Table 5 Barriers to participation and retention in study - Burden for clinicians in self-harm services (Theme 3)

Clinicians in self-harm services reported some problems with recruitment to research that is common to most RCTs carried out in busy clinical services.

“I’ll be honest, forgetting because you are doing so much anyway in an assessment and you have so much to sort out and 9 times out of 10 you’ve got another assessment to go. And the amount of times afterwards I thought argh damn e-DASH – to be honest that happened a massive amount of time, a huge amount of time, it’s the last thing on your mind when you are doing it and I know I’m not the only one – and I was particularly bad for that to be honest” (NHS Adult Site B)

However, mental health assessments with people who are in crisis and have self-harmed can be emotionally charged. Recruitment to an RCT can then seem inappropriate.

“Sometimes you don’t want to risk the fact you had got them to a place that you had got them to a place where they were happy and calm and I felt a reluctance to add some extra stuff on in case it kind of cheapened the interaction.” (NHS Adult Site C)

Randomisation can then add to staff burden, bringing out a wish to protect the patient from additional burden.

“I felt, I used to do it, but I felt like a sales person, I know how I feel when people are trying to sell you something and you feel kind of pressured, I just felt it was the wrong time to be, quite distressed, a lot of the time it’s the middle of the night and I hate seeing people then, at 3am or 5am in the morning, it’s a bit weird doing a mental health assessment when they’ve been up all night, distressed, so then to try and say “oh, we’re doing this research thing where you might get picked but you might not”, trying to sell it in a positive light. Although I used to do it and people signed up for it, it felt it wasn’t the right time to be doing it.” (NHS Adult Site C)