Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK.
BACKGROUND
Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged.


METHODS
This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge.


RESULTS
A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support.


CONCLUSIONS
The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to support the cost effectiveness of providing peer support, but neither was it proven a costly intervention to deliver. The findings support an argument for a larger scale trial of peer support as an adjunct to existing services.


BACKGROUND
Current Controlled Trials ISRCTN74852771.
School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, UK. a.simpson@city.ac.uk.
Alan
A
Simpson
Chris
C
Flood
Julie
J
Rowe
Jody
J
Quigley
Susan
S
Henry
Cerdic
C
Hall
Richard
R
Evans
Paul
P
Sherman
Len
L
Bowers
D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D037001:Directive Counseling / Q000191:economics*; D065026:Hope; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008603:Mental Health; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D010351:Patient Discharge; D010379:Peer Group; D011788:Quality of Life; D012657:Self-Help Groups / Q000191:economics*; D055815:Young Adult