Ernest Owusu

Background: Psychiatric hospitalizations are a major driver of mental health–related health care costs, with readmission risk and service utilization being highest in the months following discharge. Scalable, low-cost postdischarge interventions that reduce inpatient utilization are therefore of high policy relevance. Objective: This secondary exploratory economic study used linked administrative health care utilization data to evaluate the economic impact of supportive text messaging (SMS), alone and in combination with peer support services (PSS), following discharge from acute psychiatric care. Methods: This secondary exploratory economic evaluation was conducted alongside a pragmatic stepped-wedge cluster randomized trial in Alberta, Canada. Adults discharged from acute psychiatric inpatient care received treatment as usual (TAU), SMS, or SMS with or without PSS. Direct health system costs, including hospital care and physician costs, were assessed using administrative data for 6 months and 12 months before and after the index admission. Difference-in-difference analyses were used to estimate cost changes between groups. Results: At 6 months post discharge, the period of greatest new costs, participants receiving SMS experienced a significant reduction in hospital care costs compared with TAU (mean difference-in-differences −$7147; 95% CI −$12,388 to −$1906; P =.01). Total health care costs were also significantly lower in the SMS group at 6 months (−$8160) relative to TAU. Sensitivity analyses demonstrated that the direction and statistical significance of the primary findings remained stable across alternative intervention costing assumptions and analytic specifications. No significant cost differences were observed at 12 months. The addition of peer support did not result in incremental cost savings at either time point. Conclusions: SMS was associated with significant reductions in hospital care and total health care utilization costs during the 6-month postdischarge period compared with TAU. These findings support the integration of cost-effective and scalable digital interventions into routine psychiatric discharge pathways to help improve system efficiency in publicly funded health systems.

Background: The period following discharge from psychiatric inpatient care represents a critical transition phase marked by heightened vulnerability to relapse, including increased risks of emergency department (ED) utilization. Understanding the risk factors for ED utilization after hospital discharge will help identify individuals who should be targeted for enhanced follow up care in the community. Objective: This study aimed to examine the sociodemographic and clinical factors associated with psychiatric ED utilization within six months of discharge from inpatient psychiatric care among individuals assigned to different postdischarge interventions. The goal is to identify high-risk groups to inform targeted follow up strategies and enhance transitional care planning. Methods: This study analyzed secondary data from a pragmatic stepped-wedge cluster-randomized trial which recruited patients across ten health care sites in Alberta, Canada, from March 2022 to February 2024. For the primary study, a total of 1098 psychiatric inpatients were allocated to one of three post-discharge conditions: treatment as usual (TAU), SMS, or SMS plus peer support (SMS+ PS). Sociodemographic and clinical data were collected at discharge. ED visits 6-months postdischarge were recorded. χ ² tests identified variables associated with ED utilization. Significant predictors were entered into a logistic regression model to determine adjusted odds ratios (ORs) and 95% CIs. Results: Of the 1098 participants, demographic and clinical variables were examined for association with mental health ED visits at 6-months post discharge. Univariate analysis identified six significant predictors: age, ethnicity, relationship status, employment, housing status, and prior ED use. Logistic regression analysis identified several predictors of mental health ED visits 6-months postdischarge. Compared to participants under 25 years, those aged 26‐40 was less likely to revisit the ED (OR 0.66, 95% CI 0.46‐0.95), as were those over 40 years (OR 0.58, 95% CI 0.37‐0.92). Individuals identifying as mixed or other ethnicity were less likely than White people to return to the ED (OR 0.52, 95% CI 0.28‐0.96). Unemployed participants had higher odds of ED use than those employed (OR 1.66, 95% CI 1.18‐2.34). Prior ED attendance was the strongest predictor (OR 2.45, 95% CI 1.03‐5.80). Housing status showed varied but nonsignificant effects. Conclusions: This study highlights key demographic and clinical factors influencing psychiatric ED use following inpatient discharge. The findings emphasize the importance of targeted transitional care interventions, particularly for high-risk groups such as younger, unemployed, and previously ED-utilizing individuals, and support the integration of scalable approaches like SMS and peer support into discharge planning.

