MR1134 - The Oxford Monitoring System for Attempted Suicide: Mortality following Deliberate Self-harm
University of Oxford · Academic
In term In term in the September 2026 edition: the latest version runs to 20 October 2028.
- Reference
- DARS-NIC-147957-4444C
- Current version
- v6.2
- Term of current version
- 7 November 2025 to 20 October 2028
- Start date
- Before 1 August 2018
- Data controller
- Sole Data Controller
- Commercial purposes
- No
- Sublicensing
- No
- Files released to date
- 18
Why the data was released
Objective for processing
The Data are required for the purposes of the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England.
The Oxford Monitoring System for Attempted Suicide involves data collection on all patients presenting to the general hospital in Oxford (John Radcliffe hospital) following self-harm (also termed attempted suicide). It was established in 1976 to investigate the epidemiology, risk factors, clinical management and outcomes in patients who present to hospital following self-harm.
The University of Oxford is the sole Data Controller who also processes the data. The University of Oxford process the data under GDPR Article 6 (1) (e) and Article 9 (2) (j). This service evaluation study is in the interests of the public as it will identify factors that cause individuals to self harm and the management to help prevent them.
Mortality data (including date and cause of death) have been supplied for all individuals in the Oxford Monitoring System for Attempted Suicide who presented to hospital from 1990 onwards for the purpose of maintaining a register of all self-harm related presentations to the general hospital in Oxford which also includes information about the vital status of an individual and the cause of death.
The Oxford Monitoring System is a clinical register of information about patients who have presented to the John Radcliffe Hospital following self-harm. The aim of the monitoring system is to find out how many people come into hospital after harming themselves, to monitor trends in self harm over time, to help identify risk factors for adverse outcomes following self-harm (e.g. mortality by suicide) and to pinpoint factors that are related to the clinical management of self-harm (e.g. psychosocial assessment of patients’ needs and risks).
The University of Oxford need to be able to link historical information in their database with current information on patients because of the acknowledged importance of identifying repetition of self-harm by individuals. Most of the University of Oxford’s older patient records do not contain NHS number, so without other identifying information, it is not possible to link current records with older ones. The University of Oxford also need to be able to identify outcomes (e.g. suicide following self-harm) using national mortality databases, and linking these is not currently possible using NHS number alone because the University of Oxford do not have NHS number for all patients.
In addition, not all patients who present to hospital have an NHS number recorded. The University of Oxford published a paper as part of the Multicentre Study of Self-Harm in England project on NHS number coverage in self-harm patients across six general hospitals in Manchester, Leeds and Oxford (Cooper et al. 2007). This paper concludes that relying on NHS number for self-harm studies would result in excluding some groups of patients who are at high risk of future self-harm of suicide, including ethnic minority groups and the homeless. In order to reduce the amount of identifiable data the University of Oxford process, the study database (which only contains the bare minimum of identifying fields in order for the University of Oxford to analyse the data) is kept separate from the raw identifying database. The data are kept in two formats (raw format and processed format – processed format being the study database the University of Oxford create after removing identifying data).
The University of Oxford may access the raw database if any inconsistencies in the study dataset are found. Inconsistencies can happen for those who are identified as deceased or living. However, these are not common occurrences.
The Oxford Monitoring System for Attempted Suicide contributes data to the Multicentre Study of Self-harm in England after these have been de-identified. The Multicentre Study of Self-harm in England is a collaboration between three separate self-harm monitoring projects based in centres in different areas of England (University of Oxford, the University of Manchester, and Derbyshire Healthcare NHS Foundation Trust). Within this collaboration, researchers conduct studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. By combining data on self-harm from different areas including diverse populations, 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, 2019), and prevention and service initiatives, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011, 2022). This collaborative project is funded directly by the Department of Health and Social Care (DHSC).
Data for the Multicentre Study of Self-harm in England 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 study group. The project also has input from service users.
The Multicentre Study programme 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
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-147916-DPQ3Q for the University of Manchester. 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 which becomes the data controller for these copies. 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 agreed aims of the programme above.
The study (both Oxford Monitoring System for Attempted Suicide and Multicentre Study of Self-harm in England) are funded by the Department of Health and Social Care. The DHSC play no role in conducting the study nor do they have access to the data.
Processing activities
For the purpose of the Oxford Monitoring System for Attempted Suicide, the University of Oxford collects information about every visit to the Accident and Emergency department of the John Radcliffe Hospital following self-harm.
The University of Oxford submits identifying details of study members (i.e. individuals included on the Oxford self-harm database) to NHS England so that the individuals can be ‘flagged’ for long-term follow up. NHS England then supplies Civil Registry Death data to inform of deaths of study member (date and cause). Additionally, Demographic data is also supplied to inform of exits from or re-entries into the NHS. Receiving information on exits is essential. When the University of Oxford analyse the data, the University of Oxford must account for exits (which are not due to death) because this means that these individuals cannot experience the event under investigation. Not having these data may result in biased findings.
On receipt of the data from NHS England, the University of Oxford cleans the data and links the resulting file with the existing data on self-harm by the same person. The data are stored, checked and cleaned on the High Compliance System (HCS) at the University of Oxford.
Data are checked and identifiers removed on the HCS at the University of Oxford. After all identifiers are removed a deidentified version of the data using unique numerical identifiers is merged into the Oxford Monitoring System study file for the purpose of local analysis.
Any data including identifiers are stored only on the HCS. Identifiers are needed as this is an ongoing study with multiple updates about mortality. Therefore, identifiers from NHS England are required in order to check the accuracy of specific records. For example, if a specific individual who has been updated on the University of Oxford’s records as deceased re-presents to hospital for self-harm after their recorded date of event, the University of Oxford will need to retrieve the original record from NHS England to check this record. The University of Oxford has considered the number of identifiers required and have minimised these to include only NHS number, date of birth, forename, surname and gender of patient for the purpose of record checks and verification.
There is no requirement/attempt to re-identify individuals once the above processing has been completed.
Data processing is only carried out by substantive employees of the University of Oxford (as Data Controller who also processes the data) who have been appropriately trained in data protection and confidentiality.
As the Multicentre Coordinator, the University of Oxford receives de-identified data from the two other collaborating sites (University of Manchester and Derbyshire Health NHS Foundation Trust). On receipt of these data, the University of Oxford becomes the data controller. At the University of Oxford, the data are amalgamated to create a combined de-identified dataset consisting of data from all three sites. A copy of the combined pseudonymised dataset is transferred from University of Oxford to Derbyshire Healthcare NHS Foundation Trust and the University of Manchester. On receipt of their copies of the combined dataset, Derbyshire Healthcare NHS Foundation Trust and University of Manchester become the data controllers for their respective copies and process the data in accordance with their respective Data Sharing Agreements with NHS England. The University of Oxford in turn is the data controller for its copy of the combined dataset.
The de-identified dataset is stored separately from the Oxford self-harm cohort and, while the combined cohort contains a copy of the Oxford self-harm cohort, the two datasets are not directly linked.
NHS England variables securely submitted by the collaborating sites to the study coordinator in Oxford are:
- Date of death
- Cause of death text (A to E)
- Date of registration
- ICD10 underlying cause
- ICD10 multiple cause codes (1 to 15)
- Event type
The same variables from the Oxford Monitoring System for Attempted Suicide are shared with the collaborating sites as described above.
