The report, led by researchers from the Universities of Bristol, New South Wales, Glasgow, and 91ֱ�� and involving an international team of experts, is published today9/10/24).

Self-harm remains neglected worldwide.  There are at least 14 million episodes every year, with the greatest number in low- and middle-income countries (LMICs).

It is defined as instances of people hurting or injuring themselves intentionally, regardless of the reasons.

However, shame and stigma can often stop people from seeking help. Self-harm can occur at any age but is most common in young people and is increasing in this group.  Self-harming behaviour leads to an elevated risk of death by suicide. People attending health services only represent the ‘tip of the iceberg’ for self-harm. 

The Commission makes a number of recommendations that could change the experience of people who have self-harmed for the better.

They include suggestions for more compassionate and effective delivery of health and social care services as well as whole of government approaches to address the causes of self-harm and reduce stigma.

The commission also highlights the necessity of seeing self-harm through a global lens, responsible handling of the topic of self-harm in all types of media, and the involvement of people with lived experience in designing and delivering care.

Prof Nav Kapur, Professor of Psychiatry and Population Health at the University of Manchester has helped lead a number of NICE guidelines on self-harm and suicide prevention.  He co-led the Commission with Professors Paul Moran, Helen Christensen and Rory O Connor.  The report includes over 40 authors from around the world. 

Prof Kapur said: “It was great to be part of the team which produced this Commission.  I’ve been working in services for self-harm for 30 years but what was striking for me with this piece of work was the integration of mental health and public health with global, indigenous, and lived experience perspectives”.

Francis Creed, a professor emeritus of psychiatry at The University of Manchester, analysed the data of 120,000 people followed over 2-and-a half years to unpick the mystery around CFS/ME, Irritable Bowel Syndrome and Fibromyalgia.

“When people suffering from CFS/ME, IBS and Fibromyalgia come into contact with health professionals, negative attitudes can sometimes get in the way of treatment. but by understanding these complex conditions better, the stigma and mystery around them can be eased,” he said.

His latest study – published in the journal PLOS ONE – used data from the Dutch Lifelines cohort study to compare people who reported one of the unexplained disorders with people who reported one of three common medical illnesses: diabetes, inflammatory bowel disease and rheumatoid arthritis.

These illnesses lead to symptoms similar to the unexplained conditions: like ME, diabetes causes tiredness; irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) both lead to diarrhoea and stomach pain; and like rheumatoid arthritis (RA), Fibromyalgia causes debilitating joint and muscle pain.

All participants had a standardised interview to assess their mental health. A cross-sectional examination of the data revealed that the variables most closely associated with mental health problems were similar in all the conditions studied. These included indicators of:

• A tendency to develop mental health problems: previous anxiety and depression, stress and neuroticism.
• A psychological  reaction to the illness: severe difficulties arising from health problems including impairment of daily tasks.

A second analysis compared the prevalence of mental health problems before the onset of the six disorders in a longitudinal study. This analysis allowed Prof Creed to see if underlying mental health problems preceded or followed the onset of the conditions.

It revealed the proportion with mental health problems was smaller than might have been expected: there was no evidence of mental health problems in three quarters of the people developing the unexplained disorders.

The findings, in conjunction with previous work, suggest that mental health problems play a part in the development of the illness in approximately a quarter of people developing chronic fatigue syndrome or irritable bowel syndrome.

Professor Creed said: “This work provides evidence that for many people, a  wide variety of physical and psychological factors are associated with these debilitating conditions.

“These may be other illnesses, such as gastroenteritis,  metabolic and thyroid disorders, chronic infections, asthma, allergies, impaired sleep and excessive preoccupation with illness as well as lifestyle issues. stress, anxiety and depressive disorders.”

Appreciating this multifactorial pattern , hopes Professor Creed, will enable health professionals to take a more holistic view of medically unexplained disorders, which can cause debilitating and life changing illness.

He added: “Although mental health problems are more common in ME, they only occur in a minority of people early in the course of the illness. The treatment approach should consider a wide range of possible factors just as sound treatment of diabetes and rheumatoid arthritis should include an assessment of mental health as well as the characteristic bodily problems.

