Allan House

• BSc, MBBS, MRCP(UK), MRCPsych, DM
• Professor Emeritus at University of Leeds

Written by experts in the field, this book’s comprehensive coverage touches all the main areas of importance to those needing to understand and respond to one of the most pressing contemporary challenges in public mental health. As part of the Oxford Psychiatry Library series, this book covers topics such as the nature of self-harm, who it affects,...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Self-Harm: A Guide to Management’ describes the main features of self-harm, who is at risk, and what we know about causes, prevention, and management. The book is organized in three parts. The first section introduces the main terms used in the definition of self-harm and its relation to suicide. There follows an outline of the epidemiology of self...

Background Self-harm is a major public health challenge, and repeated self-harm is common in those attending hospital following an episode. Evidence suggests psychological interventions could help people who self-harm, but few definitive studies have assessed their clinical and cost-effectiveness. Repeated self-harm is associated with poor quality...

Background Liaison mental health services provide mental health care to patients in acute hospital settings. Evaluation of liaison services is challenging due to their heterogeneous organisation and delivery, high case throughput and varied patient case mix. We aimed to link routinely collected National Health Service data from secondary care setti...

Background Recent investment in UK liaison psychiatry services has focused on expanding provision for acute and emergency referrals. Little is known about the experiences of users and providers of these services. The aim of this study was to explore the experiences of users of acute liaison mental health services (LMHS) and those of NHS staff worki...

Aims and Objectives To develop a logic model that illustrates the steps needed to develop an effective intervention for diabetes management in a psychiatric inpatient setting, as the point of admission to a psychiatric inpatient unit may present as an opportune time for improving diabetes care. Methods We undertook (i) a survey of diabetes care amo...

Consultation-liaison psychiatry has evolved rapidly in the last decade, with significant expansion of services across the UK. Now in its third edition, Seminars in Consultation-Liaison Psychiatry provides a current, comprehensive, practically orientated guide that covers clinical topics, education, service development, audit and research. New and u...

Consultation-liaison psychiatry has evolved rapidly in the last decade, with significant expansion of services across the UK. Now in its third edition, Seminars in Consultation-Liaison Psychiatry provides a current, comprehensive, practically orientated guide that covers clinical topics, education, service development, audit and research. New and u...

Consultation-liaison psychiatry has evolved rapidly in the last decade, with significant expansion of services across the UK. Now in its third edition, Seminars in Consultation-Liaison Psychiatry provides a current, comprehensive, practically orientated guide that covers clinical topics, education, service development, audit and research. New and u...

In an age when social media is a part of life, there has been much debate about whether it is a force for good or evil. Removing personal opinion from the discussion, this book focusses on research findings to deliver a sorely needed account of the relationship between social media and mental health. Written by experts from a range of disciplines,...

In an age when social media is a part of life, there has been much debate about whether it is a force for good or evil. Removing personal opinion from the discussion, this book focusses on research findings to deliver a sorely needed account of the relationship between social media and mental health. Written by experts from a range of disciplines,...

In an age when social media is a part of life, there has been much debate about whether it is a force for good or evil. Removing personal opinion from the discussion, this book focusses on research findings to deliver a sorely needed account of the relationship between social media and mental health. Written by experts from a range of disciplines,...

Background Recent investment in UK liaison psychiatry services has focused on expanding provision for acute and emergency referrals. Little is known about the experiences of users and providers of these services. The aim of this study was to explore the experiences of users of acute liaison mental health services (LMHS) and those of NHS staff worki...

Background: Depression is an important morbidity associated with stroke that impacts on recovery, yet is often undetected or inadequately treated. Objectives: To evaluate the benefits and harms of pharmacological intervention, non-invasive brain stimulation, psychological therapy, or combinations of these to treat depression after stroke. Searc...

Background: To address the limited provision of longer-term stroke care, we conducted a programme of research (LoTS2Care) to develop and test an intervention to form part of a replicable longer-term care strategy. New Start, a programme of facilitated self-management, was developed to be delivered at 6 months post-stroke by trained facilitators. H...

Background: Antidepressants may be useful in the treatment of abnormal crying associated with stroke. This is an update of a Cochrane Review first published in 2004 and last updated in 2019. Objectives: To evaluate the benefits and harms of pharmaceutical treatment in people with emotionalism after stroke. Search methods: We searched the Cochr...

