Virtual Ward for Mental Health Disorders

Overseen By Jennifer Hensel, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Manitoba

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

Duration: 1 week

476 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications. However, it mentions medication reconciliation and management, which means your medications will be reviewed and possibly adjusted by the healthcare team.

What data supports the effectiveness of the treatment Virtual crisis stabilization support with a multi-disciplinary team, Virtual crisis stabilization support, Mental Health Virtual Ward (MH vWard), Virtual psychiatric acute care ward (vWARD)?

Research shows that virtual mental health crisis wards, like the vWARD, can effectively provide intense psychiatric support remotely, helping to keep patients out of the hospital while still receiving necessary care. These virtual wards have been shown to offer cost savings and reduce the need for in-person hospitalization, making them a viable alternative for managing acute psychiatric crises. ^{1 2 3 4 5}

Is the Virtual Ward for Mental Health Disorders safe for humans?

Research on virtual mental health crisis wards during the COVID-19 pandemic suggests they are safe for individuals who prefer to stay in the community and are deemed safe to do so. These virtual wards provide intense psychiatric support remotely, which can be a safe alternative to in-person hospitalization. ^{1 2 4 6 7}

How is the Virtual Ward for Mental Health Disorders treatment different from other treatments?

The Virtual Ward for Mental Health Disorders is unique because it provides intensive psychiatric and crisis support remotely, allowing patients to receive care at home through a multi-disciplinary team using telecommunication methods like phone or video calls, which can be more accessible and cost-effective compared to traditional in-person hospitalization. ^{1 2 4 8 9}

What is the purpose of this trial?

The goal of this study is to evaluate if admission to the Mental Health Virtual Ward (MH vWard) for mental health crisis stabilization is having a meaningful positive impact on patient reported outcomes and healthcare utilization. The objectives of this study are: 1. Prospectively measure demographic, recovery, service delivery, and systems use outcomes in a cohort of MH vWard admissions. 2. establish this cohort for use in future research. As part of the intervention, participants will receive care in the MH vWard for an average of 5 days following a visit to an emergency department or crisis centre for a mental health crisis. While admitted to the MH vWard, participants will: 1. Engage in individual therapy and care planning with a clinician or psychiatry team. 2. Have engagement with formal (community providers) and informal supports (family, friends) for collateral and collaboration. 3. Receive medication reconciliation and management. 4. Participate in group programming. 5. Receive referrals for follow-up services. 6. Have access to after hours support. 7. Have access to the Telus Home Health Monitoring (HHM) App, which is custom designed to complement the services provided by the program.

Research Team

Jennifer Hensel, MD

Principal Investigator

University of Manitoba and Shared Health Manitoba/Psychiatry

Eligibility Criteria

This trial is for individuals experiencing a mental health crisis who have recently visited an emergency department or crisis center. Participants should be willing to engage in virtual therapy, group programs, and use the Telus Home Health Monitoring App as part of their treatment.

Inclusion Criteria

Individuals admitted to the Mental Health Virtual Ward

Exclusion Criteria

Not applicable.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive care in the Mental Health Virtual Ward (MH vWard) for mental health crisis stabilization, including individual therapy, care planning, medication management, group programming, and access to the Telus Home Health Monitoring App.

1 week

Virtual visits and access to after-hours support

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 1 week, 5 weeks, and 6 months post-discharge.

6 months

Assessments at 1 week, 5 weeks, and 6 months post-discharge

Treatment Details

Interventions

• Virtual crisis stabilization support with a multi-disciplinary team

Trial Overview The study tests a Mental Health Virtual Ward (MH vWard) program that provides multi-disciplinary support over about 5 days. It includes individual therapy, medication management, group programming, after-hours support, and follow-up service referrals.

Participant Groups

Group I: Mental Health Virtual Ward Experimental Treatment 1 Intervention

Admission to the Mental Health Virtual Ward

Virtual crisis stabilization support with a multi-disciplinary team is already approved in Canada for the following indications:

Approved in Canada as Virtual crisis stabilization support for:

• Acute mental health crises
• Suicidal behavior
• Psychosis
• Mania

Who Is Running the Clinical Trial?

University of Manitoba

Lead Sponsor

Trials

628

Recruited

209,000+

Health Sciences Centre Foundation, Manitoba

Collaborator

Trials

17

Recruited

9,500+

Findings from Research

The virtual mental health crisis ward (vWard) was well-received by providers, with 39 out of 60 survey respondents believing it was an effective model for delivering psychiatric support, indicating strong acceptance of virtual care in crisis situations.

The vWard model was deemed a good fit for 67.5% of admissions, and four patient archetypes were identified, suggesting that the model can effectively cater to diverse patient needs while leveraging virtual technology for improved care outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study. Lee, K., Bolton, SL., Shterenberg, R., et al.[2022]

The virtual psychiatric acute care ward (vWARD) successfully managed 132 diverse patients, with 57% presenting suicidal behavior and 29% with psychosis or mania, demonstrating its effectiveness in providing remote psychiatric care.

