FReSHSTART: Function Replacement in repeated Self-Harm: Standardising Therapeutic Assessment and the Related Therapy


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More than 5% of the population harm themselves at some point in their life.  Multiple repetition of self-harm is common, is associated with poor quality of life and an increased risk of suicide. There is currently no treatment deliverable in community mental health services that works well for individuals with a history of multiple repetition.

Current treatment tends to focus on the act of self-harm as a symptom of underlying distress. However, personal accounts of reasons for repetition also identify perceived positive motivations such as achieving a sense of mastery or a stronger personal identity, and not simply negative drivers such as responding to distress.

Our overall aim is to develop a new approach that can take account of the full range of potential motivations and allow therapists and people who self-harm to identify, and work with, valued (positive) functions.


  • Develop a clinical assessment that identifies both positive and negative functions of self-harm from the individual’s perspective, and that is acceptable to people who self-harm and usable by therapists trained in therapies that are currently available in the NHS.
  • Using this work develop a training programme and intervention manual to allow this new self-harm-specific approach to be used as part of existing therapies.
  • Identify and train therapists experienced in relevant therapies, who are willing to undertake training and deliver the new intervention in a research setting.
  • Evaluate the feasibility and acceptability (to service users and therapists) of this modified therapy.
  • Evaluate the effectiveness and cost-effectiveness of the new intervention in a Phase 3 RCT with an internal pilot and process evaluation.
  • Investigate the processes of delivery, including mechanisms of change, for the modified therapy.


This programme has four streams of research: 

Work Package 1 will employ Q-sort methodology and a systematic review to understand the positive reasons why people self-harm (Professor Elspeth Guthrie & Dr Louise Bryant).

Work Package 2 is a national survey will identify the types of therapists currently working in the NHS, and qualitative interviews with therapists to explore how the training package can be implemented into current practice (Dr Cathy Brennan).

Work Package 3  will be a trial feasibility study to refine the intervention and logic model before we begin a Randomised Control Trial with internal pilot and process evaluation in Work Package 4 (Professor Amanda Farrin & Professor Allan House).


FReSHSTART is a collaboration between the University of Leeds, the University of York, Queen’s University Belfast, the Université Catholique de Louvain, and Leeds York Partnership Foundation Trust. 

Principle Investigator:  Professor Allan House (University of Leeds)

Co-investigators:  Professor Elspeth Guthrie, Dr Cathy Brennan & Dr Louise Bryant (Leeds Institute for Health Sciences, the University of Leeds), Dr Chris Graham (Queen’s University, Belfast), Dr Dean McMillan (University of York), Professor Sandy Tubeuf (Université Catholique de Louvain), Professor Amanda Farrin, Ms Suzanne Hartley, & Ms Alexandra Wright-Hughes (Leeds Institute of Clinical Trials Research, the University of Leeds), and Miss Satveer Nijjar (PPI collaborator). 


Funding agency: NIHR Programme Grant Reference RP-PG-1016-10003
Grant Value: £2 293 182.00
Project period: 09/2018-03/2024

Further Information

For further information about the project please contact Cathy Brennan or Allan House

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