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Self-management intervention cuts mental health care readmissions after crises

Peer-delivered self-management reduced the rate of readmission to acute care among people discharged from a mental health crisis team in England, findings published in The Lancet showed.

Self-management interventions help people learn to anticipate and respond to signs of a health-related crisis and develop skills to manage symptoms and other problems, Sonia Johnson, MRCPsych, MSc, professor in the division of psychiatry at the University College London, and colleagues explained in their study.

“If successful, such interventions could reduce relapses and repeat acute care admissions following crises,” Johnson and colleagues wrote. “However, substantial evidence is not available regarding the effectiveness of these approaches, or of self-management interventions in general, in preventing relapse or acute care readmissions among people with mental health disorders.”

The researchers conducted a randomized controlled superiority trial that examined whether a self-management intervention facilitated by peer support workers could lower the rates of readmission to acute care for people discharged from six crisis resolution teams in England. The primary outcome was readmission within 1 year.

They randomly allocated participants to an intervention group, where they could participate in up to 10 sessions with a peer support worker who provided intensive home treatment following a crisis and helped them complete a personal recovery workbook, or a control group, where they received the personal recovery workbook via mail. Specifically, the workbook helped people create personal recovery goals and crisis plans.

The authors reported data from 218 participants allocated to the intervention group and 216 assigned to the control group. In total, 64 participants who received the self-management intervention (29%) and 83 who received the control (38%) were readmitted to acute care within 1 year (OR = 0.66, 95% CI, 0.43-0.99; P = .0438). There were 71 serious adverse events: 29 in the treatment group and 42 in the control group. The number of days in acute care was not significantly different between the groups, according to the results.

Analyses showed a difference in number of days between randomization and discharge from the first acute care admission between groups (mean 8.6 days in the intervention group vs. 2.9 in the control group). After performing a post-hoc sensitivity analysis that excluded these days and only included days that were part of acute care readmissions, the investigators found that those in the intervention group had fewer days in acute care than those in the control group.

Overall satisfaction with mental health care received was greater in the intervention group than in the control group at 4 months of follow-up, and there was a significant difference in self-rated recovery favoring the intervention, the findings showed.

“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 and colleagues wrote. “This study should be replicated to confirm our 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.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.