce the ability to detect signals of concern to patient safety, and damage care for all individuals who present to hospital emergency departments for self-harm.

2. Introduction of bias – there are indications that the application of the National Data Opt Out is not random so impacts the integrity of the data, and will further exacerbate health inequalities, as the cohort is often a marginalised group.

3. Technical impacts – application of the NDO would generate additional workload for hospital teams, which may potentially harm good relationships with Trusts.

The Multicentre Study of Self-harm in England is a collaboration between three separate self-harm monitoring projects based in different areas of England (University of Oxford, the University of Manchester, and Derbyshire Healthcare NHS Foundation Trust), that conducts studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. By combining data on self-harm from different areas, the Multicentre Study of Self-harm in England provides more representative and reliable data on self-harm in England than could be achieved by each site individually. The Multicentre Study contributes to the National Suicide Prevention Strategy for England (2002, 2012, 2017, 2019), and prevention and service initiatives, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011, 2022).

Data for the study are collected in the three study sites (Oxford, Manchester, and Derbyshire) in five general hospitals; one in Oxford, three in Manchester and one in Derby. Over 10 collaborating researchers from the three study sites are part of the research group. The project also has input from service users.

The Multicentre Study programme of research includes 4 broad areas:

- Epidemiology and trends in self-harm

- Clinical management of self-harm

- Outcome of self-harm, including repetition and mortality

- Pharmaco-epidemiology, including drug toxicology and impacts of changes in prescribing legislation and trends

With regards to the Manchester Self-Harm Project, the University of Manchester is the sole controller, who also process the data, of the detailed and identifiable mortality data. No other organisation determines the purposes for which the data is processed.

With regards to the Multicentre Study of Self-Harm in England, the University of Manchester is the sole controller, who also process the data of the copy of the pseudonymised data they receive from the University of Oxford. The University of Manchester is the sole controller for the copies of pseudonymised data received from the other sites. The University of Manchester has full autonomy to determine the purposes for and the manner in which that data will be used without needing input or authorisation from the other sites. For example, a specific researcher at the University of Manchester will identify a purpose for analysing the data and will undertake the analysis. The findings may be shared with collaborators at other sites who may then have input into the writing of the paper for publication but at this point, the findings are aggregated and sufficiently derived from the data under this Agreement.

Each collaborator independently undertakes follow-up of individuals who present to hospital with self-harm in their respective areas. This involves receiving follow up data from NHS England under separate Data Sharing Agreements. These are Agreements ref: DARS-NIC-147907-MLK7R for Derbyshire Healthcare NHS Foundation Trust and ref: DARS-NIC-147957-4444C for the University of Oxford. For the purpose of the Multicentre Study of Self-harm in England, pseudonymised copies of their respective datasets are transferred to the University of Oxford. Amalgamated copies of the pseudonymised data for all three locations are then transferred to each collaborating organisation. The organisations then have autonomy to independently determine what analyses will be undertaken using their copies of the data and for what purposes, in support of the aims of the programme above.

All Data Sharing Agreements cover each organisation separately – meaning they are the sole controller who (solely) processes the data. This approach has been taken because (as opposed to naming the other stakeholders as processors in each Agreement):

The 1st stage of the request refers to each organisation’s localised processing – where they will process data for their own region’s purposes. This stage does not involve other organisations.

For the 2nd stage, once data has been amalgamated, it is then distributed back amongst each organisation. Each organisation will process this under their own sole data controllership (in addition to being the only organisation that will process).

As all DSAs effectively contain 2 different purposes (local + multi-centred national), NHS England and the Data Controllers determine that this method was the most appropriate as in no stage* would organisation A be a processor for organisation B.

*The only circumstance where this does happen is when Derbyshire Healthcare NHS Foundation Trust and the University Manchester send a pseudonymised extract to the University of Oxford. This is solely for the purpose of amalgamating and once complete is shared back amongst the organisations.

The Manchester Self-Harm Project and the Multicentre Study of Self-harm in England (including data from the monitoring systems for self-harm at University of Oxford and Derbyshire Healthcare NHS Foundation Trust) are ongoing projects.

Outputs from these projects are multiple. The aims of this study are to identify risk factors for specific causes of death (including suicide) in persons who present to hospital after self-harm and to investigate how specific aspects of in-hospital care relate to mortality following self-harm.

Specific outputs planned for the next 36 months (from late 2022 - v6) include :

A. Periodic reports and presentations:

Periodic reports to communicate progress and key findings to the Department of Health and Social Care (the study funding body) and the National Suicide Prevention Strategy for England Advisory Group will be produced.

B. Papers will be submitted for publication in peer reviewed journals on an ongoing basis over the next three years and will focus upon several areas, including:

i. Young people - Ongoing monitoring of self-harm trends and characteristics; Clustering

ii. Women in midlife - Trends, characteristics, subsequent mortality from suicide and other causes

iii. Multiple repetition of self-harm - characteristics of people who repeat self-harm on multiple occasions, antecedents, clinical management, patterns of repetition, and association with suicide risk

iv. Physical illness - Trends, characteristics, mortality in people who self-harm, including those with physical illness at the time of hospital presentation

* Findings are published on the website of the Multicentre Study of Self Harm (https://www.psych.ox.ac.uk/research/csr/ah–j - currently being updated) and on the Manchester Self-Harm Project Page anchesterter.ac.uk/mash ).

C. Other outputs include:

* Presentations of research findings at scientific meetings aimed at clinicians, researchers, patients and the public, and other stakeholders e.g. National Suicide Prevention Alliance national conferences; conferences of international suicide prevention organisations

* Presentations at meetings with clinical staff involved in delivering care for individuals who self-harm e.g. NHS Clinical team meetings (Liaison Psychiatry services), Local Suicide Prevention Strategy Groups

* Meetings with policy making and regulatory bodies such as the National Institute for Health and Care Excellence (NICE), Medicines and Healthcare products Regulatory Agency (MHRA), National Suicide Prevention Strategy working group.

