Abstract
Background: Mental health supported accommodation services are implemented across England, usually organised into a ‘step-down’ care pathway that requires the individual to repeatedly move as they gain skills and confidence for more independent living. There have been no trials comparing the effectiveness of different types of supported accommodation, but two widely used models (supported housing and floating outreach) have been found to provide similar support. We aimed to assess the feasibility of conducting a large-scale trial comparing these two models. Methods: Individually randomised, parallel group feasibility trial in three regions of England (North London, East London, and Cheltenham and Gloucestershire). We aimed to recruit 60 participants in 15 months, referred to supported accommodation, randomly allocated on an equal basis to receive either a local supported housing or floating outreach service. We assessed referrals to the trial, participants recruited, attrition, time from recruitment to moving into either type of supported accommodation, and feasibility of masking. We conducted a process evaluation to examine our results further. Results: We screened 1,432 potential participants, of whom 17 consented to participate, with 8 agreeing to randomisation (of whom 1 was lost to attrition) and 9 participating in naturalistic follow-up. Our process evaluation indicated that the main obstacle to recruitment was staff and service user preferences for certain types of supported accommodation or for specific services. Staff also felt that randomisation compromised their professional judgement. Conclusions: Our results do not support investment in a large-scale trial in England at this time. Trial registration: UK CRN Portfolio database, Trial ID: ISRCTN19689576. Trial funding: National Institute of Health Research (RP-PG-0707-10093).
Highlights
In England, one third of working-age adults with severe mental health problems reside in supported accommodation provided by health and social services and housing associations [1, 2]
The feasibility trial was conducted in three sites that provided both types of supported accommodation and where the study team had good links (North London – Camden and Islington; East London – Tower Hamlets, Newham, Hackney; Gloucestershire and Cheltenham)
We explored the feasibility of using a telephone interview to collect follow-up data from service users
Summary
In England, one third of working-age adults with severe mental health problems (around 60,000 people) reside in supported accommodation provided by health and social services and housing associations [1, 2]. These services have been categorised into three main types [3]: residential care homes (offering high levels of longer-term support, 24 h a day to individuals with high needs), supported housing (offering time-limited, buildingbased support to individuals in single or shared tenancies), and floating outreach (offering flexible, visiting support to people in a permanent tenancy). Mental health supported accommodation services are implemented across England, usually organised into a ‘step-down’ care pathway that requires the individual to repeatedly move as they gain skills and confidence for more independent living. We aimed to assess the feasibility of conducting a large-scale trial comparing these two models
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