“Although there are symptomatic treatments which may help these unexplained disorders, we should aim to understand fully their underlying causes. There are probably several different ways they may develop; a whole range of physical and mental factors are probably involved. Treatment approaches will become more effective as our understanding of the causes improves.

“Thinking about ME and the other illnesses as either “physical” or “psychological” in origin is not helpful and this artificial division could make it more difficult for sufferers to get appropriate help. This study might help to change that for the better.”

The paper Psychiatric disorders comorbid with general medical illnesses and functional somatic disorders: The Lifelines cohort study is published, in PLOS One 

The drugs, which have a tranquillising effect, are frequently used in adults to treat major mental illness, such as schizophrenia.

However, they can be associated with substantial side-effects such as sexual dysfunction, infertility, and weight gain leading to diabetes.

The National Institute for Health and Care Excellence has approved the use of some antipsychotics in under 18’s with psychosis or with severely aggressive behaviour from conduct disorder

However the study, published in the Lancet Psychiatry, suggests they are prescribed for an increasingly broad range of reasons - the most common being autism.

The team examined primary care records of 7.2 million children and adolescents, aged 3 to 18, registered at selected English General Practices over the period 2000 to 2019.

The overall percentage who were prescribed antipsychotics was relatively small – 0.06% in 2000 and 0.11%  in 2019.

However, the increasing use of antipsychotics is a cause for concern, argue the researchers, given that their safety in children, who are still rapidly developing, has not been established.

The study also found that:

• Boys and older children – aged 15 to 18 – were more likely to be prescribed antipsychotics than girls and younger children; however, the increasing trends were evident in all groups.
• The older class of antipsychotics, that may be associated with extrapyramidal side effects such as movement disorders, were more commonly prescribed in more deprived areas.

Dr Matthias Pierce, senior research fellow at the University of Manchester’s Centre for Women’s Mental Health jointly lead the study.

He said: “This study demonstrates a concerning trend in antipsychotic prescribing in children and adolescents. We do not think the changes in prescribing necessarily relate to changes in clinical need; rather, it may be more likely to reflect changes in prescribing practice by clinicians.

“However, this study will help clinicians to evaluate the prescribing of antipsychotics to children more fully and will encourage them to consider better access to alternatives.”

Senior author, Professor Kathryn Abel from The University of Manchester said: “Antipsychotic medications continue to have a valuable role in the treatment of serious mental illness. These findings represent a descriptive account of antipsychotic prescribing to children and adolescents in the UK today and provide a window onto current practice.

“It is notable, and relevant to the current discourse, that we report inequities in prescribing as a result of deprivation levels; and that the indications for which approvals are available are no longer the commonest reason these medications are being prescribed. Broadening use of antipsychotics in developing young people begs questions about their safety over time and demands more research on this topic.”

The study is available at this

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The Awards mark the highest levels of excellence and achievement within the field of psychiatry, and are given to the Psychiatrist of the Year, Patient Contributor of the Year and PsychSoc of the Year, among others. 

Commenting on his Lifetime Achievement Award, Professor Appleby said: “It's a surprise and an honour to receive this award, I must thank the College. It's also a reminder, to me at least, of how much more we need to achieve in mental health, on safety and evidence and social justice."

Professor Louis Appleby is a Professor of Psychiatry at the University of Manchester and leads the National Suicide Prevention Strategy for England. He has been the Director of the National Confidential Inquiry into Suicide and Safety in Mental Health since its inception in 1996 and under his leadership, it has developed into one of the top units for suicide prevention research in the world.  

He currently chairs the National Suicide Prevention Strategy Advisory Group for England and has championed the involvement of people with lived experience of services and families who have been bereaved.

He held successive National Clinical Director roles in Mental Health and then in Health and Criminal Justice. His work led to the re-design of community services, the reform of mental health legislation, the commissioning of a number of NICE guidelines and more effective liaison between health and criminal justice. 

His wider NHS roles have included being a board member and non–executive director of the Care Quality Commission and working the General Medical Council to advise on suicide risk in doctors under investigation. He was also a member of the Mental Health Act review committee and was appointed by the NHS to examine the after-effects of the Grenfell fire on the local community. 

Dr Adrian James, President of the Royal College of Psychiatrists, said: “Professor Appleby is an extremely deserving winner of our Lifetime Achievement Award. His achievements are numerous and his contributions to psychiatry over the last 25 years have been immense. 

