BackgroundMental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged.MethodsThis pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge.ResultsA total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support.ConclusionsThe findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to support the cost effectiveness of providing peer support, but neither was it proven a costly intervention to deliver. The findings support an argument for a larger scale trial of peer support as an adjunct to existing services.Trial registrationCurrent Controlled Trials ISRCTN74852771

This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link: AimThe aims of this paper is to: 1) describe the preparation, selection, training and support of a group of Peer Support Workers (PSWs) recruited to provide support alongside conventional aftercare to service users discharged from acute psychiatric units in London, England; and 2) report the findings of an evaluation of the training and support provided. Results of the trial are reported elsewhere (under review). From hospital to homeMental health service users recently discharged from hospital often fail to continue with treatments including medication, relapse and are readmitted to hospital. In England, it was reported that between 20% and 40% of psychiatric patients were readmitted within six months of discharge, with the peak period within the first month The Peer Support ProjectThe Peer Support Project was designed as a pilot randomised controlled trial (RCT) comparing peer support alongside care as usual following discharge, with usual care alone. Follow-up was at one month and three months post-discharge. Peer Support Workers (PSWs) would make initial contact while the service user was still an inpatient and then offer four weeks' support following discharge. This would be in Recruitment and selectionThe preparation and support of the PSWs and development of training materials was stage all demonstrated an understanding of the skills and attitude needed to effectively support a peer. Fictious scenarios were used to allow enquirers to consider how they might effectively support someone. Based on this discussion, a mutual decision was reached between the PSC and enquirer as to whether they were ready to attend the Open Day.The second stage of selection was attendance at an Open Day, facilitated by mental health staff at City University London, members of 'SUGAR: Service user and carer group advising on research', and the training programme facilitators (Susan Henry (SH), Cerdic Hall (CH)).Twenty-five participants were given an introductory presentation on peer support and then took part in paired and group exercises that reflected the style and content of the 12 week training programme. They could opt out of selection mid-way through the day. Those who remained were asked to select five other people in the group who they thought would make effective peer supporters. This was then matched to the observations and reflections of the facilitating team. Successful applicants were then contacted the next day and offered a training place following further discussion of any concerns or questions. Those considered not ready to be offered training as a PSW were also contacted and given feedback and encouragement about other possible initiatives. Sixteen participants were selected for training. Overview of trainingTraining was delivered over 12 weekly one day sessions from April to July 2010 in a newly built medical education and training centre attached to a hospital sit...

Objective: Low self-control has been linked with smoking, yet it remains unclear whether childhood self-control underlies the emergence of lifetime smoking patterns. We examined the contribution of childhood self-control to early smoking initiation and smoking across adulthood. Methods: 21,132 participants were drawn from 2 nationally representative cohort studies; the 1970 British Cohort Study (BCS) and the 1958 National Child Development Study (NCDS). Child self-control was teacher-rated at age 10 in the BCS and at ages 7 and 11 in the NCDS. Participants reported their smoking status and number of cigarettes smoked per day at 5 time-points in the BCS (ages 26–42) and 6 time-points in the NCDS (ages 23–55). Both studies controlled for socioeconomic background, cognitive ability, psychological distress, gender, and parental smoking; the NCDS also controlled for an extended set of background characteristics. Results: Early self-control made a substantial graded contribution to (not) smoking throughout life. In adjusted regression models, a 1-SD increase in self-control predicted a 6.9 percentage point lower probability of smoking in the BCS, and this was replicated in the NCDS (5.2 point reduced risk). Adolescent smoking explained over half of the association between self-control and adult smoking. Childhood self-control was positively related to smoking cessation and negatively related to smoking initiation, relapse to smoking, and the number of cigarettes smoked in adulthood. Conclusions: This study provides strong evidence that low childhood self-control predicts an increased risk of smoking throughout adulthood and points to adolescent smoking as a key pathway through which this may occur.

Reciprocal altruism may be a useful tool in increasing intentions to join the organ donor register. Further evaluation is required to determine whether this increase in intention can be translated into organ donation behaviour. Statement of contribution What was already known? Demand for organs in the United Kingdom far outstrips supply, so finding strategies to increase registration on the organ donor register could save hundreds of lives per year. Despite the majority of people in the United Kingdom agreeing that organ donation is a good thing, most people do not register as donors. A limited amount of evidence of the impact of perceived reciprocity suggests that encouraging people to consider themselves as recipients and priming ideas of shared responsibility may increase the likelihood of their subsequent willingness to register. What does this study add? Novel evidence that employing a simple reciprocity prime increases organ donor registration intentions. Replication of findings across two separate studies. Novel examination of the impact of mode of delivery of messages to encourage organ donation. A basis for further research into the translation of intentions into organ donor registration behaviour.

Reciprocal altruism appears useful for increasing intention towards joining the organ donation register. It does not, however, appear to increase organ donor behavior.