Title: A pilot study to assess the feasibilty and impact of a motivational intervention on problem drug and alcohol use in adult mental health inpatient units
Funder: Department of Health (England)

Abstract: Background Substance misuse in those with severe mental health problems is common and associated with poor: engagement in treatment, motivation to change, clinical outcomes and increased psychiatric admissions. Estimates vary, but up to 44% of those admitted into psychiatric inpatient facilities have been found to have co-existing substance misuse problems However, treatment for substance misuse on inpatient units rarely occurs, yet is highlighted as an area of unmet need. A mental health admission can present an unparalleled opportunity for inpatients to re-evaluate their substance use. National guidance recommends psychiatric inpatient staff be trained in the use of simple motivational approaches to address substance misuse amongst this client group, but as yet there is no evidence to guide this. Aims In order to prepare for a definitive trial of an inpatient focussed intervention for substance misuse within the context of integrated community mental health treatment, this phase II pilot study will aim to:- (1) Test whether engagement in treatment for substance misuse and readiness to change substance use behaviour can be significantly improved by a motivational intervention. (2) Test how feasible and acceptable the motivational intervention is to inpatients and staff as a routine inpatient intervention. (3) Conduct the groundwork for the health economics necessary in the definitive trial to enable a full cost-effectiveness analysis. Plan of Investigation Staff on each mental health admission unit will be trained to deliver a motivational intervention. New inpatient admissions with severe mental health problems who misuse substances will be invited to take part. Participants will be randomised to: Motivational Intervention (MI) or Treatment as usual (TAU). One-month post-discharge participants in the MI condition will be given a booster session to help: consolidate motivation, transfer the skills from the MI to the community, and engagement with substance misuse treatment routinely integrated within community mental health teams Participants will be followed up 3-months post-discharge.The primary outcome will be engagement in substance misuse treatment and the secondary outcome readiness to change substance use. Potential Impact This pilot study will provide an evidence base for inpatient care of people with co-morbid substance misuse. It will seek to improve readiness to change problematic substance use and lead to improved engagement with community-based treatment services post-discharge for this aspect of their care. The longer-term impact will be that the trial will provide the groundwork for mental health service providers to identify a feasible, cost-effective and easy to implement treatment option that can be readily integrated into standard inpatient and community-based care.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: STROKE;MENTAL HEALTH;CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL