Rehabilitation Effectiveness and Activities for Life (REAL): a multicentre study of rehabilitation services and the efficacy of promoting activities for people with severe mental health problems
Around one in five NHS inpatient beds sits in a mental health rehabilitation unit, yet no one has systematically measured whether those services actually help people regain the skills to live in the community. This study will survey every inpatient rehabilitation unit in England, assess each unit’s quality, and then run two parallel investigations. Lower-quality services will test a staff training programme designed to boost patients’ everyday activities, while higher-quality services will be followed in a cohort study to identify which service features and patient characteristics predict successful discharge. The problem is stark: roughly one percent of people with schizophrenia need lengthy, expensive rehabilitation stays, and the evidence base for what works is almost nonexistent. If the training intervention proves effective, it could be manualised and rolled out across the NHS at relatively low cost, potentially shortening admissions and saving money. For commissioners and clinicians, the cohort study will provide concrete data on where to focus resources—whether that means more occupational therapy, different staffing models, or specific support for patients with co-occurring conditions.
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Aims and objectives: 1.To investigate current provision and quality of mental health rehabilitation services in England.2.To investigate the clinical and cost effectiveness of an enhanced rehabilitation intervention for poorer quality services. 3.To investigate service and service user predictors of better clinical outcomes in higher quality services.Background: Recent Government policy has invested in community mental health services resulting in patchy provision of rehabilitation services. Around 20% of NHS inpatient beds are in rehabilitation units and around 1% of people with a diagnosis of schizophrenia require rehabilitation to gain/regain skills for community living. This group has complex problems and comorbidities that necessitate lengthy admissions that are expensive for the NHS. There has been little research to identify the service and service user factors associated with better outcomes to date or interventions that can reduce the length of stay and associated costs. Research plans: We will carry out a comprehensive survey of all inpatient rehabilitation units in England and assess the quality of each using a standardised toolkit being developed in a related study (the “DEMoBinc study”). We will describe current service provision, factors associated with service quality and whether provision is appropriate to local psychiatric morbidity. Services that score below the median for quality will be recruited into a randomised controlled trial that will test the efficacy of an enhanced rehabilitation intervention, a staff training programme, to facilitate service users’ activity. This intervention will be devloped as part of the research programme. Simultaneously, services that score above the median for quality will be recruited to take part in a cohort study to investigate service and service user characteristics that predict better outcomes such as successful community discharge. Research team: many of the team have previously collaborated in the Mental Health Research Network’s Rehabilitation and Recovery Research Group and on previous studies. They have a wide range of expertise relevant to all aspects of the research programme including successful co-ordination of large multicentre studies, methodology, clinical psychiatry, health services research, occupational therapy, organisational psychology, service user collaboration and senior managerial support from the host Trust.Research environment: as well as previous successful collaborations amongst the research team that will ensure a positive culture for the research programme, the researchers will be based at the Department of Mental Health Sciences, UCL which has an excellent track record of mental health services research. The thriving Department provides all necessary administrative, educational, IT and estate support for the researchers and research team.Anticipated outputs, outcomes and impact of this research on the health of patients and/or the public, and on the NHS: The results of this programme of research will deliver i) a detailed account of contemporary mental health rehabiliation service provision ii) the clincial and cost effectiveness of a relatively simple and brief training intervention which, if successful will be manualised and could potentially be widely implemented iii) information for practitioners, service planners and commissioners to better understand how to focus resources for this complex service user group.Public involvement: we have consulted with our service user research forum in the development of this research programme and have an experienced service user representative co-applicant who will join the project steering committee. Service user/s will also be involved in delivering part of the staff training intervention.Ethical implications: due to the severity and complexity of mental health problems of the service user group we are focussing on, we will seek ethical approval to collect staff rated, anonymised outcome data o
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