PROJECT SUMMARY
The development of appropriate and effective community-based care for people living with severe mental illness
(SMIs) continues to be a global challenge, especially in low-and-middle income countries (LMICs). A particularly
damaging cycle emerges when people with SMIs are admitted to hospital for acute psychiatric treatment,
discharged back into community settings without appropriate support, only to be readmitted again due to
psychiatric relapse. This “revolving door” phenomenon is a multilevel challenge to mental health systems,
including in countries such as South Africa, with little to no formal community-based support systems for people
living with SMIs. However, promising evidence has been produced that Critical Time Intervention (CTI), a time-
limited psychosocial intervention with origins in the prevention of homelessness in the USA, could potentially
improve individual and system outcomes by providing support to vulnerable service users during the difficult
transition period from hospital to community settings. The proposed research project aims to build on a CTI
version that draws from community health workers and peer support workers, adapted for low-resource settings
in South America, to develop and pilot a locally appropriate intervention program for South Africa. Specifically,
we will draw from partner project data, supplemented by additional qualitative research and collated to provide
a contextual basis from which to adapt the CTI approach, its content and materials. In particular, we will seek
out specific community resources that could be included in the development of support networks, including
existing peer support groups, and, importantly, the involvement of traditional health practitioners. We will then
conduct a pilot feasibility cohort study in the uMgungundlovu District Municipality in KwaZulu-Natal, South Africa.
We will recruit and train five teams that each include an auxiliary social worker and a peer support worker to
provide CTI support to 40 people with SMIs who are being discharged to community settings following acute
psychiatric hospitalization. Quantitative and qualitative process measures in terms of the Consolidated
Framework for Implementation Research (CFIR), and outcome measures in terms of Reach, Effectiveness,
Adoption, Implementation, and Maintenance (RE-AIM) will be gathered at several intervals throughout the CTI
piloting period. Our primary outcome will be the reduction in psychiatric readmission over a 16-month study
period, relative to the previous 16-month period. Along with several secondary outcomes, these measures will
provide the necessary data to establish feasibility, appropriateness, and limited effectiveness of the adapted CTI,
and lay a foundation for further trial research.