“He has been an important leader in suicide prevention, mental health policy and the NHS more widely. His inspiring work has had a huge impact on clinical practice, academic research and the lives of mental health patients and their carers.” 

The clinical researcher is the first UK winner of the prestigious award in 20 years and only the fourth ever.

In its 50^th year, the award was given by the Association for his "leadership, devotion and creativity".

He said: “I’m absolutely thrilled that our work has been recognised in this way. As a clinical academic it’s a privilege to be working in an area where you have an opportunity to do real world research that impacts on health services and people’s lives.

“I would like to thank AAS, my mentors, my colleagues, and of course my family.”

The American Association of Suicidology is the world’s largest membership-based suicide prevention organization.

Founded in 1968 by Dr Edwin S. Shneidman, it promotes the research of suicide and its prevention, public awareness programs, public education and training for professionals and volunteers.

Membership of AAS includes mental health and public health professionals, researchers, suicide prevention and crisis intervention centers, school districts, crisis center professionals, survivors of suicide loss, attempt survivors, and a variety of laypersons who have in interest in suicide prevention.

People with Borderline Personality Disorder are 13 times more likely to report childhood trauma than people without any mental health problems, according to University of Manchester research.

The analysis of data from 42 international studies of over 5,000 people showed that 71.1% of people who were diagnosed with the serious health condition reported at least one traumatic childhood experience.

The study was carried out by researchers at The University of Manchester in collaboration with Greater 91ֱ�� Mental Health NHS Foundation Trust and the Spectrum Centre for Mental Health Research, Lancaster University. It is published in the journal Acta Psychiatrica Scandinavia.

In the latest of a series of Meta-anayses by the team on the effects of childhood trauma on adult mental health, they show it is much more likely to be associated with BPD than mood disorders, psychosis and other personality disorders.

The most common form of adverse experience reported by people with BPD was physical neglect at 48.9%, followed by emotional abuse at 42.5%, physical abuse at 36.4%, sexual abuse at 32.1% and emotional neglect at 25.3%.

BPD is often a debilitating mental heath problem that makes it hard for someone a control their emotions and impulses.

The disorder, often linked to self-harm and substance abuse, is hard to treat and associated with significant costs to sufferers and society as a whole.

Some of the characteristics of this condition -such as experiencing extreme, overwhelming emotions over what might be seen to others as a minor issue - are common, but become chronic and exaggerated after childhood trauma.

Dr Filippo Varese, from The University of Manchester, said: “During childhood and adolescence, our brain is still undergoing considerable development and we are also refining strategies to deal with the challenges of everyday life, and the negative feelings that come with them.

“In some people who have experienced chronic, overwhelming stress in childhood, it is likely that these responses do not develop in the same way. People can become more sensitive to ‘normal’ stress. They are sometimes unable to deal with intense negative thoughts and feelings, and they might resort to dangerous or unhelpful measures to feel better, such as taking drugs or self-harming. This can lead to various mental health difficulties, including the problems commonly seen in people who receive a diagnosis of BPD.

“We found a strong link between childhood trauma and BPD, which is particularly large when emotional abuse and neglect was involved.”

He added: “Borderline is a slightly misleading term – as it implies that this condition only has a mild impact. Far from that, BPD can be very distressing and difficult to treat.

“The term BPD was originally used to indicate mental health problems that were not a psychosis nor an anxiety or depressive disorder - but something in the middle. Another term used in modern times is ‘emotionally unstable personality disorder’, which perhaps gives a clearer picture of the kind of problems typically described by these people.

“We hope these findings underline the importance of trauma informed care for people accessing mental health services, where prevalence rates of BPD are high.

“But further research is needed to explore the complex factors also likely to be involved such as biology, experiences in later life, and psychological processes.”

Childhood Adversity and Borderline Personality Disorder: A Meta-Analysis is published in .

One in four UK children between the ages of 0 and 16 have a mother with a mental illness, according to a team of University of Manchester researchers

Also according to the study published in the Lancet Public Health, just over a half of UK children will have had a mother who has experienced mental illness by the age of 16.

