title: The ACCESS study: Zelen randomised controlled trial of a package of care for people presenting to hospital after self-harm.
abstract: BACKGROUND
  The problem of people presenting to hospitals with self-harm is important because such presentations are common, there is a clear link to suicide and a high premature mortality. However, the best treatment for this population is unclear.
  
  
  OBJECTIVE
  To see whether a package of measures, that included regular postcards and problem-solving therapy, improved outcomes at 1 year compared with usual care in people who presented to hospital with self-harm (the ACCESS study: trial registration Australian and New Zealand Clinical Trials Registry ACTRN12609000641291).
  
  
  METHODS
  The design of the study was a Zelen randomised controlled trial. The primary outcome was re-presentation to hospital with self-harm within 12 months of the index episode.
  
  
  RESULTS
  There were no significant differences in the primary outcome and most of the secondary outcomes between the two groups. About half the people offered problem-solving therapy did not receive it, for various reasons.
  
  
  CONCLUSIONS
  The package as offered had little effect on the proportion of people re-presenting to hospital with self-harm. The dose of problem-solving therapy may have been too small to have an effect and there was a difficulty engaging participants in active treatment.
authors.affiliation: Simon Hatcher, MBBS, MD, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Cynthia Sharon, MSc, University of Auckland, Auckland, New Zealand; Allan House, MBBS, DM, University of Leeds, Leeds, UK; Nicola Collins, University of Auckland, Auckland, New Zealand; Sunny Collings, MBChB, PhD, University of Otago, Dunedin, New Zealand; Avinesh Pillai, MSc, University of Auckland, Auckland, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: Hatcher
authors.affiliation: Simon Hatcher, MBBS, MD, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Cynthia Sharon, MSc, University of Auckland, Auckland, New Zealand; Allan House, MBBS, DM, University of Leeds, Leeds, UK; Nicola Collins, University of Auckland, Auckland, New Zealand; Sunny Collings, MBChB, PhD, University of Otago, Dunedin, New Zealand; Avinesh Pillai, MSc, University of Auckland, Auckland, New Zealand.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Sharon
authors.affiliation: Simon Hatcher, MBBS, MD, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Cynthia Sharon, MSc, University of Auckland, Auckland, New Zealand; Allan House, MBBS, DM, University of Leeds, Leeds, UK; Nicola Collins, University of Auckland, Auckland, New Zealand; Sunny Collings, MBChB, PhD, University of Otago, Dunedin, New Zealand; Avinesh Pillai, MSc, University of Auckland, Auckland, New Zealand.
authors.forename: Allan
authors.initials: A
authors.lastname: House
authors.affiliation: Simon Hatcher, MBBS, MD, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Cynthia Sharon, MSc, University of Auckland, Auckland, New Zealand; Allan House, MBBS, DM, University of Leeds, Leeds, UK; Nicola Collins, University of Auckland, Auckland, New Zealand; Sunny Collings, MBChB, PhD, University of Otago, Dunedin, New Zealand; Avinesh Pillai, MSc, University of Auckland, Auckland, New Zealand.
authors.forename: Nicola
authors.initials: N
authors.lastname: Collins
authors.affiliation: Simon Hatcher, MBBS, MD, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Cynthia Sharon, MSc, University of Auckland, Auckland, New Zealand; Allan House, MBBS, DM, University of Leeds, Leeds, UK; Nicola Collins, University of Auckland, Auckland, New Zealand; Sunny Collings, MBChB, PhD, University of Otago, Dunedin, New Zealand; Avinesh Pillai, MSc, University of Auckland, Auckland, New Zealand.
authors.forename: Sunny
authors.initials: S
authors.lastname: Collings
authors.affiliation: Simon Hatcher, MBBS, MD, Department of Psychiatry, University of Ottawa, Ottawa, Canada; Cynthia Sharon, MSc, University of Auckland, Auckland, New Zealand; Allan House, MBBS, DM, University of Leeds, Leeds, UK; Nicola Collins, University of Auckland, Auckland, New Zealand; Sunny Collings, MBChB, PhD, University of Otago, Dunedin, New Zealand; Avinesh Pillai, MSc, University of Auckland, Auckland, New Zealand.
authors.forename: Avinesh
authors.initials: A
authors.lastname: Pillai
mesh_terms: D000328:Adult; D006761:Hospitals; D006801:Humans; D011613:Psychotherapy; D012008:Recurrence; D016728:Self-Injurious Behavior / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult