A brief psychological crisis intervention to reduce the risk of re-admission within acute inpatient psychiatric settings for people with psychotic symptoms; A feasibility randomised controlled trial

Project: Project at a former HEI


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.

Layman's description

Background: Having to go into hospital because of a mental health problem can be a very distressing and disruptive experience. One of the main reasons people have to go into hospital is due to problems such as hearing voices, or experiencing distressing beliefs, such as feeling in danger from other people. These are also known as psychotic symptoms. One reason there is high demand for psychiatric beds is because sometimes people get re-admitted to hospital quite soon after leaving hospital. Aims: We wanted to find out whether it was possible to carry out a study to establish whether having a talking therapy in hospital might help people to stay well for longer after they are discharged. Method: We did a trial called the amBITION study (BrIef Talking TherapIes ON wards). People admitted to hospital were able to take part in the trial if they report experiencing a psychotic symptom, such as voices or distressing beliefs, and they were interested in having a talking therapy. Everyone in the study was offered one of two possible short talking therapies (1-5 sessions), allocated at random. This involved individual therapy sessions, either talking about what led to them coming into hospital and how they were coping with things (Mindfulness-Based Crisis-Interventions; MBCI) or doing activities they enjoyed with the therapist (Social Activity Therapy; SAT). Everyone was followed up for 6 months after they left hospital. Results: We found that we could recruit enough people to take part in the study, people were highly satisfied with the therapy they received, and we were able to keep in touch with most people to follow them up after they left hospital. Conclusions: The amBITION trial went well, and will help us plan a larger trial to find out whether the therapy really works (whether it is ‘effective’).
Short title284, 639
AcronymamBITION study
Effective start/end date1/01/1531/12/17