* Locally, presentations to clinical staff involved in delivering care for individuals who self-harm in the local trust.

Level of Data

Data will be presented in an aggregate format with all small numbers suppressed within study outputs.

Dissemination and Communication

a) Dissemination of key findings

Study findings will be shared with stakeholders throughout the project. Dissemination will occur through scientific meetings (conferences and interest groups). Furthermore, key target audience for dissemination are policy makers and healthcare providers. Key findings and messages will be shared through presentations, lay summaries, websites and social media, clinical team newsletters and day-to-day informal conversations with clinical colleagues involved in mental health care delivery, emergency departments and suicide prevention strategy groups. Findings from these studies (three monitoring projects and the resulting combined data which form the Multicentre Study of Self-harm in England) have informed the development of NICE guidelines for self-harm, as well as local and national suicide prevention strategies.

Dissemination channels include: scientific journals, public reports, direct bilateral engagement using new and established relationships,

newsletters, and co-hosted events.

b) Communication of results/outputs

Regular and active communication activities are undertaken with clinicians and policy makers to ensure the study findings improve the provision of care for people who self-harm and the development of effective suicide prevention approaches. Due to the long-standing nature of the project and reputational status of the study leads, key findings and recommendations are regularly fed back to key groups through strong, well established communication channels. Findings

are also shared via more public forums, such as study websites, at National Suicide Prevention Alliance meetings and newsletters, and press releases.

c) Exploitation of results/outputs

The main aim of the study is monitoring self-harm rates over time, examining the link between self-harm and suicide, and identification of high-risk groups and areas for intervention in order to improve the understanding around and therefore clinical care for people who self-harm The funders, Department of Health and Social Care, play no role in conducting the research nor do they have access to the data. The University of Manchester owns its data. A collaboration contract is in place detailing ownership of the data and knowledge generated from the Multicentre study. All deliverables specified in the previous NHS England approval period have been realised. Annual reports have been made to the Department of Health and Social Care and papers have been published in/submitted to a number of peer reviewed journals on the areas of study previously specified:

1. Identifying overall risk factors for suicide and other specific causes of death following self-harm.

Geulayov, G., Casey, D., Bale, L., Brand, F., Clements, C., Farooq, B., ... & Hawton, K. (2019). Suicide following presentation

to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study. The Lancet

Psychiatry, 6(12), 1021-1030.

Clements, C., Farooq, B., Hawton, K., Geulayov, G., Casey, D., Waters, K., ... & Kapur, N. (2022). Self-harm in people

experiencing homelessness: investigation of incidence, characteristics and outcomes using data from the Multicentre Study.

2. Identifying risk factors for suicide and non-suicidal premature mortality in children and adolescents

Hawton, K., Bale, L., Brand, F., Townsend, E., Ness, J., Waters, K., ... & Geulayov, G. (2020). Mortality in children and

adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective

observational cohort study. The Lancet Child & Adolescent Health, 4(2), 111-120.

Geulayov, G., Casey, D., Bale, L., Brand, F., Townsend, E., Ness, J., ... & Hawton, K. (2022). Self-harm in children 12 years and

younger: characteristics and outcomes based on the Multicentre Study of Self-harm in England. Social psychiatry and

psychiatric epidemiology, 57(1), 139-148.

Farooq, B., Clements, C., Hawton, K., Geulayov, G., Casey, D., Waters, K., ... & Kapur, N. (2021). Self-harm in children and

adolescents by ethnic group: an observational cohort study from the Multicentre Study of Self-Harm in England. The Lancet

Child & Adolescent Health, 5(11), 782-791.

3. Specific method of self-harm as a risk for suicide and premature death

Geulayov, G., Casey, D., Bale, E., Brand, F., Clements, C., Farooq, B., ... & Hawton, K. (2021). Risk of suicide in patients who

present to hospital after self-cutting according to site of injury: findings from the Multicentre Study of Self-harm in England.

Psychological medicine, 1-9.

4. Epidemiology of paracetamol poisoning and risk of death by suicide.

Casey, D., Geulayov, G., Bale, E., Brand, F., Clements, C., Kapur, N., ... & Hawton, K. (2020). Paracetamol self-poisoning:

epidemiological study of trends and patient characteristics from the multicentre study of self-harm in England. Journal of

affective disorders, 276, 699-706.

Studies conducted are relevant to local and national services and policies on self-harm and suicide prevention and to the treatment of self-harm.

Data from the Manchester Self-Harm Project which are linked to information about mortality (supplied by NHS England) contribute to the Multicentre Study of Self-harm in England. Studies using data from the Multicentre Study of Self-harm have been used to inform clinical services and policies which are aimed at preventing self-harm and suicide.

More recently UoM have identified clinically important risk factors for suicide and premature mortality following self-harm. For example, UoM have found that the risk of suicide after self-harm is at its highest closer to the hospital visit. In fact, UoM have shown that the first month is especially risky, highlighting the importance of prompt and early intervention. UoM have also shown that, in patients who present to hospital following self-cutting, certain sites of cutting are related to heightened risk of subsequent death by suicide. This finding underscores the importance of assessing all patients who self-harm regardless of the methods they use, a recommendation which is endorsed by NICE.

In children and adolescents, the UoM have shown that risk of future suicide is strongest in boys, in those with multiple episodes of previous self-harm and where certain methods of self-harm have been used. In adults, the UoM have found a particularly high risk of suicide in people who have a history of multiple episodes of self-harm. UoM have also explored the relationship between clinical management of self-harm and subsequent suicide, enabling the UoM to demonstrate that the receipt of a psychosocial assessment whilst in hospital significantly reduces the risk of further self-harm. This is a very important finding that now underpins national policy and strategy on suicide e.g. NICE Guidelines for the Management of Self-harm.

