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Background
Self-harm among young people is a growing mental health crisis in the United Kingdom and beyond. Suicide is now the leading cause of death among adolescent girls and a major risk for boys. Research shows that young people who self-harm are significantly more likely to attempt suicide later on. Many seek help through emergency services, but hospital admissions alone do not prevent further self-harm, highlighting the urgent need for earlier, community-based support.
One of the most effective treatments for self-harm in young people is Dialectical Behaviour Therapy for Adolescents (DBT-A). Adapted from adult DBT, it helps young people manage emotions, build skills, and reduce harmful behaviours. Studies show DBT-A reduces self-harm, depression, and hospital visits.
However, access to DBT-A through the NHS remains limited, with long waits and strict eligibility criteria. At the same time, funding for early intervention services such as youth centres and community mental health teams have been cut. Many adolescents who struggle with self-harm and mental health difficulties and their families report that accessing support can be challenging, with long waiting times and, at times, the type of support they are offered does not fully meet their needs. This has forced many young people into crisis, with parents often reporting deterioration in their child’s mental health while waiting—sometimes resulting in suicide attempts.
Digital mental health interventions offer a promising solution. Online therapy has been introduced for anxiety and depression in young people, and early research suggests DBT-A could be delivered effectively online. Digital tools offer greater accessibility, flexibility, and engagement—allowing young people to fit therapy around their lives, with features such as self-paced learning and support outside sessions. Involving parents may further enhance outcomes by equipping families with tools to support their children.
Speek has developed a structured, evidence-based digital DBT-A-informed programme to improve access to mental health support for young people who self-harm and their families.
Aims
This study aims to develop a more effective way of providing support through a digital app, known as DBT-A-informed programme, designed to support young people and their families in managing self-harm. The study will assess self-harm rates, engagement, retention, clinical outcomes, and user experience. Findings will inform refinement and broader implementation—offering a scalable, effective alternative to crisis care and supporting families before things reach breaking point.
Who can take part?
Young people aged 12–18 who self-harm and their caregivers living in England, Wales and Scotland.
Outcomes
Data will be collected at four time points - pre intervention, mid-point assessment, post intervention and 6 month follow up. Quantitative outcome measures will explore self-harm, anxiety, emotional regulation, communication, mindfulness and wellbeing. Qualitative interviews aim to explore motivation, experience, perceived impact, barriers to engagement and suggestion for improvement.
Patient and Public Involvement
Individuals with lived experience of self-harm or caring for a young person with self-harm difficulties supported the development of the semi-structured interview topic guide and will guide the dissemination of the findings of this study.
Further Information
- Funders
National Institute for Health Research. Invention for Innovation under the i4i Connect 8 (NIHR207821)
- Partners
This project is a collaboration with Speek Health. Speek offers specialist care for young people who self-harm and practical support for their carers.
- Trial team
Professor Peter Fonagy, Principal Investigator, University College London
Dr Elizabeth Simes, Principal Investigator, University College London
Dr Rob Saunders, Statistician, University College London
Dr Olivia Collier, Clinical lead, Speek Health
- Useful links
Speek Health https://lets-speek.com/