The study also revealed significant regional variation: it estimated the proportion of children with a mother with a mental illness was highest in Northern Ireland at 29·8%.

The other highest regions were estimated to be Scotland (26·0%), the East Midlands (25·4%), the South West (25·3%), and the North West of England (25·1%). It was lowest in London (16·8%) and the south east of England (21·2%).

The areas of the UK with the highest prevalence of maternal mental illness coincide with areas with the highest levels of deprivation and adult mental illness in general, as shown by previous research.

Children born into poverty, or who are offspring of teenage mothers, were most likely to be exposed to maternal mental illness.

The study examined children aged 0–16 years born between Jan 1, 1991, and Dec 31, 2015, registered on the primary care Clinical Practice Research Datalink between 2005 and 2017.

They identified 783,710 children registered in the UK CPRD mother-baby link database, and included 547,747 children and 381 685 mothers in their analysis.

91ֱ�� author from The University of Manchester said: “As well as the consequences of having a mother suffering from mental health problems, these children face a number of adversities, including living in poverty and having a teenage parent.

“While many of these children are very resilient, these children are more likely to suffer from a range of negative life outcomes, including poorer physical and mental health, lower educational attainment and reduced quality of life.”

The study also revealed that the number of children exposed to maternal mental illness increased substantially between 2005 and 2017.

The number of children of mothers with depression or anxiety increased from 22.2% between 2005 and 2007 to 25·1% between 2015 and 2017.

Although serious mental illness is rare, the number of children exposed to mothers treated for psychosis increased substantially, as did the numbers of children exposed to mothers with personality disorders.

Professor Kathryn Abel, from The University of Manchester said: “Our work is not about stigmatising women suffering from mental health problems, but about recognising the number and needs of these children.

“This study highlights how reliable, detailed information provides vital information for researchers, policy makers, clinical commissioners, and education and health service providers.

“Appropriate and timely diversion of funds to areas of greatest need is now required to make funding of health care and health research more representative of disease burden across the country.”

The paper is available 

A large clinical trial led by researchers at the Universities of Bristol, Exeter, Keele, 91ֱ�� and Hull York Medical School, and published in the British Medical Journal has found that a popular combination of antidepression drugs was no more effective in improving depression than a placebo. The studies' author's  call on doctors to rethink their use.

Psychiatrists and GPs increasingly combine mirtazapine with an SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin-noradenaline reuptake inhibitor) antidepressant for patients whose depression does not respond to a single antidepressant.

The trial led looked at the effectiveness of adding mirtazapine to an SSRI or SNRI in patients who remain depressed after at least six weeks of conventional (SSRI or SNRI) antidepressant treatment.

Psychiatrists and GPs increasingly combine mirtazapine with an SSRI or SNRI antidepressant for patients whose depression does not respond to a single antidepressant.

The study, funded by the National Institute for Health Research, also found that patients taking mirtazapine in combination with another antidepressant had more adverse effects and were more likely to stop treatment than those who took an antidepressant and placebo.

Depression is one of the top five contributors to the global burden of disease and by 2030 is predicted to be the leading cause of disability in high income countries. People with depression are usually managed in primary care in the UK and antidepressants are often the first line of treatment. However, many patients do not respond to antidepressants.

The National Institute for Health and Care Excellence (NICE) advises GPs to reconsider treatment if there has been no response after 4-6 weeks of treatment. The practice of adding mirtazapine has grown as psychiatrists and GPs search for effective ways of treating those who don’t respond to a single antidepressant. Previous small-scale studies had shown that this combination might be effective.

Dr from the Centres for Academic Mental Health and Academic Primary Care at the University of Bristol, and lead author of the study, said:

“Half of patients in primary care who take antidepressants remain depressed despite sticking to their treatment, yet there is little evidence about how to treat those for whom the drugs don’t work.

“Our study has found that there is unlikely to be a clinically important benefit for mirtazapine over placebo in addition to an SSRI or SNRI antidepressant in primary care patients with treatment resistant depression, and that the combination is not well tolerated. We recommend that GPs think very carefully before adding mirtazapine as a second antidepressant in this group of patients. This is particularly important when there are clear alternatives such as cognitive behavioural therapy, which has been shown to be effective in this group of patients.”

