Umbrella review of psychosocial and ward-based interventions to reduce self-harm and suicide risks in in-patient mental health settings

Quinlivan, L; Westhead, J; Graney, J; Su, F; Steeg, S; Nielsen, E; Curtis, E; Wildbore, E; Mughal, F; Elliott, R; Webb, RT; Kapur, N

Journal article

Umbrella review of psychosocial and ward-based interventions to reduce self-harm and suicide risks in in-patient mental health settings

Abstract:: Background: Understanding what psychosocial interventions can reduce self-harm and suicide within inpatient mental health settings can be challenging, due to clinical demands and the large volume of published reviews. Aims: To summarise evidence from systematic reviews on psychosocial and ward-level interventions (excluding environmental modifications), for self-harm and suicide that may enhance patient safety in inpatient mental health settings.Methods: We systematically searched Medline, Embase, CINAHL, PsycINFO, and CDSR (2013- 2023) for systematic reviews on self-harm and suicide prevention interventions that included inpatient data. Review quality was assessed using AMSTAR-2, primary study overlap via an evidence matrix, and evidence strength evaluated (GRADE algorithm). Findings were narratively synthesised, with input from experts-by-experience throughout. [PROSPERO ID: CRD42023442639]Results: Thirteen systematic reviews (7 meta-analyses, 6 narrative), comprising over 160,000 participants were identified. Based on quantitative reviews, CBT reduces repeat self-harm by follow-up, and DBT decreases the frequency of self-harm. Narrative review evidence suggested that post-discharge follow-up, system, and ward-based interventions (e.g., staff training) may reduce suicide and/or self-harm. However, review quality varied, patient involvement was lacking, and methodological quality of trials informing reviews was predominately low. Overlap was slight (Covered Area= 12.4%).Conclusions: The effectiveness of interventions to prevent self-harm and suicide in inpatient settings remains uncertain due to variable quality reviews, evidence gaps, poor methodological quality of primary studies, and a lack of pragmatic trials and co-production. There is an urgent need for better, co-designed research within inpatient mental health settings.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Quinlivan, L., Westhead, J., Graney, J., Su, F., Steeg, S., Nielsen, E., Curtis, E., Wildbore, E., Mughal, F., Elliott, R., Webb, R. T., & Kapur, N. (2025). Umbrella review of psychosocial and ward-based interventions to reduce self-harm and suicide risks in in-patient mental health settings. BJPsych Open, 11(5), e196–e196.

MLA Style

Quinlivan, L, et al. “Umbrella Review of Psychosocial and Ward-Based Interventions to Reduce Self-Harm and Suicide Risks in in-Patient Mental Health Settings.” BJPsych Open, vol. 11, no. 5, 2025, pp. e196–e196.

Chicago Style

Quinlivan, L, J Westhead, J Graney, et al. 2025. “Umbrella Review of Psychosocial and Ward-Based Interventions to Reduce Self-Harm and Suicide Risks in in-Patient Mental Health Settings.” BJPsych Open 11 (5): e196–e196.
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