The University of Manchester wishes to retain previously disseminated demographic and mortality data for use in the Manchester Self-Harm project (MaSH) and the Multicentre Study of Self-Harm in England. The core remit of these projects are to monitor self-harm presentations to general hospitals and to investigate associated risks, such as death by suicide. This work is funded directly by the Department of Health, and feeds into the National Suicide Prevention Strategy for England. Funding from the Department of Health has now expired, but is in the process of being renewed, the University of Manchester wish to temporarily extend this Agreement while renewed funding is obtained.

The data will be processed under General Data Protection Regulation Article 6 (1) (e) “processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller” and General Data Protection Regulation Article 9 (2) (j) “processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject”. There are minimal moral or ethical issues raised by the proposed dissemination, and no potential harm to the public. These data are essential for informing health care provisions and allocation of resources in local and public health suicide prevention strategies.

The civil registration mortality and demographics data from NHS Digital will enable the Project to establish risk of suicide following self-harm, identify sub-groups who are particularly at risk (of suicide and other causes of early mortality), and help healthcare services provision and direct resources to the most appropriate places to help reduce suicide in England, in line with the goals of the national Suicide Prevention Strategy.

The Manchester Self-Harm (MaSH) Project was established in 1997 as a stand-alone self-harm monitoring study. At the time, people who attended hospital for self-harm accounted for some of the highest rates of people being admitted to hospital beds in English NHS Trusts, and investigation of this group was of great interest. The original funding for this project came from local sources, including Manchester City Council, and four local acute NHS Trusts. The success of the study led to a number of extensions beyond the original funding period that enabled the study to continuously collect data on self-harm in the City of Manchester from 1997 onwards.

From April 2012 the Manchester Self-Harm Project has been funded directly from the Department of Health budget, under the umbrella of the Multicentre Study of Self-harm in England. However, the Manchester Self-Harm project continues to be a separate project with a separate identity and continues to audit self-harm in Manchester and to conduct studies and produce outputs focused on the Manchester-based cohort. The University of Manchester also collaborates with the other sites in the Multicentre Study.

Self-harm is a major public health problem, with in excess of 200,000 presentations to hospital emergency departments in England each year. As well as looking at changes in rates of self-harm over time; identifying sub-groups who are at high risk for self-harm, and looking at what type of care is the most effective for people who self-harm, an important part of the Manchester Self-Harm Project's work is following-up people who presented to hospital emergency departments for self-harm to see what happened to them afterwards. Based on work conducted by the Manchester Self-Harm Project at the University of Manchester and by the Multicentre Study of Self-harm in England, there is evidence to show that self-harm is one of the strongest predictors of future completed suicide. People who attend hospital for self-harm are also around fifty times more likely to die by suicide than people in the general population. Self-harm is also associated with increased risk of dying early by any cause, including natural causes, with an average loss of around 20 to 30 years of life.

The Manchester Self-Harm Project follows up individuals who present to hospital with self-harm to find out what happens to them after they are discharged. It is important that the Manchester Self-Harm Project maintains access to mortality follow-up data in order to continue investigating patient outcome after self-harm, to track this data over time to identify increases/decreases in deaths after self-harm, and to identify any factors that could be useful in developing interventions to help reduce self-harm and prevent suicide.

The data subjects in the Manchester Self-Harm Project are individuals who presented to one of three general hospitals in the City of Manchester following self-harm.

The aims of the Manchester Self-Harm project are to monitor rates of suicide following self-harm in Manchester; to investigate risk factors pertinent to the local area, and to input directly into local clinical services and suicide prevention strategies. The Manchester Self-Harm Project can also look at how risk varies over time which allows identification of when risk of suicide might be at its highest for people who self-harm.

Mortality and demographic data is required to establish risk of suicide following self-harm. There is not alternative source for mortality data at the individual level, which is required for this work.

Furthermore, to be sure of exact matching and to avoid bias in the data, the University of Manchester need to be sure that individuals are being matched correctly (there is a particular issues with people who self-harm being members of vulnerable groups who do not always give consistent identities, spelling of names etc). Therefore, the University of Manchester require identifiable data, including confirmation of name and NHS number as well as the details of mortality e.g. date of death, ICD-10 cause codes and/or cause of death text.

As an ongoing follow-up study, updates are required for the whole cohort until an individual is excluded from follow-up e.g. by death or by notification of emigration.

Data has only been requested for individuals who attended hospitals in Manchester, however individuals may not be resident in Manchester, or may move to other locations over-time while follow-up is still ongoing.

Detailed mortality data is essential to meet the primary purposes of the Project. The majority of identifiable data returned e.g. name, NHS number, will be identical to the data submitted by the Project to initiate the link (the University of Manchester already hold the identifiable details of these individuals) and are only requested in return to ensure that linkage has been accurately undertaken, as this is essential for the validity of any subsequent analyses.

The Multicentre Study of Self-harm in England is a collaboration between three separate self-harm monitoring projects based in different areas of England (University of Oxford, the University of Manchester, and Derbyshire Healthcare NHS Foundation Trust), that conducts studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. By combining data on self-harm from different areas, the Multicentre Study of Self-harm in England provides more representative and reliable data on self-harm in England than could be achieved by each site individually. The Multicentre Study contributes to the National Suicide Prevention Strategy for England (2002, 2012), and prevention and service initiatives, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011).

Data for the study are collected in the three study sites (Oxford, Manchester, and Derby) in five general hospitals; one in Oxford, three in Manchester and one in Derby. Over 10 collaborating researchers from the three study sites are part of the research group. The project also has input from service users.

