Peer support for frequent users of inpatient mental health care in Uganda: protocol of a quasi-experimental study

Grace K Ryan,James Mugisha,Karen M Devries,Dave Baillie,Cerdic Hall,Eddie Nkurunungi,Mary J De Silva,Carter Newman,Mauricia Kamuhiirwa,Richard Mpango,Sujit D Rathod

doi:10.1186/s12888-019-2360-8

Abstract

BackgroundReducing readmissions among frequent users of psychiatric inpatient care could result in substantial cost savings to under-resourced mental health systems. Studies from high-income countries indicate that formal peer support can be an effective intervention for the reduction of readmissions among frequent users. Although in recent years formal peer support programmes have been established in mental health services in a few low- and middle-income countries (LMICs), they have not been rigorously evaluated.MethodsThis protocol describes a quasi-experimental difference-in-differences study conducted as part of a broader evaluation of the Brain Gain II peer support programme based at Butabika National Referral Hospital in Kampala, Uganda. The primary objective is to investigate whether frequent users of psychiatric inpatient care who have access to a peer support worker (PSW+) experience a greater reduction in rehospitalisation rates and number of days spent in hospital compared to those who do not have access to a peer support worker (PSW-). Frequent users, defined as adults diagnosed with either a mental disorder or epilepsy who have had three or more inpatient stays at Butabika over the previous 24 months, are referred to Brain Gain II by hospital staff on five inpatient wards. Frequent users who normally reside in a district where peer support workers currently operate (Kampala, Jinja, Wakiso and Mukono) are eligible for formal peer support and enter the PSW+ group. Participants in the PSW+ group are expected to receive at least one inpatient visit by a trained peer support worker before hospital discharge and three to six additional visits after discharge. Frequent users from other districts enter the PSW- group and receive standard care. Participants’ admissions data are extracted from hospital records at point of referral and six months following referral.DiscussionTo the best of our knowledge, this will be the first quasi-experimental study of formal peer support in a LMIC and the first to assess change in readmissions, an outcome of particular relevance to policy-makers seeking cost-effective alternatives to institutionalised mental health care.

Highlights

Reducing readmissions among frequent users of psychiatric inpatient care could result in substantial cost savings to under-resourced mental health systems
This study will contribute to the evaluation of one of the first formal peer support programmes to be established in a low- and middle-income countries (LMICs)
Given the high cost of inpatient care, the outcomes are relevant to mental health policy in Uganda and other LMICs, where most government expenditure on mental health continues to be spent on psychiatric hospitals [23]

Summary

Introduction

Reducing readmissions among frequent users of psychiatric inpatient care could result in substantial cost savings to under-resourced mental health systems. In recent years formal peer support programmes have been established in mental health services in a few low- and middle-income countries (LMICs), they have not been rigorously evaluated. More recent studies from low- and middle-income countries (LMICs) observe high rates of readmission and large numbers of frequent users among psychiatric inpatient populations [1, 4,5,6,7,8,9]. In Nigeria, for example, 41.4% of psychiatric inpatients at a university teaching hospital were readmitted within five years Among those readmitted, mean number of admissions was 2.9 [6].

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