Enhanced discharge from inpatient to community mental health care (ENRICH): a programme of applied research to manualise, pilot and trial a Peer Worker intervention

Aims and Objectives The aim of the ENRICH programme is to enhance the experience of discharge from psychiatric inpatient care for mental health service users, preventing readmission, reducing costs and improving individual recovery. The primary objective is to establish the effectiveness and cost-effectiveness of a Peer Worker intervention to enhance discharge. Background and rationale Rates of readmission to psychiatric inpatient care are high in the initial weeks post-discharge, as are suicidality and self-harm. Costs of readmission are high. Systematic review evidence suggests that interventions supporting transition from inpatient to community care are feasible and can be cost-effective. There is some evidence suggesting that Peer Worker interventions supporting discharge can impact on readmission rates, associated costs and individual recovery outcomes. A Cochrane review of Peer Worker interventions indicates quality of RCTs is low and an absence of formal cost-effectiveness studies. Mental health service providers are introducing a range of Peer Worker interventions in the UK in the absence of a clear evidence base. Research environment The host SW London Trust-University partnership has a track record in evaluating innovative service development in mental health, including recent NIHR-funded evaluations of self-care and Peer Worker roles. Our East London Trust-University partnerships have piloted a Peer Worker discharge intervention, host the programme CTU and have extensive expertise in conducting RCTs of complex interventions. We have extended NHS and voluntary sector networks focused on developing Peer Worker interventions. Research plan WP1. Manualising the ENRICH intervention Systematic narrative synthesis of evidence for Peer Worker interventions in mental health, to refine the intervention model and finalise intervention components. Work with expert panels will produce the manual for the WP4 trial; WP2. Developing the PROLIFIC Peer Worker Fidelity Index Fidelity index developed to assess the extent to which the intervention is implemented to principles underpinning peer support; WP3. Pilot trial Pilot trial of the intervention conducted in two sites using the protocol for the full RCT (WP4) to test and refine processes of recruitment, randomisation and allocation to intervention. Formal stop-go rules will determine progress to full trial; WP4. Randomised controlled trial Fully-powered pragmatic RCT of the ENRICH Peer Worker intervention conducted in six sites to establish the effectiveness and cost-effectiveness of the intervention. Primary outcome will be readmission to psychiatric inpatient care within one year of discharge. Secondary outcomes include a range of intra-personal, behavioural and service use outcomes; WP5. Impact study Mixed method cohort study of Peer Workers employed in the intervention will explore the impact of the role on wellbeing and employment outcomes for Peer Workers. Projected Outputs & Dissemination plans The programme will produce the ENRICH Peer Worker intervention manual, guidance on training and supporting Peer Workers, the PROLIFIC Fidelity Index for Peer Worker interventions and COMPOSE commissioning Peer Workers for mental health tool for commissioners. Dissemination will be through academic, professional and service user publications and conferences, with outputs promoted through our NHS, professional college, voluntary sector and international networks. A programme website will make findings and outputs readily accessible. We will work to influence mental health commissioning guidance and revisions to NICE guidelines. Relevant expertise & experience of the research team The team has considerable expertise in developing and evaluating Peer Worker interventions in mental health services and so is well placed to deliver programme academic and applied outputs. The PI (Gillard), with mentoring from senior trialist Professor Priebe, has a proven track record i