The Multicentre Study programme of research includes 4 broad areas:

- Epidemiology and trends in self-harm

- Clinical management of self-harm

- Outcome of self-harm, including repetition and mortality

- Pharmaco-epidemiology, including drug toxicology and impacts of changes in prescribing legislation and trends

With regards to the Manchester Self-Harm Project, the University of Manchester is the sole data controller, who also process the data, of the detailed and identifiable mortality data. No other organisation determines the purposes for which the data is processed.

With regards to the Multicentre Study of Self-Harm in England, the University of Manchester is the sole data controller, who also process the data of the copy of the pseudonymised data they receive from the University of Oxford. The University of Manchester is the sole data controller for the copies of pseudonymised data received from the other sites. The University of Manchester has full autonomy to determine the purposes for and the manner in which that data will be used without needing input or authorisation from the other sites. For example, a specific researcher at the University of Manchester will identify a purpose for analysing the data and will undertake the analysis. The findings may be shared with collaborators at other sites who may then have input into the writing of the paper for publication but at this point, the findings are aggregated and sufficiently derived from the data under this Agreement.

Each collaborator independently undertakes follow-up of individuals who present to hospital with self-harm in their respective areas. This involves receiving follow up data from NHS Digital under separate Data Sharing Agreements. These are Agreements ref: DARS-NIC-147907-MLK7R for Derbyshire Healthcare NHS Foundation Trust and ref: DARS-NIC-147957-4444C for the University of Oxford. For the purpose of the Multicentre Study of Self-harm in England, pseudonymised copies of their respective datasets are transferred to the University of Oxford. Amalgamated copies of the pseudonymised data for all three locations are then transferred to each collaborating organisation. The organisations then have autonomy to independently determine what analyses will be undertaken using their copies of the data and for what purposes, in support of the aims of the programme above.

For the Manchester Self-Harm Project, outputs include:

- Biennial reports

- Ad hoc reports

- Infographics summarising data for a lay audience

- Peer reviewed publications

- Newsletters reporting news, collaborations and publications

- Conference presentations

The latest data from NHS Digital will be used to investigate mortality as an outcome following self-harm, risk factors for suicide after self-harm and periods of high risk for suicide after self-harm. The findings will be reported in the formats above as appropriate.

All outputs including lay summaries of publications are accessible on the MaSH Project webpages on the University of Manchester’s website: http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/MaSH/projects/.

MaSH findings are:

- presented to the ED Medics in order to help them better assess and manage risk of further self-harm and suicide;

- presented to the clinical governance teams in order that they can best assess the service needs of patients who self-harm;

- inputs into local guidance and guidelines on self-harm to local service providers (e.g. Greater Manchester Mental Health Trust, Manchester City Council).

The Manchester Self-Harm Project has a strong history of publications in multiple high impact factor peer-reviewed journals (psychiatry, medicine, and epidemiology) based on the self-harm data and the linked data provided by NHS Digital. The Manchester Self-Harm Project participates in conferences and events locally, nationally and internationally. The Manchester Self-Harm Project regularly runs exhibition stalls at local health/mental health events where project staff engage patients and public in the work. The Manchester Self-Harm Project webpages on the University of Manchester website, maintain links to all publications (many freely available via open access) and copies of the reports are available at manchester.ac.uk/mash and via the Multicentre Study website (http://cebmh.warne.ox.ac.uk/csr/mcm/). Studies are on-going, and the Manchester Self-Harm Project has a reasonable expectation that it will continue to publish high quality work alone, and as part of the Multicentre Study of Self-harm in England that includes analyses of mortality data received from NHS Digital.

Some of the important studies currently being undertaken by the Multicentre Study group include studies of the financial cost of self-harm and suicide, self-harm in midlife, self-harm and homelessness, life problems that precipitate self-harm in children and adolescents and an exploration of the ratios of community self-harm to hospital presenting self-harm, to suicide in children and adolescents. The University of Manchester expects these studies to be completed within 12 months.

Details of publications by the Multicentre Study are published on the Multicentre Study website: http://cebmh.warne.ox.ac.uk/csr/mcm/index.html

The data from NHS Digital Data contained in outputs is anonymous and aggregated with small numbers suppression applied. All outputs will not contain anything that could potentially re-identify individuals.

As a long-running project (20+ years) the University of Manchester’s dissemination and communication routes are well developed, and will continue to be used for work that uses mortality data.

The dissemination and communication activities above target a wide range of audiences including academics, researchers, clinicians, patients, policy makers, charitable organisations and more. The Project have an email distribution list that is regularly used to disseminate new outputs, as well as posting to social media via the MaSH twitter account (@mashproject). Both Manchester-based reports and Multicentre reports are freely available online, along with links to published papers, many of which are open access. The University of Manchester regularly present this work at conferences as well as free events, and operate information stalls.

There are targets in place with the MaSH funders (Department of Health) for the completion of particular work items by the end of the current funding period (March 2021). These include the financial cost of self-harm and suicide (submitted for publication), self-harm in midlife (now published doi: https://doi.org/10.1192/bjp.2019.90), self-harm and homelessness, life problems that precipitate self-harm in children and adolescents.

Data contributed to the Multicentre Study of Self-harm has resulted in multiple annual reports to the Department of Health, multiple empirical studies published in scientific journals and presented at international conferences. Such published findings inform Department of Health policies e.g. the Suicide Prevention Strategy for England (2002, 2012, 2017) and NICE guidelines for the management of self-harm (2004, 2011) and suicide prevention (2018). Therefore, this work has a direct impact on health.

The inclusion of additional mortality data in the current work programme allows for the important areas of suicide following self-harm to be examined, as well as any other common causes of premature death following self-harm to be identified. This may be particularly important for specific subgroups, such as men in midlife – who have the highest rates of suicide.

