Reducing readmission rates for individuals discharged from acute psychiatric care in Alberta using peer and text message support: Protocol for an innovative supportive program.

BACKGROUND: Individuals discharged from inpatient psychiatry units have the highest readmission rates of all hospitalized patients. These readmissions are often due to unmet need for mental health care compounded by limited human resources. Reducing the need for hospital admissions by providing alternative effective care will mitigate the strain on the healthcare system and for people with mental illnesses and their relatives. We propose implementation and evaluation of an innovative program which augments Mental Health Peer Support with an evidence-based supportive text messaging program developed using the principles of cognitive behavioral therapy. METHODS: A pragmatic stepped-wedge cluster-randomized trial, where daily supportive text messages (Text4Support) and mental health peer support are the interventions, will be employed. We anticipate recruiting 10,000 participants at the point of their discharge from 9 acute care psychiatry sites and day hospitals across four cities in Alberta. The primary outcome measure will be the number of psychiatric readmissions within 30 days of discharge. We will also evaluate implementation outcomes such as reach, acceptability, fidelity, and sustainability. Our study will be guided by the Consolidated Framework for Implementation Research, and the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. Data will be extracted from administrative data, surveys, and qualitative methods. Quantitative data will be analysed using machine learning. Qualitative interviews will be transcribed and analyzed thematically using both inductive and deductive approaches. CONCLUSIONS: To our knowledge, this will be the first large-scale clinical trial to assess the impact of a daily supportive text message program with and without mental health peer support for individuals discharged from acute psychiatric care. We anticipate that the interventions will generate significant cost-savings by reducing readmissions, while improving access to quality community mental healthcare and reducing demand for acute care. It is envisaged that the results will shed light on the effectiveness, as well as contextual barriers and facilitators to implementation of automated supportive text message and mental health peer support interventions to reduce the psychological treatment and support gap for patients who have been discharged from acute psychiatric care. TRIAL REGISTRATION: clinicaltrials.gov, NCT05133726 . Registered 24 November 2021.

Emerging issues and challenges for improving patient safety in mental health: a qualitative analysis of expert perspectives.

OBJECTIVES: It is only recently that patient safety in mental health was considered a field in its own right, and there is a lack of awareness of the issues and a shortage of readily available information. This research builds on existing knowledge by soliciting the expertise of leaders in the area of patient safety and/or mental health via 2 qualitative methods. METHODS: Qualitative interviews were held with 19 key informants. Small group discussions were held during a Canadian invitational roundtable event with 72 participants. A thematic qualitative analysis involving a 2-step process was performed: (1) coding each interview, and (2) identifying larger themes. RESULTS: The findings revealed that more work is required to establish clear patient safety definitions, develop awareness, set priorities, and develop strategies for responding to patient safety incidents in mental health settings. Establishing a culture of patient safety and embedding it within all levels of an organization is vital, including adopting a systems level approach to examining patient safety incidents, encouraging open reporting and communication, considering the patient/caregiver perspective, and eliminating discrimination and stigma. Patient safety issues pertaining to community care settings are an urgent issue and require greater understanding. The need to promote national leadership, standardization of practice, ongoing training, information sharing, and additional research also was voiced. CONCLUSIONS: The results from this research highlight that greater action is required to improve patient safety in mental health settings. This research has identified several potentially important future directions for improving patient safety in mental health.