Peer support for discharge from inpatient to community mental health services: Study protocol clinical trial (SPIRIT Compliant)

Introduction: 

In the period shortly after discharge frominpatient to community mental health care, people are at increased risk ofself-harm, suicide, and readmission to hospital. Discharge interventionsincluding peer support have shown potential, and there is someevidence that community-based peer support reduces readmissions.However, systematic reviews of peer support in mental health servicesindicate poor trial quality and a lack of reporting of how peer support isdistinctive from other mental health support. This study is designed toestablish the clinical and cost effectiveness of a peer workerintervention to support discharge from inpatient to community mentalhealth care, and to address issues of trial quality and clarity of reportingof peer support interventions.

Methods: 

This protocol describes an individually randomizedcontrolled superiority trial, hypothesizing that people offered a peerworker discharge intervention in addition to usual follow-up care inthe community are less likely to be readmitted in the 12 months post discharge thanpeople receiving usual care alone. A total of 590 people will be recruitedshortly before discharge from hospital and randomly allocated to careas usual plus the peer worker intervention or care as usual alone.Manualized peer support provided by trained peer workers beginsin hospital and continues for 4 months in the community post discharge.Secondary psychosocial outcomes are assessed at 4 months post discharge,and service use and cost outcomes at 12 months post discharge, alongside amixed methods process evaluation.

Discussion: 

Clearly specified procedures for sequencingparticipant allocation and for blinding assessors to allocation, plus fullreporting of outcomes, should reduce risk of bias in trial findings andcontribute to improved quality in the peer support evidence base. Theinvolvement of members of the study team with direct experience of peersupport, mental distress, and using mental health services, in coproducing theintervention and designing the trial, ensures that we theorize and clearlydescribe the peer worker intervention, and evaluate how peer support isrelated to any change in outcome. This is an important methodologicalcontribution to the evidence base.

Trial registration: 

This study was prospectively registered as ISRCTN 10043328on November 28, 2016.