A cluster randomised controlled trial of a ward-based intervention to improve access to psychologically-informed care and psychological therapy for mental health in-patients

Katherine Berry,Gillian Haddock,Helen Wilson,Bolanle Odebiyi,Richard J Drake,Rachel Winter,Dawn Edge,Karina Lovell,Sandra Bucci,Richard Emsley,Owen Price,Gill Gilworth,Jessica Raphael,Matt Sutton

doi:10.1186/s12888-022-03696-7

Abstract

BackgroundThere is good evidence that psychological interventions improve patient well-being and independent living, but patients on acute mental health wards often do not have access to evidence-based psychological therapies which are strongly advised by NICE guidance for severe mental health problems. The overall aim of this programme of work is to increase patient access to psychological therapies on acute mental health inpatient wards. Stage one of the programme (which is complete) aimed to identify barriers and facilitators to delivering therapy in these settings through a large qualitative study. The key output of stage one was an intervention protocol that is designed to be delivered on acute wards to increase patient access to psychologically-informed care and therapy. Stage two of the programme aims to test the effects of the intervention on patient wellbeing and serious incidents on the ward (primary outcomes), patient social functioning and symptoms, staff burnout, ward atmosphere from staff and patient perspectives and cost effectiveness of the intervention (secondary outcomes).MethodsThe study is a single blind, pragmatic, cluster randomised controlled trial and will recruit thirty-four wards across England that will be randomised to receive the new intervention plus treatment as usual, or treatment as usual only. Primary and secondary outcomes will be assessed at baseline and 6-month and 9-month follow-ups, with serious incidents on the ward collected at an additional 3-month follow-up.DiscussionThe key output will be a potentially effective and cost-effective ward-based psychological intervention that increases patient access to psychological therapy in inpatient settings, is feasible to deliver in inpatient settings and is acceptable to patients.Trial Registration numberClinicalTrials.gov Identifier: NCT03950388. Registered 15th May 2019. https://clinicaltrials.gov/ct2/show/NCT03950388

Highlights

There is good evidence that psychological interventions improve patient well-being and independent living, but patients on acute mental health wards often do not have access to evidence-based psychological therapies which are strongly advised by National Institute for Health and Care Excellence (NICE) guidance for severe mental health problems
Strategies to improve and monitor adherence All psychologists will receive two days of training in the intervention model which will be delivered by the research team
The content of the training will include an introduction to the project and intervention, training others, 1:1 therapy on inpatient settings, supervision with others, team formulation, reflective practice, data collection and reporting, and implementation challenges and will involve a combination of direct teaching and opportunities for discussion

Summary

Introduction

There is good evidence that psychological interventions improve patient well-being and independent living, but patients on acute mental health wards often do not have access to evidence-based psychological therapies which are strongly advised by NICE guidance for severe mental health problems. The overall aim of this programme of work is to increase patient access to psychological therapies on acute mental health inpatient wards. The key output of stage one was an intervention protocol that is designed to be delivered on acute wards to increase patient access to psychologically-informed care and therapy. The care of people with severe mental health problems costs around £12 billion a year This figure accounts for more than half of the mental health and social care budget and much of it is spent on acute inpatient admissions [2]. Between April 2017 and March 2018, 103,952 people who were in contact with mental health services spent time on mental health wards [3] On average, it costs the NHS over £12,000 per acute inpatient admission [2]. Despite extremely high costs associated with inpatient care, inquiries and surveys of patient satisfaction highlight poor quality of care in these settings [1, 4, 5] and there are high levels of staff burn out and absenteeism [6]

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