Around 120,000 NHS patients with psychosis have social networks far smaller than the general population, often limited to family members. This programme tests a structured intervention to expand those networks, aiming to improve quality of life and reduce symptoms, substance abuse, crises, and hospitalisations. Social isolation in psychosis is a recognised problem across the NHS, but the evidence for effective interventions comes mostly from other countries with different healthcare systems. This research adapts and tests a targeted approach within the UK context. It involves seven work packages, from assessing patients’ social contacts and willingness to participate, through refining the intervention with patients and professionals, to a full randomised controlled trial with 453 patients tracked over 18 months. A Lived Experience Advisory Panel of eight patients will guide the work. If successful, the programme will produce a manualised intervention and a web-based training module for mental health professionals, along with implementation plans tailored to NHS service organisation. The goal is a scalable, cost-effective tool that clinicians can use routinely to help patients build meaningful social connections—directly tackling a root cause of poor health outcomes rather than just managing symptoms.
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AIMS AND OBJECTIVES The overall aim of this programme is to improve quality of life and health outcomes for patients with psychosis through expanding their social networks. We will refine and test a targeted, standardized intervention to expand social networks of patients with psychosis, develop a training module for different mental health professionals, and specify implementation plans in collaboration with patients and professionals. BACKGROUND AND RATIONALE About 120,000 patients with psychosis are being cared for in secondary services in the NHS at any point of time. Their social networks are much smaller than those of the general population and of other patient groups, and are dominated mainly by family members. Social isolation can have a negative impact on patients quality of life and other health outcomes, including symptoms, substance abuse, crises and hospitalisations. Evidence suggests that interventions directly targeting the social networks of these patients may be effective, and that larger networks are linked with better health outcomes. The need for interventions to increase the social networks of patients with psychosis is already acknowledged in many areas in the NHS. However, the current evidence base for such interventions is small, and refers to trials conducted in other countries with different social and health care systems. Thus, interventions with positive evidence from other countries require adjusting to the context of the NHS. RESEARCH PLAN The research comprises seven work packages (WPs). All data collection will be done in inner-city, semi-urban and rural areas (Devon, East London, Luton/Bedfordshire, and North East). In WP1, we will assess social networks, i.e. the number of meaningful social contacts in a week, of 100 patients with psychosis, and explore their willingness to expand their network and participate in a trial. This will determine the most appropriate social network size to be used as an inclusion criterion in a trial, estimate recruitment rates and present information about the trial. In WP2 initial ideas about the intervention based on existing evidence will be refined in four focus groups with different stakeholders, and eight in-depth interviews with socially isolated patients. In WP3, the intervention will be tested and further specified in an exploratory testing. Six mental health professionals with different backgrounds will deliver the intervention to four patients each. We will assess both patients and professionals experiences through open interviews, and analyse audio-taped sessions. Based on the findings, we will write a detailed manual for the intervention and specify a training module. WP4 will be a feasibility trial to inform the design of the full trial and refine the intervention further. In WP5, the clinical and cost-effectiveness of the intervention will be tested in a full randomized controlled trial with an internal pilot. The total sample size will be 453 patients. The patients will be assessed at baseline, after 6 months (end of intervention), 12 and 18 months. Qualitative process evaluation and mediator analysis will be carried out to explore whether quality of life as the primary outcome has indeed been improved through expanded social networks, as hypothesized. In WP6, we will explore the best way to deliver the intervention in the NHS, considering the service organization for patients with psychosis at that time. A web-based training module and implementation plans will be developed to facilitate dissemination in practice. A Lived Experience Advisory Panel, consisting of 8 patients, will be formed at the beginning of the project and contribute to all work packages. We will work with the LEAP to develop research consent procedures and topic guides, and to analyse and interpret results. PROJECTED OUTPUT AND DISSEMINATION We will disseminate the findings through publications in peer-reviewed journals and conference presentations, and
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