Abstract
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. People often need to go into hospital when they have a mental health crisis due to overwhelming distressing psychotic symptoms, such as hearing voices (hallucinations) or experiencing unusual beliefs (delusions). Brief talking therapies may be helpful for people during an acute inpatient admission as an adjunct to medication in reducing re-admission rates, and despite promising findings from trials in the USA, there have not yet been any clinical trials on this kind of intervention within NHS settings.Objectives: The primary objective of the study was to find out whether it was possible to carry out this kind of trial successfully within UK inpatient settings in terms of successfully recruiting and retaining patients in the trial. The secondary objective was to collect pilot data on clinical outcome measures, including re-admission rates at 6-month follow-up.
Method: The amBITION study (BrIef Talking therapIes ON wards; ISRCTN376253384) was a parallel groups, feasibility randomised controlled trial (RCT) of a manualised brief talking therapy (Mindfulness-Based Crisis Intervention; MBCI). Inpatients on acute psychiatric wards were eligible for the study if they reported at least one positive psychotic symptom, and were willing and able to engage in a talking therapy. In addition to treatment as usual (TAU), participants were randomly allocated to receive either MBCI or a control intervention (Social Activity Therapy; SAT) which involved doing activities on the ward with the therapist.
Results: Fifty participants were recruited to the trial (26 MBCI; 24 TAU). No participants dropped-out during the therapy phase, and everyone in the trial received at least one therapy session. The average number of sessions per participant was 3 in both arms of the trial. Retention in the trial was excellent, and exceeded the pre-set benchmark of no more than 20% loss to follow-up at trial end-point (6-month follow-up after discharge). The follow-up rate at 6-month follow-up was 98% for service use data extracted from clinical notes, and 86% for self-report questionnaire measures. Three participants experienced adverse events, but none of these were considered to be related to their participation in the trial.
Conclusions: It is feasible to recruit and retain participants in the trial. The therapy was acceptable to patients, and satisfaction ratings with therapy was high. Progression to a further trial is warranted based on these encouraging feasibility outcomes.
| Date of Award | 2018 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Emmanuelle Peters (Supervisor) & Paul Chadwick (Supervisor) |