No patient-identifiable data are shared between the three collaborating centres.
Both datasets (the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-harm in England) are analysed by University of Oxford staff to identify risk factors for specific causes of death including suicide and other causes in persons who present to hospital after self-harm and to investigate how specific aspects of in-hospital care may relate to subsequent mortality.
Expected output
The Oxford monitoring System and the Multicentre Study of Self-harm in England (including data from the monitoring systems for self-harm at University of Manchester 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 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/ahoj - currently being updated) and on the Manchester Self-harm Project Pages (https://www.research.manchester.ac.uk/portal/en/projects/manchester-selfharm-project(5e5f3c18-db80-41a4-9761-95feb90ac877).html).
C. Other outputs include:
* Presentations of study 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.
Oxford University owns (in terms of data controllership) its data . A collaboration contract is in place detailing ownership of the data and knowledge generate d from the Multicentre study.
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.
Expected measurable benefits
Every year there are about 200,000 presentations to general hospitals following self-harm in England. Self-harm is the strongest risk factor for completed suicide and is associated with non-suicidal premature death. It is also associated with considerable healthcare costs. Self-harm has been highlighted as a priority area for research in the National Suicide Prevention Strategy for England.
Publishing information about the incidence of self-harm using data from the Multicentre Study of Self-harm is key to understanding the burden of self-harm and for planning services to meet patients' needs. The University of Oxford have continuously published data on the rates of self-harm in the Multicentre Study of Self-harm, including estimates about the likely occurrence of self-harm within the population in England.
Understanding risk factors for mortality following self-harm and how clinical services may mitigate these risks are key to reducing premature mortality and other adverse outcomes. The University of Oxford have published numerous scientific reports about this topic through various communication channels (see Outputs section for details). The University of Oxford findings inform the Department of Health and Social Care policies e.g. the Suicide Prevention Strategy for England (2002, 2012, 2017, 2021) and NICE guidelines for the management of self-harm (2022 -Currently under review, 2011). Key findings from papers are also fed back to influential stakeholder groups, including the National Suicide Advisory Group to the Government, of which the study leads are members. Such dissemination ensures that the national guidelines about healthcare and support provision for people who self-harm is based on recent robust evidence.
Data from this study are expected to continue to improve understanding of specific risk factors for premature mortality and specific causes of death following presentation to hospital for self-harm. In addition, this study is expected to improve the University of Oxfords understanding of how specific aspects of in-hospital care for patients who self-harm are related to risk of premature death. This will help design better services for patients who self-harm which aim to reduce distress, self-harm repetition and mortality.
The study is part of a collaboration between three centres: University of Oxford, University of Manchester, and Derbyshire Healthcare NHS Foundation Trust. Sharing of de-identified data between these three centres is important for maintaining this collaboration.
Findings from this study inform the research community as well as policy and decision-making bodies who translate the findings into healthcare benefits.
Benefits reported so far
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 Oxford Monitoring System for Attempted Suicide 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 the University of Oxford have identified clinically important risk factors for suicide and premature mortality following self-harm. For example, the University of Oxford have found that the risk of suicide after self-harm is at its highest closer to the hospital visit. In fact, the University of Oxford have shown that the first month is especially risky, highlighting the importance of prompt and early intervention.
The University of Oxford 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 University of Oxford 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 University of Oxford have found a particularly high risk of suicide in people who have a history of multiple episodes of self-harm. The University of Oxford have also explored the relationship between clinical management of self-harm and subsequent suicide, enabling the University of Oxford 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.
Datasets on the current version
Legal basis for provision: Health and Social Care Act 2012 - s261(5)(d); National Health Service Act 2006 - s251 - 'Control of patient information'.; Health and Social Care Act 2012 – s261(2)(a)
| Dataset | Type of data | Sensitivity | Frequency | Confidential data |
|---|---|---|---|---|
| Civil Registrations of Death | Identifiable | Sensitive | Ongoing | Section 251 NHS Act 2006 |
| Demographics | Identifiable | Sensitive | Ongoing | Section 251 NHS Act 2006 |
| MRIS - Bespoke | Anonymised - ICO Code Compliant | Sensitive | One-Off | Section 251 NHS Act 2006 |
| MRIS - Cause of Death Report | Identifiable | Sensitive | One-Off | Section 251 NHS Act 2006 |
| MRIS - Cohort Event Notification Report | Identifiable | Sensitive | Ongoing | Section 251 NHS Act 2006 |
| MRIS - Flagging Current Status Report | Identifiable | Sensitive | One-Off | Section 251 NHS Act 2006 |
| MRIS - Members and Postings Report | Identifiable | Sensitive | One-Off | Section 251 NHS Act 2006 |
Files released
Files released counts only files released externally by DARS. Access granted in NHS England's own systems, such as its Secure Data Environment, is not included.
Patient opt-outs were applied to 16 of the 18 files released under this agreement, across every version. About opt-outs
Files released against version 6.2 of this agreement, summarised by dataset.
| Dataset | Files | First released | Last released | Opt-outs applied |
|---|---|---|---|---|
| Civil Registrations of Death | 1 | December 2025 | December 2025 | No |
| Demographics | 1 | December 2025 | December 2025 | No |
Version history
The register lists each renewal of this agreement as a separate row. This site has 5 versions — earlier versions existed before this site's records begin.
DARS-NIC-147957-4444C-v6.2 7 November 2025 to 20 October 2028
- Title
- MR1134 - The Oxford Monitoring System for Attempted Suicide: Mortality following Deliberate Self-harm
- Commercial
- No
- Sublicensing
- No
- Datasets
- 7
- Files released
- 2
Datasets: Civil Registrations of Death; Demographics; MRIS - Bespoke; MRIS - Cause of Death Report; MRIS - Cohort Event Notification Report; MRIS - Flagging Current Status Report; MRIS - Members and Postings Report
What changed from DARS-NIC-147957-4444C-v5.3
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2025-11-07 | |
| End date | 2028-10-20 |
Objective for processing
On 1 February 2023, NHS Digital merged with NHS England. NHS England has assumed responsibility for all activities previously undertaken by NHS Digital. The merger was completed by a statute change. Any reference made to NHS Digital within this Data Sharing Agreement is in reference to the merged organisation known as NHS England.
The Data are required for the purposes of the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England.
NHS Digital has previously provided the University of Oxford civil registration mortality and demographics data for use in the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England. The University of Oxford require the same type of information including updates on existing cohort and also on newly recruited cohort (those who presented to the general hospital (in Oxford) following self-harm after 2016).
[1 paragraph unchanged]
The University of Oxford is the sole Data Controller who also processes
[9 words unchanged]
under GDPR Article 6 (1) (e) and Article 9 (2) (j). This
service evaluation
study is in the interests of the public as it will identify factors that cause individuals to self harm and the management to help prevent them.
Data from NHS Digital on mortality
Mortality data
(including date and cause of death) have been supplied for all individuals
[37 words unchanged]
about the vital status of an individual and the cause of death.
