Effectiveness, implementation and sustainability of Open Access Mental Health Support in Wales

Research question: Which factors influence effectiveness, implementation and sustainability of Open Access Mental Health Support (OAMHS) in Wales? Background: UK mental health services face significant infrastructure challenges and high demand, negatively impacting care. Welsh Government has set an ambition for Wales to become the first country globally to implement OAMHS nationally incorporating person-centred, same-day and One-at-a-Time (OAAT) approaches. Evidence indicates same day care and OOAT increase positive outcomes, reduce distress and waiting times. Aims and objectives: (1) Define local adaptations to OAMHS programme theory (2) Establish baseline data (3) Explore barriers/facilitators to implementation (4) Evaluate impact on service users; carers; professionals; service-level outcomes (5) Determine costs/benefits (6) Explore systems for delivery at scale. Methods: WP1a. Lived Experience Panels (Children and Young People (CYP), adults) will contribute across WPs developing inclusive methods. WP1b. A Stakeholder Group comprising PPI, clinicians/services, 3rd sector and social care will coproduce objectives and outputs and contribute to a continuous implementation cycle. WP2. Baseline assessment of outcomes using secondary analysis of electronic health records will generate demographic profiles and insights into mental health-related activity across Wales. WP3. Realist implementation evaluation. Each Health Board will be a case study, exploring what approach to OAMHS works well for whom in which context. Informed by Normalisation Process Theory, findings will inform long-term sustainability. WP4 The Target Trial Emulation framework will be applied to draw inferences from observational data and secondary sources. We will conduct two target trials for i) CYP and ii) adults, exploring mental health/resource use indicators, mental wellbeing, clinical symptoms, quality of life and patient experience. WP5. Health economic evaluation. A discrete event simulation (DES) will be developed to represent patient flow and pathways. Distributional Cost Effectiveness analysis will be embedded to assess efficiency and equity. Initial analysis of incremental cost per Quality-adjusted life year (QALY) will be extended to inform decision making for NHS, patients and society. Results will be presented as a Cost-Consequence Analysis (CCA) and a Budget Impact Analysis (BIA) developed. Timelines: PPI and stakeholder engagement (WP1) m1-48; baseline evaluation (WP2) m1-18; realist evaluation (WP3) m1-48; phase 1 demonstrator sites m7-18; phase 2 case studies m18-41; target trials (WP4) m1-48; baseline (including pilot) m7-22; 12m follow-up m19-34; linkage/analysis m26-46. Health economic evaluation (WP5) m1-48; DES m7-43; CCA m34-43; BIA m37-44. Dissemination, knowledge exchange m8-48. Knowledge mobilisation (KM) and impact: Emergent findings will be shared via existing structures to oversee implementation and evaluation-specific engagement. Project outputs will be disseminated via tailored KM strategies for each stakeholder group. Intended impacts: increased workforce skills; sustainable implementation; equitable access to high quality mental health support; increased satisfaction, improved clinical and wellbeing outcomes. Research inclusion: This proposal has been shaped through extensive stakeholder engagement and coproduction to ensure adequate consideration of intersecting characteristics in people seeking mental health support.