Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique

Abstract

Background: Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority.Methods: Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a fourstage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events.Results: Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency 'Discharge Team' (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan.Conclusion: This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and Frontiers in Psychiatry | www.frontiersin.org

What does safety in mental healthcare transitions mean for service users and other stakeholder groups: An open‐ended questionnaire study

“…Adopting a wider view of safety, including social outcomes that are rarely measured in clinical trials, 1 could allow for researchers to be explicit in terms of outlining theory of change. Bringing multiple perspectives together to co‐design potential solutions and including patients and carers/family members is key for future quality and safety mental health transition intervention development 33 . We foresee that improving patient safety in mental health transitions requires a tailored and multifaceted approach to target clinical, system and human, behavioural and social factors.…”

“…Bringing multiple perspectives together to co-design potential solutions and including patients and carers/family members is key for future quality and safety mental health transition intervention development. 33 We foresee that improving patient safety in mental health transitions requires a tailored and multifaceted approach to target clinical, system and human, behavioural and social factors.…”

Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England

“…SAFER, 20 discharge teams, patient written discharge plans), previous literature and the experience of members of the research team of working in mental health services. 3,8,20,21 The semi-structured approach enabled us to undertake a 'conversation with purpose' with parallel flexibility to discussing issues that may be particularly relevant to each participant. 22 The discussion around COVID-19 arose organically using the topic guide that was approved before the pandemic.…”

“…Collaborative working between multidisciplinary/multiagency teams to improve discharge planning was previously a core element of integrative care models, yet widespread implementation was previously considered unrealistic. 8 Technologyenabled meetings also improved patients' attendance for postdischarge follow-up meetings as practical barriers were eliminated (such as travelling complications, social phobia). The emphasis on social factors in deciding discharge readiness was perceived positively as social factors are often responsible for delayed discharges.…”

“…6 Increased demand for acute mental health services creates pressure to discharge, but limited integration with community health and social care settings often makes timely and safe discharge challenging. 3,7,8 The coronavirus disease 2019 (COVID-19) pandemic forced the rapid implementation of several practice changes in mental health services in ad hoc ways 9 and amendments in the operationalisation of the Mental Health Act. 10 NHS England and NHS Improvement guidance at the beginning of the pandemic suggested 'providers may need to make difficult decisions in the context of reduced capacity and increasing demand.…”