Evaluating mental health decision units in acute care pathways (DECISION): a quasi-experimental and health economic evaluation
| ISRCTN | ISRCTN53431343 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN53431343 |
| IRAS number | 256406 |
| Secondary identifying numbers | NIHR HS&DR 17/49/70, IRAS 256406 |
- Submission date
- 10/02/2020
- Registration date
- 11/02/2020
- Last edited
- 18/02/2021
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Mental and Behavioural Disorders
Plain English summary of protocol
Current plain English summary as of 18/02/2021:
Background and study aims
Many people experiencing a mental health crisis go to A&E and wait a long time for assessment. They may be admitted to a psychiatric ward unnecessarily because of a lack of proper assessment. People not signposted to the most appropriate aftercare might repeatedly attend A&E and be admitted to hospital. New Psychiatric Decision Units (PDUs; also called mental health decision units [MDHUs]) are designed to address this. PDUs are short stay units with a high staff: patient ratio delivering in-depth assessment of individual support, aiming to reduce unnecessary hospital admissions and attendance at A&E, and to improve experiences of crisis care.
The researchers will study four new MHDUs in England in detail. The researchers will use a longitudinal cohort study to examine the changes in crisis care service use by comparing service use in the nine month period leading up to a service user’s first stay on a mental health decision unit to the nine months following that stay.
The researchers will also conduct in-depth interviews with service users and with PDU staff and staff who refer to PDUs about experiences of care, assessment and aftercare. Staff will be interviewed once, but service users will be interviewed for a second time, nine months following their stay on the PDU. There are other studies which are connected to this study - these are registered separately and include an interrupted time series and synthetic control study. The DECISION research team includes people who have used mental health services and the research is coproduced.
Who can participate?
There are no eligibility criteria other than capacity to consent and admission to MHDU as this is a naturalistic study and we are interested in understanding who is admitted to MHDUs. Staff participants will be working at an MDHU.
What does the study involve?
For participants taking part in the longitudinal cohort study:
There will be a short questionnaire about your quality of life, and we will ask the local Trusts to let us know how much you have used services, and which services you have used for your mental health in the nine months preceding and following your first admission to the MHDU. We will be in touch after 9 months to ask you to complete the short questionnaire again. Participants are involved in the study for 9 months.
For participants taking part in qualitative interviews for service users:
There will be two in-depth interviews about experiences of crisis care in mental health services. The first interview will be within a fortnight of leaving MHDU and the second will be nine months later. The interview will take about-60-90 minutes to complete. We will audio record the interview.
For staff participants taking part in qualitative interviews:
We will conduct an in-depth interview about your experiences of working in mental health crisis care, your experiences of working in or with the decision unit, and/or your knowledge of the mental health crisis care pathway. The interview will take about 45-60 minutes to complete and will be audio recorded.
As the Covid-19 pandemic occurred during the study period, we will also have a non-pandemic retrospective comparison study. This will include the same sites and have study dates exactly one year prior to the originally planned study.
What are the possible benefits and risks of participating?
It is unlikely that there are any risks in taking part. It is possible that some people may find some of the issues discussed in the interviews sensitive or uncomfortable to talk about. Participants do not have to discuss anything that you find difficult to talk about, and it is OK to not answer any of the questions. If difficult issues come up during the interview participants are free to stop the interview at any point to take a break, rearrange or end the interview, or withdraw from the study. There are no consequences to doing so for participants.
Where is the study run from?
1. St George's, University of London (UK)
2. St George's Hospital (UK)
3. Springfield Hospital (UK)
4. Lincolnshire Partnership NHS Foundation Trust (UK)
5. Lincoln County Hospital (UK)
6. Birmingham and Solihull Mental Health NHS Foundation Trust (UK)
7. Sheffield Health & Social Care NHS Foundation Trust (UK)
8. Royal Hallamshire Hospital (UK)
9. Sandwell General Hospital (UK)
When is the study starting and how long is it expected to run for?
September 2019 to February 2020
Who is funding the study?
National Institute for Health Research (NIHR) (UK)
Who is the main contact?
Dr Lucy Goldsmith
lgoldsmi@sgul.ac.uk
_____
Previous plain English summary:
Background and study aims
Many people experiencing a mental health crisis go to A&E and wait a long time for assessment. They may be admitted to a psychiatric ward unnecessarily because of a lack of proper assessment. People not signposted to the most appropriate aftercare might repeatedly attend A&E and be admitted to hospital. New Psychiatric Decision Units (PDUs; also called mental health decision units [MDHUs]) are designed to address this. PDUs are short stay units with a high staff: patient ratio delivering in-depth assessment of individual support, aiming to reduce unnecessary hospital admissions and attendance at A&E, and to improve experiences of crisis care.
