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Peer support reduces hospital readmissions for mental health crises, shows study

BMJ 2018; 362 doi: (Published 03 August 2018) Cite this as: BMJ 2018;362:k3405
  1. Susan Mayor
  1. London

Self management training provided by peer workers with personal experience of mental illness significantly reduced readmission to mental health crisis units in patients discharged from acute mental healthcare, a randomised controlled trial has found.1

The lead author, Sonia Johnson, professor of social and community psychiatry at University College London, UK, said, “People discharged from community crisis services are often readmitted to acute care. Not only does this impede recovery but it also consumes resources that might otherwise be dedicated to longer term improvements in functioning and quality of life.”

Over half of people currently admitted to acute mental healthcare in the UK are readmitted within one year, and no clear evidence has shown how to reduce these readmissions.

“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 Johnson.

The study, funded by the National Institute for Health Research, included patients with a variety of mental illnesses, including schizophrenia and bipolar affective disorder, who had recently been discharged from the care of six crisis resolution teams in England. These teams provide community based care to people with a mental health crisis of sufficient severity that hospital admission would otherwise be considered.

Researchers randomly assigned 221 patients to a maximum of 10 one hour sessions working through a personal recovery workbook with a trained peer support worker who had personal experience of using mental health services. The workbook included formulating personal recovery goals, re-establishing the patient’s place in the community, learning to identify early warning signs, and creating an action plan to prevent relapse.

A further 220 patients were randomly allocated to standard care, where they received the recovery workbook by post but without peer support.

The results, published in the Lancet,1 showed that readmission to acute care at one year was significantly lower in patients taking part in the peer support programme (29%; 64/218 patients) than in those receiving standard care (38%; 83/216 patients) (odds ratio 0.66 (95% confidence interval 0.43 to 0.99); P=0.0438).

The time to first readmission was significantly longer in the intervention group than in the control group (mean 112 days v 86 days; hazard ratio 0.71; P=0.0291). But, when admitted, the number of days in acute care was not significantly different.

A total of 71 serious adverse events were identified during the study (29 in the treatment group and 42 in the control group).

“Our findings suggest that peer delivered self management reduces readmission to acute care,” said the research group. However, they noted that admission rates were lower than anticipated and that the confidence intervals were relatively wide.

“The complexity of the study intervention limits interpretability,” the authors acknowledged. They said that the primary goal was to maximise the likelihood that the intervention would be effective, but the combination of the workbook plus peer support made it difficult to pinpoint the key elements contributing to success.

They recommended further studies to assess whether implementing the peer support intervention in routine care settings reduces acute care readmission in people at risk for mental health crises.


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