The ReCoN intervention: a co-created comprehensive intervention for primary mental health care aiming to prevent involuntary admissions

Abstract

Background Reducing involuntary psychiatric admissions is a global concern. In Norway, the rate of involuntary admissions was 199 per 100,000 people 16 years and older in 2020. Individuals’ paths towards involuntary psychiatric admissions usually unfold when they live in the community and referrals to such admissions are often initiated by primary health care professionals. Interventions at the primary health care level can therefore have the potential to prevent such admissions. Interventions developed specifically for this care level are, however, lacking. To enhance the quality and development of services in a way that meets stakeholders’ needs and facilitates implementation to practice, involving both persons with lived experience and service providers in developing such interventions is requested. Aim To develop a comprehensive intervention for primary mental health care aiming to prevent involuntary admissions of adults. Methods This study had an action research approach with a participatory research design. Dialogue conferences with multiple stakeholders in five Norwegian municipalities, inductive thematic analysis of data material from the conferences, and a series of feedback meetings were conducted. Results The co-creation process resulted in the development of the ReCoN (Reducing Coercion in Norway) intervention. This is a comprehensive intervention that includes six strategy areas: [1] Management, [2] Involving Persons with Lived Experience and Family Carers, [3] Competence Development, [4] Collaboration across Primary and Specialist Care Levels, [5] Collaboration within the Primary Care Level, and [6] Tailoring Individual Services. Each strategy area has two to four action areas with specified measures that constitute the practical actions or tasks that are believed to collectively impact the need for involuntary admissions. Conclusions The ReCoN intervention has the potential for application to both national and international mental health services. The co-creation process with the full range of stakeholders ensures face validity, acceptability, and relevance. The effectiveness of the ReCoN intervention is currently being tested in a cluster randomised controlled trial. Given positive effects, the ReCoN intervention may impact individuals with a severe mental illness at risk of involuntary admissions, as more people may experience empowerment and autonomy instead of coercion in their recovery process.

Something Happened with the Way We Work: Evaluating the Implementation of the Reducing Coercion in Norway (ReCoN) Intervention in Primary Mental Health Care

“…A full outline of the co-creation process is available elsewhere [17]. In brief, we first mapped current practices and common features of pathways ending in involuntary admissions.…”

“…Each conference produced a prioritised list of action points. These were taken forward in a set of iterative discussions between local stakeholders and the research team, through which the intervention was finalised [17]. As shown in Table 1, the intervention consists of six strategy areas, each of which contains two to four areas of action with a number of specific action points (hereafter 'actions'), 53 in total.…”

“…• A detailed implementation manual was produced by the researchers. This included the rationale and evidence for each strategy area and details of actions with specified responsibilities and suggested timelines [17]. It also contained templates for postincident reviews and joint crisis plans, to be used or adapted for strategy area 2.…”