Acute Care

Established: April 2006; first meeting Sept 06

Convenor (Chair): Dr Sonia Johnson, Senior Lecturer in Social & Community Psychiatry, University College London. (e-mail: s.johnson@ucl.ac.uk)

Members: A mixture of professional backgrounds (including nursing, psychiatry, clinical psychology and public health) is represented, as well as a variety of methodological expertise, including clinical trials, epidemiology, organisational research and qualitative methods. Several geographical areas and hubs within the MHRN are included, providing a base for development of multicentre investigations.

Group members have access to several networks of service users and carers whom we plan to engage in our work, including participants from the Sainsbury Centre User Focused Monitoring Group, from the Care Services Improvement Partnership User Participation leads, SURGE, RETHINK and from SURE (the Service User Research Enterprise) at the Institute of Psychiatry, as well as from the local groups with whom several participants have links.

Members:
Professor Paul Bebbington, Head of the Department of Mental Health Sciences, Royal Free and University College Medical Schools; Professor Gyles Glover, Consultant in Public Health, North East Public Health Observatory; Dr Richard Gray, Head of the Section of Psychiatric Nursing, Institute of Psychiatry; Dr Louise Howard, Senior Lecturer in Women’s Mental Health, Institute of Psychiatry; Dr Sonia Johnson, Senior Lecturer in Social & Community Psychiatry, University College London; Mr Brynmor Lloyd-Evans, Research Worker, University College London; Dr Oliver Mason, Lecturer in Clinical Psychology, University College London; Ms Fiona Nolan, Mental Health Nursing Research Lead, Camden and Islington Mental Health and Social Care Trust; Professor Steve Onyett, Senior Development Consultant, National Institute for Mental Health, England and Visiting Professor, University of the West of England; Dr David Osborn, Senior Lecturer in Social and Epidemiological Psychiatry, Royal Free and University College Medical Schools; Mr Stephen Pilling, Director, the British Psychological Society’s Centre for Outcomes Research and Effectiveness (CORE), University College London; Dr Chiara Samele, Head of Research, Sainsbury Centre for Mental Health; Dr Alan Simpson, Senior Research Fellow in Mental Health Nursing, City University; Professor Graham Thornicroft, Head of Health Services Research Department, Institute of Psychiatry; Professor Scott Weich, Professor of Psychiatry, Warwick University; Dr Waquas Waheed, Academic Consultant Psychiatrist, University Department of Psychiatry, Preston, Lancashire (University of Manchester)

Remit and Aims:
Acute inpatient care remains central to the mental health service system: the proportion of mental health care budgets dedicated to it is high and there is a consensus that some admissions are required even in a well-developed community care system. However, little evidence is available about the effectiveness of hospital care and about which modes of service delivery and treatments work best in this setting.

Many service users are dissatisfied with hospital care. A robust evidence base is thus needed to support the development of more effective and acceptable acute hospital care and of a range of alternatives to admission.

Acute in-patient units, crisis resolution and home treatment teams, community residential alternatives to admission and acute day hospitals will be within the group’s scope.

The main aims will be:
• To investigate the effectiveness of innovations in service delivery that are intended to improve service user experiences of inpatient care and its outcomes.
• To study the organisation, effectiveness and sustainability of alternatives to acute hospital admission, such as crisis resolution teams, crisis houses and acute day hospitals.
• To investigate the outcomes and costs of specific patient-level interventions implemented within acute mental health settings, such as brief substance misuse treatments, interventions for carers, and strategies for reducing readmission rates, such as advance directives and relapse prevention packages.

A major aim of the group will be to develop proposals for multicentre randomised controlled trials in these areas, but other methodologies, including qualitative investigations of user and carer experiences and organisational analysis, will also be used where these provide the most appropriate way of investigating the effects of interventions.

Current Status & Future Plans:
Improvement of inpatient care and the development of alternatives are high priorities in national policy, and are also the focus of significant international interest.

6 month update
Three initial areas have been selected for core writing groups to work up initial proposals. These areas are:
a. An investigation of the organisation and outcomes of well-establshed crisis resolution teams. (to be submitted to the current Research for Patient Benefit call for proposals)
b. A cluster randomised evaluation of an intervention for improving the quantity and quality of interaction between staff and patients on inpatient wards.
c. Pilot randomised controlled trial of a brief family interventoin within CRTs.

Other areas in which the group hopes to submit proposals within the lifespan of the group are a multicentre trial of community residential alternatives to hospital, and a European study on acute home treatment models and their outcomes.

2010 update

The group has held several meetings, giving rise to writing groups and, so far, the submission of four main grant proposals. One of these proposals has so far been funded - the NIHR Research for Patient Benefit programme has funded "A preliminary comparison of acute mental health inpatient wards which use Patient Engagement time with other wards delivering standard care alone" (PB-PG-08-08-1704) (Lead Fiona Nolan, Co-applicants Sonia Johnson, Brynmor Lloyd-Evans, Alan Simpson, Richard Gray, Helen Gilburt, Nicola Morant). This will begin in early 2010. An application for a Programme Grant researching crisis resolution teams, led by Sonia Johnson and involving many of the Acute Care Research Group, has been shortlisted and a full application submitted in October 2009: a decision is awaited. A decision is also pending on two further applications: a proposal submitted to the SDO Responsive Funding programme to investigate therapeutic relationships in acute wards and residential alternatives, and a proposal to the Research for Patient Benefit programme to investigate a residential intervention for suicidality.