The University of Manchester requires demographic and mortality data for use in the Manchester Self-Harm project (MaSH) and the Multicentre Study of Self-Harm in England. The core remit of these projects are to monitor self-harm presentations to general hospitals and to investigate associated risks, such as death by suicide. This work is funded directly by the Department of Health, and feeds into the National Suicide Prevention Strategy for England.

The data will be processed under General Data Protection Regulation Article 6 (1) (e) “processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller” and General Data Protection Regulation Article 9 (2) (j) “processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject”. There are minimal moral or ethical issues raised by the proposed dissemination, and no potential harm to the public. These data are essential for informing health care provisions and allocation of resources in local and public health suicide prevention strategies.

The civil registration mortality data from NHS Digital will enable the Project to establish risk of suicide following self-harm, identify sub-groups who are particularly at risk (of suicide and other causes of early mortality), and help healthcare services provision and direct resources to the most appropriate places to help reduce suicide in England, in line with the goals of the national Suicide Prevention Strategy.

The Manchester Self-Harm (MaSH) Project was established in 1997 as a stand-alone self-harm monitoring study. At the time, people who attended hospital for self-harm accounted for some of the highest rates of people being admitted to hospital beds in English NHS Trusts, and investigation of this group was of great interest. The original funding for this project came from local sources, including Manchester City Council, and four local acute NHS Trusts. The success of the study led to a number of extensions beyond the original funding period that enabled the study to continuously collect data on self-harm in the City of Manchester from 1997 onwards.

From April 2012 the Manchester Self-Harm Project has been funded directly from the Department of Health budget, under the umbrella of the Multicentre Study of Self-harm in England. However, the Manchester Self-Harm project continues to be a separate project with a separate identity and continues to audit self-harm in Manchester and to conduct studies and produce outputs focused on the Manchester-based cohort. The University of Manchester also collaborates with the other sites in the Multicentre Study.

Self-harm is a major public health problem, with in excess of 200,000 presentations to hospital emergency departments in England each year. As well as looking at changes in rates of self-harm over time; identifying sub-groups who are at high risk for self-harm, and looking at what type of care is the most effective for people who self-harm, an important part of the Manchester Self-Harm Project's work is following-up people who presented to hospital emergency departments for self-harm to see what happened to them afterwards. Based on work conducted by the Manchester Self-Harm Project at the University of Manchester and by the Multicentre Study of Self-harm in England, there is evidence to show that self-harm is one of the strongest predictors of future completed suicide. People who attend hospital for self-harm are also around fifty times more likely to die by suicide than people in the general population. Self-harm is also associated with increased risk of dying early by any cause, including natural causes, with an average loss of around 20 to 30 years of life.

The Manchester Self-Harm Project follows up individuals who present to hospital with self-harm to find out what happens to them after they are discharged. It is important that the Manchester Self-Harm Project maintains access to mortality follow-up data in order to continue investigating patient outcome after self-harm, to track this data over time to identify increases/decreases in deaths after self-harm, and to identify any factors that could be useful in developing interventions to help reduce self-harm and prevent suicide.

The data subjects in the Manchester Self-Harm Project are individuals who presented to one of three general hospitals in the City of Manchester following self-harm. Each individual appears only once in the mortality cohort e.g. the first presentation by each individual is identified, and new individuals who appear in the database each year are added to the main morality cohort. Under this agreement, individuals meeting this criteria during 2000 to 2016 are flagged by NHS Digital. The University of Manchester hold approximately 25,500 individuals that were presented to one of the 3 Manchester hospitals during the 2000 to 2016 period.

The aims of the Manchester Self-Harm project are to monitor rates of suicide following self-harm in Manchester; to investigate risk factors pertinent to the local area, and to input directly into local clinical services and suicide prevention strategies. The Manchester Self-Harm Project can also look at how risk varies over time which allows identification of when risk of suicide might be at its highest for people who self-harm.

Mortality data is required to establish risk of suicide following self-harm. There is not alternative source for mortality data at the individual level, which is required for this work.

Furthermore, to be sure of exact matching and to avoid bias in the data, the University of Manchester need to be sure that individuals are being matched correctly (there is a particular issues with people who self-harm being members of vulnerable groups who do not always give consistent identities, spelling of names etc). Therefore the University of Manchester require confirmation of name and NHS number as well as the details of mortality e.g. date of death, ICD-10 cause codes and/or cause of death text.

As an ongoing follow-up study, updates are required for the whole cohort until an individual is excluded from follow-up e.g. by death or by notification of emigration. Updates are required for the full cohort at least annually.

Data is only requested for individuals who attended hospitals in Manchester, however individuals may not be resident in Manchester, or may move to other locations over-time while follow-up is still ongoing.

Detailed mortality data is essential to meet the primary purposes of the Project. The majority of identifiable data returned e.g. name, NHS number, will be identical to the data submitted by the Project to initiate the link (the University of Manchester already hold the identifiable details of these individuals) and are only requested in return to ensure that linkage has been accurately undertaken, as this is essential for the validity of any subsequent analyses.

The Multicentre Study of Self-harm in England is a collaboration between three separate self-harm monitoring projects based in different areas of England (University of Oxford, the University of Manchester, and Derbyshire Healthcare NHS Foundation Trust), that conducts studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. By combining data on self-harm from different areas, the Multicentre Study of Self-harm in England provides more representative and reliable data on self-harm in England than could be achieved by each site individually. The Multicentre Study contributes to the National Suicide Prevention Strategy for England (2002, 2012), and prevention and service initiatives, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011).

Data for the study are collected in the three study sites (Oxford, Manchester, and Derby) in five general hospitals; one in Oxford, three in Manchester and one in Derby. Over 10 collaborating researchers from the three study sites are part of the research group. The project also has input from service users.

