The aim of this technology note is to provide information to the National Health Committee (NHC) about making PST available to all New Zealanders who present to hospital with self-harm. This information will be used by the Committee to:
- Understand how this intervention compares with the current treatment protocol for patients that present to hospital with self-harm in terms of safety, clinical effectiveness and cost-effectiveness.
- Determine what further information is required in order to recommend whether or not the intervention should be provided to all New Zealanders who present to hospital with self-harm.
- Start engaging with the sector around whether all costs and benefits have been accurately captured and the priority and feasibility of introducing the intervention in New Zealand relative to other interventions that might be available for addressing the health outcomes of interest.
Purpose
To provide a synthesis of existing clinical and economic information to the National Health Committee (NHC) about making Problem Solving Therapy (PST) available to all New Zealanders who present to hospital with self-harm in order to provide a basis for exploring with stakeholders how this intervention aligns with the existing care pathways and mental health priorities in different District Health Boards (DHBs).
Methodology
A list of key words was sent to the Ministry of Health’s information specialist to be used to identify existing HTA reports, systematic reviews, and randomised controlled trials (RCTs) that might be related to the intervention. The search was run between 23 November 2011 and 13 December 2011 in Ovid MEDLINE(R) and Cochrane Library databases using the following search criteria: problem solving therapy, suicide, RCTs and systematic reviews; Limits: Clinical trial, phase iii or clinical trial, phase iv or guideline or meta-analysis or randomized controlled trial or systematic review. No date parameters were used but the search was restricted to papers published in the English language.
To supplement this information, and obtain information on epidemiological burden, the internet was also used, and in particular the data & statistics pages and mental health and addictions pages of the Ministry of Health website. Information contained in the referral and the feedback received from the sector on the referral was also considered.
Key Results
The proposed target population for this intervention in New Zealand (people who present to hospital with self-harm) could include anywhere from 2,825 to around 5,000 people (from 0.07% to 0.13% of the total population).
Among people presenting to hospital with self-harm, current evidence suggests that PST, in addition to usual care, may be a more clinically effective intervention than usual care alone for improving underlying psychiatric conditions such as hopelessness and depression.
When compared with usual care alone, the addition of PST may also be a more clinically effective intervention for reducing further hospital presentations among those presenting with self-harm that already have a history of previous presentations with self-harm. However, among patients presenting for the first time at hospital with self-harm there was no significant difference in the primary outcome (re-presentation with self-harm) when compared with usual care alone.
There is currently no information on the cost-effectiveness of PST plus usual care. While a trial is currently underway that includes PST as part of a package of care, the individual contribution to the results from PST in isolation from the other interventions may not be possible to determine. If the PST plus usual care remains the intervention of interest, further work is required to assess the cost-effectiveness of the intervention.