New service in south London reduces hospital readmissions for people with bipolar disorder

A new specialist programme at South London and Maudsley NHS Foundation Trust (SLaM) has been shown to significantly reduce the rate of hospital readmissions for people with bipolar disorder, in an early-stage audit funded by the NIHR Maudsley Biomedical Research Centre. The findings have been published in BJPsych Bulletin today.

Bipolar disorder is a condition in which an individual experiences recurrent episodes of mania, hypomania and depression. Bipolar disorder is fairly common: one in 50 adults will be diagnosed with the condition. An initial three-year audit of admissions at South London and Maudsley NHS Foundation Trust showed that there were approximately 500 hospital admissions of people with bipolar disorder each year. Two-thirds of these were re-admissions in that three year period, and approximately 150 people were admitted more than once a year. This audit strongly evidenced the need for a strong focus on effective preventative strategies in service users’ recovery programmes.

The OPTIMA Mood Disorders Service 

The OPTIMA Mood Disorders Service was established in 2015 to address this need. The Core Programme is an intensive, specialist programme for people who have recently had frequent hospital admissions for manic or depressive episodes. At the time of the audit, 30 people had been through the OPTIMA programme. The average rates of hospital admission and home treatment for these 30 patients, over the three years prior to them beginning the programme, were calculated using their electronic health records. These were compared to the average rates of admission for the patients over their post-programme period (an average of 9.5 months). 

The average rate of hospital readmission post-OPTIMA was substantially lower than the average rate over the three years pre-OPTIMA. The finding provides initial evidence that the treatments provided by the OPTIMA programme are successful in reducing hospital readmissions for frequently admitted patients.

The core programme is designed to consolidate recovery. It involves a range of treatments tailored to the individual, including frequent psychiatric review, expert pharmacotherapy (therapy using pharmaceutical drugs), specialist nursing interventions, occupational therapy and individual and group psychoeducation.

Psychoeducation helps people with bipolar disorder gain more control over their illness. It sensitively looks at the past course of illness to identify episode triggers and early warning signs of mania or depression. By recognising that an episode is just beginning and accessing help early, the development of full episodes can be prevented. Pragmatic planning on when and how to access help in a developing crisis is essential. The programme also offers occupational therapy, which helps service users find a balance between rest, work and leisure activity when building their functional recovery following a bipolar episode.

Senior author, Professor Allan Young, Director of the Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, said: “It is extremely encouraging to see that our specialist OPTIMA programme is successfully helping people with bipolar disorder, resulting in fewer readmissions to hospital. However, this early-stage audit does have some limitations. It examines a relatively small number of patients and a relatively short period of time post-programme, a more extensive study is required to confirm these benefits.”

First author, Dr Karine Macritchie, Lead Consultant Psychiatrist at OPTIMA said: “The period immediately following hospital admission for bipolar depression or mania is often a very vulnerable time for people struggling with this illness.  Our early results show that this period offers a valuable opportunity to optimise on-going treatment and to prevent loss of recovery, episode recurrence and re-admission.

“People with bipolar disorder can be given appropriate treatment, frequent support and a greater sense of agency over their condition at the time when they need these things the most.  OPTIMA shows the very positive results that can be achieved when a flexible, responsive service is offered in a timely and targeted way.”

Read the paper

‘A new inner-city specialist programme reduces re-admission rates in frequently admitted patients with bipolar disorder.’ BJPsych Bulletin, Karine Macritchie, Tim Mantingh, Diego Hidalgo-Mazzei, Sarah Bourne, Emma Borthwick, Allan H. Young. The paper will be live at the below link on Tuesday 27 November: https://doi.org/10.1192/bjb.2018.89