The Multicentre Study programme of research includes 4 broad areas:

- Epidemiology and trends in self-harm

- Clinical management of self-harm

- Outcome of self-harm, including repetition and mortality

- Pharmaco-epidemiology, including drug toxicology and impacts of changes in prescribing legislation and trends

With regards to the Manchester Self-Harm Project, the University of Manchester is the sole data controller, who also process the data, of the detailed and identifiable mortality data. No other organisation determines the purposes for which the data is processed.

With regards to the Multicentre Study of Self-Harm in England, the University of Manchester is the sole data controller, who also process the data of the copy of the pseudonymised data they receive from the University of Oxford. The University of Manchester is the sole data controller for the copies of pseudonymised data received from the other sites. The University of Manchester has full autonomy to determine the purposes for and the manner in which that data will be used without needing input or authorisation from the other sites. For example, a specific researcher at the University of Manchester will identify a purpose for analysing the data and will undertake the analysis. The findings may be shared with collaborators at other sites who may then have input into the writing of the paper for publication but at this point, the findings are aggregated and sufficiently derived from the data under this Agreement.

Each collaborator independently undertakes follow-up of individuals who present to hospital with self-harm in their respective areas. This involves receiving follow up data from NHS Digital under separate Data Sharing Agreements. These are Agreements ref: DARS-NIC-147907-MLK7R for Derbyshire Healthcare NHS Foundation Trust and ref: DARS-NIC-147957-4444C for the University of Oxford. For the purpose of the Multicentre Study of Self-harm in England, pseudonymised copies of their respective datasets are transferred to the University of Oxford. Amalgamated copies of the pseudonymised data for all three locations are then transferred to each collaborating organisation. The organisations then have autonomy to independently determine what analyses will be undertaken using their copies of the data and for what purposes, in support of the aims of the programme above.

For the Manchester Self-Harm Project, outputs include:

- Biennial reports

- Ad hoc reports

- Infographics summarising data for a lay audience

- Peer reviewed publications

- Newsletters reporting news, collaborations and publications

- Conference presentations

The latest data from NHS Digital will be used to investigate mortality as an outcome following self-harm, risk factors for suicide after self-harm and periods of high risk for suicide after self-harm. The findings will be reported in the formats above as appropriate.

All outputs including lay summaries of publications are accessible on the MaSH Project webpages on the University of Manchester’s website: http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/MaSH/projects/.

MaSH findings are:

- presented to the ED Medics in order to help them better assess and manage risk of further self-harm and suicide;

- presented to the clinical governance teams in order that they can best assess the service needs of patients who self-harm;

- inputs into local guidance and guidelines on self-harm to local service providers (e.g. Greater Manchester Mental Health Trust, Manchester City Council).

The Manchester Self-Harm Project has a strong history of publications in multiple high impact factor peer-reviewed journals (psychiatry, medicine, and epidemiology) based on the self-harm data and the linked data provided by NHS Digital. The Manchester Self-Harm Project participates in conferences and events locally, nationally and internationally. The Manchester Self-Harm Project regularly runs exhibition stalls at local health/mental health events where project staff engage patients and public in the work. The Manchester Self-Harm Project webpages on the University of Manchester website, maintain links to all publications (many freely available via open access) and copies of the reports are available at manchester.ac.uk/mash and via the Multicentre Study website (http://cebmh.warne.ox.ac.uk/csr/mcm/). Studies are on-going, and the Manchester Self-Harm Project has a reasonable expectation that it will continue to publish high quality work alone, and as part of the Multicentre Study of Self-harm in England that includes analyses of mortality data received from NHS Digital.

Some of the important studies currently being undertaken by the Multicentre Study group include studies of the financial cost of self-harm and suicide, self-harm in midlife, self-harm and homelessness, life problems that precipitate self-harm in children and adolescents and an exploration of the ratios of community self-harm to hospital presenting self-harm, to suicide in children and adolescents. The University of Manchester expects these studies to be completed within 12 months.

Details of publications by the Multicentre Study are published on the Multicentre Study website: http://cebmh.warne.ox.ac.uk/csr/mcm/index.html

The data from NHS Digital Data contained in outputs is anonymous and aggregated with small numbers suppression applied. All outputs will not contain anything that could potentially re-identify individuals.

As a long-running project (20+ years) the University of Manchester’s dissemination and communication routes are well developed, and will continue to be used for work that uses mortality data.

The dissemination and communication activities above target a wide range of audiences including academics, researchers, clinicians, patients, policy makers, charitable organisations and more. The Project have an email distribution list that is regularly used to disseminate new outputs, as well as posting to social media via the MaSH twitter account (@mashproject). Both Manchester-based reports and Multicentre reports are freely available online, along with links to published papers, many of which are open access. The University of Manchester regularly present this work at conferences as well as free events, and operate information stalls.

There are targets in place with the MaSH funders (Department of Health) for the completion of particular work items by the end of the current funding period (March 2021). These include the financial cost of self-harm and suicide (submitted for publication), self-harm in midlife (now published doi: https://doi.org/10.1192/bjp.2019.90), self-harm and homelessness, life problems that precipitate self-harm in children and adolescents.

Data contributed to the Multicentre Study of Self-harm has resulted in multiple annual reports to the Department of Health, multiple empirical studies published in scientific journals and presented at international conferences. Such published findings inform Department of Health policies e.g. the Suicide Prevention Strategy for England (2002, 2012, 2017) and NICE guidelines for the management of self-harm (2004, 2011) and suicide prevention (2018). Therefore, this work has a direct impact on health.

The inclusion of additional mortality data in the current work programme allows for the important areas of suicide following self-harm to be examined, as well as any other common causes of premature death following self-harm to be identified. This may be particularly important for specific subgroups, such as men in midlife – who have the highest rates of suicide.

