Project details

Summary

What is the study about?

Mental health rehabilitation services provide specialist treatment to people with particularly severe and complex problems. These services include inpatient units and supported accommodation in the community.

When people have access to local rehabilitation services, most gain the skills to manage with less support over time, progressing from inpatient care to higher, and then lower, supported accommodation. Over recent years there has been a reduction in the provision of NHS inpatient mental health rehabilitation services across England and now around half of these beds are provided by the independent sector.

In 2018, the Care Quality Commission raised concerns that people receiving inpatient rehabilitation in the independent sector were staying twice as long as those treated in the NHS and they were much further from their home. This situation has been criticised in the press, but we do not know whether the services provided by the NHS and independent sector differ in quality or patient outcomes. For example, it could be that NHS Trusts send their most complex patients for treatment in the independent sector as their needs cannot be met locally and that is why they stay in hospital longer.

What are you trying to find out?

There have been no studies investigating the effectiveness of inpatient rehabilitation services that have included the independent sector. Our study aims to address this gap.

As we cannot compare NHS and independent sector services through a randomised trial, our programme will draw together findings from five components to assess the effectiveness of these services:

• Component 1 (C1): A survey of 60 inpatient mental health rehabilitation services across England (30 NHS and 30 independent sector)
• Component 2 (C2): In-depth interviews with users, relatives/carers, staff and commissioners of these services to explore their experiences and perspectives
• Component 3 (C3): Compare 18-month outcomes for 600 patients of the NHS and independent sector
• Component 4 (C4): Compare outcomes of all users of NHS and independent sector inpatient rehabilitation on a census date using anonymised records
• Component 5 (C5): Cost effectiveness analysis.

What does taking part involve?

We may ask you to take part in different activities depending on your connection to an inpatient mental health rehabilitation service. 

Patients

If you are happy to take part, you will be asked to confirm this by completing and signing a consent form. The researcher will then ask you a series of questions about how satisfied you are with different aspects of your life, how you spend your time, the freedom you have to make day to day decisions, and how you feel about the care you receive from the inpatient rehabilitation service. This interview should take no longer than 30 minutes.

We will also ask your permission to ask a staff member about your abilities, needs, any specific difficulties you may have, your activities in the community, and whether you have been at risk or posed any risk to others. We will then contact staff involved in your healthcare at regular intervals over the next 18 months to see if you have been discharged from the inpatient rehabilitation service, and if you have been discharged, details of where you have been discharged to and whether you have had any readmissions. You may ask the researcher to see a copy of these questions.

We will also invite you to take part in a brief interview in around six months, 12 months, and 18 months to see how you are getting on. These interviews will take place over telephone or via video call (Teams or Zoom) and will be arranged at another time. These interviews will be shorter and should only take around 10 minutes.

We would also like your permission to collect some information from your healthcare records about the care you have received from mental health services in the past. You may also ask the researcher to see a copy of this data collection form.

Relative / Friend / Carer

• As a consultee to a patient: help decide if he/she should join the study, we’d like to ask your opinion whether or not they would want to be involved. We’d ask you to consider what you know of their wishes and feelings, and to consider their interests. 
• As a relative and carer: a research interview which should take less than 60 minutes and will take place remotely via telephone or video call (Teams or Zoom). During this interview you will be asked about your experiences and perspective as a relative or care of someone receiving treatment at a mental health inpatient rehabilitation service.

Members of Staff

• Community based members of staff: a research interview which should take less than 60 minutes and will take place remotely via a video call (Teams or Zoom). During this interview you will be asked about your experiences and perspective as a community member of staff who works with someone receiving treatment at a mental health inpatient rehabilitation service.
• Inpatient Staff: a focus group or a research interview. Both the interview and focus group should take less than 60 minutes, and at both you will be asked about your experiences and perspective as someone who works at a mental health inpatient rehabilitation service. The focus group will take place at the inpatient service where you work. The focus group will include around six of your colleagues at the service who have also been asked to participate in this study, plus the researcher. The interview may also take place at the inpatient service, or if it is more convenient, it may take place via telephone or videoconference call (Zoom or Teams).
• Managers: to take part in a research interview which will take around one hour to complete. During the interview, the researcher will ask you about the service you manage, and will complete with you something called the QuIRC, which is a quality and assessment tool designed specifically for mental health inpatient rehabilitation units. The QuIRC generates a report once the researcher has entered the data online. Also, to see what happens to patient participants during the course of the 18-month cohort study, we will be contacting you or a member of staff monthly to ask if any of the patients recruited from this service have been discharged.
• Senior Manager / Commissioner: a research interview which should take less than 60 minutes which will take place remotely via a video call (Teams or Zoom). During this interview you will be asked about your experiences and perspective as a senior manager or commissioner of inpatient mental health rehabilitation.
• Staff: The researcher will ask you a series of questions about one or more of the patients that you work with. We will ask you about the patient’s social functioning, engagement in activities, challenging behaviours, substance misuse, needs, current and previous risk, and current engagement with activities in the community. This interview should take less than 30 minutes.

Who is it for?

We are inviting you to take part because we understand you:

• are a community based member of staff who is working with someone who is a patient of an inpatient mental health rehabilitation service, or was in the past
• are currently a patient at one of the inpatient services selected for the study (we may ask a relative/friend/patient to help you decide)
• have a relative or the person you care for is already participating in this study as a patient of an inpatient rehabilitation service
• are currently working at one of the inpatient services selected for the study
• are currently work as a manager at one of the inpatient services selected for the study
• are a senior manager or commissioner of inpatient mental health rehabilitation services

Why is it important? 

By participating in this study you will help us better understand the experiences and perspectives of people working in inpatient mental health rehabilitation services. We hope that the information we collect from this study will help us to improve inpatient rehabilitation services in the future.

How can I find out more?

You can find out more information about taking part in this study by downloading the key documents at the top of this page. 

If you are interested in taking part in this study, or have questions for the research team, click the button below to email the research team:

Email the research team