Objective To test the feasibility of a telephone delivered intervention, informed by cognitive behavioural principles, for post-stroke fatigue, and estimated its effect on fatigue and other outcomes. Design Randomised controlled parallel group trial. Setting Three Scottish stroke services. Subjects Stroke survivors with fatigue three months to t...

It is unclear how statin-use influences the adoption of healthy lifestyle choices. It is important to understand the nature of this relationship as this could facilitate targeted public health interventions which could help promote a healthy lifestyle, curb the rise of non-communicable diseases, and facilitate overall health. This study aimed to ex...

Objective: There are few longitudinal studies of poststroke emotionalism (PSE) and our understanding of the psychological associations of PSE is limited, constraining assessment of existing interventions and the development of new therapies. This study aimed to assess the prevalence and course of PSE over the first year poststroke, and its psychol...

Serenity Integrated Monitoring (SIM) involved the police and mental health crisis services working in a single team, developing case management plans that allowed a seamless move from offers of therapeutic engagement (by the mental health team) to use of coercive measures (by the police) with those who persisted with frequent crisis presentations....

Background Self-harm is an important public health problem but therapeutic interventions, particularly for people who have a history of multiple repetition, are not always taken up or effective when they are. The aim of this review is to explore first-hand accounts of what helps outside therapy and identify actions and processes, which can support...

Purpose There are calls for greater regulation of online content related to self-harm and suicide, particularly that which is user-generated. However, the online space is a source of support and advice, including an important sharing of experiences. This study aims to explore what it is about such online content, and how people interact with it, th...

Therapeutic interventions are an important adjunct to self-help strategies for people who self-harm. There is little guidance for those offering therapy on the effective components of interventions for people who self-harm. This was a systematic review aiming to identify the factors that contribute to positive experiences of therapy as described by...

Background In recent years the UK has expanded the provision of liaison mental health services (LMHS). Little work has been undertaken to explore first-hand experiences of them. Aims The aim of this study was to gain insights into the experiences of users of LMHS in both emergency departments and acute inpatient wards in the UK. Methods This cros...

Objective To evaluate, using a classification tree methodology, the ability of the Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q) to determine the need for further assessment of post-stroke emotionalism and to identify those whose emotionalism is sufficiently clear that they need assessment for potential intervention. Setting A...

Aims To develop a logic model that illustrates the steps needed to develop an effective intervention for diabetes management in a psychiatric inpatient setting, as the point of admission to a psychiatric inpatient unit may present as an opportune time for improving diabetes care. Method We undertook (i) a survey of diabetes care among inpatients i...

Aims Recently the NHS has expanded the provision of liaison mental health services (LMHS) to ensure that every acute hospital with an emergency department in England has a liaison psychiatry service. Little work has been undertaken to explore first-hand experiences of these services. The aim of this study was to capture service users’ experiences o...

Background It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified. Objectives The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of pa...

Objectives To identify the prevalence, methods, associations and reported reasons for self-harm among in-school and street-connected adolescents in Ghana. Design A cross-sectional survey. We applied multi-level regression models and model-based cluster analysis to the data. Setting Three contexts in the Greater Accra region were used: second cycl...

Safety planning is recommended as a part of the response to everybody who presents after self-harm, although there is surprisingly little evidence for its effectiveness. There is potential for such plans to be experienced as unhelpful if patients are not genuinely involved in their production and if the plan does not include information about meani...

Objectives: We sought to estimate the prevalence of self-reported self-harm among adolescents identifying as lesbian, gay, bisexual, and transgender (LGBT) in Ghana, and compare self-reported personal and social adversities related to self-harm in this group to those in a random sample of heterosexual adolescents from the same locality. Results:...

Objective To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q). Setting Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects A total of 224 clinically diagnosed st...

Background Levels of mental disorder, self-harm and violent behaviour are higher in prisons than in the community. The purpose of this study was to determine whether a brief peer-led problem-support mentor intervention could reduce the incidence of self-harm and violence in an English prison. Methods An existing intervention was adapted using a th...

Suicide has emerged as a major cause of death from non-communicable disease worldwide, leading to a burgeoning interest in its prevention. Naturally, in this context one of the focuses of research and clinical interest is the presence of suicidal thinking—a potentially identifiable and reversible precursor of suicide—with much interest lately being...

