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Peer support workers ‘reduce readmission to mental health crisis units’

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Care from peer support workers with lived experience of mental health conditions may help reduce readmission for people who have recently left acute mental health care, according to researchers.

A UK study has found that fewer people who received this type of support were readmitted to acute care a year after the study began, compared to people who only received a workbook.

“Our study provides the most robust evidence for the effectiveness of peer-provided support in a UK secondary mental health setting”

Sonia Johnson

The researchers behind the study noted that more than half of people admitted to acute care were readmitted within a year in the UK, with little “robust evidence” on how to reduce them.

They noted that support from people with lived experience of mental health problems was used in the UK via programmes such as the NHS’ Implementing Recovery through Organisational Change.

Their study, involving more than 400 people and published today in The Lancet, was the first randomised trial to evaluate the effectiveness and shows positive results from such initiatives.

It took place across six crisis resolution teams in England, and people were recruited after they had been discharged by a crisis resolution team.

“People discharged from community crisis services are often readmitted to acute care”

Sonia Johnson

Participants had a variety of diagnoses including schizophrenia, bipolar affective disorder, psychosis, depression anxiety disorder, post-traumatic stress disorder, and personality disorder. All people within the study continued treatment and usual care throughout the study, noted the researchers.

The study authors combined a self-management workbook with help from a support worker who had also experienced a mental health problem. Participants either received the personal recovery workbook or peer support plus the workbook.

The workbook included sections on setting personal recovery goals, re-establishing their place in the community and support networks. It also covered identifying early warning signs and creating an action plan to avoid or delay relapse, and planning strategies to maintain wellbeing.

Participants who received support from a person who had also experienced mental health problems were offered 10 one-hour sessions, which took place each week.

The support worker listened to their problems and aimed to instil hope by sharing the skills and coping strategies they learnt during their own recovery.

Support workers received training beforehand in listening skills, cultural awareness, self-disclosure, and confidentiality, and how to use the workbook.

The authors monitored participants’ health records to determine whether they were readmitted to acute care within one year, and conducted interviews with participants at four and 18 months.

After one year, readmission to acute care was lower in the intervention group than in the control group – with 29% of participants readmitted in intervention group versus 38% of controls.

“The intervention is acceptable to patients and feasible for service managers and users”

Sonia Johnson

Intervention uptake was seen as good, with 72% of people offered the support and workbook attending at least three meetings with their support worker and a third attending all 10 meetings.

Similar numbers of participants in the intervention and control groups read the booklet, but more people in the intervention group used it to make written plans.

Lead study author Professor Sonia Johnson, from University College London, highlighted that people discharged from community crisis services were often readmitted to acute care.

“Not only does this impede recovery, but also consumes resources that might otherwise be dedicated to longer term improvements in functioning and quality of life,” she said.

“Peer support workers could provide support and encouragement that is particularly warm and empathetic, because it is rooted in personal experience, as well as providing service users with a role model for their recovery,” she noted.

University College London

Professor Sonia Johnson

Sonia Johnson

She added: “Our study provides the most robust evidence for the effectiveness of any peer-provided support in a UK secondary mental health setting.

“Our novel findings are potentially important as the intervention is acceptable to patients and feasible for service managers and users who would like to avoid relapse and readmission to acute care,” said Professor Johnson.

The study, which was funded by the National Institute for Health Research, involved researchers from a range of NHS trusts and UK universities, as well as the University of Sydney in Australia.

These included University College London, Camden and Islington NHS Foundation Trust, University of Surrey, King’s College London, University of Bristol, Avon and Wiltshire Mental Health Partnership NHS Trust, West London Mental Health Trust and Oxford Health NHS Foundation Trust.

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