SHIFT. Self-Harm Intervention, Family Therapy: a randomised controlled trial of family therapy vs. treatment as usual for young people seen after second or subsequent episodes of self-harm

A teenager who has harmed themselves twice is three times more likely to do so again, yet no robust trial has tested whether family therapy can break that cycle. The SHIFT trial directly addresses this gap. Self-harm is the strongest predictor of future suicide in young people, but the evidence base for psychological treatments after a second or subsequent episode is thin. Most existing trials focus on first episodes or are too small to produce reliable results. This study randomises 832 adolescents aged 11–17 across three English regions to either family therapy or standard care, then tracks hospital attendance for self-harm over 18 months. The family therapy follows a manualised approach developed with MRC funding, ensuring the intervention is consistent and replicable. If family therapy reduces repeat self-harm leading to hospital attendance, the impact would be immediate and practical. The NHS could adopt a tested, cost-effective treatment for a high-risk group that currently has no clear care pathway. Secondary outcomes—cost-effectiveness and quality of life—will tell commissioners whether the therapy is worth scaling. If the result is negative, the trial still provides the largest dataset on adolescent self-harm repetition, which can inform future trial design and clinical guidelines.