Background/Objective: The transition from psychiatric inpatient care to community settings poses risks of relapse, rehospitalization, and poor well-being. This study examined changes in anxiety, depression, suicidal ideation, sleep issues, and well-being over six months post-discharge and assessed the effectiveness of supportive text messaging (Text4Support) alone and with peer support, compared to treatment as usual (TAU). Methods: A pragmatic stepped-wedge cluster-randomized trial included 1098 participants discharged from psychiatric units across Alberta, Canada. Participants were allocated to the TAU, Supportive Text Messaging (SMS), or SMS plus peer support (SMS+PS) group. Outcomes were measured using GAD-7, PHQ-9, and WHO-5 at baseline and at six weeks, three months, and six months post-discharge. ANCOVA compared outcomes across groups at each time point, controlling for baseline values. Results: Follow-up completion declined (20% at six weeks, 16% at three months, and 15% at six months). No group differences emerged for anxiety, depression, suicidal ideation, or sleep issues at six weeks or three months. Well-being was significantly higher in the SMS group at six weeks (η² = 0.10). At six months, between-group differences appeared for anxiety and depression, though post hoc tests showed no pairwise differences. Conclusions: Supportive text messaging may improve well-being shortly after discharge and holds promise as a low-intensity transitional care strategy, though findings are limited by low follow-up.

Background: Mental health recovery typically continues after patients leave the hospital. However, hospital readmission in the 12 months after discharge is common and costly. Objective: This study aimed to examine the effectiveness of supportive text messaging (hereinafter “SMS”) and SMS with or without peer support service on hospital readmission and length of stay after discharge from inpatient psychiatric care. Methods: A stepped-wedge cluster randomized trial was used to examine differences in the changes in the mean number of admissions and the mean duration of total length of stay in days, for patients discharged from psychiatric inpatient care, at 6 and 12 months pre- and post index admissions, for 2 intervention periods compared to a control period of treatment as usual. Results: Overall, 1070 participants were assigned to 1 of 3 study arms: SMS (n=302), SMS with or without peer support service (n=342), or treatment as usual (n=426). Compared to treatment as usual, SMS with or without peer support service reduced hospital readmissions 6 months pre- and post index admission by an average of 0.26 admissions, and SMS alone reduced inpatient length of stays 6 months pre- and post index admission by an average of 7.28 days. Conclusions: Our results demonstrate that simple, low-cost digital tools—either by themselves or paired with peer support—can help close gaps in postdischarge care. We anticipate that these findings may inform future service delivery models and policy development aimed at enhancing postdischarge mental health support. By supporting smoother transitions and reducing future hospital use, such approaches may offer a scalable way to build more sustainable and person-centered mental health systems. Trial Registration: ClinicalTrials.gov NCT05133726; https://clinicaltrials.gov/study/NCT05133726

BACKGROUND Mental health recovery typically continues after patients leave the hospital. However, hospital readmission in the 12 months after discharge is common and costly. OBJECTIVE This study aimed to examine the effectiveness of supportive text messaging (hereinafter “SMS”) and SMS with or without peer support service on hospital readmission and length of stay after discharge from inpatient psychiatric care. METHODS A stepped-wedge cluster randomized trial was used to examine differences in the changes in the mean number of admissions and the mean duration of total length of stay in days, for patients discharged from psychiatric inpatient care, at 6 and 12 months pre- and post index admissions, for 2 intervention periods compared to a control period of treatment as usual. RESULTS Overall, 1070 participants were assigned to 1 of 3 study arms: SMS (n=302), SMS with or without peer support service (n=342), or treatment as usual (n=426). Compared to treatment as usual, SMS with or without peer support service reduced hospital readmissions 6 months pre- and post index admission by an average of 0.26 admissions, and SMS alone reduced inpatient length of stays 6 months pre- and post index admission by an average of 7.28 days. CONCLUSIONS Our results demonstrate that simple, low-cost digital tools—either by themselves or paired with peer support—can help close gaps in postdischarge care. We anticipate that these findings may inform future service delivery models and policy development aimed at enhancing postdischarge mental health support. By supporting smoother transitions and reducing future hospital use, such approaches may offer a scalable way to build more sustainable and person-centered mental health systems. CLINICALTRIAL ClinicalTrials.gov NCT05133726; https://clinicaltrials.gov/study/NCT05133726

