A major two year study investigating England's mental health decision units (MHDUs) is being spearheaded by researchers at St George's.

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The mixed methods study, known as the Decision study, has been funded by the NIHR. Mental Health Decision units have recently emerged in Mental Health NHS trusts, and are an innovative source of support for people undergoing acute mental health crises. Usually situated in or near mental health hospitals, they provide 24 hour facilities for enhanced assessment, intense treatment and onward signposting. They do not have ward status, and are for a short stay only, from a few hours to a maximum of 3 days. A typical unit might offer shared living quarters with access to snacks and drinks, chairs or recliner beds and meeting or treatment rooms.

The purpose of MHDUs is to provide a safe place for people to access urgent help when it is needed, without having to be admitted to a hospital ward. The units are run by a mental health nursing team and staffed 24 hours a day. Admission is voluntary, with referrals coming from community mental health teams, A&E (emergency departments) or psychiatric services.

Lucy Goldsmith, project manager, said: “Our study is looking closely at many different aspects of these units. Initially we will be mapping their locations across the country, including looking at other units that perform a similar function. We will be looking at their structure and activities. Next we will establish data collection across participating sites, including looking at trustwide indicators of how well the crisis care pathway in mental health is working – e.g. how long people in mental health crisis are waiting at A&E. We will be carrying out a quantitative study on the effect of the units on the care received by individuals and then moving on to interview service users and staff about their experiences of decision units. Finally we are carrying out an economic evaluation and looking at the most effective design and configuration of the units.”

Dr Steve Gillard, Reader in Social and Community Mental Health, is lead ing the project and said: “These units have been springing up around the country since 2016. Although they seem a sensible idea and come from a good understanding of mental health, proper evidence is needed of their effectiveness. We are setting out to complete a high-quality and thorough evaluation. The research papers we produce, as well as our final report, will be relevant for other mental health trusts considering implementing these units.”

The study is funded by the NIHR's Health Service and Delivery Research programme at a cost of £418,000. Collaborators include St George's Hospital Trust A&E Department, South West London & St George's Mental Health NHS Trust, University College London, the London School of Economics and the Health Foundation.

The research team also includes local service users, in the form of St George's Peer Expertise in Education and Research (PEER) group, who helped design the study and have provided vital lived-experience input into the project, and a national lived-experience advisory panel, which will meet several times a year. Both groups will advise on the implementation of the protocol using their members' own knowledge of using services and will help interpret the results of the study.

The team's final report will be produced after the study ends in March 2021.

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