The CORE study-An adapted mental health experience codesign intervention to improve psychosocial recovery for people with severe mental illness: A stepped wedge cluster randomized-controlled trial.

Victoria J Palmer,John Furler,Jane M Gunn,Patty Chondros,Konstancja Densley,Kali Godbee,Helen Herrman,David Pierce

doi:10.1111/hex.13334

Victoria J Palmer, John Furler + Show 6 more

Open Access

https://doi.org/10.1111/hex.13334

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Journal: Health Expectations	Publication Date: Aug 4, 2021
Citations: 12	License type: CC BY 4.0

Affiliation: University of Melbourne, Orygen Youth Health

Abstract

BackgroundMental health policies outline the need for codesign of services and quality improvement in partnership with service users and staff (and sometimes carers), and yet, evidence of systematic implementation and the impacts on healthcare outcomes is limited.ObjectiveThe aim of this study was to test whether an adapted mental health experience codesign intervention to improve recovery‐orientation of services led to greater psychosocial recovery outcomes for service users.DesignA stepped wedge cluster randomized‐controlled trial was conducted.Setting and ParticipantsFour Mental Health Community Support Services providers, 287 people living with severe mental illnesses, 61 carers and 120 staff were recruited across Victoria, Australia.Main Outcome MeasuresThe 24‐item Revised Recovery Assessment Scale (RAS‐R) measured individual psychosocial recovery.ResultsA total of 841 observations were completed with 287 service users. The intention‐to‐treat analysis found RAS‐R scores to be similar between the intervention (mean = 84.7, SD= 15.6) and control (mean = 86.5, SD= 15.3) phases; the adjusted estimated difference in the mean RAS‐R score was −1.70 (95% confidence interval: −3.81 to 0.40; p = .11).DiscussionThis first trial of an adapted mental health experience codesign intervention for psychosocial recovery outcomes found no difference between the intervention and control arms.ConclusionsMore attention to the conditions that are required for eight essential mechanisms of change to support codesign processes and implementation is needed.Patient and Public InvolvementThe State consumer (Victorian Mental Illness Awareness Council) and carer peak bodies (Tandem representing mental health carers) codeveloped the intervention. The adapted intervention was facilitated by coinvestigators with lived‐experiences who were coauthors for the trial and process evaluation protocols, the engagement model and explanatory model of change for the trial.

Highlights

Mental healthcare policies are replete with references to embed coproduction and codesign with service users in the design, planning and delivery of programmes.[1,2,3,4,5,6,7,8,9] The 2017 United Nations Special Report identified coproduction as fundamental to mental health service participation to reach the highest attainment of physical and mental health.[10]
As mental health policy increasingly advocates for coproduction and codesign approaches[37,38] to facilitate better services, improved experiences and outcomes, there is a need for controlled studies to measure impacts
The broader implications of these findings might best be reflected by consideration of the main action areas identified by people living with SMI and their carers that highlighted the central concerns of better communication, the importance of involvement in decision‐making and the provision of opportunities for being with other people with similar life experiences not solely because of having a diagnosis of mental illnesses

Summary

Introduction

Mental healthcare policies are replete with references to embed coproduction and codesign with service users in the design, planning and delivery of programmes.[1,2,3,4,5,6,7,8,9] The 2017 United Nations Special Report identified coproduction as fundamental to mental health service participation to reach the highest attainment of physical and mental health.[10]. Mental health policies outline the need for codesign of services and quality improvement in partnership with service users and staff (and sometimes carers), and yet, evidence of systematic implementation and the impacts on healthcare outcomes is limited. Objective: The aim of this study was to test whether an adapted mental health experience codesign intervention to improve recovery‐orientation of services led to greater psychosocial recovery outcomes for service users. Discussion: This first trial of an adapted mental health experience codesign intervention for psychosocial recovery outcomes found no difference between the intervention and control arms

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Conclusion