Peer support could reduce readmission to mental health crisis units
3 August 2018
Care from peer support workers with lived experience of mental health conditions may help reduce the likelihood of readmission for people who have recently left acute mental health care, finds a new UCL-led study.
The research, published today in The Lancet, found that close to 24% fewer people who received peer support were readmitted to acute care within a year, compared to people who only received a workbook.
"People discharged from community crisis services are often readmitted to acute care. Not only does this impede recovery, but also consumes resources that might otherwise be dedicated to longer term improvements in functioning and quality of life. Peer support workers could provide support and encouragement that is particularly warm and empathetic because it is rooted in personal experience, as well as providing service users with a role model for their recovery," said lead author Professor Sonia Johnson (UCL Psychiatry).
In the UK, more than half of people admitted to acute care are readmitted within a year, but there is no robust evidence on how these readmissions can be reduced.
Support from people with lived experience of mental health problems is used in programmes such as the NHS' Implementing Recovery through Organisational Change and the USA's Wellness Recovery Action Plan. This study is the first randomised controlled trial to evaluate the effectiveness of such peer support programmes. However, more research, including to understand what causes the effect, is needed before the strategy is implemented nationally in the UK.
Self-management interventions may help people manage their mental health better, and in this study, the researchers provided participants with either a personal recovery workbook (220 people) or the workbook in addition to help from a support worker who had also experienced a mental health problem (221 people). Participants also continued their usual care.
The study took place across six crisis resolution teams in England, and people were recruited after they had been discharged by a crisis resolution team. Participants had a variety of diagnoses including schizophrenia, bipolar affective disorder, psychosis, depression, anxiety disorder, post-traumatic stress disorder, and personality disorder.
Participants who received peer support were offered 10 weekly one-hour sessions. The support worker listened to their problems and aimed to instil hope by sharing the skills and coping strategies they learnt during their own recovery. Support workers received training beforehand in listening skills, cultural awareness, self-disclosure, and confidentiality, and how to use the workbook.
The researchers monitored participants' health records to determine whether they were readmitted to acute care (such as acute inpatient wards, crisis resolution teams, crisis houses, and acute day care services) within one year.
After one year, readmission to acute care was lower in the intervention group than in the control group - with 29% of participants readmitted after having support from a peer worker versus 38% of participants who only received a workbook.
Uptake of the intervention was good - 72% of people offered the support and workbook attended at least three meetings with their peer support worker, and a third attended all 10 meetings.
"We know that many service users feel that mental health crisis care ends abruptly with insufficient follow-on care in place. Our study suggests peer support workers can help fill this gap in care by helping service users develop self-management strategies and a recovery plan which are individualised and feel meaningful, which can help people stay well following a crisis," said co-author Dr Brynmor Lloyd-Evans (UCL Psychiatry).
"Our study provides the most robust evidence for the effectiveness of any peer-provided support in a UK secondary mental health setting. Our novel findings are potentially important as the intervention is acceptable to patients and feasible for service managers and users who would like to avoid relapse and readmission to acute care," added Professor Johnson.
During the study there were 71 serious adverse events but none were deemed related to the study.
The authors note that a high proportion of people in the control group used the booklet, and readmission rates in this group were below the national average, which may suggest the booklet is effective on its own too, and may also mean the effectiveness of peer support was under estimated.
The study was funded by the National Institute for Health Research, and conducted by researchers from UCL, Camden and Islington NHS Foundation Trust, University of Surrey, King's College London, University of Sydney, University of Bristol, Avon and Wiltshire Mental Health Partnership NHS Trust, West London Mental Health Trust, and Oxford Health NHS Foundation Trust.
- Research paper in The Lancet
- Professor Sonia Johnson's academic profile
- Dr Brynmor Lloyd-Evans' academic profile
- UCL Psychiatry
- Source: Time to Change 'Get the Picture', Credit: Newscast Online
- The Lancet
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Email: chris.lane [at] ucl.ac.uk