In the period between obtaining funding and preparing the study, unexpected large changes in the organisation of mental health care took place. Budgets were restrained and care delivery shifted from specialists towards general mental health care, leading to necessary adjustments in study design. The initial sample size was estimated based on 64 nurses all including 10 patients leading to a target sample of 640 patients. The Medical Ethics Committee advised us to plan an extra 20% inclusion to account for clustering of the data, yielding a target sample of 768 patients. However, due to increased workload, inclusion of twelve patients per nurse seemed unfeasible. To compensate, we planned to train more nurses so that less patients per nurse need to be included, and we furthermore broadened inclusion criteria so that patients in sheltered living facilities could be included as well. As we now had many clusters (teams and nurses) and relatively few patients per nurse, it was not necessary anymore to account for clustering of the data in calculating the sample size. The funding agency (ZonMw) and the Medical Ethics Committee have approved the adjusted study design and adjusted final target sample size of 275 patients.