[2 paragraphs unchanged]
In addition, not all patients who present to hospital have an NHS
[38 words unchanged]
al. 2007). This paper concludes that relying on NHS number for self-harm
research
studies
would result in excluding some groups of patients who are at high
[16 words unchanged]
reduce the amount of identifiable data the University of Oxford process, the
research
study
database (which only contains the bare minimum of identifying fields in order
[22 words unchanged]
two formats (raw format and processed format – processed format being the
research
study
database the University of Oxford create after removing identifying data).
The University of Oxford may access the raw database if any inconsistencies in the
research
study
dataset are found. Inconsistencies can happen for those who are identified as deceased or living. However, these are not common occurrences.
[1 paragraph unchanged]
Data for the Multicentre Study of Self-harm in England are collected in
[23 words unchanged]
10 collaborating researchers from the three study sites are part of the
research
study
group. The project also has input from service users.
The Multicentre Study programme
of research
includes 4 broad areas:
[4 paragraphs unchanged]
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
England
under separate Data Sharing Agreements. These are Agreements ref: DARS-NIC-147907-MLK7R for Derbyshire
[82 words unchanged]
what purposes, in support of the agreed aims of the programme above.
The study (both Oxford Monitoring System for Attempted Suicide and Multicentre Study
[10 words unchanged]
Health and Social Care. The DHSC play no role in conducting the
research
study
nor do they have access to the data.
Processing activities
[1 paragraph unchanged]
The University of Oxford submits identifying details of study members (i.e. individuals included on the Oxford self-harm database) to NHS
Digital
England
so that the individuals can be ‘flagged’ for long-term follow up. NHS
Digital
England
then supplies Civil Registry Death data to inform of deaths of study
[57 words unchanged]
event under investigation. Not having these data may result in biased findings.
On receipt of the data from NHS
Digital,
England,
the University of Oxford cleans the data and links the resulting file
[16 words unchanged]
cleaned on the High Compliance System (HCS) at the University of Oxford.
[1 paragraph unchanged]
Any data including identifiers are stored only on the HCS. Identifiers are needed as this is an ongoing study with multiple updates about mortality. Therefore, identifiers from NHS
Digital
England
are required in order to check the accuracy of specific records. For
[29 words unchanged]
University of Oxford will need to retrieve the original record from NHS
Digital
England
to check this record. The University of Oxford has considered the number
[17 words unchanged]
and gender of patient for the purpose of record checks and verification.
[2 paragraphs unchanged]
As the Multicentre Coordinator, the University of Oxford receives de-identified data from
[101 words unchanged]
the data in accordance with their respective Data Sharing Agreements with NHS
Digital.
England.
The University of Oxford in turn is the data controller for its copy of the combined dataset.
[1 paragraph unchanged]
NHS
Digital
England
variables securely submitted by the collaborating sites to the study coordinator in Oxford are:
[9 paragraphs unchanged]
Expected output
[12 paragraphs unchanged]
* Presentations of
research
study
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
[14 paragraphs unchanged]
All deliverables specified in the previous NHS Digital approval period have been realised.
Annual reports have been made to the Department of Health and Social
[9 words unchanged]
number of peer reviewed journals on the areas of study previously specified:
[11 paragraphs unchanged]
Benefits reported
[1 paragraph unchanged]
Data from the Oxford Monitoring System for Attempted Suicide which are linked to information about mortality (supplied by
NHS-Digital)
NHS England)
contribute to the Multicentre Study of Self-harm in England. Studies using data
[11 words unchanged]
clinical services and policies which are aimed at preventing self-harm and suicide.
[3 paragraphs unchanged]
Unchanged: Expected measurable benefits.
DARS-NIC-147957-4444C-v5.3 8 May 2023 to 20 October 2025
- Title
- MR1134 - The Oxford Monitoring System for Attempted Suicide: Mortality following Deliberate Self-harm
- Commercial
- No
- Sublicensing
- No
- Datasets
- 7
- Files released
- 6
Datasets: Civil Registrations of Death; Demographics; MRIS - Bespoke; MRIS - Cause of Death Report; MRIS - Cohort Event Notification Report; MRIS - Flagging Current Status Report; MRIS - Members and Postings Report
What changed from DARS-NIC-147957-4444C-v4.3
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2023-05-08 | |
| End date | 2025-10-20 | |
| Civil Registrations of Death: legal basis | Health and Social Care Act 2012 - s261(5)(d); National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| Demographics: legal basis | Health and Social Care Act 2012 - s261(5)(d); National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| MRIS - Bespoke: legal basis | Health and Social Care Act 2012 – s261(2)(a) | |
| MRIS - Cause of Death Report: legal basis | Health and Social Care Act 2012 - s261(5)(d); National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| MRIS - Cohort Event Notification Report: legal basis | Health and Social Care Act 2012 - s261(5)(d); National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| MRIS - Flagging Current Status Report: legal basis | Health and Social Care Act 2012 - s261(5)(d); National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| MRIS - Members and Postings Report: legal basis | Health and Social Care Act 2012 - s261(5)(d); National Health Service Act 2006 - s251 - 'Control of patient information'. |
Objective for processing
The University of Oxford requires demographic and mortality data for use in the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England.
On 1 February 2023, NHS Digital merged with NHS England. NHS England has assumed responsibility for all activities previously undertaken by NHS Digital. The merger was completed by a statute change. Any reference made to NHS Digital within this Data Sharing Agreement is in reference to the merged organisation known as NHS England.
The Oxford Monitoring System for Attempted Suicide involves data collection on all patients presenting to the general hospital in Oxford following self-harm (also termed attempted suicide). It was established in 1976 to investigate the epidemiology, risk factors, clinical management and outcomes in patients who present to hospital following self-harm.
NHS Digital has previously provided the University of Oxford civil registration mortality and demographics data for use in the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England. The University of Oxford require the same type of information including updates on existing cohort and also on newly recruited cohort (those who presented to the general hospital (in Oxford) following self-harm after 2016).
Data from NHS Digital on mortality (including date and cause of death) have been supplied for all individuals from the Oxford Monitoring System for Attempted Suicide who presented to hospital from 1990 onwards for the purpose of maintaining a register of all deliberate self-harm presentations to the general hospital in Oxford. The Oxford Monitoring System is a clinical register of information about self-harm. It includes patients who have presented to the John Radcliffe Hospital following self-harm. The aim of the monitoring system is to find out how many people come into hospital after harming themselves, to monitor trends in self harm over time and to help identify risk factors for specific outcomes following self-harm and its clinical management.
The Oxford Monitoring System for Attempted Suicide involves data collection on all patients presenting to the general hospital in Oxford (John Radcliffe hospital) following self-harm (also termed attempted suicide). It was established in 1976 to investigate the epidemiology, risk factors, clinical management and outcomes in patients who present to hospital following self-harm.
De-identified data from the Oxford Monitoring System for Attempted Suicide contributes to the Multicentre Study of Self-harm in England. 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).
The University of Oxford is the sole Data Controller who also processes the data. The University of Oxford process the data under GDPR Article 6 (1) (e) and Article 9 (2) (j). This study is in the interests of the public as it will identify factors that cause individuals to self harm and the management to help prevent them.
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.
