Effectiveness of text messages, and text messages plus peer support, on psychiatric readmission and length of stay: Outcomes from a stepped-wedge cluster randomized trial (Preprint)

Mental health recovery typically continues after patients leaves the hospital. However, hospital readmission in the 12 months after discharge is common and costly. To examine the effectiveness of supportive text messaging (SMS) and SMS with or without peer support service (SMS+/-PSS) on hospital readmission and length of stay after discharge from inpatient psychiatric care. 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 six- and 12-months pre- and post index admissions, for two intervention periods compared to a control period of treatment as usual Trial registration: Clinicaltrials.gov, NCT05133726. Registered on the 24th of November 2021. Overall, 1,070 participants were assigned to one of three study arms: SMS (n = 302), SMS+/-PS (n = 342), or treatment as usual (TAU, n = 426). The SMS+/-PS reduced readmissions and inpatient length of stay. Compared to TAU, SMS+/-PS reduced hospital readmissions six months pre and post index admission by an average of 0.26 admissions and SMS alone reduced inpatient length of stays six months pre and post index admission by an average of 7.87 days. Our results demonstrate that simple, low-cost digital tool-either by themselves or paired with peer support-can help close gaps in post-discharge care. We anticipate that these findings may inform future service delivery models and policy development aimed at enhancing post-discharge 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-centred mental health systems. Clinicaltrials.gov, NCT05133726.