Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial
The study aimed to evaluate the effectiveness, cost effectiveness and overall reduction of mental health symptoms and self-harm behaviour in young people admitted to inpatient psychiatric case versus young people who are offered a supported community based discharge service in addition to inpatient treatment.
The supported discharge service (SDS) provided by an intensive community treatment team reduced bed usage at 6 months’ follow-up but had no effect on overall functioning and mental health symptoms (i.e. both were equally effective).
This same research team has now been provided with funding from the National Institute of Health Research, to enable them to address this issue of community prevention across 7 UK sites (due to finish in 2024).
This trial evaluated the effectiveness and cost-effectiveness of a supported discharge service in addition to an inpatient psychiatric stay and compare this with a traditional inpatient hospital stay only (e.g. treatment as usual). The study was funded by the South London & Naudsley NHS trust.
Eligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust.
Patients were assigned 1:1 to either the Support Discharge Service or to usual care by use of a computer-generated pseudorandom code with random permuted blocks of varying sizes. A total of 226 young people participated in the trial, with a further 20 participating in qualitative interviews.
The primary outcome was a number of inpatient bed-days, change in Strengths and Difficulties Questionnaire (SDQ) scores, and change in Children’s Global Assessment Scale (CGAS) scores at 6 months, assessed by intention to treat.
Cost-effectiveness was explored using the Children’s Global Assessment Scores (CGAS) and quality-adjusted life-years (QALYs) calculated from the three-level EuroQol measure of health-related quality of life, taking a health and social care perspective.
The qualitative approaches were used to examine in-depth the experiences of young people who received the hospital treatment only and the supported discharge service.
The use of both quantitative and qualitative approaches was used to build a subsequent (successful) funding bid to explore the role of preventative community interventions versus hospital stay as usual.
The trial lasted three years in total and the findings were published in The Lancet (psychiatry) in 2018.
The study was the first one to evaluate the effect of supported discharge service for young people and more broadly explore the potential for intensive community based interventions.
AUsing the community based supported discharge service led to early discharge and an overall reduction in bed use and there were no differences in levels of mental health between the treatment as usual hospital group and the young people who left hospital early and supported in the community. This indicates that the community-based intervention is just as effective in treating young people for acute mental health challenges and is cost effective.