Professor Ian Anderson from The University of Manchesteer said: "There is a clear need for guidance about the best way to improve the outcome of depression treated in primary care, especially when the first treatment has not worked. Probably the best way to summarise the outcome of this study is that it provided weak evidence of a small benefit from the combination of mirtazapine with an SSRI/SNRI antidepressant compared with continuing the SSR/SNRI alone, but at the expense of poorer tolerability.

"In a primary care context, the possible marginal benefit we found in the short-term does not support using this combination as a routine strategy. However, it doesn’t exclude useful benefit in other contexts, and at other doses, or in individual patients. This study provides important evidence about the mirtazapine-SSRI/SNRI combination in the setting and way in which it was studied, but we need to be careful not to take it as the final word in all situations."

MIRtazapine added to SSRIs or SNRIs for Treatment Resistant Depression in Primary Care: a placebo controlled randomised trial (MIR) is available

People over 65 who harm themselves are more likely to die by suicide than other age groups according to new research published in the by University of Manchester and Keele University academics.

Funded by the , the study analysed patient records using the (CPRD) and found that 4,124 patients harmed themselves between 2001 and 2014, mostly by taking overdoses of medication.

It showed that people over 65 who self-harm are 20 times more likely to die an unnatural death and 145 times more likely to die by suicide than people of the same age who had not self-harmed.

The study also found that only 12% of older patients who self-harmed had a record of being referred to a mental health service for aftercare. National Institute of Health and Care Excellence (NICE) guidelines suggest that the involvement of mental health specialists is important because older people who self-harm may have higher suicidal intent than younger people.

Physical health problems were more common in older patients who had harmed themselves compared to those who had not.

Following a self-harm episode, over one in ten of those aged 65 and over were prescribed tricyclic antidepressants which can be toxic when taken in overdose.

, who led the study and analysed the data said: “With the aging population rising and a lack of research in this age group, this study - - the first of its kind conducted in primary care – has gone some way in highlighting the risks of self-harm in older people.

“This study emphasises the need for early intervention, careful alternative prescribing and better support for older people who may see their GP following an episode of self-harm or for other health problems.”

, one of the authors of the paper who chaired the NICE guidelines for self-harm said: “We sometimes think of self-harm as a problem in younger people and of course it is. But it effects older adults too and the concerning issue is the link with increased risk of suicide.

“Older people might be particularly vulnerable as they are uniquely exposed to issues such as bereavement, isolation and physical as well as mental illness.

“They also might fear the consequences of becoming a burden to their family or friends, or not being able to function from day to day.”

He added: “We hope our study will alert clinicians, service planners, and policy makers to the need to implement preventative measures for this potentially vulnerable group of people. Referral and management of mental health conditions are likely to be key”

Professor Carolyn Chew-Graham, from Keele University one of the research team and a practising GP said: “Since drug ingestion is one of the main methods of self-harm, we highlight the need to consider less toxic medication in older adults for the management of both mental illness and pain related conditions.

“We also recommend maintaining frequent medication reviews following self-harm.”

“GPs are after all in a unique position to intervene as older patients come to the surgery more frequently than younger adults.”

The children of families who fall upon hard times are at significantly greater risk of being involved in violent crime and harming themselves as young adults, according to a major new study.

The research by University of Manchester epidemiologists is a major addition to our understanding of the risk factors for self-harm and violent criminality.

The knowledge was generated from a study funded by the European Research Council of the young adult population of Denmark published today in

The results are highly relevant to the UK context argue and , two of the study’s authors.

Children who remained in the top 20% of wealthiest families over their first 15 years of life were the least likely to harm themselves or commit violent crime between the ages of 15 and 33.

Compared to the wealthiest fifth, children from families who remained in the least affluent fifth of society were 7 times more likely to harm themselves and 13 times more likely to commit violent crime as young adults.

Children from families whose income dropped from the top fifth to the bottom fifth were 2.9 times more likely to commit violent crime and 2.3 times more likely to self-harm as young adults.

And children from families whose income rose from the bottom fifth to the top fifth were 1.6 times more likely to self-harm and to commit violent crime as young adults.

Using Danish national registers of over one million young adults, the study analysed 21,267 patients who presented to hospital with self-harm episodes and 23,724 people who were convicted for violent crime aged 15 to 33.

