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
Trial website
Contact information
Type
Public
Primary contact
Dr Lucy Goldsmith
ORCID ID
http://orcid.org/0000-0002-6934-1925
Contact details
Population Health Research Institute
St George's
University of London
Cramner Road
Tooting
London
SW17 0RE
United Kingdom
+44 (0)208 7250167
lgoldsmi@sgul.ac.uk
Additional identifiers
EudraCT number
Nil known
ClinicalTrials.gov number
Nil known
Protocol/serial number
NIHR HS&DR 17/49/70, IRAS 256406
Study information
Scientific title
Evaluating mental health decision units in acute care pathways (DECISION): a quasi-experimental and health economic evaluation
Acronym
DECISION
Study hypothesis
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
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
Study design
Observational longitudinal cohort study with additional qualitative data collection
Primary study design
Observational
Secondary study design
Longitudinal study
Trial setting
Hospitals
Trial type
Treatment
Patient information sheet
Not available in web format, please use contact details to request a participant information sheet.
Condition
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.
Intervention type
Mixed
Phase
Drug names
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 trial start date
01/03/2019
Overall trial end date
30/11/2020
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
For patients:
1. First admission to MHDU
2. Capacity to consent to participate in research.
For staff:
1. MDHU staff
Participant type
Mixed
Age group
Adult
Gender
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
Participant exclusion criteria
Does not meet inclusion criteria
Recruitment start date
01/09/2019
Recruitment end date
29/02/2020
Locations
Countries of recruitment
United Kingdom
Trial participating centre
St George's University Hospitals NHS Foundation Trust
St George's Hospital
Blackshaw Road
Tooting
London
SW17 0QT
United Kingdom
Trial participating centre
South West London and St George's Mental Health NHS Trust
Springfield Hospital
61 Glenburnie Road
London
SW17 7DJ
United Kingdom
Trial participating centre
Lincolnshire Partnership NHS Foundation Trust
Unit's 8 & 9
The Point
Lions Way
Sleaford
Lincolnshire
NG34 8GG
United Kingdom
Trial participating centre
United Lincolnshire Hospitals NHS Trust
Lincoln County Hospital
Greetwell Road
Lincolnshire
LN2 4AX
United Kingdom
Trial participating centre
Birmingham and Solihull Mental Health NHS Foundation Trust
Unit 1
50 Summer Hill Road
Birmingham
B1 3RB
United Kingdom
Trial participating centre
University Hospitals Birmingham NHS Foundation Trust
Queen Elizabeth Medical Centre
Edgbaston
Birmingham
B15 2TH
United Kingdom
Trial participating centre
Sheffield Health & Social Care NHS Foundation Trust,
Fulwood House
Old Fulwood Rd
Sheffield
S10 3TH
United Kingdom
Trial participating centre
Sheffield Teaching Hospitals NHS Foundation Trust
Royal Hallamshire Hospital
Glossop Rd
Sheffield
S10 2JF
United Kingdom
Sponsor information
Organisation
St George's, University of London
Sponsor details
Cramner Road
Tooting
London
SW17 0RE
United Kingdom
+44 (0)208 266 6866
jmontebe@sgul.ac.uk
Sponsor type
University/education
Website
Funders
Funder type
Government
Funder name
National Institute for Health Research
Alternative name(s)
NIHR
Funding Body Type
government organisation
Funding Body Subtype
National government
Location
United Kingdom
Results and Publications
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 statement:
The datasets generated during and/or analysed during the current study will be stored in a non-publically available repository
Intention to publish date
01/04/2021
Participant level data
Stored in repository
Basic results (scientific)
Publication list