The University of Manchester requires demographic and mortality data for use in the Manchester Self-Harm project (MaSH) and the Multicentre Study of Self-Harm in England. The core remit of these projects are to monitor self-harm presentations to general hospitals and to investigate associated risks, such as death by suicide. This work is funded directly by the Department of Health, and feeds into the National Suicide Prevention Strategy for England.

The data will be processed under General Data Protection Regulation Article 6 (1) (e) “processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller” and General Data Protection Regulation Article 9 (2) (j) “processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member State law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and the interests of the data subject”. There are minimal moral or ethical issues raised by the proposed dissemination, and no potential harm to the public. These data are essential for informing health care provisions and allocation of resources in local and public health suicide prevention strategies.

The civil registration mortality data from NHS Digital will enable the Project to establish risk of suicide following self-harm, identify sub-groups who are particularly at risk (of suicide and other causes of early mortality), and help healthcare services provision and direct resources to the most appropriate places to help reduce suicide in England, in line with the goals of the national Suicide Prevention Strategy.

The Manchester Self-Harm (MaSH) Project was established in 1997 as a stand-alone self-harm monitoring study. At the time, people who attended hospital for self-harm accounted for some of the highest rates of people being admitted to hospital beds in English NHS Trusts, and investigation of this group was of great interest. The original funding for this project came from local sources, including Manchester City Council, and four local acute NHS Trusts. The success of the study led to a number of extensions beyond the original funding period that enabled the study to continuously collect data on self-harm in the City of Manchester from 1997 onwards.

From April 2012 the Manchester Self-Harm Project has been funded directly from the Department of Health budget, under the umbrella of the Multicentre Study of Self-harm in England. However, the Manchester Self-Harm project continues to be a separate project with a separate identity and continues to audit self-harm in Manchester and to conduct studies and produce outputs focused on the Manchester-based cohort. The University of Manchester also collaborates with the other sites in the Multicentre Study.

Self-harm is a major public health problem, with in excess of 200,000 presentations to hospital emergency departments in England each year. As well as looking at changes in rates of self-harm over time; identifying sub-groups who are at high risk for self-harm, and looking at what type of care is the most effective for people who self-harm, an important part of the Manchester Self-Harm Project's work is following-up people who presented to hospital emergency departments for self-harm to see what happened to them afterwards. Based on work conducted by the Manchester Self-Harm Project at the University of Manchester and by the Multicentre Study of Self-harm in England, there is evidence to show that self-harm is one of the strongest predictors of future completed suicide. People who attend hospital for self-harm are also around fifty times more likely to die by suicide than people in the general population. Self-harm is also associated with increased risk of dying early by any cause, including natural causes, with an average loss of around 20 to 30 years of life.

The Manchester Self-Harm Project follows up individuals who present to hospital with self-harm to find out what happens to them after they are discharged. It is important that the Manchester Self-Harm Project maintains access to mortality follow-up data in order to continue investigating patient outcome after self-harm, to track this data over time to identify increases/decreases in deaths after self-harm, and to identify any factors that could be useful in developing interventions to help reduce self-harm and prevent suicide.

The data subjects in the Manchester Self-Harm Project are individuals who presented to one of three general hospitals in the City of Manchester following self-harm. Each individual appears only once in the mortality cohort e.g. the first presentation by each individual is identified, and new individuals who appear in the database each year are added to the main morality cohort. Under this agreement, individuals meeting this criteria during 2000 to 2016 are flagged by NHS Digital. The University of Manchester hold approximately 25,500 individuals that were presented to one of the 3 Manchester hospitals during the 2000 to 2016 period.

The aims of the Manchester Self-Harm project are to monitor rates of suicide following self-harm in Manchester; to investigate risk factors pertinent to the local area, and to input directly into local clinical services and suicide prevention strategies. The Manchester Self-Harm Project can also look at how risk varies over time which allows identification of when risk of suicide might be at its highest for people who self-harm.

Mortality data is required to establish risk of suicide following self-harm. There is not alternative source for mortality data at the individual level, which is required for this work.

Furthermore, to be sure of exact matching and to avoid bias in the data, the University of Manchester need to be sure that individuals are being matched correctly (there is a particular issues with people who self-harm being members of vulnerable groups who do not always give consistent identities, spelling of names etc). Therefore the University of Manchester require confirmation of name and NHS number as well as the details of mortality e.g. date of death, ICD-10 cause codes and/or cause of death text.

As an ongoing follow-up study, updates are required for the whole cohort until an individual is excluded from follow-up e.g. by death or by notification of emigration. Updates are required for the full cohort at least annually.

Data is only requested for individuals who attended hospitals in Manchester, however individuals may not be resident in Manchester, or may move to other locations over-time while follow-up is still ongoing.

Detailed mortality data is essential to meet the primary purposes of the Project. The majority of identifiable data returned e.g. name, NHS number, will be identical to the data submitted by the Project to initiate the link (the University of Manchester already hold the identifiable details of these individuals) and are only requested in return to ensure that linkage has been accurately undertaken, as this is essential for the validity of any subsequent analyses.

The Multicentre Study of Self-harm in England is a collaboration between three separate self-harm monitoring projects based in different areas of England (University of Oxford, the University of Manchester, and Derbyshire Healthcare NHS Foundation Trust), that conducts studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. By combining data on self-harm from different areas, the Multicentre Study of Self-harm in England provides more representative and reliable data on self-harm in England than could be achieved by each site individually. The Multicentre Study contributes to the National Suicide Prevention Strategy for England (2002, 2012), and prevention and service initiatives, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011).

Data for the study are collected in the three study sites (Oxford, Manchester, and Derby) in five general hospitals; one in Oxford, three in Manchester and one in Derby. Over 10 collaborating researchers from the three study sites are part of the research group. The project also has input from service users.

