Virtual Ward for Mental Health Disorders

Overseen By Lauren Kelly, 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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a virtual mental health ward can help people in crisis feel better and use healthcare services more effectively. Participants will receive virtual crisis stabilization support from a multi-disciplinary team for about five days after visiting an emergency room or crisis center. They will have therapy sessions, medication management, and access to group programs and after-hours support. This trial targets individuals admitted to this virtual ward following a mental health crisis. As an unphased trial, the study offers a unique opportunity to explore innovative mental health support methods.

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 prior data suggests that the Mental Health Virtual Ward is safe for mental health crisis stabilization?

Research has shown that virtual mental health crisis wards are safe for individuals who prefer to remain in their own community. Studies suggest they effectively manage serious mental health issues without requiring hospitalization. For instance, one study found that virtual wards help individuals avoid hospital visits and facilitate easier access to care. Another study highlighted their cost-saving potential. During the COVID-19 pandemic, these virtual wards proved especially important, demonstrating their effectiveness even in challenging times. Overall, collaborating with a team of diverse health experts through these virtual wards appears well-received and beneficial for individuals in crisis. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Virtual Ward for Mental Health Disorders because it offers a new way to stabilize mental health crises without requiring hospitalization. Unlike traditional treatments that often involve inpatient care, this approach uses a virtual platform to provide crisis stabilization support with a multi-disciplinary team, allowing patients to receive care at home. This method could potentially reduce the stigma and disruption associated with hospital stays, offering a more comfortable and flexible option for those in need.

What evidence suggests that the Mental Health Virtual Ward is effective for mental health crisis stabilization?

Research shows that virtual crisis support can effectively manage mental health emergencies. In this trial, participants will enter the Mental Health Virtual Ward, receiving virtual crisis stabilization support from a multi-disciplinary team. One study found that a virtual ward effectively assists people with severe psychiatric issues, possibly reducing the need for hospital stays. This approach allows patients to receive comprehensive care at home, including personal therapy, medication management, and support from community providers and family. Evidence also indicates that virtual care provides thorough crisis assessments and support, leading to better recovery and service outcomes. Overall, virtual wards enhance accessibility to mental health care and can be as effective as traditional hospital settings. ^{1 2 3 5 6}

Who Is on the Research Team?

Jennifer Hensel, MD

Principal Investigator

University of Manitoba and Shared Health Manitoba/Psychiatry

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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]

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 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]

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]

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]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/37016824/

Virtual Acute Psychiatric Ward: Evaluation of Outcomes ... A virtual ward is a feasible, effective, and potentially cost-saving intervention to manage acute psychiatric crises in the community and avoid hospitalization.

2. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ps.20220332

Virtual Acute Psychiatric Ward: Evaluation of Outcomes ... A virtual ward or “hospital-at-home” can be structured either as early supported discharge, where the goal is to reduce the length of hospital ...

3. cdn.clinicaltrials.gov cdn.clinicaltrials.gov/large-docs/26/NCT06526026/Prot_SAP_000.pdf

July 20, 2024 An Innovative Mental Health Virtual Ward This research proposes to prospectively measure demographic, recovery, service delivery, and systems use outcomes in a cohort of MH vWard ...

4. frontiersin.org frontiersin.org/journals/health-services/articles/10.3389/frhs.2023.1030396/pdf

a virtual based crisis stabilization unit Results: 30.1% of patients admitted to the vCSU received initial mental health assessment virtually (phone/videoconference), therefore receiving ...

5. liebertpub.com liebertpub.com/doi/abs/10.1177/15305627251381632

Crisis and Post-Crisis Virtual Mental Health Care Data synthesis highlighted the feasibility and potential for virtual care models supporting comprehensive crisis assessment (services that go ...

6. withpower.com withpower.com/trial/phase-mental-health-impairment-6-2024-c60ab

Virtual Ward for Mental Health Disorders · Info for Participants 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 ...