The researchers will study four new MHDUs in England in detail. The researchers will use a longitudinal cohort study to examine the changes in crisis care service use by comparing service use in the nine month period leading up to a service user’s first stay on a mental health decision unit to the nine months following that stay.
The researchers will also conduct in-depth interviews with service users and with PDU staff and staff who refer to PDUs about experiences of care, assessment and aftercare. Staff will be interviewed once, but service users will be interviewed for a second time, nine months following their stay on the PDU. There are other studies which are connected to this study - these are registered separately and include an interrupted time series and synthetic control study. The DECISION research team includes people who have used mental health services and the research is coproduced.
Who can participate?
There are no eligibility criteria other than capacity to consent and admission to MHDU as this is a naturalistic study and we are interested in understanding who is admitted to MHDUs. Staff participants will be working at an MDHU.
What does the study involve?
For participants taking part in the longitudinal cohort study:
There will be a short questionnaire about your quality of life, and we will ask the local Trusts to let us know how much you have used services, and which services you have used for your mental health in the nine months preceding and following your first admission to the MHDU. We will be in touch after 9 months to ask you to complete the short questionnaire again. Participants are involved in the study for 9 months.
For participants taking part in qualitative interviews for service users:
There will be two in-depth interviews about experiences of crisis care in mental health services. The first interview will be within a fortnight of leaving MHDU and the second will be nine months later. The interview will take about-60-90 minutes to complete. We will audio record the interview.
For staff participants taking part in qualitative interviews:
We will conduct an in-depth interview about your experiences of working in mental health crisis care, your experiences of working in or with the decision unit, and/or your knowledge of the mental health crisis care pathway. The interview will take about 45-60 minutes to complete and will be audio recorded.
What are the possible benefits and risks of participating?
It is unlikely that there are any risks in taking part. It is possible that some people may find some of the issues discussed in the interviews sensitive or uncomfortable to talk about. Participants do not have to discuss anything that you find difficult to talk about, and it is OK to not answer any of the questions. If difficult issues come up during the interview participants are free to stop the interview at any point to take a break, rearrange or end the interview, or withdraw from the study. There are no consequences to doing so for participants.
Where is the study run from?
1. St George's, University of London (UK)
2. St George's Hospital (UK)
3. Springfield Hospital (UK)
4. Lincolnshire Partnership NHS Foundation Trust (UK)
5. Lincoln County Hospital (UK)
6. Birmingham and Solihull Mental Health NHS Foundation Trust (UK)
7. Queen Elizabeth Medical Centre (UK)
8. Sheffield Health & Social Care NHS Foundation Trust (UK)
9. Royal Hallamshire Hospital (UK)
10. Kingston Hospital NHS Foundation Trust (UK)
11. Sandwell General Hospital (UK)
When is the study starting and how long is it expected to run for?
September 2019 to February 2020
Who is funding the study?
National Institute for Health Research (NIHR) (UK)
Who is the main contact?
Dr Lucy Goldsmith
lgoldsmi@sgul.ac.uk
Contact information
Public
Population Health Research Institute
St George's, University of London
Cramner Road
Tooting
London
SW17 0RE
United Kingdom
 ORCID ID |
0000-0002-6934-1925 |
|---|---|
| Phone | +44 (0)208 7250167 |
| lgoldsmi@sgul.ac.uk |
Study information
| Study design | Observational longitudinal cohort study with additional qualitative data collection |
|---|---|
| Primary study design | Observational |
| Secondary study design | Longitudinal study |
| Study setting(s) | Hospital |
| Study type | Treatment |
| Participant information sheet | Not available in web format, please use contact details to request a participant information sheet. |
| Scientific title | Evaluating mental health decision units in acute care pathways (DECISION): a quasi-experimental and health economic evaluation |
| Study acronym | DECISION |
| Study objectives | The aims of the study are: 1. To establish the effects of psychiatric decision units (also known as mental health decision units) in England on service use outcomes 2. To examine whether psychiatric decision units benefit all people equally 3. To ascertain the staff and service user experiences of these units in order to inform potential national scale-up |
| Ethics approval(s) | Approved 12/08/2019, NRES Committee: East Midlands – Leicester South Research Ethics Committee (The Old Chapel, Royal Standard Place, Nottingham, NG1 6FS; +44 (0)207 104 8310; NRESCommittee.Eastmidlands-LeicesterSouth@nhs.net), Ref: 19/EM/0226 |
| Health condition(s) or problem(s) studied | Psychiatric crisis / Mental health crisis |