The Multicentre Study programme of research includes 4 broad areas:

- Epidemiology and trends in self-harm

- Clinical management of self-harm

- Outcome of self-harm, including repetition and mortality

- Pharmaco-epidemiology, including drug toxicology and impacts of changes in prescribing legislation and trends

With regards to the Manchester Self-Harm Project, the University of Manchester is the sole data controller, who also process the data, of the detailed and identifiable mortality data. No other organisation determines the purposes for which the data is processed.

With regards to the Multicentre Study of Self-Harm in England, the University of Manchester is the sole data controller, who also process the data of the copy of the pseudonymised data they receive from the University of Oxford. The University of Manchester is the sole data controller for the copies of pseudonymised data received from the other sites. The University of Manchester has full autonomy to determine the purposes for and the manner in which that data will be used without needing input or authorisation from the other sites. For example, a specific researcher at the University of Manchester will identify a purpose for analysing the data and will undertake the analysis. The findings may be shared with collaborators at other sites who may then have input into the writing of the paper for publication but at this point, the findings are aggregated and sufficiently derived from the data under this Agreement.

Each collaborator independently undertakes follow-up of individuals who present to hospital with self-harm in their respective areas. This involves receiving follow up data from NHS Digital under separate Data Sharing Agreements. These are Agreements ref: DARS-NIC-147907-MLK7R for Derbyshire Healthcare NHS Foundation Trust and ref: DARS-NIC-147957-4444C for the University of Oxford. For the purpose of the Multicentre Study of Self-harm in England, pseudonymised copies of their respective datasets are transferred to the University of Oxford. Amalgamated copies of the pseudonymised data for all three locations are then transferred to each collaborating organisation. The organisations then have autonomy to independently determine what analyses will be undertaken using their copies of the data and for what purposes, in support of the aims of the programme above.

For the Manchester Self-Harm Project, outputs include:

- Biennial reports

- Ad hoc reports

- Infographics summarising data for a lay audience

- Peer reviewed publications

- Newsletters reporting news, collaborations and publications

- Conference presentations

The latest data from NHS Digital will be used to investigate mortality as an outcome following self-harm, risk factors for suicide after self-harm and periods of high risk for suicide after self-harm. The findings will be reported in the formats above as appropriate.

All outputs including lay summaries of publications are accessible on the MaSH Project webpages on the University of Manchester’s website: http://research.bmh.manchester.ac.uk/cmhs/research/centreforsuicideprevention/MaSH/projects/.

MaSH findings are:

- presented to the ED Medics in order to help them better assess and manage risk of further self-harm and suicide;

- presented to the clinical governance teams in order that they can best assess the service needs of patients who self-harm;

- inputs into local guidance and guidelines on self-harm to local service providers (e.g. Greater Manchester Mental Health Trust, Manchester City Council).

The Manchester Self-Harm Project has a strong history of publications in multiple high impact factor peer-reviewed journals (psychiatry, medicine, and epidemiology) based on the self-harm data and the linked data provided by NHS Digital. The Manchester Self-Harm Project participates in conferences and events locally, nationally and internationally. The Manchester Self-Harm Project regularly runs exhibition stalls at local health/mental health events where project staff engage patients and public in the work. The Manchester Self-Harm Project webpages on the University of Manchester website, maintain links to all publications (many freely available via open access) and copies of the reports are available at manchester.ac.uk/mash and via the Multicentre Study website (http://cebmh.warne.ox.ac.uk/csr/mcm/). Studies are on-going, and the Manchester Self-Harm Project has a reasonable expectation that it will continue to publish high quality work alone, and as part of the Multicentre Study of Self-harm in England that includes analyses of mortality data received from NHS Digital.

Some of the important studies currently being undertaken by the Multicentre Study group include studies of the financial cost of self-harm and suicide, self-harm in midlife, self-harm and homelessness, life problems that precipitate self-harm in children and adolescents and an exploration of the ratios of community self-harm to hospital presenting self-harm, to suicide in children and adolescents. The University of Manchester expects these studies to be completed within 12 months.

Details of publications by the Multicentre Study are published on the Multicentre Study website: http://cebmh.warne.ox.ac.uk/csr/mcm/index.html

The data from NHS Digital Data contained in outputs is anonymous and aggregated with small numbers suppression applied. All outputs will not contain anything that could potentially re-identify individuals.

As a long-running project (20+ years) the University of Manchester’s dissemination and communication routes are well developed, and will continue to be used for work that uses mortality data.

The dissemination and communication activities above target a wide range of audiences including academics, researchers, clinicians, patients, policy makers, charitable organisations and more. The Project have an email distribution list that is regularly used to disseminate new outputs, as well as posting to social media via the MaSH twitter account (@mashproject). Both Manchester-based reports and Multicentre reports are freely available online, along with links to published papers, many of which are open access. The University of Manchester regularly present this work at conferences as well as free events, and operate information stalls.

There are targets in place with the MaSH funders (Department of Health) for the completion of particular work items by the end of the current funding period (March 2021). These include the financial cost of self-harm and suicide (submitted for publication), self-harm in midlife (now published doi: https://doi.org/10.1192/bjp.2019.90), self-harm and homelessness, life problems that precipitate self-harm in children and adolescents.

Data contributed to the Multicentre Study of Self-harm has resulted in multiple annual reports to the Department of Health, multiple empirical studies published in scientific journals and presented at international conferences. Such published findings inform Department of Health policies e.g. the Suicide Prevention Strategy for England (2002, 2012, 2017) and NICE guidelines for the management of self-harm (2004, 2011) and suicide prevention (2018). Therefore, this work has a direct impact on health.

The inclusion of additional mortality data in the current work programme allows for the important areas of suicide following self-harm to be examined, as well as any other common causes of premature death following self-harm to be identified. This may be particularly important for specific subgroups, such as men in midlife – who have the highest rates of suicide.