Peer Support Helps Reduce Mental Crisis Readmissions.
A personal peer-support worker also improved satisfaction with mental health care.
Peer-supported self-management can help reduce readmission rates in individuals experiencing a mental health crisis, researchers reported.
In a randomized controlled trial, only 29% of individuals who were involved in a peer-support program were readmitted to acute care within the year compared with 38% of those who didn’t receive peer support (OR 0.66, 95% CI 0.43-0.99, P=0.0438), found Sonia Johnson, MSc, of University College London, and colleagues.
As they reported in the Lancet, time to readmission was significantly longer in those having peer support compared with individuals who did not receive this support — with a time to first acute care readmission of 112 days versus 86 days (HR 0.71, 95% CI 0.52-0.97, P=0.029).
Significantly greater satisfaction with mental health services after 4 months of the peer-support program was also seen among these patients compared with those who didn’t receive this type of care (difference in means 1.96, 95% CI 1.03-2.89, P<0.0001).
Interestingly, there were also more adverse events reported among the control group, including two suicides.
“If the finding that repeats periods of acute care were reduced by around a quarter is replicated in routine settings, the burden on the acute care system could be reduced substantially, and service users would have greater opportunities for sustained recovery,” the researchers explained. “This trial adds promising evidence for self-management interventions for people with significant mental health problems.”
The analysis included 218 individuals randomly assigned to the peer-support intervention group compared with 220 in the control group. All participants were from six crisis resolution teams around England, who were recruited following a discharge by the crisis resolution team. Individuals were excluded if they were considered to be a high risk to others and unsafe for the peer-support workers.
The peer-support intervention included 10 sessions of 1 hour each led by a peer-support worker once a week. All had personal experience utilizing mental health services themselves, and could, therefore, relate to the individuals in the group. The aim was to assist the individual in completing a personal recovery workbook and provide encouragement and coping strategies. The workbook included information on “setting personal recovery goals, making plans to re-establish community functioning and support networks after a crisis, using the recent crisis experience to identify early warning signs and formulate an action plan to avoid or attenuate relapse, and planning strategies to maintain well-being once a crisis had abated,” the researchers explained
There was largely good adherence to this intervention, with 72% of participants completing at least three meetings with their peer support worker, while 33% attended all 10 sessions.
The control group was not provided with an individual peer-support worker and instead were instructed to complete the personal recovery workbook independently.
However, nearly all secondary outcomes also assessed at 4 and 18 months during follow-up — including self-management skills, self-rated recovery, symptom severity, loneliness, and social network size — were not significantly different between the peer-support group and non-peer support groups.
The results were praised in an accompanying commentary by Marcia Valenstein, MD, MS, and Paul Pfeiffer, MD, MS, both of the University of Michigan in Ann Arbor, who said that “the finding of reduced readmissions is welcome, given that the implementation of peer support has proceeded apace despite the scarcity of substantial evidence regarding its efficacy.”
However, the peer-support intervention seemingly had no effect on nearly all the secondary outcomes, and therefore “leaves the mechanism of reduced readmissions unclear.”
Despite the need for additional research in the future to address these lingering questions, Valenstein and Pfeiffer said they agreed that “health services that use peer supporters should strongly consider having peers deliver structured self-management curriculums as part of their efforts to assist other individuals with mental health challenges, particularly those at high-risk for relapse.”