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

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.