Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach

Introduction
Transition following discharge from mental health hospital is high risk in terms of relapse, readmission, and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The MINDS study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co designing and evaluating implementation of a systemic approach to discharge planning.

Methods and analysis
The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subject to process and economic evaluation in Stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage.

Ethics and dissemination
MINDS stage 1 has received ethical approval from Yorkshire & The Humber - Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and NHS professionals including blogs, podcasts and short videos.

Registration
MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013 The realist review protocol is registered on PROSPERO (CRD42021293255).