JMIR Publications

ABSTRACT

Background:

Mental health recovery typically continues long after patients leave the hospital, and effective support during this transition is essential. However, many individuals face gaps in care, which can lead to worsening symptoms and readmissions.

Objective:

To examine the potential impact of daily web-based automated supportive text messaging (SMS) and peer support service (PSS) on readmission and length of stay for patients discharged from inpatient psychiatric care.

Methods:

A cluster randomized trial was designed to identify statistically significant differences in the mean changes in the number of readmissions and the mean changes in the total length of stay for patients six and 12 months from pre- to post-index admission in three arms of the study: text messaging arm, text messaging with or without peer support arm, and treatment as usual arm.

Results:

Overall, 1,070 participants were assigned to one of three study arms: supportive text messaging alone (SMS, n = 302), supportive text messaging with or without peer support (SMS+/-PSS, n = 342), or treatment as usual (TAU, n = 426). The SMS with or without PSS reduced readmissions and inpatient length of stay. Compared to usual care, SMS with or without PSS reduced hospital readmissions by an average of 0.24 admissions within six months and SMS alone reduced inpatient length of stays at six and twelve months by an average of 7.87 days and 6.34 days respectively.

Conclusions:

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. Clinical Trial: Trial registration: Clinicaltrials.gov, NCT05133726. Registered on the 24th of November 2021.