Mindfulness-Based Crisis Interventions (MBCI) for psychosis within acute inpatient psychiatric settings; A feasibility randomised controlled trial

Background: Inpatient psychiatric care is a scarce and expensive resource in the National Health Service (NHS), with chronic bed shortages being partly driven by high re-admission rates. Brief inpatient talking therapies for psychosis could help reduce re-admission rates. The primary aim was to assess feasibility and acceptability of a novel, brief, mindfulness-based intervention for inpatients with psychosis. The secondary aim was to collect pilot outcome data on readmission rate, at 6 and 12 months (m) post discharge, and self-report symptom measures at 6m.

Methods: The amBITION study (BrIef Talking therapIes ON wards) was a parallel group, feasibility randomised controlled trial (RCT). In addition to treatment as usual (TAU), eligible inpatients with psychotic symptoms were randomly allocated to receive either (Mindfulness-Based Crisis Intervention; MBCI) or a control intervention (Social Activity Therapy; SAT), for 1-5 sessions.

Results: Fifty participants were recruited (26 MBCI; 24 SAT); all received at least 1 therapy session (mean=3). Follow-up rates were 98% at 6m and 96% at 12m for service use data extracted from clinical notes, and 86% for self-report measures. At 6m follow-up, re-admission rates were similar across groups (MBCI=6, SAT=5; odds ratio=1.20, 95% CI: 0.312-4.61). At 12m follow-up, re-admissions were lower in the MBCI group (MBCI=7, SAT=11; odds ratio=0.46, 95% CI: 0.14-1.51). Three participants experienced adverse events; none was related to trial participation.

Conclusions: Delivering a brief mindfulness-based inpatient intervention for psychosis is feasible and acceptable, and may reduce risk of short-term readmission. These promising findings warrant progression to a larger clinical effectiveness trial.

Trial registration number: ISRCTN37625384