Meeting with a peer support worker to complete a personal recovery workbook reduced readmissions over a year for patients with mental health challenges.
Sonia Johnson, MRCPsych
A study of patients discharged from acute mental health care found that 29% of participants who met with a peer support worker to complete a personal recovery workbook were readmitted to acute care compared to 38% of participants who received only the workbook.
"People discharged from community crisis services are 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," lead author Sonia Johnson, MRCPsych, MB.ChB, MSc, Professor of Social and Community Psychiatry at the University College of London, UK, said in a statement.
The study included 441 patients receiving acute mental health care from 6 crisis resolution teams in the UK, with outcome data obtained for 434. Participants were randomized to receive either usual care plus 10 one-hour-long sessions with peer support workers who helped participants complete a personal recovery workbook or usual care plus a personal recovery workbook delivered by mail.
The workbook used in the study directed participants to set personal recovery goals, make plans to reconnect with community support networks after a crisis, identify early warning signs, and create strategies to maintain wellbeing following a crisis.
The peer support workers “offered supportive listening and sought to instill hope through appropriate sharing of skills and coping strategies acquired in their own recovery,” according to the study authors. These workers all had previous personal experience with mental health challenges and were trained in using the workbook, listening skills, cultural awareness, self-disclosure, and confidentiality.
"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," explained Johnson.
Readmission rates to acute care within 1 year were significantly lower in the intervention group (29%, 64/218) than in the control group (38%, 83/216) (odds ratio [OR] 0.66, 95% CI 0.43—0.99; p = 0.0438).
Additionally, median time to readmission was 112 days (IQR 42 to 242) in the intervention group compared to 86 (IQR 43 to 180) for the control group (hazard ratio [HR] 0.71, 95% CI 0.52—0.97; p = 0.0291). However, the number of days spent in acute care during the study year was not significantly different between the groups (0 [0 to 26] for intervention vs 0 [0 to 24] for control; incident rate ratio 1.01 [0.76 to 1.36]; p = 0.9208)
In their discussion, study authors noted that due to the design of the study, it was not possible to pinpoint which exact elements provided the observed benefits.
"Our study provides the most robust evidence for the effectiveness of any peer-provided support in a UK secondary mental health setting," said Professor Johnson. "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."
The study, “Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial,” was published in August 2018 in The Lancet.