Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in‐patient settings

Abstract

ObjectiveThis proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in‐patient settings, to improve engagement in treatment for drug and alcohol misuse.MethodA randomised controlled trial using concealed randomisation, blind, independent assessment of outcome at 3 months. Participants were 59 new adult admissions, to six acute mental health hospital units in one UK mental health service, with schizophrenia related or bipolar disorder diagnoses, users of community mental health services and also misusing alcohol and/or drugs. Participants were randomised to Brief Integrated Motivational Intervention (BIMI) with Treatment As Usual (TAU), or TAU alone. The BIMI took place over a 2‐week period and encouraged participants to explore substance use and its impact on mental health.ResultsFifty‐nine in‐patients (BIMI n = 30; TAU n = 29) were randomised, the BIMI was associated with a 63% relative odds increase in the primary outcome engagement in treatment [OR 1.63 (95% CI 1.01–2.65; P = 0.047)], at 3 months. Qualitative interviews with staff and participants indicated that the BIMI was both feasible and acceptable.ConclusionMental health hospital admissions present an opportunity for brief motivational interventions focussed on substance misuse and can lead to improvements in engagement.

Mental Health Hospital Admissions: a Teachable Moment and Window of Opportunity To Promote Change in Drug and Alcohol Misuse

“…The pilot feasibility study was an open (rater blinded), prospective randomised trial that analysed by intention to treat (as outlined in Graham et al 2016b). The trial utilised concealed randomisation; blind, independent assessment of outcome at 3-months; characterisation of refusers and drop-outs.…”

“…A randomised controlled feasibility trial was conducted to assess whether a mental health hospital admission represented a natural window of opportunity for inpatients who misuse alcohol or drugs to be offered a Brief Integrated Motivational Intervention (BIMI) for drug and alcohol misuse whilst on a ward (Graham et al 2016b). The qualitative component is reported separately in this paper to allow an in-depth analysis of the following aims:…”

“…When considering individuals who had contact with mental health services during the preceding 12 months, these individuals were highlighted to account for 28% (18,172) of deaths by suicide across the UK between 2004 and 2014, furthermore that 'over half the patients who died by suicide had a history of alcohol or drug misuse' (University of Manchester 2016, p. 9). Despite the high prevalence of this client group and the risks associated with being part of it for example violence (Fazelet et al 2009) and lung disease (Sokal et al 2004), there is currently no routine assessment of the role substance use plays in a psychiatric admission within the admission process (DOH 2006, Graham et al 2016b. In recent years, the needs of this client group have received increasing focus in government policy; most recently a Public Health England (PHE) Guide (PHE 2017) which supports the Five Year Forward View for Mental Health (Mental Health Taskforce 2016) implementation (PHE 2017).…”

“…Mental health diagnoses included both common and severe mental health problems, the most prevalent being depression (8 studies). Of these, five studies were conducted in inpatient settings (Bagøien et al 2013;Brown et al 2015;Milner et al 2009;Goti et al 2010 andGraham et al 2016b), three of which included adults (Bagøien et al 2013;Graham et al 2016b;Milner et al 2009) and the remaining two adolescents (Brown et al 2015;Goti et al 2010). Of these five studies, four evaluated motivational interviewing interventions, one was the current study of the BIMI (which incorporated cognitive behavioural and motivational techniques) and the final study evaluated a standardised workbook (Milner et al 2009).…”

“…small sample size (e.g. Graham et al 2016b). The review therefore suggests the need for robust trials with the provision of follow-up sessions after discharge from hospital (Goulding 2016).…”