Abstract
BackgroundA documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. Peer-facilitated self-management interventions have potential to meet this need, but evidence for their effectiveness is limited. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs).MethodsA five-stage iterative mixed-methods approach of sequential data collection and intervention development was adopted, following the development and piloting stages of the MRC framework for developing and evaluating complex interventions. Evidence review (stage 1) included systematic reviews of both peer support and self-management literature. Interviews with CRT service users (n = 41) regarding needs and priorities for support following CRT discharge were conducted (stage 2). Focus group consultations (n = 12) were held with CRT service-users, staff and carers to assess the acceptability and feasibility of a proposed intervention, and to refine intervention organisation and content (stage 3). Qualitative evaluation of a refined, peer-provided, self-management intervention involved qualitative interviews with CRT service user participants (n = 9; n = 18) in feasibility testing (stage 4) and a pilot trial (stage 5), and a focus group at each stage with the peer worker providers (n = 4).ResultsExisting evidence suggests self-management interventions can reduce relapse and improve recovery. Initial interviews and focus groups indicated support for the overall purpose and planned content of a recovery-focused self-management intervention for people leaving CRT care adapted from an existing resource: The personal recovery plan (developed by Repper and Perkins), and for peer support workers (PSWs) as providers. Participant feedback after feasibility testing was positive regarding facilitation of the intervention by PSWs; however, the structured self-management booklet was underutilised. Modifications to the self-management intervention manual and PSWs’ training were made before piloting, which confirmed the acceptability and feasibility of the intervention for testing in a future, definitive trial.ConclusionsA manualised intervention and operating procedures, focusing on the needs and priorities of the target client group, have been developed through iterative stages of intervention development and feedback for testing in a trial context.Trial Registration ISRCTN01027104 date of registration: 11/10/2012
Highlights
A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided
There is a lack of information about rates of readmission to acute care nationally following a period of crisis resolution team (CRT) support, but high rates have been reported—just over 50% within 1 year—in a recent study in two inner London national health service (NHS) trusts [11]
In this paper, following medical research council (MRC) guidance for the development and evaluation of complex interventions [25], we report the iterative development and feasibility testing of a peer supported, self-management intervention for people leaving CRT services for use in a definitive randomised controlled trial
Summary
A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs). Crisis resolution teams (CRTs), referred to as home treatment teams, provide rapid assessment for service users experiencing mental health crises and, where possible, offer brief, intensive home treatment as an alternative to acute admission [1]. Since their adoption into the national health service (NHS) plan [2], CRTs are available in every NHS trust in England [3] and have been implemented nationally in Norway and Flemish Belgium [4]. There is a lack of information about rates of readmission to acute care nationally following a period of CRT support, but high rates have been reported—just over 50% within 1 year—in a recent study in two inner London NHS trusts [11]
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