TP103A pilot patient preference RCT of admission to a women s crisis house compared with psychiatric hospital admission

Lead Research Organisation: King's College London
Department Name: Unlisted

Abstract

A small number of women?s crisis houses have opened around the UK. They aim to offer a service which is more acceptable, less coercive and less stigmatising than psychiatric hospital admission for women. However, there has been little research examining whether these services really do lead to better outcomes for women in terms of their symptoms, quality of life, needs or satisfaction. We therefore propose to evaluate women s crisis houses, comparing them with psychiatric inpatient wards. There are two phases to this proposal. In phase one we will explore with women and staff from women s crisis houses and psychiatric wards in the same catchment areas, suitable points in their admissions for recruitment and randomisation. We will discuss what they consider to be the most important outcome measures e.g. quality of life or symptoms. We will also use published literature about research in mental health crises to help us to identify the best and most acceptable ways of inviting people to take part in research at such times.

In phase two we will use a study design known as a patient preference randomised controlled trial (RCT). With this type of design, women are first asked whether they have a strong preference for a particular type of service: if they do, they will receive the service they prefer. Women who do not have a preference will have a 50:50 chance of being admitted to either a crisis house or a psychiatric inpatient ward ? this process is called randomisation. This design has been chosen because we expect many women to prefer women?s crisis houses. A more traditional study using randomisation would not allow for such preferences: many women might therefore be unwilling to take part.

In this pilot study, we will test the outcome and cost measures, which will include questionnaires asking about quality of life, symptoms, satisfaction with the services, needs and contact with services. We will also explore the number of women s services nationally that could participate in a future larger study.

If this initial trial suggests that a patient preference RCT is a good method for evaluating crisis houses, we plan to conduct a larger national study including several more women?s crisis houses: this should give a clear answer as to whether this type of service is effective.

Technical Summary

Women s crisis houses offer women an innovative alternative to psychiatric admission which may be less stigmatising and less coercive. Policy makers and service users favour their introduction throughout the country, but this is not yet supported by evidence from a rigorous evaluation. We propose to develop and test a framework for such an evaluation. Recruiting trial participants at the time of a psychiatric crisis poses various challenges, so that we need to carry out careful developmental work to establish the best way of doing this: this is phase 1 of our study, to be followed by a pilot patient preference trial in phase II.
Phase 1 ? the developmental work ? includes the following objectives:
1. To explore best methods of recruiting study participants at the point of a psychiatric crisis, including ways of managing both the practical and ethical difficulties this poses ? by systematic review
2. To examine pathways to care for women referred to women?s crisis houses or psychiatric wards, and find suitable points for recruitment and randomisation ? by quantitative data collection of a large series of admissions and more detailed qualitative interviews with a sub-group of service users and referring professionals.
3. To establish candidate primary outcome measures for appropriateness, acceptability, sensitivity to change and completeness of data collection ? by qualitative interview and quantitative data collection.

Phase 2 ? the pilot study ? includes the following objectives:
1. To establish the feasibility of a patient preference RCT study design for investigating the effectiveness and cost effectiveness of women?s crisis houses
2. To pilot the outcome and cost measures
3. To estimate recruitment and drop out rates, and the levels of outcome variability to calculate sample sizes for the main study.
4. To develop a user focused instrument designed by users to evaluate women?s crisis houses (user focused monitoring).

Method of pilot study: Patient preference RCT, 6 month recruitment phase with assessments at baseline and 3 month follow up. Depending on the outcome of Phase 1, measures will be allocated primary or secondary outcome status for the follow up.

A proposal for a larger multicentre patient preference RCT evaluating women?s crisis houses will be developed if this study indicates that it is feasible.

Publications

10 25 50
 
Description role of women's crisis houses in adult mental health services
Geographic Reach Multiple continents/international 
Policy Influence Type Citation in systematic reviews
 
Description MRC Training Fellowship
Amount £357,997 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 10/2009 
End 08/2014
 
Description NIHR Programme development grant RP-DG-1108-10012 The Effectiveness and Cost-effectiveness of Perinatal Psychiatry Services
Amount £97,099 (GBP)
Funding ID RP-DG-1108-10012 
Organisation National Institute for Health Research 
Sector Public
Country United Kingdom
Start 02/2010 
End 04/2011
 
Title Pathways to admission to Women's Services 
Description Created new measures of pathways to admission to women's mental health services and service use for cost-effectiveness 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2009 
Provided To Others? Yes  
Impact Used for analysis of data on pathways and cost-effectiveness for this project and also used in subsequent projects of our group 
 
Title Service use schedule for women with severe mental illness 
Description Development of standardised instrument to measure service use in women with severe mental illness for use in cost-effectiveness studies. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2010 
Provided To Others? Yes  
Impact Use of instrument in RCTs 
 
Description UCL colleagues 
Organisation University College London
Department Institute of Neurology
Country United Kingdom 
Sector Academic/University 
PI Contribution We have written papers together, have obtained a new grant from NIHR and jointly supervised an MRC training fellow
Collaborator Contribution We have written papers together. we have obtained an NIHR Programme Development Grant and are currently working on an NIHR Programme Grant Application. We are also jointly supervising an MRC training Fellow (Hind Khalifeh).
Impact Publications as under publications section and an Editorial published in the British Journal of Psychiatry. We both belong to the same discipline - psychiatry.
Start Year 2006
 
Description Hospital visit - Springfield 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact Presented results to relevant health professionals

Not known
Year(s) Of Engagement Activity 2008
 
Description Mental health trust visit - Brighton 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Health professionals
Results and Impact Presented results to relevant health professionals

Not known
Year(s) Of Engagement Activity 2008
 
Description Women's crisis house visit - Drayton Park 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Invited to discuss results at Women's Crisis House annual open day for commissioners, service users, staff, other health professionals, Department of Health representatives and the public

Not known
Year(s) Of Engagement Activity 2009