Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial

Background: High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse is frequent after a period of acute care. Evidence on how to prevent such relapses is limited. Some evidence supports self-management interventions, but their effect on readmissions to acute care following a crisis is untested. We tested the hypothesis that a self-management intervention, facilitated by peer support workers,, would reduce rates of readmission to acute care within one year (the primary outcome) for people discharged from crisis resolution teams (CRTs). CRTs provide intensive home treatment following a crisis.

Methods: We conducted a rater-blinded, randomised controlled superiority trial, , recruiting from six CRTs in England. . Eligible participants had been on CRT caseloads for at least a week, and had capacity to give informed consent. Consenting participants were block-randomised into treatment and control groups by an unblinded data manager, using an independent randomisation service. Those collecting and analysing data were blinded, but blinding participants was not feasible. Treatment group participants were offered up to ten sessions with a Peer Support Worker who supported them in completing a Personal Recovery Workbook, including formulation of personal recovery goals and crisis plans. The control group received the Personal Recovery Workbook by post.

Findings: 221 participants were randomised to the experimental and 220 the control intervention: primary outcomes were obtained for 218 and 216 respectively. 29% (64/218) of the intervention and 38% (83/216) of the control group were readmitted to acute care within one year (Odds ratio: 0.66[0.43, 0.99], p=0.0438). This remained significant with planned adjustments.

Interpretation: Our findings suggest peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals are relatively wide. Complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission.