Recommendations for research

The guideline committee has made the following recommendations for research.

1 Care and support for people with dementia

What is the effect of specific interventions to support people with dementia during transition between inpatient mental health settings and community or care home settings?

Why this is important

The review did not identify any studies about transition for people with dementia from or to inpatient mental health settings. This is one of the groups identified in the equality impact assessment that need special consideration.

Mental health disorders may be under-diagnosed in people with dementia due to 'diagnostic overshadowing', in which a person's symptoms may be wrongly attributed to dementia. If they are admitted to a psychiatric ward, being able to support them to communicate and function in a new environment, and to return to the community, may help ensure that they do not stay on inpatient wards longer than necessary. It is also important to consider how to achieve continuity of care if the person's usual residence is, or will be, a care home.

Effectiveness studies are needed to evaluate different approaches and interventions to support people with dementia during transition between inpatient mental health settings and community or care home settings. Qualitative studies exploring views and experiences of people with dementia and their families and carers would also be welcome.

2 People with complex needs other than dementia

What is the effect of specific interventions to support people with complex needs because of multiple diagnoses and resistance to treatment during transition between inpatient mental health settings and community or care home settings? (This includes people with physical or learning disabilities, people with personality disorder, people with complex psychosis, people with long-term severe mental illness and people on the autistic spectrum.)

Why this is important

As the population ages and people live longer, the number of people with severe and complex mental and physical care needs is increasing. They may need ongoing intensive support from rehabilitation and other mental health services to live in the community after discharge. Although they are a relatively small group, expenditure on care for people in this group accounts for around 25% of the total mental health budget.

Studies are needed to evaluate different approaches and interventions to support people with complex needs during transition. Qualitative studies exploring views and experiences of people with complex needs and their families are also needed. These should include the views of staff from the receiving care home.

3 Children and young people in transition between settings

What is the effect of specific interventions to support children and young people during transition between inpatient mental health settings and community or care home settings? Is there any particular benefit for black, Asian and minority ethnic communities?

Why this is important

Young people admitted to inpatient mental health settings may have a range of associated difficulties, and may be more likely than adults to be admitted to out-of-area or specialist units.

The committee highlighted particular gaps in the evidence about children and young people during transitions. These included gaps in evidence on:

  • child protection and safeguarding

  • voluntary compared with involuntary admission

  • understanding by children and young people of their status

  • how looked-after children are best supported through transitions and reintegration into the school system after hospital discharge

  • self-directed support or peer support for children and young people and their parents.

Effectiveness studies are needed to evaluate the different approaches and interventions to support children and young people through safe and timely transitions. These need to be supplemented with views and experiences studies.

ISBN: 978-1-4731-2023-5

  • National Institute for Health and Care Excellence (NICE)