Data from NHS Digital on mortality (including date and cause of death) have been supplied for all individuals in the Oxford Monitoring System for Attempted Suicide who presented to hospital from 1990 onwards for the purpose of maintaining a register of all self-harm related presentations to the general hospital in Oxford which also includes information about the vital status of an individual and the cause of death.
The Oxford Monitoring System is a clinical register of information about patients who have presented to the John Radcliffe Hospital following self-harm. The aim of the monitoring system is to find out how many people come into hospital after harming themselves, to monitor trends in self harm over time, to help identify risk factors for adverse outcomes following self-harm (e.g. mortality by suicide) and to pinpoint factors that are related to the clinical management of self-harm (e.g. psychosocial assessment of patients’ needs and risks).
The University of Oxford need to be able to link historical information in their database with current information on patients because of the acknowledged importance of identifying repetition of self-harm by individuals. Most of the University of Oxford’s older patient records do not contain NHS number, so without other identifying information, it is not possible to link current records with older ones. The University of Oxford also need to be able to identify outcomes (e.g. suicide following self-harm) using national mortality databases, and linking these is not currently possible using NHS number alone because the University of Oxford do not have NHS number for all patients.
In addition, not all patients who present to hospital have an NHS number recorded. The University of Oxford published a paper as part of the Multicentre Study of Self-Harm in England project on NHS number coverage in self-harm patients across six general hospitals in Manchester, Leeds and Oxford (Cooper et al. 2007). This paper concludes that relying on NHS number for self-harm research would result in excluding some groups of patients who are at high risk of future self-harm of suicide, including ethnic minority groups and the homeless. In order to reduce the amount of identifiable data the University of Oxford process, the research database (which only contains the bare minimum of identifying fields in order for the University of Oxford to analyse the data) is kept separate from the raw identifying database. The data are kept in two formats (raw format and processed format – processed format being the research database the University of Oxford create after removing identifying data).
The University of Oxford may access the raw database if any inconsistencies in the research dataset are found. Inconsistencies can happen for those who are identified as deceased or living. However, these are not common occurrences.
The Oxford Monitoring System for Attempted Suicide contributes data to the Multicentre Study of Self-harm in England after these have been de-identified. The Multicentre Study of Self-harm in England is a collaboration between three separate self-harm monitoring projects based in centres in different areas of England (University of Oxford, the University of Manchester, and Derbyshire Healthcare NHS Foundation Trust). Within this collaboration, researchers conduct studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. By combining data on self-harm from different areas including diverse populations, 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, 2019), and prevention and service initiatives, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011, 2022). This collaborative project is funded directly by the Department of Health and Social Care (DHSC).
Data for the Multicentre Study of Self-harm in England 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.
[5 paragraphs unchanged]
Each collaborator independently undertakes follow-up of individuals who present to hospital with
[56 words unchanged]
transferred to the University of Oxford which becomes the data controller for
those
these
copies. Amalgamated copies of the pseudonymised data for all three locations are
[21 words unchanged]
copies of the data and for what purposes, in support of the
agreed
aims of the programme above.
The study (both Oxford Monitoring System for Attempted Suicide and Multicentre Study of Self-harm in England) are funded by the Department of Health and Social Care. The DHSC play no role in conducting the research nor do they have access to the data.
Processing activities
[1 paragraph unchanged]
The University of Oxford submits identifying details of study members (i.e. individuals
[12 words unchanged]
individuals can be ‘flagged’ for long-term follow up. NHS Digital then supplies
notifications
Civil Registry Death data to inform of deaths
of study
members’ deaths
member
(date and
cause) or
cause). Additionally, Demographic data is also supplied to inform of
exits from or re-entries into the NHS.
Receiving information on exits is essential. When the University of Oxford analyse the data, the University of Oxford must account for exits (which are not due to death) because this means that these individuals cannot experience the event under investigation. Not having these data may result in biased findings.
The University of Oxford has been receiving data on individuals recorded in the Oxford self-harm database from 1976 onwards. Reports on all flagged patients are supplied to the University of Oxford on an annual frequency.
On receipt of the data from NHS Digital, the University of Oxford cleans the data and links the resulting file with the existing data on self-harm by the same person. The data are stored, checked and cleaned on the High Compliance System (HCS) at the University of Oxford.
On receipt of the data from NHS Digital, the University of Oxford cleans the data and links it with the existing data on self-harm by the same person. The data are stored on the High Compliance System (HCS) at the University of Oxford.
Data are checked and identifiers removed on the HCS at the University of Oxford. After all identifiers are removed a deidentified version of the data using unique numerical identifiers is merged into the Oxford Monitoring System study file for the purpose of local analysis.
Data will be checked and processed on the HCS at the University of Oxford. After all identifiers are removed a de-identified version of the data using unique numerical identifiers will be merged into the Oxford Monitoring System study file for the purpose of local analysis.
Any data including identifiers are stored only on the HCS. Identifiers are needed as this is an ongoing study with multiple updates about mortality. Therefore, identifiers from NHS Digital are required in order to check the accuracy of specific records. For example, if a specific individual who has been updated on the University of Oxford’s records as deceased re-presents to hospital for self-harm after their recorded date of event, the University of Oxford will need to retrieve the original record from NHS Digital to check this record. The University of Oxford has considered the number of identifiers required and have minimised these to include only NHS number, date of birth, forename, surname and gender of patient for the purpose of record checks and verification.
Identifiers are needed as this is an ongoing study with multiple updates about mortality. Therefore, identifiers from NHS Digital are required in order to check the accuracy of specific records. For example, if a specific individual who has been updated on the University of Oxford’s records as deceased re-presents to hospital for self-harm after their recorded date of event, the University of Oxford will need to retrieve the original record from NHS Digital to check this record. The University of Oxford has considered the number of identifiers required and have minimised these to include only NHS number, date of birth, forename, surname and gender of patient for the purpose of record checks and verification.
There is no requirement/attempt to re-identify individuals once the above processing has been completed.
As the Multicentre Coordinator, the University of Oxford receives deidentified data from the two other collaborating sites (University of Manchester and Derbyshire Health NHS Foundation Trust). On receipt of this data, the University of Oxford becomes the data controller. At the University of Oxford, the data is amalgamated to create a combined de-identified dataset consisting of data from all three sites. A copy of the combined pseudonymised dataset is transferred from University of Oxford to Derbyshire Healthcare NHS Foundation Trust and the University of Manchester. On receipt of their copies of the combined dataset, Derbyshire Healthcare NHS Foundation Trust and University of Manchester become the data controllers for their respective copies and will process the data in accordance with their respective Data Sharing Agreements with NHS Digital. The University of Oxford in turn is the data controller for its copy of the combined dataset.
Data processing is only carried out by substantive employees of the University of Oxford (as Data Controller who also processes the data) who have been appropriately trained in data protection and confidentiality.
As the Multicentre Coordinator, the University of Oxford receives de-identified data from the two other collaborating sites (University of Manchester and Derbyshire Health NHS Foundation Trust). On receipt of these data, the University of Oxford becomes the data controller. At the University of Oxford, the data are amalgamated to create a combined de-identified dataset consisting of data from all three sites. A copy of the combined pseudonymised dataset is transferred from University of Oxford to Derbyshire Healthcare NHS Foundation Trust and the University of Manchester. On receipt of their copies of the combined dataset, Derbyshire Healthcare NHS Foundation Trust and University of Manchester become the data controllers for their respective copies and process the data in accordance with their respective Data Sharing Agreements with NHS Digital. The University of Oxford in turn is the data controller for its copy of the combined dataset.
