Article Text

Download PDFPDF

Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study
  1. Natasha Tyler1,2,
  2. Ioannis Angelakis3,
  3. Richard Neil Keers1,4,
  4. Claire Planner1,
  5. Alexander Hodkinson5,
  6. Sally J Giles1,
  7. Andrew Grundy6,
  8. Navneet Kapur1,7,
  9. Chris Armitage1,8,
  10. Tom Blakeman1,2,
  11. Stephen M Campbell1,
  12. Catherine Robinson6,
  13. Jessica Leather1,
  14. Maria Panagioti1,2
  1. 1NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
  2. 2NIHR School for Primary Care Research, University of Manchester, Manchester, UK
  3. 3Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
  4. 4Centre for Pharmacoepidemiology and Drug Safety Research, University of Manchester, Manchester, UK
  5. 5Centre for Primary Care, University of Manchester, Manchester, UK
  6. 6Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
  7. 7Centre for Suicide Prevention, University of Manchester, Manchester, UK
  8. 8Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
  1. Correspondence to Dr Natasha Tyler; natasha.tyler{at}


Introduction Patients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted two versions of a care bundle intervention, the SAFER Mental Health care bundle for adult and youth inpatient mental health settings (SAFER-MH and SAFER-YMH, respectively), that look to address these concerns through the introduction of new or improved processes of care.

Methods and analysis Two uncontrolled before-and-after feasibility studies, where all participants will receive the intervention. We will examine the feasibility and acceptability of the SAFER-MH in inpatient mental health settings in patients aged 18 years or older who are being discharged and the feasibility and acceptability of the SAFER-YMH intervention in inpatient mental health settings in patients aged between 14 and 18 years who are being discharged. The baseline period and intervention periods are both 6 weeks. SAFER-MH will be implemented in three wards and SAFER-YMH in one or two wards, ideally across different trusts within England. We will use quantitative (eg, questionnaires, completion forms) and qualitative (eg, interviews, process evaluation) methods to assess the acceptability and feasibility of the two versions of the intervention. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients/wards should be included.

Ethics and dissemination Ethical approval was obtained from the National Health Service Cornwall and Plymouth Research Ethics Committee and Surrey Research Ethics Committee (reference: 22/SW/0096 and 22/LO/0404). Research findings will be disseminated with participating sites and shared in various ways to engage different audiences. We will present findings at international and national conferences, and publish in open-access, peer-reviewed journals.

  • mental health
  • child & adolescent psychiatry
  • adult psychiatry

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @DrNatashaTyler, @TomBlakeman

  • Contributors NT and MP had the initial research idea and obtained funding for this study. NT, MP and IA formulated the research questions and designed the study. AH, NT, IA and MP devised the qualitative and statistical analysis plan. NT, MP and IA drafted the protocol. AG led the patient and public involvement components of the study design. JL drafted the protocol and completed ethics documentation/application. RNK, CP, SJG, NK, CA, TB, SMC and CR substantially contributed to the manuscript by providing review comments and edits and approved the final manuscript.

  • Funding This work is supported by the NIHR Greater Manchester Patient Safety Translational Research Centre (grant number: PSTRC-2016-003) and NIHR School for Primary Care Research Capacity award 21/22 (grant number C015; postdoctoral fellowship award).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.