title: 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.
authors.affiliation: a School of Social and Community Medicine, University of Bristol , Bristol , UK.
authors.forename: Olive
authors.initials: O
authors.lastname: Bennewith
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Jenny
authors.initials: J
authors.lastname: Donovan
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Paramasivan
authors.forename: Amanda
authors.initials: A
authors.lastname: Owen-Smith
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
authors.forename: Rosemary
authors.initials: R
authors.lastname: Davies
authors.forename: Susan
authors.initials: S
authors.lastname: O'Connor
authors.forename: Keith
authors.initials: K
authors.lastname: Hawton
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000379:methods*; D000368:Aged; D015709:Correspondence as Topic; D004739:England; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D019964:Mood Disorders / Q000628:therapy; D010351:Patient Discharge; D010554:Personality Disorders / Q000628:therapy; D010865:Pilot Projects; D012559:Schizophrenia / Q000628:therapy; D019966:Substance-Related Disorders / Q000628:therapy; D055815:Young Adult; D000092864:Suicide Prevention
keywords: inpatient; intervention; psychiatric patients; self-harm; suicide