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Both datasets
(the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-harm in England)
are analysed by University of Oxford staff to identify risk factors for
[13 words unchanged]
to hospital after self-harm and to investigate how specific aspects of in-hospital
care,
care
may relate to subsequent mortality.
The University of Oxford must comply with the Data Sharing Framework Contract requirements, including those regarding the use (and purposes of that use) by “Personnel” (as defined within the Data Sharing Framework Contract - i.e. employees, agents and contractors of the Data Recipient who may have access to that data).
Expected output
The Oxford monitoring System and the Multicentre Study of Self-harm in England
[9 words unchanged]
University of Manchester 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 18 months include:
* Identifying overall risk factors for suicide and other specific causes of death following self-harm.
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 include:
* Identifying risk factors for suicide and non-suicidal premature mortality in children and adolescents
A. Periodic reports and presentations:
* Specific method of self-harm as a risk for suicide and premature death
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.
* Epidemiology of paracetamol poisoning and risk of death by suicide.
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:
* The findings from these studies will be published in peer-reviewed journals aimed at clinicians and researchers.
i. Young people - Ongoing monitoring of self-harm trends and characteristics; Clustering
* Periodic reports for the Department of Health (the study funding body) and the National Suicide Prevention Strategy for England Advisory Group to communicate progress and key findings will be produced.
ii. Women in midlife - Trends, characteristics, subsequent mortality from suicide and other causes
* Findings are published on the website of the Multicentre Study of Self Harm in England where information is summarized in layman's terms.
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
Other outputs include:
iv. Physical illness - Trends, characteristics, mortality in people who self-harm, including those with physical illness at the time of hospital presentation
* Presentations of research findings at scientific meetings aimed at clinicians, researchers and stakeholders
* Findings are published on the website of the Multicentre Study of Self Harm
* Presentations at meetings with clinical staff involved in delivering care for individuals who self-harm
(https://www.psych.ox.ac.uk/research/csr/ahoj - currently being updated) and on the Manchester Self-harm Project Pages (https://www.research.manchester.ac.uk/portal/en/projects/manchester-selfharm-project(5e5f3c18-db80-41a4-9761-95feb90ac877).html).
* 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
C. Other outputs include:
In all the above, data will be presented in an aggregate format and individuals cannot be identified.
* 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
The University of Oxford has previously produced a large number of studies on mortality following self-harm using the linked data from NHS Digital.
* 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
All outputs including lay summaries of publications are accessible on the Centre for Suicide Research webpages on the University of Oxford’s website:
* 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.
http://cebmh.warne.ox.ac.uk/csr/recentpubs.html
* Locally, presentations to clinical staff involved in delivering care for individuals who self-harm in the local trust.
Details of publications by the Multicentre Study are published on the Multicentre Study website: http://cebmh.warne.ox.ac.uk/csr/mcm/index.html
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.
Oxford University owns (in terms of data controllership) its data . A collaboration contract is in place detailing ownership of the data and knowledge generate d from the Multicentre study.
All deliverables specified in the previous NHS Digital 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.
Expected measurable benefits
Every year there are about 200,000 presentations to general hospitals following self-harm in
England and Wales.
England.
Self-harm is the strongest risk factor for completed suicide and is associated
[17 words unchanged]
a priority area for research in the National Suicide Prevention Strategy for
England and especially in the 2017 update of the strategy.
England.
Understanding risk factors for mortality following self-harm and how clinical services may mitigate these risks are key to reducing premature mortality. Data from this study are expected to improve understanding of specific risk factors for premature mortality and specific causes of death following presentation to hospital for self-harm. In addition, this study is expected to improve the University of Oxford’s understanding of how specific aspects of in-hospital care for patients who self-harm are related to risk of premature death. This will help design better services for patients who self-harm which aim to reduce distress, self-harm repetition and mortality.
Publishing information about the incidence of self-harm using data from the Multicentre Study of Self-harm is key to understanding the burden of self-harm and for planning services to meet patients' needs. The University of Oxford have continuously published data on the rates of self-harm in the Multicentre Study of Self-harm, including estimates about the likely occurrence of self-harm within the population in England.
Understanding risk factors for mortality following self-harm and how clinical services may mitigate these risks are key to reducing premature mortality and other adverse outcomes. The University of Oxford have published numerous scientific reports about this topic through various communication channels (see Outputs section for details). The University of Oxford findings inform the Department of Health and Social Care policies e.g. the Suicide Prevention Strategy for England (2002, 2012, 2017, 2021) and NICE guidelines for the management of self-harm (2022 -Currently under review, 2011). Key findings from papers are also fed back to influential stakeholder groups, including the National Suicide Advisory Group to the Government, of which the study leads are members. Such dissemination ensures that the national guidelines about healthcare and support provision for people who self-harm is based on recent robust evidence.
Data from this study are expected to continue to improve understanding of specific risk factors for premature mortality and specific causes of death following presentation to hospital for self-harm. In addition, this study is expected to improve the University of Oxfords understanding of how specific aspects of in-hospital care for patients who self-harm are related to risk of premature death. This will help design better services for patients who self-harm which aim to reduce distress, self-harm repetition and mortality.
[2 paragraphs unchanged]
Benefits reported
Conducted studies which are relevant to clinical services and policy on suicide prevention. One example is how through linking episodes of self-harm with suicide as an outcome, researchers are able to identify clinically important risk factors for suicide following an episode of self-harm (non-fatal self-harm being the most important risk factor for suicide). For example, in children and adolescents is has been shown that risk of future suicide is strongest in boys, and in those with multiple episodes of previous self-harm and where certain specific methods of self-harm have been used. In adults it has been shown that a particularly high risk of subsequent suicide in people who have a history of multiple episodes of self-harm. Another example concerns the relationship between clinical management and subsequent suicide. Thus, the researchers have been able to investigate whether receipt of a psycho-social assessment while a person is in hospital following self-harm decreases the risk of future suicide. A further example has been to show that a measure of suicidal intent (that is of an individual’s apparent wish to die that is associated with an episode of self-harm) is related to short-term risk of future suicide, but not longer-term risk. This is relevant to clinical practice because suicidal intent is often measured by clinicians using a specific scale (the one used in this research).
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 Oxford Monitoring System for Attempted Suicide which are linked to information about mortality (supplied by NHS-Digital) 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 the University of Oxford have identified clinically important risk factors for suicide and premature mortality following self-harm. For example, the University of Oxford have found that the risk of suicide after self-harm is at its highest closer to the hospital visit. In fact, the University of Oxford have shown that the first month is especially risky, highlighting the importance of prompt and early intervention.
The University of Oxford 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 University of Oxford 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 University of Oxford have found a particularly high risk of suicide in people who have a history of multiple episodes of self-harm. The University of Oxford have also explored the relationship between clinical management of self-harm and subsequent suicide, enabling the University of Oxford 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.