Only 13% of patients were transferred to a hospital, primarily those with psychosis or mania, indicating that vWARD can effectively divert many patients from hospitalization while also being a cost-saving alternative to traditional inpatient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual Acute Psychiatric Ward: Evaluation of Outcomes and Cost Savings. Castillo, BA., Shterenberg, R., Bolton, JM., et al.[2023]

Crisis Resolution Home Treatment (CRHT) was found to be as effective as standard inpatient treatment for managing acute psychiatric crises, with no significant differences in symptom reduction, readmission rates, or length of readmissions over a two-year follow-up period.

While CRHT initially resulted in a longer treatment duration (29.6% longer on average), its duration decreased over time, eventually becoming comparable to that of standard hospitalization, indicating its potential as an effective alternative treatment option.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography. Soldini, E., Alippi, M., Zufferey, MC., et al.[2022]

Virtual wards provide a model for managing high-risk patients at home, aiming to prevent unplanned hospitalizations through intensive, multidisciplinary care, first introduced in Croydon, England, in 2006.

The implementation of virtual wards varies across different sites in the UK, US, and Canada, affecting patient selection and care processes, which is important for evaluating their cost-effectiveness and overall impact.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multidisciplinary case management for patients at high risk of hospitalization: comparison of virtual ward models in the United kingdom, United States, and Canada. Lewis, G., Wright, L., Vaithianathan, R.[2016]

This study will evaluate the effectiveness of virtual wards (VWs) in reducing unplanned hospital admissions for high-risk patients by comparing their healthcare and social care usage to matched control groups.

The research aims to assess not only the impact of VWs on emergency care and primary services but also to analyze the associated costs and potential savings for the NHS and local authorities, providing a comprehensive view of their economic viability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Do 'virtual wards' reduce rates of unplanned hospital admissions, and at what cost? A research protocol using propensity matched controls. Lewis, G., Bardsley, M., Vaithianathan, R., et al.[2021]

The Safewards approach has shown effectiveness in reducing conflict and containment events in general mental health inpatient settings, based on a systematic review of 13 studies.

However, the evidence is primarily of moderate quality, and there is a need for more high-quality research to confirm its effectiveness in various mental health contexts beyond general services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Systematic Review of the Effectiveness of Safewards: Has Enthusiasm Exceeded Evidence? Finch, K., Lawrence, D., Williams, MO., et al.[2022]

The Safewards model aims to reduce conflict in inpatient mental health settings, thereby minimizing the use of coercive interventions like restriction and containment, which can negatively impact patient care.

This scoping review will systematically describe the implementation of Safewards interventions, their effectiveness, and the barriers to their adoption, laying the groundwork for future research on improving mental health service delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of the Safewards Model in healthcare services: a mixed-method scoping review protocol. Gerdtz, M., Daniel, C., Jarden, R., et al.[2021]

The virtual ward model effectively managed 238 COVID-19 patients, with only 7.6% requiring hospital transfer, demonstrating its efficacy as a low-cost alternative to inpatient care during the pandemic.

Patient feedback was overwhelmingly positive, with 96.5% rating their experience as good or very good, indicating high acceptance and satisfaction with this innovative approach to healthcare delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of a virtual ward as a response to the COVID-19 pandemic. Schultz, K., Vickery, H., Campbell, K., et al.[2021]

The establishment of a temporary COVID-positive mental health ward in Melbourne highlighted the importance of creating a skilled multidisciplinary workforce that combines expertise in mental health and infectious diseases to optimize patient care.

Key factors for effective management included addressing physical space needs, ensuring security, and enhancing communication between different healthcare disciplines, which can inform strategies for future outbreaks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Establishing a COVID-positive mental health ward: an Australian-first case study. Keppich-Arnold, S., Hopkins, L.[2022]

References

1. Canada pubmed.ncbi.nlm.nih.gov

Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Virtual Acute Psychiatric Ward: Evaluation of Outcomes and Cost Savings. [2023]

3. England pubmed.ncbi.nlm.nih.gov

Effectiveness of crisis resolution home treatment for the management of acute psychiatric crises in Southern Switzerland: a natural experiment based on geography. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Multidisciplinary case management for patients at high risk of hospitalization: comparison of virtual ward models in the United kingdom, United States, and Canada. [2016]

5. England pubmed.ncbi.nlm.nih.gov

Do 'virtual wards' reduce rates of unplanned hospital admissions, and at what cost? A research protocol using propensity matched controls. [2021]

6. England pubmed.ncbi.nlm.nih.gov

A Systematic Review of the Effectiveness of Safewards: Has Enthusiasm Exceeded Evidence? [2022]

7. England pubmed.ncbi.nlm.nih.gov

Use of the Safewards Model in healthcare services: a mixed-method scoping review protocol. [2021]

8. Australia pubmed.ncbi.nlm.nih.gov

Implementation of a virtual ward as a response to the COVID-19 pandemic. [2021]

9. England pubmed.ncbi.nlm.nih.gov

Establishing a COVID-positive mental health ward: an Australian-first case study. [2022]