Peer support tied to fewer repeat mental health hospitalizations

Researchers followed 441 patients for one year after they were discharged from the hospital. All of them received personal recovery workbooks to help them manage their own care. Half of them also received 10 sessions with a peer support worker with a history of mental illness.

One year after they left the hospital, patients who received peer counseling were 34 percent less likely to have a repeat admission than people who didn’t get this type of support, the study found.

“Reducing hospital admissions is quite hard to do, and a good number of strategies aimed at doing this have failed in trials,” said study leader Sonia Johnson of University College London.

“So it’s impressive to find that a fairly short and simple intervention with someone with their own experience of mental health problems has succeeded where some rather more elaborate interventions have failed,” Johnson said by email.

Half of patients hospitalized for serious psychiatric crises are admitted for another serious mental health episode within one year, the study authors note in The Lancet. Not only does this slow down patients’ recovery, it also diverts resources to cover costly acute care that might instead be devoted to longer-term interventions designed to improve patients’ quality of life.

The study participants had a variety of diagnoses including schizophrenia, bipolar affective disorder, psychosis, depression, anxiety disorder, post-traumatic stress disorder and personality disorder. They all continued usual treatment throughout the study period, including any prescribed medication and psychotherapy.

The workbook they all received included sections on setting personal recovery goals, re-establishing their place in the community and support networks, identifying early warning signs and creating an action plan to avoid or delay relapse, and planning strategies to maintain their wellbeing. Participants were asked to record observations and plans in each of these areas.

Patients in the group that received support from a person who had experienced mental health problems were offered 10 one-hour sessions over four months. The support worker listened to their problems and aimed to instill hope by sharing the skills and coping strategies they learned during their own recovery process.

Support workers received training beforehand in listening skills, cultural awareness, self-disclosure, and confidentiality, as well as how to use the workbook.

One year after they left the hospital, 29 percent of patients who received peer support had a repeat psychiatric admission, compared with 38 percent of those who didn’t receive peer support.

Most participants in both groups read the workbook, but more people who received peer support used the workbook to write down concrete plans for their recovery.

During the study there were 29 serious adverse events in the peer support group and 42 in the control group, but researchers determined that none were related to the study. These included 55 repeat hospitalizations, 11 suicide attempts, one attempted murder, two suicides and two deaths with unclear circumstances.

One limitation of the study is that researchers couldn’t tell whether or how the two components of the intervention - the workbook and the peer support - directly impacted patients’ recovery or chance of repeat hospitalizations, the authors note.

“We simply don’t fully understand why this intervention worked,” said Dr. Marcia Valenstein, co-author of an accompanying editorial and a professor emerita in psychiatry at the University of Michigan in Ann Arbor.

“The intervention might have worked because of sharing of life experiences with the peer or because the patients engaged more with the recovery workbook and then developed better self-management behaviors - with these changes in self-management behaviors not being picked up by study measures,” Valenstein said by email. “Additional research is clearly needed on the ‘why’.”