Peer support for discharge from inpatient to community mental health care as an addition to usual community follow up: study protocol for a randomized controlled trial.

In the period shortly after discharge from inpatient to community mental health care people are at 3 increased risk of self-harm, suicide and readmission to hospital. Discharge interventions including peer 4 support have shown potential, and there is some evidence that community-based peer support reduces 5 readmissions. However systematic reviews of peer support in mental health services indicate poor trial 6 quality and a lack of reporting of how peer support is distinctive from other mental health support. This 7 study is designed to establish the clinical and cost-effectiveness of a peer worker intervention to support 8 discharge from inpatient to community mental health care, and to address issues of trial quality and clarity 9 of reporting of peer support interventions. 10 Methods This protocol describes an individually randomised controlled superiority trial, hypothesizing that people 12 offered a peer worker discharge intervention in addition to usual follow-up care in the community are less 13 likely to be readmitted in the 12 months post-discharge than people receiving usual care alone. 590 people 14 will be recruited shortly before discharge from hospital and randomly allocated to care as usual plus the 15 peer worker intervention or care as usual alone. Manualised peer support provided by trained peer 16 workers begins in hospital and continues for four months in the community post discharge. Secondary 17 psychosocial outcomes are assessed at four months post-discharge, and service use and cost outcomes at 18 12 months post-discharge, alongside a mixed methods process evaluation. 19 Clearly specified procedures for sequencing participant allocation and for blinding assessors to allocation, 21 plus full reporting of outcomes, should reduce risk of bias in trial findings and contribute to improved 22 quality in the peer support evidence base. The involvement of members of the study team with direct 23 experience of peer support, mental distress and using mental health services, in coproducing the 24 intervention and designing the trial, ensures that we theorise and clearly describe the peer worker 25 intervention, and evaluate how peer support is related to any change in outcome. This is an important 26 methodological contribution to the evidence base. ISRCTN