A randomized controlled trial comparing self-referral to inpatient treatment and treatment as usual in patients with severe mental disorders

Abstract

Background: There has been a call for increased patient autonomy and participation in

When patients decide the admission – a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts

“…The whiskers mark an additional 1.5 interquartile range. Circles mark mild outlying observations (up to three interquartile ranges) and asterisks mark extreme outliers (outside three interquartile ranges) outside the middle quartiles indicating no true effect of PCA [8]. That study reported very high baseline levels of inpatient days in both control (a mean of 113 days) and intervention group (a mean of 141 days).…”

“…Later, PCAs were studied in a small randomized controlled trial from middle Norway. In the year after the introduction of PCA contracts, patients used PCAs to a limited degree (with a median of 1.5 times and five days); nevertheless, both the control and the intervention group had reduced their use of inpatient days by almost 45% from a high level of days (113 and 140 days, respectively), and no important effect differentiated the intervention group from the control group [8]. In a larger Danish study, 422 patients used 1037 PCAs (with a mean of 2.5) in the year following the signing of PCA contracts, and the reduction in inpatient days from the previous year was 17.…”

Is it time for a more nuanced view on self‐admission to in‐patient treatment in psychiatry?

“…The same group showed that this impairment was not present in the remitted summer state but only in depressive winter state (4). The recent study by Berman et al and the 2016 study by Laurenzo et al both included individuals with SAD, individuals with non-seasonal depression and healthy controls without depression (1,3). In these studies, the pupillary responses did not differentiate the two DOI: 10.1111/acps.12895…”

“…The recent study of Berman et al published in Acta Psychiatrica Scandinavica (1) adds to a list of reports of quantifiable attenuations in the pupillary responses to blue light in persons with depressive disorder (2)(3)(4). With pupillometry, the pupillary contraction and dilatation in response to different wavelength light stimuli are recorded and quantified.…”

Predictable, Collaborative and Safe: Healthcare Provider Experiences of Introducing Brief Admissions by Self-referral for Self-harming and Suicidal Persons with a History of Extensive Psychiatric Inpatient Care

“…Brief self-referral initiatives (also called brief admission, self-admission, or patient-controlled admission) have evolved as a promising alternative to lengthy and unstructured psychiatric admissions for those diagnosed with BPD (Helleman, Goossens, Kaasenbrood, & van Achterberg, 2014a), eating disorders (Strand, Gustafsson, Bulik, von, & Juhlin, 2015); schizophrenia, and bipolar disorder (Moljord et al, 2017;Sigrunarson, Moljord, Steinsbekk, Eriksen, & Morken, 2017;Thomsen et al, 2018). These structured crisis management programs are founded on predefined agreements regulating admission length and services included.…”