Community support program to help adults with severe mental illness transition from hospital to home in Pietermaritzburg

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This pilot implements a co‑developed, multi‑level health system strengthening intervention in a South African district to improve transitions from acute psychiatric care to community settings. Components include streamlined referral processes across facilities, a psychosocial rehabilitation program, and structured support for caregivers and patients after discharge. The project will recruit adults hospitalized for acute severe mental illness, deliver the intervention in the local community, and collect feasibility, appropriateness, and limited efficacy outcomes including readmission rates and implementation measures. Results will inform whether the program can be scaled or adapted for other low‑resource settings.

Why it matters

Who can join: the full rules

Service user inclusion criteria:

* Adults (aged 18 years and above);
* Being admitted to the psychiatric ward of a hospital for observation and treatment due to an acute psychiatric event, based on ICD diagnosis on patient charts according to the following criteria:

  * F20-29 including schizophrenia, delusional disorders, schizotypal disorders, acute polymorph psychotic disorders, schizoaffective disorders
  * F30-39 Mood \[affective\] disorders with psychoses
  * F30.2 Mania with psychotic symptoms
  * F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms
  * F31.5 Bipolar affective disorder, current episode severe depression with psychotic symptoms
  * F32.3 Severe depressive episode with psychotic symptoms
  * F33.3 Recurrent depressive disorder, current episode severe with psychotic symptoms
* Determined by the attending psychiatrist to be discharged into community settings following appropriate recovery from the psychiatric event;
* Willing and able to participate in the intervention programme
* Resides with a caregiver (which could be a family member or member of the household).
* Resides within the geographic boundaries of uMgungundlovu

Service user exclusion criteria:

* Under 18 years of age
* Are indicated by their chart history to have the following conditions:

  * Active suicidal ideation
  * Substance abuse or dependence as primary diagnosed psychiatric condition
  * Personality disorders
  * Serious cognitive or other sensorial impairment likely to preclude informed consent and reliable assessment
* Does not reside with a caregiver
* Does not reside within the geographic boundaries of uMgungundlovu

Caregiver inclusion criteria

* Adults (aged 18 years and above)
* Willing and able to participate in the intervention programme
* Resides with a caregiver (which could be a family member or member of the household).
* Resides within the geographic boundaries of uMgungundlovu

Caregiver exclusion criteria

* Adults (aged 18 years and above)
* Willing and able to participate in the intervention programme
* Resides with a caregiver (which could be a family member or member of the household).
* Resides within the geographic boundaries of uMgungundlovu

Where it's running

• Msunduzi Local Municipality
  Pietermaritzburg, KwaZulu-Natal, South Africa Recruiting

Study contacts

• Study coordinator: André Janse van Rensburg, PhD
• Email: jansevanrensburga@ukzn.ac.za
• Phone: +27312601569

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.