Conducting mental health studies in Emergency Departments in England: Lessons learnt from a randomised controlled trial testing a brief psychological intervention for adults who self-harm.

Conducting mental health trials in busy EDs presents challenges, including record demand, bed shortages, 4-hour targets from arrival to discharge or admission, and staff shortages. This essay reflects on real-world challenges in a mental health trial involving people presenting to the ED with self-harm and/or suicidal thoughts and outlines lessons learned for future studies. No quantitative data will be reported. ASSURED is a randomised controlled clinical trial investigating the effectiveness of a brief psychological intervention for adults attending the ED with self-harm and/or suicidal thoughts. The original aims were to improve psychosocial assessments conducted by liaison psychiatry practitioners and to have the same practitioner deliver the intervention after discharge ensuring relational continuity. We worked with people with lived experience to address engagement challenges during mental health crises. 620 people across 14 EDs in England were recruited between 2022-2024. Although liaison psychiatry practitioners were trained to deliver the intervention, recruiting participants in crisis was difficult due to 4-hour targets and limited mental health research nurses. Delivering follow-up care post-discharge was challenging, as practitioners prioritised urgent assessments over delivering the follow-up intervention. However, it was feasible for researchers to recruit people within 1-2 weeks of ED attendance and for other mental health professionals to deliver the intervention. Flexibility in time and mode of delivery was paramount in participant engagement, which was mostly not achievable within liaison psychiatry roles. As many patients reattended the ED, experienced suicidal ideation or harmed themselves, supporting local clinical Principal Investigators to complete time-consuming paperwork in relation to these Serious/Adverse Events was helpful. ED liaison psychiatry teams face significant barriers to trial participation compared to other settings. Brief psychological interventions after ED attendance were more feasibly delivered by other practitioners such as assistant psychologists, and lived-experience advisors were central to ensuring sensitive engagement, approach and follow-up in research. Clinical Trial Number ISRCTN 13472559, Registered on 18 of November 2021.