Peer Support for Mental Illness Shown to Reduce Acute Care Readmission
August 5, 2018 | By Janice Wood
A new study shows that care and support from peers who have also experienced mental health problems reduces readmission rates for people who have recently left acute mental health care.
Published in The Lancet, the randomized controlled trial of 400 people in England found that fewer people who received this type of support were readmitted to acute care a year after the study began, compared to people who only received a workbook.
In the U.K., more than half of people admitted to acute care are readmitted within a year, according to researchers.
Support from people who have had mental health problems is used in the U.K. and the United States in programs such as the NHS’ Implementing Recovery through Organizational Change and the Wellness Recovery Action Plan in the U.S.
According to researchers, their study is the first randomized trial to evaluate the effectiveness of these programs, which show positive results.
However, more research — including understanding the specific causes of the drop in readmissions — is now needed before the strategy is implemented nationally in the U.K., researchers said.
The researchers add that self-management interventions may help people manage their mental health better, and in this study, they combined a self-management workbook with help from a support worker who had also experienced a mental health problem.
“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,” said lead author Professor Sonia Johnson at University College London.
“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.”
The new study took place across six crisis resolution teams in England. People were recruited after they had been discharged by a crisis resolution team, researchers said.
Participants had a variety of diagnoses, including schizophrenia, bipolar disorder, psychosis, depression, anxietydisorder, post-traumatic stress disorder, and personality disorder. All people within the study continued treatment and usual care throughout the study.
Half of the participants — 220 people — received a personal recovery workbook, while the remaining 221 people received peer support and the workbook.
The workbook included sections on setting personal recovery goals, re-establishing their place in the community and support networks, identifying early warning signs, and creating an action plan to avoid or delay relapse, and planning strategies to maintain well-being. Participants were asked to record observations and plans in each of these areas, the researchers said.
Participants who received peer support were offered 10 one-hour sessions, which took place each week. The support worker listened to their problems and aimed to instill hope by sharing skills and coping strategies learned during their own recovery.
Support workers received training beforehand in listening skills, cultural awareness, self-disclosure and confidentiality, and how to use the workbook, according to the researchers.
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, and conducted interviews with participants at four and 18 months to obtain their views on the intervention.
After one year, readmission to acute care was lower in the intervention group than in the control group; with 29 percent (64 out to 218) of participants readmitted in the intervention group versus 38 percent (83 out of 216) of the participants in the control group, according to the study’s findings.
The researchers added that 72 percent (160 of 221) of people offered the support and workbook attended at least three meetings with their peer support worker, and a third (65 out of 198) attended all 10 meetings.
Similar numbers of participants in the intervention and control groups read the workbook — 84 percent (133 out of 158) of people in the control group vs 88 percent (142 out of 162) of people in the intervention group, according to the study’s findings.
But more people in the intervention group used it to make written plans — 58-64 percent of people in the intervention group vs 28-44 percent of people in the control group.
During the study there were 71 serious adverse events (29 in the intervention group and 42 in the control group), but none were deemed related to the study, the researchers noted. These included 55 readmissions to acute care, 11 attempted suicides, one attempted murder, two suicides, and two deaths with unclear circumstances.
“Our study provides the most robust evidence for the effectiveness of any peer-provided support in a U.K. secondary mental health setting,” Johnson said. “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.”
The researchers note some limitations, including that the secondary outcomes of the study gave unclear results, so it is not possible to identify which part of the intervention caused the improvement in patient outcomes.
Additionally, a high proportion of people in the control group used the workbook, and readmission rates in this group were below the national average, which may suggest that the workbook is effective on its own too. This could mean the effectiveness of peer support was underestimated in the study, the researchers noted.