Development, Feasibility Testing and Pilot Trial of a Crisis Planning and Monitoring Intervention to Reduce Compulsory Hospital Readmissions (the FINCH Study)

Research question: The main research questions addressed are: whether an intervention to prevent compulsory readmission can be developed that is acceptable to people who have recently been compulsorily admitted (including Black and Black British people); whether it appears feasible to evaluate the effectiveness of this intervention in a future fully powered randomised controlled trial; and whether preliminary evidence from this study is congruent with the intervention being effective.

Background: The rate of compulsory admission has been rising in the UK.

This is highly problematic because of the associated distress and disempowerment, and because mental health care should as far as possible be based on principles of consent and collaboration.

People with previous compulsory admissions are at high risk of a repeat compulsory admission, making them an important potential focus for interventions to reduce detentions.

Aims and objectives We aim to develop and test an intervention to prevent compulsory readmission and develop self-management skills among people being discharged following a compulsory admission.

In the first phase of the study, a co-produced approach will be taken to adapting an intervention that has shown considerable promise in a trial in a large metropolitan area in Switzerland.

This stage includes initial investigation of feasibility and acceptability, especially to Black/Black British service users.

The second phase involves a pilot trial, intended to assess whether this intervention can be tested through a definitive trial and to make an initial assessment of its potential effectiveness.

Methods and Timelines Phase 1 (Months 1-8): A Co-Production Group including researchers, clinicians and service users will meet frequently to make key decisions about adaptation of the study intervention from its Swiss model.

Inputs will include: emerging policy guidance on advance statements; relevant research literature; consultation with key experts (including the original intervention's developer), qualitative data collection from staff and service users (especially from Black/Black British backgrounds), and learning from initial delivery of the intervention to 6 service users.

Phase 2 (Months 9 to 31): A pilot trial, designed to establish proof of concept, will be conducted in three sites, two in London and one in a non-metropolitan area. Forty people will be randomised to receive the intervention and 40 controls will receive treatment as usual. We aim for at least half of participants to be Black/Black British.

The intervention will be finalised in Phase 1: current plans are for four initial sessions focused on psychoeducation, crisis planning, early warning signs of crises and recovery goals, followed by a one year period of monitoring monthly by video call or phone.

Recruitment and retention will be examined, as well as outcomes including compulsory readmission over a year (the primary clinical outcome) Anticipated impact and dissemination Clear research evidence on how to prevent compulsory admission is lacking: if our intervention is eventually found to be effective, national and international impact will be high.

We will engage stakeholders throughout by a blog, dissemination events, policy briefs and social media, and will publish scientific papers from both phases describing justified conclusions thus far and their implications.