Parental income was measured at birth-year, and at ages 5, 10 and 15.

Professor Webb said: “This study casts new light on our understanding of the deep-rooted causes of self-harm and violent behaviour. Though to some extent, we all make choices, what children go through does have a powerful effect on these harmful behaviours.

“Though the report drew on data relating to the entire population of Denmark, its results are relevant to the UK, whose population demographics are similar, as is their health system.

“In fact, income inequality in Denmark is one of the lowest in the world, so we’d expect these findings to be even more pronounced in countries with greater levels of income inequality, such as the UK.”

He added: “These two harmful behaviours pose serious societal challenges. After accidents, intentional self-harm and assault are the next two most common causes of death among young people globally.

“Exposure to poverty can have an adverse impact on early child development as well as parental conflict and separation, harming children’s psychosocial development and well-being.

“We would also imagine that ten years of austerity in the UK would escalate and entrench these problems: Poverty still affects more than one in four children in the UK today according to Child Poverty Action group.

“So this study underlines just how important it is to tackle socioeconomic inequalities during childhood.

“That encompasses access to public services, good housing and education but also things like local and social environments.”

Mental health patients are at much greater risk of dying from unnatural causes following their first discharge from inpatient care than the rest of the population, according to new research.

In the most comprehensive study of this topic ever carried out, The University of Manchester team say though danger to patients is still relatively low, community services and GPs must be aware of the critical period in the first few weeks of discharge - when they are most at risk.

Though the report drew on data derived the entire population of Denmark, its results are relevant to the UK, which has a similar population and health system, say authors Professor Roger Webb and PhD student Florian Walter.

According to the team, the most common threat to life among patients after discharge is fatal poisoning compared to accidents among the general population.

The research was funded by Medical Research Council, European Research Council in partnership with Centre for Integrated Register-based Research and National Centre for Register-based Research at Aarhus University. It is published in the Journal of Clinical Psychiatry today.

The analysis compared over 1.6 million Danes with a subset of 47,000 people who were discharged from their first inpatient stay between 1982 and 1996.

Utilising national administrative datasets, the research team were able to track the group of patients, who averaged age 25 when they were discharged until they died or 31 December 2011.

They looked at method of suicide, types of accidental death, types of fatal poisoning and death by homicide.

Though there is a strong association between hospital discharge and unnatural death, there is no evidence of a causal link between the two, say the researchers.

According to the research, suicide was 32 times more likely after discharge: 171.7 people in every 100,000 died after leaving hospital, compared to 5.3 in every 100,000 for the general population

Intentional self-poisoning was 41 times more likely: 57.1 people in every 100,000 died after hospital discharge, compared to 1.3 in every 100,000 for the general population

And death from fatal psychotropic drugs poisoning , irrespective of intent was over 90 times more likely: 25.6 people in every 100,000 after hospital discharge, compared to 0.2 in every 100,000 for the general population.

Professor Webb said: “When we look at detailed causes of death, each one is markedly raised whether that’s traffic accidents or poisoning.

“So it’s clear this group of people is more vulnerable to dying from a variety of different unnatural causes after discharge, although the risks for each of these causes are nonetheless relatively low in absolute terms.

”However, it’s important to point out hospital is not a cause of unnatural death as these patients are a young cohort already from high risk groups; therefore the risk of dying could be even higher without hospitalisation.”

Florian Walter said: “This is the first study to look at the full range unnatural causes of death among mental health patients after discharge from hospital ever carried out.

“The Danish system is ideal for this sort of research because Danes are given a unique identification number which provides data that are entered into several national registers.”

A previous study by Walter, published in JAMA Psychiatry in 2017, found that patients are most at risk in the first month after discharge.

He added: “The overarching message is that transition from hospital to community is riskier for these people, especially during the first few weeks after discharge.

“Therefore mental health services need to develop broad strategies that include enhanced post-discharge surveillance. These strategies must account for the fact that discharged patients have higher risks of dying unnaturally in lots of different ways.

“We also think better liaison between inpatient and community services is important so that services can be more vigilant about patients taking their medication correctly at the doses prescribed.”

The paper: a national cohort study is published in the Journal of Clinical Psychiatry.