The 15-Mental Project: Implementation and Evaluation of the 15-Mental in a Mental Health Hospital Setting

Overview

The present project will implement and evaluate the effectiveness of a novel, but simple model for addressing and treating alcohol problems among patients admitted to outpatient treatment at mental health hospitals, called the '15-Mental'. The 15-Mental supports healthcare professionals in addressing patients' use of alcohol and in helping patients reduce their intake of alcohol if the alcohol intake potentially may affect the patients' primary illness, symptoms, and/or treatment course. The 15-Mental is based on the 15-Method that was originally developed as a toolbox for clinicians in general practice. In 2024, the 15-Method was feasibility-tested in a mental health setting, and based on the feasibility study, the 15-Mental was developed as an adapted version of the original 15-Method. The present study aims to assess if the 15-Mental, adapted particularly to mental health settings, will lead to a reduction in the proportion of patients with a risky alcohol intake. It will also be investigated if successful implementation of the model will increase patients' adherence to treatment for mental health disorders, prevent premature dropout of treatment, and increase the patients' quality of life. Furthermore, staff's and patients' perspectives on and experiences with the 15-Mental will be explored.

The 15-Mental is a strategy to increase staff's awareness towards alcohol use that may have an impact on patients' symptoms and treatment courses, it is not possible to perform a randomized controlled trial with individual patient randomization. Staff cannot be asked to at random ignore or pay attention to the use of alcohol among patients. The study is thus designed as a stepped wedge cluster-randomized controlled study. This involves randomization of the 15 teams at the Outpatient Mental Health Hospital Odense, from status of control teams to status of teams trained in the 15-Mental ('trained teams') during the study period. The 15 teams at the Outpatient Mental Health Hospital will be randomized into five clusters of three teams each. During the first 8 months of the study period, all teams will be considered control teams, offering treatment as usual (TAU). Following the 8 months control period, the first cluster of teams will undergo training in the 15-Mental and thereby crossing over to becoming trained teams, having increased awareness on alcohol use in addition to offering TAU. Every four months, a new cluster of teams will transition from control teams to trained teams. The teams in a cluster will undergo training in the 15-Mental within the two weeks prior to their transition, thereby becoming trained teams. After 17 months, all teams will have undergone training in the 15-Mental and transitioned into being trained teams. For the remaining 6 months of the study period, the 15-Mental will thus be implemented in the entire Outpatient Mental Health Hospital.