New data, published in The Lancet, highlights the importance of peer support in reducing the risk of readmission to an acute crisis unit. Dr. Sonia Johnson, from the Division of Psychiatry, University College London, found that individuals who had peer support while learning self-management techniques and completing a workbook were less likely to be readmitted to acute care than those learning the book and completing the interventions independently.
This research provides important insights toward the goal of preventing readmission, an objective targeted to reduce the heavy use of services and assist individuals in their recovery. In previous research, locating a path toward preventing re-entry has been difficult.
“A scoping review on interventions relevant to mental health crises found no robust evidence on how to prevent repeat crises in people leaving crisis care,” Johnson and her team write.
In a nationwide effort to reduce “acute bed use,” the National Health Service (NHS) developed crisis resolution teams. However, initiatives to implement this model have not corresponded to a promising reduction in service use.
Participants in this study were randomly assigned to either the treatment group or the control group. In the treatment group, participants received “a peer-supported self-management intervention, based on a recovery workbook.” The peer support model was adapted to offer individuals sessions in which peer supporters were trained to provide supportive listening and interventions to instill hope about recovery. Additionally, peer supporters actively encouraged participants to complete the workbook. Alternatively, those participants placed in the control group received the book in the mail and were given the option to complete it independently.
A total of 440 individuals participated. The primary focus was to examine readmission rates. If readmission rates were reduced for those who had received peer support than those who had not, it would serve to demonstrate support for peer intervention as a way to cut readmission. This was this case in this study, which found there to be a significant difference across groups such that peer intervention lowered the risk of readmission.
In discussing the results of these findings, the authors wrote about how their study may address the objective to reduce repeat crises:
“It addresses the need for evidence on how to prevent repeat crises and provides the most robust evidence yet for the effectiveness of any peer-provided intervention in a UK secondary mental health setting.”
Johnson and colleagues conclude with future directions related to their findings:
“Research is needed on how to embed and sustain peer-supported self-management in routine services, and on associated outcomes and staff and service user experiences. Our trial provides support for the wider and more systematic roll-out of practices that already attract considerable support from service planners and from service users themselves.”
Johnson, S., Lamb, D., Marston, L., Osborn, D., Mason, O., Henderson, C., … & Sullivan, S. (2018). Peer-supported self-management for people discharged from a mental health crisis team: a randomized controlled trial. The Lancet, 392(10145), 409-418. (Link)