Objective for processing
On 1 February 2023, NHS Digital merged with NHS England. NHS England has assumed responsibility for all activities previously undertaken by NHS Digital. The merger was completed by a statute change. Any reference made to NHS Digital within this Data Sharing Agreement is in reference to the merged organisation known as NHS England.
NHS Digital has previously provided the University of Oxford civil registration mortality and demographics data for use in the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England. The University of Oxford require the same type of information including updates on existing cohort and also on newly recruited cohort (those who presented to the general hospital (in Oxford) following self-harm after 2016).
The Oxford Monitoring System for Attempted Suicide involves data collection on all patients presenting to the general hospital in Oxford (John Radcliffe hospital) following self-harm (also termed attempted suicide). It was established in 1976 to investigate the epidemiology, risk factors, clinical management and outcomes in patients who present to hospital following self-harm.
The University of Oxford is the sole Data Controller who also processes the data. The University of Oxford process the data under GDPR Article 6 (1) (e) and Article 9 (2) (j). This study is in the interests of the public as it will identify factors that cause individuals to self harm and the management to help prevent them.
Data from NHS Digital on mortality (including date and cause of death) have been supplied for all individuals in the Oxford Monitoring System for Attempted Suicide who presented to hospital from 1990 onwards for the purpose of maintaining a register of all self-harm related presentations to the general hospital in Oxford which also includes information about the vital status of an individual and the cause of death.
The Oxford Monitoring System is a clinical register of information about patients who have presented to the John Radcliffe Hospital following self-harm. The aim of the monitoring system is to find out how many people come into hospital after harming themselves, to monitor trends in self harm over time, to help identify risk factors for adverse outcomes following self-harm (e.g. mortality by suicide) and to pinpoint factors that are related to the clinical management of self-harm (e.g. psychosocial assessment of patients’ needs and risks).
The University of Oxford need to be able to link historical information in their database with current information on patients because of the acknowledged importance of identifying repetition of self-harm by individuals. Most of the University of Oxford’s older patient records do not contain NHS number, so without other identifying information, it is not possible to link current records with older ones. The University of Oxford also need to be able to identify outcomes (e.g. suicide following self-harm) using national mortality databases, and linking these is not currently possible using NHS number alone because the University of Oxford do not have NHS number for all patients.
In addition, not all patients who present to hospital have an NHS number recorded. The University of Oxford published a paper as part of the Multicentre Study of Self-Harm in England project on NHS number coverage in self-harm patients across six general hospitals in Manchester, Leeds and Oxford (Cooper et al. 2007). This paper concludes that relying on NHS number for self-harm research would result in excluding some groups of patients who are at high risk of future self-harm of suicide, including ethnic minority groups and the homeless. In order to reduce the amount of identifiable data the University of Oxford process, the research database (which only contains the bare minimum of identifying fields in order for the University of Oxford to analyse the data) is kept separate from the raw identifying database. The data are kept in two formats (raw format and processed format – processed format being the research database the University of Oxford create after removing identifying data).
The University of Oxford may access the raw database if any inconsistencies in the research dataset are found. Inconsistencies can happen for those who are identified as deceased or living. However, these are not common occurrences.
The Oxford Monitoring System for Attempted Suicide contributes data to the Multicentre Study of Self-harm in England after these have been de-identified. The Multicentre Study of Self-harm in England is a collaboration between three separate self-harm monitoring projects based in centres in different areas of England (University of Oxford, the University of Manchester, and Derbyshire Healthcare NHS Foundation Trust). Within this collaboration, researchers conduct studies on the epidemiology, causes, clinical management, outcome and prevention of self-harm. By combining data on self-harm from different areas including diverse populations, 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, 2019), and prevention and service initiatives, including NICE guidance on self-harm (National Collaborating Centre for Mental Health 2004, 2011, 2022). This collaborative project is funded directly by the Department of Health and Social Care (DHSC).
Data for the Multicentre Study of Self-harm in England 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
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-147916-DPQ3Q for the University of Manchester. 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 which becomes the data controller for these copies. 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 agreed aims of the programme above.
The study (both Oxford Monitoring System for Attempted Suicide and Multicentre Study of Self-harm in England) are funded by the Department of Health and Social Care. The DHSC play no role in conducting the research nor do they have access to the data.
Expected output
The Oxford monitoring System and the Multicentre Study of Self-harm in England (including data from the monitoring systems for self-harm at University of Manchester 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 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/ahoj - currently being updated) and on the Manchester Self-harm Project Pages (https://www.research.manchester.ac.uk/portal/en/projects/manchester-selfharm-project(5e5f3c18-db80-41a4-9761-95feb90ac877).html).
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.
Oxford University owns (in terms of data controllership) its data . A collaboration contract is in place detailing ownership of the data and knowledge generate d from the Multicentre study.
All deliverables specified in the previous NHS Digital 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.
Benefits reported
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 Oxford Monitoring System for Attempted Suicide which are linked to information about mortality (supplied by NHS-Digital) 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 the University of Oxford have identified clinically important risk factors for suicide and premature mortality following self-harm. For example, the University of Oxford have found that the risk of suicide after self-harm is at its highest closer to the hospital visit. In fact, the University of Oxford have shown that the first month is especially risky, highlighting the importance of prompt and early intervention.
The University of Oxford 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 University of Oxford 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 University of Oxford have found a particularly high risk of suicide in people who have a history of multiple episodes of self-harm. The University of Oxford have also explored the relationship between clinical management of self-harm and subsequent suicide, enabling the University of Oxford 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.
DARS-NIC-147957-4444C-v4.3 21 October 2021 to 20 October 2022
- Title
- MR1134 - The Oxford Monitoring System for Attempted Suicide: Mortality following Deliberate Self-harm
- Commercial
- No
- Sublicensing
- No
- Datasets
- 7
- Files released
- 0
Datasets: Civil Registrations of Death; Demographics; MRIS - Bespoke; MRIS - Cause of Death Report; MRIS - Cohort Event Notification Report; MRIS - Flagging Current Status Report; MRIS - Members and Postings Report
What changed from DARS-NIC-147957-4444C-v3.2
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2021-10-21 | |
| End date | 2022-10-20 | |
| Civil Registrations of Death: legal basis | Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'. ; Other-Section 251 | |
| Demographics: legal basis | Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'. ; Other-Section 251 | |
| MRIS - Bespoke: legal basis | Health and Social Care Act 2012 - s261 - 'Other dissemination of information'; National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| MRIS - Cause of Death Report: legal basis | Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| MRIS - Cohort Event Notification Report: legal basis | Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'. ; National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| MRIS - Flagging Current Status Report: legal basis | Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'. ; National Health Service Act 2006 - s251 - 'Control of patient information'. | |
| MRIS - Members and Postings Report: legal basis | Health and Social Care Act 2012 – s261(7); National Health Service Act 2006 - s251 - 'Control of patient information'. ; National Health Service Act 2006 - s251 - 'Control of patient information'. |
Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits, Benefits reported.
Objective for processing
The University of Oxford requires demographic and mortality data for use in the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England.
The Oxford Monitoring System for Attempted Suicide involves data collection on all patients presenting to the general hospital in Oxford following self-harm (also termed attempted suicide). It was established in 1976 to investigate the epidemiology, risk factors, clinical management and outcomes in patients who present to hospital following self-harm.