Patient satisfaction with hospital services has been increasingly discussed as an important indicator of healthcare quality. It has been demonstrated that improving patient satisfaction is associated with better compliance with treatment plans and a decrease in patient complaints regarding doctors’ and nurses’ misconduct. This scoping review’s objective is to investigate the pertinent literature on the experiences and satisfaction of patients with mental disorders receiving inpatient psychiatric care. Our goals are to highlight important ideas and explore the data that might serve as a guide to enhance the standard of treatment and patient satisfaction in acute mental health environments. This study is a scoping review that was designed in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) statement. A systematic search was conducted in the following databases: PubMed, MEDLINE, PsycINFO, CINAHL, and EMBASE. A comprehensive review was completed, including articles from January 2012 to June 2022. Qualitative and quantitative studies were included in this review based on our eligibility criteria, such as patient satisfaction as a primary outcome, adult psychiatric inpatients, and non-review studies published in the English language. Studies were considered ineligible if they included nonpsychiatric patients or patients with neurocognitive disorders, review studies, or study measure outcomes other than inpatient satisfaction. For the eligible studies, data extraction was conducted, information was summarized, and the findings were reported. A total of 31 studies representing almost all the world’s continents were eligible for inclusion in this scoping review. Different assessment tools and instruments were used in the included studies to measure the level of patients’ satisfaction. The majority of the studies either utilized a pre-existing or newly created inpatient satisfaction questionnaire that appeared to be reliable and of acceptable quality. This review has identified a variety of possible factors that affect patients’ satisfaction and can be used as a guide for service improvement. More than half of the included studies revealed that the following factors were strongly recommended to enhance inpatient satisfaction with care: a clear discharge plan, less coercive treatment during the hospital stay, more individualized, higher quality information and teaching about the mental disorder to patients by staff, better therapeutic relationships with staff, and specific treatment components that patients enjoy, such as physical exercise sessions and music therapy. Patients also value staff who spend more time with them. The scope of patient satisfaction with inpatient mental health services is a growing source of concern. Patient satisfaction is associated with better adherence to treatment regimens and fewer complaints against health care professionals. This scoping review has identified several patient satisfaction research gaps as well as important determinants of satisfaction and how to measure and utilize patient satisfaction as a guide for service quality improvement. It would be useful for future research and reviews to consider broadening their scope to include the satisfaction of psychiatric patients with innovative services, like peer support groups and other technologically based interventions like text for support. Future research also could benefit from utilizing additional technological tools, such as electronic questionnaires.

(1) Background: Transitioning from mental health inpatient care to community care is often a vulnerable time in the treatment process where additional risks and anxiety may arise. We collected data for this study as part of a pragmatic cluster-randomized, longitudinal approach in Alberta. As the first phase of the ongoing innovative supportive program, this paper assessed the progression of mental health symptoms in patients six weeks after hospital discharge. Factors that may contribute to the presence or absence of anxiety and depression symptoms, as well as well-being, following return to the community were investigated. This provides evidence and baseline data for future phases of the project. (2) Methods: An observational study design was adopted for this study. Data on a variety of sociodemographic and clinical factors were collected at discharge and six weeks after via REDCap. Anxiety, depression, and well-being symptoms were assessed using the Generalized Anxiety Disorder (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9), and the World Health Organization-Five Well-Being Index (WHO-5), respectively. Descriptive, chi-square, independent t-tests, and multivariate regression analyses were conducted. (3) Result: The survey was completed by 88 out of 306 participants (28.8% response rate). The chi-square/Fisher exact test and independent t-test revealed no significant change in the mental health conditions from baseline to six weeks after discharge. It was found that the only significant factor predicting symptoms six weeks after discharge from inpatient treatment was the baseline symptoms in all three logistic regression models. It was four times more likely for those who experienced anxiety and depression at baseline to experience anxiety and depression symptoms six weeks after discharge (OR = 4.27; 95% CI: 1.38–13.20) (OR = 4.04; 95% CI: 1.25–13.05). Those with poor baseline well-being were almost 12 times more likely to experience poor well-being six weeks after discharge (OR = 11.75; 95% CI: 3.21–42.99). (4) Conclusions: Study results found no significant change in mental health conditions in the short term following hospital discharge. It is essential that researchers and policymakers collaborate in order to implement effective interventions to support and maintain the mental health conditions of patients following discharge.

Background: The transition from hospital to community settings for most mental health service users is often hindered by challenges that affect community adjustment and continuity of care. The first few weeks and days after discharge from mental health inpatient units represent a critical phase for many service users. This paper aims to evaluate the changes in the resilience, personal recovery, and quality of life status of individuals with mental health challenges recently discharged from acute mental health care into the community. Methods: Data for this study were collected as part of a pragmatic stepped-wedge cluster-randomized, longitudinal approach in Alberta. A paired sample t-test and Chi-squared/Fisher test were deployed to assess changes from baseline to six weeks in the recovery assessment scale (RAS), brief resilience scale (BRS), and EuroQol-5d (EQ-5D), using an online questionnaire. Results: A total of 306 service users were recruited and 88 completed both baseline and six weeks, giving a response rate of 28.8%. There was no statistically significant change in the level of resilience, recovery and quality of life as measured with the brief resilience scale, recovery assessment scale and EQ-5D from baseline to six weeks (p > 0.05). Conclusions: The study showed that there was neither an improvement nor deterioration in resilience, recovery, or quality of life status of service users six weeks post-discharge from inpatient mental health care. The lack of further progress calls into question whether the support available in the community when patient’s leave inpatient care is adequate to promote full recovery. The results justify investigations into the effectiveness of innovative and cost-effective programs such as peer and text-based supportive interventions for service users discharged from inpatient psychiatric care.