# What should be included in a digital mental health intervention, based on solution-focused therapy, for young people who self-harm? A qualitative exploration of young people and clinicians’ views

## TL;DR

This study explores what young people and clinicians think should be included in a digital mental health intervention based on solution-focused therapy for young people who self-harm.

## Contribution

The study is the first to explore the acceptability of a solution-focused therapy-based digital mental health intervention for young people who self-harm.

## Key findings

- Participants emphasized the importance of clear, straightforward, and personalized content in a digital mental health intervention.
- Stakeholders wanted the intervention to challenge users with novel ways of thinking and ensure confidentiality.
- Chatbots that lack understanding or only refer users elsewhere were seen as discouraging.

## Abstract

Digital mental health interventions (DMHIs) are an important resource for individuals who find it difficult to access in-person services, such as young people who self-harm. Most DMHIs currently are based on Cognitive-Behavioural Therapy. Solution-Focused Therapy (SFT) could provide different skills and learning but is not currently delivered digitally. Involving key stakeholders in the development of a novel DMHI is important for ensuring acceptability. The aims of this study are to explore stakeholder perceptions of a novel DMHI based in SFT, to determine what would promote or hinder engagement, and identify important content to include. We conducted focus groups and individual interviews with young people with lived experience of self-harm (n = 12) and clinicians experienced in SFT and working with young people who self-harm (n = 16). We captured a range of views through collective discussion in focus groups and more in-depth exploration in individual interviews. Data were analysed using content and framework methodologies. Content analysis enabled us to capture the direct likes, dislikes, and suggestions expressed, whereas framework analysis enabled capturing the overall perceptions of our proposed DMHI. Features identified as paramount to engagement were clear and straightforward content, personalisation to individual users, freely accessible, and assurances of confidentiality. Participants wanted content that challenged and provided novel ways of thinking. SFT was perceived as providing a different perspective to supporting mental health that participants viewed positively. Conversely, chatbots that cannot understand users and respond appropriately, or just refer people elsewhere, would discourage use. This study is the first to explore the application of SFT to a novel digital intervention, and the first to explore its acceptability with young people who self-harm. Key stakeholders felt positively about the proposed intervention, and provided specific recommendations to consider in the development of novel DMHIs.

There are lots of digital mental health interventions available but very few are developed and tested thoroughly. Additionally, many existing digital interventions are not used consistently by their target users. Including the target user of these interventions in the design and development phase will help them to be acceptable and engaging. Young people who self-harm may particularly benefit from digital mental health interventions since they often find it difficult to access in-person services. Solution-focused therapy is one type of therapy used with young people, and with people who self-harm, that has not yet been delivered through a digital intervention. We interviewed young people with lived experience of self-harm and clinical experts to explore what they would like a digital intervention, based on solution-focused therapy, to look like. They were positive about a digital intervention based in solution-focused therapy, and suggested it needed to be personalised, accessible, clear and straightforward, and prioritise user privacy and confidentiality. They liked the different perspective that solution-focused questions stimulated and the convenience of engaging with digital interventions. These recommendations will help us to develop an intervention that is acceptable and engaging for young people who self-harm.