Peer-delivered self-management decreases readmission to acute care among those discharged from care by a mental health crisis team, according to the results of a study published in The Lancet.
Inpatient and acute care consume a disproportionate amount of scarce mental health resources in the United Kingdom and elsewhere. Crisis resolution teams are available within the United Kingdom as part of an attempt to reduce the use of acute care in mental health, but readmission to acute care remains high. Self-management interventions are known to support patients in actively managing their health problems and may help reduce readmission.
Sonia Johnson, DM, Division of Psychiatry, University College London, London, United Kingdom, and colleagues recruited patients from 6 crisis resolution teams in England for a randomized, controlled trial. Patients had been treated by the crisis resolution team for at least 1 week and were offered up to 10 sessions with a peer support worker who helped them complete a personal recovery workbook that included personal recovery goals and plans for dealing with crises. The control group received the same workbook by mail. The primary outcome was readmission to acute care within one year.
Primary outcome data were available for 218 people in the intervention group and 216 in the control group. Readmission to acute care occurred within 1 year in 29% of the intervention group vs 38% of the control group (odds ratio 0.66; 95% CI, 0.43-0.99; P =0.0438). Furthermore, time to readmission was significantly longer in the intervention group than in the control group, although the number of days spent in acute care did not differ significantly between the groups. At 4 months, overall satisfaction with the mental health care provided was also greater in the intervention group than in the control group, and there was a significant difference in self-rated recovery for the intervention group as well. However, at 18 months, no significant effect was found.
There were 71 serious adverse events, including readmission to acute care, attempted suicide, attempted murder, and death; however, none were judged as related to the study intervention.
The authors noted that these findings should be confirmed in other studies and they called for research on how to embed and sustain peer-supported self-management in routine services. They acknowledge, however, that admission rates were lower than anticipated and that confidence intervals were relatively large.
Johnson S, Lamb D, Marston L, et al. Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial. Lancet. 2018;392:409-418.