Background Multiple repetition of self-harm is common and is associated with poor quality of life and with an increased risk of suicide. Treatment outside specialist clinics rarely takes account of what is known about the varied and conflicting reasons for multiple repetition. We aimed to identify ways in which individuals who self-harm make sense...

Purpose The purpose of this paper is to explore the challenges that are experienced by staff responsible for commissioning liaison psychiatry services and to establish if these are shared by other health professionals. Design/methodology/approach Using a mixed-methods design, the findings from a mental health commissioner workshop ( n = 12) were u...

Background: Non-fatal self-harm is one of the commonest reasons for adults' emergency hospital attendance. Although strongly associated with fatal and non-fatal repetition, there is weak evidence about effective interventions-and no clear NICE guidance or clinical consensus concerning aftercare. We examined the practicability of a definitive trial...

Background: In Ghana, rates of self-harm in young people are as high as they are in high income countries. Self-reported interpersonal, familial and societal stressors form the most important background, and self-harm is seen by young people as a way of responding to that stress. In the present study, we obtained the views of key adult informants...

Background: Approximately, half of stroke survivors experience fatigue. Fatigue may persist for many months and interferes with participation in everyday activities and has a negative impact on social and family relationships, return to work, and quality of life. Fatigue is among the top 10 priorities for 'Life after Stroke' research for stroke su...

Background: Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person perspectives...

Despite recent fears about online influences on self-harm, the internet has potential to be a useful resource, and people who self-harm commonly use it to seek advice and support. Our aim was to identify and describe UK-generated internet resources for people who self-harm, their friends or families, in an observational study of information availab...

Background: Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evi...

Background Mentoring is frequently suggested as an intervention to address gender inequalities in the workplace. Objectives To systematically review evidence published since a definitive review in 2006 on the effectiveness of mentoring interventions aimed at achieving gender equality in academic medicine. Design Systematic Review, using the Templ...

Background: Depression is an important consequence of stroke that influences recovery yet often is not detected, or is inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and previously updated in 2008. Objectives: The primary objective is to test the hypothesis that pharmacological, psychological t...

Self-harm remains a serious public health concern, not least because of its strong link with suicide. Twenty-five years ago we lamented the deficits in UK services, research and policy. Since then, there has not been nearly enough effective action in any of these three domains. It is time for action.

Background Our Cochrane review of selective serotonin inhibitors for stroke recovery indicated that fluoxetine may improve functional recovery, but the trials were small and most were at high risk of bias. Objectives The Fluoxetine Or Control Under Supervision (FOCUS) trial tested the hypothesis that fluoxetine improves recovery after stroke. Des...

Self‐harm in men is a risk factor for suicide but it is not always well recognised as one. All healthcare professionals engaging with men who self‐harm must be aware of the association and be prepared to discuss mental health issues with these patients.

Background: To describe the clinical activity patterns and nature of interventions of hospital-based liaison psychiatry services in England. Methods: Multi-site, cross-sectional survey. 18 acute hospitals across England with a liaison psychiatry service. All liaison staff members, at each hospital site, recorded data on each patient they had fac...

There are a number of candidates as useful outcomes in self-harm research – repetition of self-harm; symptom states; quality of life, social participation. Repetition of self-harm has been the predominant choice of researchers, not least because of its status as a risk for eventual suicide. Use of alternatives would respond to the preferences of st...

Background: Depression is an important morbidity associated with stroke that impacts on recovery yet often undetected or inadequately treated. This is an update and expansion of a Cochrane Review first published in 2004 and updated in 2008. Objectives: Primary objective • To determine whether pharmacological therapy, non-invasive brain stimulati...

Background: The purpose of the study was to determine whether establishment of a specific liaison psychiatry service designed to offer a rapid response with facilitated hospital discharge led to reduced acute hospital length of inpatient stay. Methods: We used interrupted time series based upon routine NHS data from secondary care service in two...

Use of social media by people with mental health problems, and especially those who are prone to self-harm, has potential advantages and disadvantages. This poses a dilemma about how and by how much the form and content of social media sites should be regulated. Unfortunately, participation in the public debate about this dilemma has been restricte...

Background: Self-harm in adolescents is common and repetition frequent. Evidence for effective interventions to reduce self-harm is limited. Long term follow-up of existing studies is rare. Methods: Extended follow up, from 18 to at least 36-months, of the SHIFT trial: a pragmatic, multi-centre, individually-randomised, controlled trial involving y...

