Understanding and improving experience and safety at transitions of care for patients with mental illness

The immediate period following discharge from adult acute inpatient mental health care presents a vulnerable time for the safety of service users, with around 13% of service user suicides occurring in the first few weeks post-discharge. Service-led processes and interventions developed to improve safety at this transition are typically evaluated using readmission and suicide rates, which do not allow for the appraisal of care processes that may contribute to these outcomes. Patient-reported measures can be used to positively impact service performance and patient-centred care. No measure currently exists that assesses the experience and safety of service users at this transition, from a service user perspective. Thus, this thesis aimed to develop a deeper understanding of safety at the transition, and to use this knowledge to produce a service user-reported Measure of Safety at the Transition from acute adult inpatient mental health care to community settings (MoSaT).
A scoping review (study 1) mapped the evidence of provider-level factors and interventions that have been associated with safety-related outcomes within 30-days post-discharge. Next, semi-structured interviews with service users and carers (study 2) were carried out to explore perspectives and experiences of safety at the transition. A conceptual model of safety was developed based on findings from the scoping review and interview study, which informed the measurement domains for a measure of safety. Stakeholder engagement groups were facilitated to develop and revise items (study 3). A think aloud study with service users (study 4) tested and refined items, yielding 28 experience items and 7 outcome items. Feasibility of MoSaT was tested in a small sample of service users in collaboration with an external research project (MINDS). The findings demonstrate promise for MoSaT being a valid measure of safety at this care transition. Further research is needed to test the full psychometric properties of MoSaT.