Data from NHS Digital on mortality (including date and cause of death) have been supplied for all individuals from the Oxford Monitoring System for Attempted Suicide who presented to hospital from 1990 onwards for the purpose of maintaining a register of all deliberate self-harm presentations to the general hospital in Oxford. The Oxford Monitoring System is a clinical register of information about self-harm. It includes patients who have presented to the John Radcliffe Hospital following self-harm. The aim of the monitoring system is to find out how many people come into hospital after harming themselves, to monitor trends in self harm over time and to help identify risk factors for specific outcomes following self-harm and its clinical management.
De-identified data from the Oxford Monitoring System for Attempted Suicide contributes to the Multicentre Study of Self-harm in England. 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
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-147916-DPQ3Q for the University of Manchester. 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 which becomes the data controller for those copies. 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.
Expected output
The Oxford monitoring System and the Multicentre Study of Self-harm in England (including data from the monitoring systems for self-harm at University of Manchester 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 18 months include:
* Identifying overall risk factors for suicide and other specific causes of death following self-harm.
* Identifying risk factors for suicide and non-suicidal premature mortality in children and adolescents
* Specific method of self-harm as a risk for suicide and premature death
* Epidemiology of paracetamol poisoning and risk of death by suicide.
* The findings from these studies will be published in peer-reviewed journals aimed at clinicians and researchers.
* Periodic reports for the Department of Health (the study funding body) and the National Suicide Prevention Strategy for England Advisory Group to communicate progress and key findings will be produced.
* Findings are published on the website of the Multicentre Study of Self Harm in England where information is summarized in layman's terms.
Other outputs include:
* Presentations of research findings at scientific meetings aimed at clinicians, researchers and stakeholders
* Presentations at meetings with clinical staff involved in delivering care for individuals who self-harm
* 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
In all the above, data will be presented in an aggregate format and individuals cannot be identified.
The University of Oxford has previously produced a large number of studies on mortality following self-harm using the linked data from NHS Digital.
All outputs including lay summaries of publications are accessible on the Centre for Suicide Research webpages on the University of Oxford’s website:
http://cebmh.warne.ox.ac.uk/csr/recentpubs.html
Details of publications by the Multicentre Study are published on the Multicentre Study website: http://cebmh.warne.ox.ac.uk/csr/mcm/index.html
Benefits reported
Conducted studies which are relevant to clinical services and policy on suicide prevention. One example is how through linking episodes of self-harm with suicide as an outcome, researchers are able to identify clinically important risk factors for suicide following an episode of self-harm (non-fatal self-harm being the most important risk factor for suicide). For example, in children and adolescents is has been shown that risk of future suicide is strongest in boys, and in those with multiple episodes of previous self-harm and where certain specific methods of self-harm have been used. In adults it has been shown that a particularly high risk of subsequent suicide in people who have a history of multiple episodes of self-harm. Another example concerns the relationship between clinical management and subsequent suicide. Thus, the researchers have been able to investigate whether receipt of a psycho-social assessment while a person is in hospital following self-harm decreases the risk of future suicide. A further example has been to show that a measure of suicidal intent (that is of an individual’s apparent wish to die that is associated with an episode of self-harm) is related to short-term risk of future suicide, but not longer-term risk. This is relevant to clinical practice because suicidal intent is often measured by clinicians using a specific scale (the one used in this research).
DARS-NIC-147957-4444C-v3.2 2 June 2020 to 31 July 2021
- Title
- MR1134 - The Oxford Monitoring System for Attempted Suicide: Mortality following Deliberate Self-harm
- Commercial
- No
- Sublicensing
- No
- Datasets
- 7
- Files released
- 2
Datasets: Civil Registrations of Death; Demographics; MRIS - Bespoke; MRIS - Cause of Death Report; MRIS - Cohort Event Notification Report; MRIS - Flagging Current Status Report; MRIS - Members and Postings Report
What changed from DARS-NIC-147957-4444C-v2.4
Text removed is struck through; text added is underlined. Unchanged paragraphs are summarised rather than repeated.
| Field | Was | Became |
|---|---|---|
| Start date | 2020-06-02 |
Datasets: + Civil Registrations of Death; + Demographics
Unchanged: Objective for processing, Processing activities, Expected output, Expected measurable benefits, Benefits reported.
Objective for processing
The University of Oxford requires demographic and mortality data for use in the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England.
The Oxford Monitoring System for Attempted Suicide involves data collection on all patients presenting to the general hospital in Oxford following self-harm (also termed attempted suicide). It was established in 1976 to investigate the epidemiology, risk factors, clinical management and outcomes in patients who present to hospital following self-harm.
Data from NHS Digital on mortality (including date and cause of death) have been supplied for all individuals from the Oxford Monitoring System for Attempted Suicide who presented to hospital from 1990 onwards for the purpose of maintaining a register of all deliberate self-harm presentations to the general hospital in Oxford. The Oxford Monitoring System is a clinical register of information about self-harm. It includes patients who have presented to the John Radcliffe Hospital following self-harm. The aim of the monitoring system is to find out how many people come into hospital after harming themselves, to monitor trends in self harm over time and to help identify risk factors for specific outcomes following self-harm and its clinical management.
De-identified data from the Oxford Monitoring System for Attempted Suicide contributes to the Multicentre Study of Self-harm in England. 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
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-147916-DPQ3Q for the University of Manchester. 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 which becomes the data controller for those copies. 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.
Expected output
The Oxford monitoring System and the Multicentre Study of Self-harm in England (including data from the monitoring systems for self-harm at University of Manchester 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 18 months include:
* Identifying overall risk factors for suicide and other specific causes of death following self-harm.
* Identifying risk factors for suicide and non-suicidal premature mortality in children and adolescents
* Specific method of self-harm as a risk for suicide and premature death
* Epidemiology of paracetamol poisoning and risk of death by suicide.
* The findings from these studies will be published in peer-reviewed journals aimed at clinicians and researchers.
* Periodic reports for the Department of Health (the study funding body) and the National Suicide Prevention Strategy for England Advisory Group to communicate progress and key findings will be produced.
* Findings are published on the website of the Multicentre Study of Self Harm in England where information is summarized in layman's terms.
Other outputs include:
* Presentations of research findings at scientific meetings aimed at clinicians, researchers and stakeholders
* Presentations at meetings with clinical staff involved in delivering care for individuals who self-harm
* 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
In all the above, data will be presented in an aggregate format and individuals cannot be identified.
The University of Oxford has previously produced a large number of studies on mortality following self-harm using the linked data from NHS Digital.