Introduction: Longer-term outcomes remain poor for many stroke survivors and strategies for their care are under-developed. New Start, a complex intervention to improve their quality of life through needs identification at 6 months and components of problem-solving and self-management, has been rigorously developed and feasibility tested in a clust...

Introduction We describe the protocol for a project that will use linkage of routinely collected NHS data to answer a question about the nature and effectiveness of liaison psychiatry services in acute hospitals in England. Methods and analysis The project will use three data sources: (1) Hospital Episode Statistics (HES), a database controlled by...

Research into patient suicide indicates that it has an impact on the psychiatrists involved, but leaves a number of unanswered questions about which elements of the experience are most likely to cause problems, who is most at risk, what is the clinical or professional significance of any effect on the psychiatrist and how other professionals are af...

Background The rise of cardiovascular diseases in sub-Saharan Africa strains fragile healthcare systems. Cardiovascular disease prevention involves the use of prophylactic medications like statins and the adoption of healthy lifestyle choices. However, the nature of the relationship between statin-use and the adoption of healthy lifestyle choices r...

Background and Purpose— The FOCUS trial (Fluoxetine or Control Under Supervision) showed that fluoxetine did not improve modified Rankin Scale scores (mRS) but increased the risk of fractures. We aimed to describe the fractures, their impact on mRS and factors associated with fracture risk. Methods— A United Kingdom, multicenter, parallel-group, r...

Background: Social problem-solving is one technique used to help reduce incidence of self-harm. Our study evaluated the feasibility and acceptability of the adaptation and implementation of a brief Problem-Solving Training (PST) intervention to reduce self-harm in prisons. Methods: The process involved i) adaptation of the training materials usi...

Background: Liaison psychiatry services provide mental health care for patients in physical healthcare (usually acute hospital) settings including emergency departments. Liaison work involves close collaboration with acute hospital staff so that high quality care can be provided. Services however are patchy, relatively underfunded, heterogeneous a...

Background Mood disorder after stroke is common but drug and psychosocial treatments have been assessed with disappointing results. Preventing mood disorder from developing in the first place could be a better approach and might reduce the need for pharmacotherapy in this predominantly older patient group. We used a brief problem-solving therapy an...

Objectives Problem-solving skills training is adaptable, inexpensive and simple to deliver. However, its application with prisoners who self-harm is unknown. The study assessed the feasibility and acceptability of a problem-solving training (PST) intervention for prison staff and prisoners who self-harm, to inform the design of a large-scale study....

Review question Does pharmaceutical treatment reduce the frequency of unwanted emotional displays in people with emotionalism after stroke compared to placebo? Background Emotionalism often occurs after stroke. Emotionalism means that the person has difficulty controlling their emotional behaviour. People after stroke may suddenly start crying or...

Objectives To explore the nature of images tagged as self-harm on popular social media sites and what this might tell us about how these sites are used. Design A visual content and thematic analysis of a sample of 602 images captured from Twitter, Instagram and Tumblr. Results Over half the images tagged as self-harm had no explicit representatio...

Background: Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects. Methods: FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible...

Background In trials incorporating a health economic evaluation component, reliable validated measures for health-related quality of life (HRQOL) are essential. The EQ-5D is the preferred measure for cost-effectiveness analysis in UK trials. This paper presents a qualitative evaluation of the use of the EQ-5D-3L in a feasibility randomised control...

Background: Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice. Method: We synthesised data from a variety of sources including a large nationa...

Purpose of Review The aim of this paper was to review the recent international developments in health promotion and wellness initiatives targeting chronic disease prevention and management for adults with intellectual and developmental disabilities (IDD) targeting type 2 diabetes (T2D). Recent Findings There has been one diabetes prevention progra...

Objectives To describe the current provision of hospital-based liaison psychiatry services in England, and to determine different models of liaison service that are currently operating in England. Design Cross-sectional observational study comprising an electronic survey followed by targeted telephone interviews. Setting All 179 acute hospitals w...

Background In the UK managers from multiple organisations are commonly tasked with collectively devising and implementing local health and wellbeing policies as a way of addressing increasing demand for healthcare. This requires them to create knowledge together but relatively little is known about how this occurs. This paper reports the results of...