A Contact-Based Intervention for People Recently Discharged from Inpatient Psychiatric Care: A Pilot Study

Abstract

People recently discharged from inpatient psychiatric care are at high risk of suicide and self-harm, with 6% of all suicides in England occurring in the 3 months after discharge. There is some evidence from a randomized trial carried out in the United States in the 1960s–70s that supportive letters sent by psychiatrists to high-risk patients in the period following hospital discharge resulted in a reduction in suicide. The aim of the current pilot study was to assess the feasibility of conducting a similar trial, but in a broader group of psychiatric discharges, in the context of present day UK clinical practice.

The intervention was piloted on 3 psychiatric inpatient wards in southwest England. On 2 wards a series of 8 letters were sent to patients over the 12 months after discharge and 6 letters were sent from the third ward over a 6 month period. A total of 102 patients discharged from the wards received at least 1 letter, but only 45 (44.1%) received the full series of letters. The main reasons for drop-out were patient opt-out (n = 24) or readmission (n = 26). In the context of a policy of intensive follow-up post-discharge, qualitative interviews with service users showed that most already felt adequately supported and the intervention added little to this. Those interviewed felt that it was possible that the intervention might benefit people new to or with little follow-up from mental health services but that fewer letters should be mailed.

Keywords:

• inpatient
• intervention
• psychiatric patients
• self-harm
• suicide

ACKNOWLEDGMENTS

We thank Jerome Motto for information on the content of the letters sent to participants in his contact-based study that contributed to the development of our study and staff on the intervention wards and the Mental Health Research Network for their assistance in administering the mailing of the letters—in particular, Davina Chauhan, Nicola Cook, and Genevieve Riley who also collected data on patient participation and retention and outcome data on community contacts. We also thank Sarah Greef who carried out some of the qualitative interviews, Keith Hall and Stephen Hoddell who contributed to study design, and staff in the AWP Information Department for providing anonymized outcome data on admissions and readmissions.

Notes

Note. *Based on data for 33 (89.2%) cases for ward A, 16 (37.2%) for ward B, 22 (100%) for ward C, data missing for 31 cases.

DG initiated the study, DG, OB, JE, RD, SO'C, WH, and NK contributed to the design of the study, OB collated and analyzed the quantitative data, DG, OB, and AOS carried out the qualitative interviews, SP and AOS analyzed and reported on the qualitative data, all authors contributed to the paper.