Experiences of patients with borderline personality disorder with the brief admission intervention: A phenomenological study

Abstract

Brief admission is a crisis intervention for patients with borderline personality disorder (BPD), and refers to a clinical admission at a psychiatric hospital for a period of 1-5 nights. Patients formulate a treatment plan together with their community mental health nurse about the maximum frequency allowed for these brief admissions. The purpose of the study was to describe the lived experiences of patients with BPD with use of the brief admission intervention. The study used a phenomenological approach. Inclusion criteria were a diagnosis of BPD, according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria; experience with brief admission, and sufficient understanding of the Dutch language. A total of 16 female patients and one male patient participated in the study. Thematic analysis of the transcripts of the interviews revealed four major meaning units: (i) organization of the brief admission; (ii) contact with a nurse; (iii) time out from daily life; and (iv) experienced value for the patient. Patients highlighted the quality of the contact with a nurse as the most important aspect of the brief admission. Nurses should be aware of the importance of connecting with patients who have BPD during a brief admission, particularly in light of the interpersonal hypersensitivity that characterizes these patients.

Patient-controlled hospital admission in psychiatry: A systematic review

“…somewhat surprisingly, considering the widespread use of brief hospitalization schemes in the netherlands reported elsewhere (29), no dutch controlled studies concerning patient-controlled admission in the strict sense used in this review was identified. two dutch studies conducted by the same research group were identified during article selection; however, one lacked a control group (30) and the other was a review of articles already scrutinized and excluded (13). After being in contact with the dutch authors behind these studies, it appears that there are no further studies available on the dutch programs at this time.…”

“…However, the rigorous manual selection process allowed for the conclusion that these criteria were not unduly narrow and that slightly more generous inclusion criteria would not have resulted in a broader array of relevant data. for example, the requirement that studies included for review should be designed as controlled studies only excluded two articles: one descriptive single case study (31) and one qualitative study regarding general experiences of useful and less useful elements of brief hospital admission in patients with borderline personality disorder (30). furthermore, allowing for a broader age span only yielded one further article: a study on adolescents hospitalized after a suicide attempt (32).…”

A standardized crisis management model for self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder: The Brief Admission Skåne randomized controlled trial protocol (BASRCT)

“…Over repeated experiences of BA, the structure and stabilizing aspects of BA generalizes to the individuals’ life outside of the hospital, leading to reduced reliance on acute and general psychiatric hospital admissions while remaining safe in times of crisis [13, 14]. By learning new ways of responding/not responding during crises, and staying safe regardless of current emotion, gains from psychotherapy engaged in concurrently with BA (treatment as usual: TAU) facilitates capability to manage subsequent crises without turning to self-harm and suicidal behaviour [15].…”

“…As a crisis management strategy, BA was rapidly adopted across most mental health service centers in the Netherlands. Helleman, Goossens, Kaasenbrood, and van Achterberg [13] conducted a phenomenological study involving 17 participants with lived experience of BA in the Netherlands. With respect to the key features of BA that were identified, participants endorsed: (i) the organization of the brief admission; (ii) the quality of the contact with a nurse over the course of BA; (iii) the restorative value of time out from daily life; and (iv) the experienced value of the intervention.…”

“…The nature of self-admission to BA was described as key to providing support at the exact time needed by participants. A key feature of BA is participant control over when the BA occurs, as well as its duration within the confines of short parameters, such as days [13]. Twenty years after its inception in the Netherlands, the Dutch Multidisciplinary Guidelines for Personality Disorders [17] recommended BA as a crisis management strategy for individuals with a BPD.…”