| Intervention | This is an observational study investigating an intervention which is already part of clinical practice. The intervention is ‘mental health decision units’ (also known as ‘psychiatric decision units). The longitudinal cohort study examines changes in crisis care service use following the first stay on a psychiatric decision unit, by comparing changes in the pattern and rate of crisis care service use in the nine months preceding and following the first admission to a decision unit. The qualitative study examines both staff and patient experiences of psychiatric decision units. The researchers will study four new MHDUs in England in detail. The researchers will use a longitudinal cohort study to examine the changes in crisis care service use by comparing service use in the nine-month period leading up to a service user’s first stay on a mental health decision unit to the nine months following that stay. The researchers will also conduct in-depth interviews with service users and with PDU staff and staff who refer to PDUs about experiences of care, assessment and aftercare. Staff will be interviewed once, but service users will be interviewed for a second time, nine months following their stay on the PDU. There are other studies which are connected to this study - these are registered separately and include an interrupted time series and synthetic control study. The DECISION research team includes people who have used mental health services and the research is coproduced. (added 18/02/2021): As the Covid-19 pandemic occurred during the study period, we will also have a non-pandemic retrospective comparison study. This will include the same sites and have study dates exactly one year prior to the originally planned study. Due to the covid-19 pandemic and the new comparison study, data for both cohort studies will be supplied from electronic record searches. |
| Intervention type | Mixed |
| Primary outcome measure | Note: there is a primary outcome for both mental health trusts and acute trusts. For the longitudinal cohort study, these primary outcomes are: 1. Informal admissions (mental health trust) during the study 2. A&E presentations, as measured as liaison psychiatry episodes (acute trust) during the study |
| Secondary outcome measures | Note: there are a large number of secondary outcomes as mental health decision units (MHDUs) are purported to make a difference to these outcomes; the study will enable these claims to be examined. Using patient records, during the study period: 1. Inpatient admissions 2. 0-5 day inpatient admissions 3. Average length of inpatient stay (bed days) 4. Compulsory admissions 5. Use of community mental health team (CMHT) and other mental health trust services Qualitative study: 6. Staff and patient experiences of psychiatric decision units measured using qualitative interviews at the end of the study |
| Overall study start date | 01/03/2019 |
| Completion date | 30/11/2020 |
Eligibility
| Participant type(s) | Mixed |
|---|---|
| Age group | Adult |
| Sex | Both |
| Target number of participants | Longitudinal cohort study: estimate of throughput to and recruitment from PDUs in a 6 month recruitment period: 1,151; qualitative study: 66. |
| Total final enrolment | 148 |
| Key inclusion criteria | For patients: 1. First admission to MHDU 2. Capacity to consent to participate in research. For staff: 1. MDHU staff |
| Key exclusion criteria | Does not meet inclusion criteria |
| Date of first enrolment | 01/09/2019 |
| Date of final enrolment | 29/02/2020 |
Locations
Countries of recruitment
- England
- United Kingdom
Study participating centres
Blackshaw Road
Tooting
London
SW17 0QT
United Kingdom
61 Glenburnie Road
London
SW17 7DJ
United Kingdom
The Point
Lions Way
Sleaford
Lincolnshire
NG34 8GG
United Kingdom
Greetwell Road
Lincolnshire
LN2 4AX
United Kingdom
50 Summer Hill Road
Birmingham
B1 3RB
United Kingdom
Old Fulwood Rd
Sheffield
S10 3TH
United Kingdom
Glossop Rd
Sheffield
S10 2JF
United Kingdom
Sponsor information
University/education
Cramner Road
Tooting
London
SW17 0RE
England
United Kingdom
| Phone | +44 (0)208 266 6866 |
|---|---|
| jmontebe@sgul.ac.uk | |
| Website | http://www.sgul.ac.uk/ |
"ROR" |
https://ror.org/040f08y74 |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
- Location
- United Kingdom
Results and Publications
| Intention to publish date | 31/05/2021 |
|---|---|
| Individual participant data (IPD) Intention to share | No |
| IPD sharing plan summary | Stored in repository |
| Publication and dissemination plan | Longitudinal Cohort Study Results 01/04/2021 Service user experience: qualitative study 01/04/2021 Staff experience: qualitative study 01/04/2021 |
| IPD sharing plan | The datasets generated during and/or analysed during the current study will be stored in a non-publically available repository |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| HRA research summary | 28/06/2023 | No | No |
Editorial Notes
18/02/2021: The following changes were made to the trial record:
1. The trial participating centre "University Hospitals Birmingham NHS Foundation Trust" was removed.
2. The time for the study analysis and write-up has been extended to 31st May 2021 due to pandemic related delays obtaining data. There will be a cut-off date for the supply of data for it to be included in the analysis.
3. The intention to publish date was changed from 01/04/2021 to 31/05/2021.
4. The interventions were updated.
5. The plain English summary was updated to reflect these changes.
18/03/2020: The following changes were made to the trial record:
1. The overall end date was changed from 28/02/2021 to 30/11/2020.
2. The total final enrolment was added.
25/02/2020: Internal review.
11/02/2020: Trial’s existence confirmed by East Midlands – Leicester South Research Ethics Committee
