Nurse-led quality improvement initiative improves support for people who repeatedly self-harm

A nurse-led quality improvement initiative “Start-a-Fresh” is helping people who repeatedly self-harm access specialist psychological support sooner across Kent and Medway.

Start-a-Fresh, developed by Kent and Medway Mental Health NHS Trust, provides Cognitive Behavioural Therapy (CBT) for adults who have repeatedly self-harmed and are referred through liaison psychiatry services. The initiative was led by Amy Cunningham, Liaison Psychiatry Senior Clinician Practitioner at the trust, to improve support for people who repeatedly self-harm following a presentation to liaison psychiatry services.

Repeated self-harm is linked to significant distress, poor quality of life, depression and a higher risk of suicide. Around 70% of people who attend hospital after self-harm have self-harmed before, while around 1 in 4 will attend hospital again following further self-harm within 18 months.

Start-a-Fresh was developed to address a gap in specialist support. As part of the improvement work, clinicians were trained to deliver 1 of 2 adapted therapies: Cognitive Behavioural Therapy (CBT) or Acceptance and Commitment Therapy (ACT).

At least 1 trained clinician is now in place at every trust liaison psychiatry site across Kent and Medway. This has made self-harm-specific therapy available across liaison psychiatry services and strengthened staff skills.

The first session includes a detailed assessment of self-harm and looks at the part it plays in a person’s life. Clinicians work with patients to understand what they may get from self-harm, such as relief from distress or a sense of control, while exploring risks, difficulties, personal values and goals.

The therapy helps people understand their patterns of self-harm, develop other ways to cope with distress and make choices based on what matters to them.

Amy Cunningham, Liaison Psychiatry Senior Clinician Practitioner at Kent and Medway Mental Health NHS Trust, said: “People who repeatedly self-harm can experience significant distress and need support that recognises the role self-harm can play in coping with difficult emotions. Start-a-Fresh gives clinicians a structured and compassionate way to work with people on the issues that matter most to them, while helping them develop practical skills they can use beyond therapy.

“This intervention has improved access to specialist support so that more people can receive timely, self-harm-specific care closer to the point of crisis.”

Patient feedback shows the programme’s practical skills, compassionate support and specialist focus are helping people better understand their self-harm patterns and find new ways to cope with distress. The data also reflects a decline in patients requiring access to secondary and emergency services such as the crisis line, A&E departments, and reducing psychiatric admissions.

Julie Kirby, Acting Chief Nurse at Kent and Medway Mental Health NHS Trust said: “Start-a-Fresh shows how quality improvement can make a real difference to patient care. This nurse-led initiative has turned learning from clinical practice into a more focused, consistent and accessible therapeutic offer for people who repeatedly self-harm.

“It is a strong example of how our teams are improving care, building specialist skills and supporting people earlier, while helping to reduce pressure on urgent and crisis services.”

Start-a-Fresh demonstrates how quality improvement can lead to practical changes in care, giving people who repeatedly self-harm access to a more consistent approach while supporting staff to build their skills and confidence.