All outputs including lay summaries of publications are accessible on the Centre for Suicide Research webpages on the University of Oxford’s website:
http://cebmh.warne.ox.ac.uk/csr/recentpubs.html
Details of publications by the Multicentre Study are published on the Multicentre Study website: http://cebmh.warne.ox.ac.uk/csr/mcm/index.html
Benefits reported
Conducted studies which are relevant to clinical services and policy on suicide prevention. One example is how through linking episodes of self-harm with suicide as an outcome, researchers are able to identify clinically important risk factors for suicide following an episode of self-harm (non-fatal self-harm being the most important risk factor for suicide). For example, in children and adolescents is has been shown that risk of future suicide is strongest in boys, and in those with multiple episodes of previous self-harm and where certain specific methods of self-harm have been used. In adults it has been shown that a particularly high risk of subsequent suicide in people who have a history of multiple episodes of self-harm. Another example concerns the relationship between clinical management and subsequent suicide. Thus, the researchers have been able to investigate whether receipt of a psycho-social assessment while a person is in hospital following self-harm decreases the risk of future suicide. A further example has been to show that a measure of suicidal intent (that is of an individual’s apparent wish to die that is associated with an episode of self-harm) is related to short-term risk of future suicide, but not longer-term risk. This is relevant to clinical practice because suicidal intent is often measured by clinicians using a specific scale (the one used in this research).
DARS-NIC-147957-4444C-v2.4 1 August 2018 to 31 July 2021
- Title
- MR1134 - The Oxford Monitoring System for Attempted Suicide: Mortality following Deliberate Self-harm
- Commercial
- No
- Sublicensing
- No
- Datasets
- 5
- Files released
- 8
Datasets: MRIS - Bespoke; MRIS - Cause of Death Report; MRIS - Cohort Event Notification Report; MRIS - Flagging Current Status Report; MRIS - Members and Postings Report
Objective for processing
The University of Oxford requires demographic and mortality data for use in the Oxford Monitoring System for Attempted Suicide and the Multicentre Study of Self-Harm in England.
The Oxford Monitoring System for Attempted Suicide involves data collection on all patients presenting to the general hospital in Oxford following self-harm (also termed attempted suicide). It was established in 1976 to investigate the epidemiology, risk factors, clinical management and outcomes in patients who present to hospital following self-harm.
Data from NHS Digital on mortality (including date and cause of death) have been supplied for all individuals from the Oxford Monitoring System for Attempted Suicide who presented to hospital from 1990 onwards for the purpose of maintaining a register of all deliberate self-harm presentations to the general hospital in Oxford. The Oxford Monitoring System is a clinical register of information about self-harm. It includes patients who have presented to the John Radcliffe Hospital following self-harm. The aim of the monitoring system is to find out how many people come into hospital after harming themselves, to monitor trends in self harm over time and to help identify risk factors for specific outcomes following self-harm and its clinical management.
De-identified data from the Oxford Monitoring System for Attempted Suicide contributes to the Multicentre Study of Self-harm in England. 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
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-147916-DPQ3Q for the University of Manchester. 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 which becomes the data controller for those copies. 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.
Expected output
The Oxford monitoring System and the Multicentre Study of Self-harm in England (including data from the monitoring systems for self-harm at University of Manchester 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 18 months include:
* Identifying overall risk factors for suicide and other specific causes of death following self-harm.
* Identifying risk factors for suicide and non-suicidal premature mortality in children and adolescents
* Specific method of self-harm as a risk for suicide and premature death
* Epidemiology of paracetamol poisoning and risk of death by suicide.
* The findings from these studies will be published in peer-reviewed journals aimed at clinicians and researchers.
* Periodic reports for the Department of Health (the study funding body) and the National Suicide Prevention Strategy for England Advisory Group to communicate progress and key findings will be produced.
* Findings are published on the website of the Multicentre Study of Self Harm in England where information is summarized in layman's terms.
Other outputs include:
* Presentations of research findings at scientific meetings aimed at clinicians, researchers and stakeholders
* Presentations at meetings with clinical staff involved in delivering care for individuals who self-harm
* 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
In all the above, data will be presented in an aggregate format and individuals cannot be identified.
The University of Oxford has previously produced a large number of studies on mortality following self-harm using the linked data from NHS Digital.
All outputs including lay summaries of publications are accessible on the Centre for Suicide Research webpages on the University of Oxford’s website:
http://cebmh.warne.ox.ac.uk/csr/recentpubs.html
Details of publications by the Multicentre Study are published on the Multicentre Study website: http://cebmh.warne.ox.ac.uk/csr/mcm/index.html
Benefits reported
Conducted studies which are relevant to clinical services and policy on suicide prevention. One example is how through linking episodes of self-harm with suicide as an outcome, researchers are able to identify clinically important risk factors for suicide following an episode of self-harm (non-fatal self-harm being the most important risk factor for suicide). For example, in children and adolescents is has been shown that risk of future suicide is strongest in boys, and in those with multiple episodes of previous self-harm and where certain specific methods of self-harm have been used. In adults it has been shown that a particularly high risk of subsequent suicide in people who have a history of multiple episodes of self-harm. Another example concerns the relationship between clinical management and subsequent suicide. Thus, the researchers have been able to investigate whether receipt of a psycho-social assessment while a person is in hospital following self-harm decreases the risk of future suicide. A further example has been to show that a measure of suicidal intent (that is of an individual’s apparent wish to die that is associated with an episode of self-harm) is related to short-term risk of future suicide, but not longer-term risk. This is relevant to clinical practice because suicidal intent is often measured by clinicians using a specific scale (the one used in this research).
Register history
When this agreement appeared in, or was edited in, each monthly edition of the register. Built by comparing every edition this site holds, the earliest of which is July 2021.
-
July 2021 —
already listed in the earliest edition this site holds, so it may be older. 2 versions: DARS-NIC-147957-4444C-v2.4, DARS-NIC-147957-4444C-v3.2
-
December 2021
1 version added: DARS-NIC-147957-4444C-v4.3
-
December 2022
Register-wide edit DARS-NIC-147957-4444C-v2.4, DARS-NIC-147957-4444C-v3.2 — Datasets: legal basis: “
s261(1) and” taken out. Made to 639 agreements in this edition, so it is reported once, on the changes page, and not counted as an amendment of this agreement. -
June 2023
Amended DARS-NIC-147957-4444C-v4.3
- Civil Registrations of Death: legal basis:
“
information'.;” became “information'. ;” - Demographics: legal basis:
“
information'.;” became “information'. ;” - MRIS - Cohort Event Notification Report: legal basis:
“
information'.;” became “information'. ;” - MRIS - Flagging Current Status Report: legal basis:
“
information'.;” became “information'. ;” - MRIS - Members and Postings Report: legal basis:
“
information'.;” became “information'. ;”
- Civil Registrations of Death: legal basis:
“
-
July 2023
1 version added: DARS-NIC-147957-4444C-v5.3
-
January 2026
1 version added: DARS-NIC-147957-4444C-v6.2
"Amended in place" means NHS England changed the record without issuing a new version number. The register publishes no changelog for those edits; this site infers them by comparing editions. An edit is attributed to the edition it first appears in, not to the date it was made.
Cite this page
NHS England (2026) Data Uses Register, September 2026 edition, agreement DARS-NIC-147957-4444C, “MR1134 - The Oxford Monitoring System for Attempted Suicide: Mortality following Deliberate Self-harm”. Read via NHS Data Access Explorer (unofficial), https://healthdatauses.uk/agreements/dars-nic-147957-4444c/ (accessed [date]).
This address stays the same, but the page is rebuilt with each monthly edition, so the citation names the edition it shows. Every edition's data is kept in the facts store.
Source: datausesregister_september2026.xlsx, September 2026 edition of the NHS England Data Uses Register. Search that workbook for DARS-NIC-147957-4444C to see the original rows.