Patient-controlled hospital admission for patients with severe mental disorders: study protocol for a nationwide prospective multicentre study

Abstract

IntroductionPatient-controlled hospital admission for individuals with severe mental disorders is a novel approach in mental healthcare. Patients can admit themselves to a hospital unit for a short stay without being assessed by a psychiatrist or contacting the emergency department. Previous studies assessing the outcomes of patient-controlled hospital admission found trends towards reduction in the use of coercive measures and length of hospital stay; however, these studies have methodological shortcomings and small sample sizes. Larger studies are needed to estimate the effect of patient-controlled hospital admission on the use of coercion and of healthcare services.Design and methodsWe aim to recruit at least 315 patients who are offered a contract for patient-controlled hospital admissions in eight different hospitals in Denmark. Patients will be followed-up for at least 1 year to compare the use of coercive measures and of healthcare services, the use of medications and suicidal behaviour. Descriptive statistics will be used to investigate hospitalisations, global assessment of functioning (GAF) and patient satisfaction with treatment. To minimise selection bias, we will match individuals using patient-controlled hospital admission and controls with a 1:5 ratio via a propensity score based on the following factors: sex, age group, primary diagnosis, substance abuse as secondary diagnosis, coercion, number of psychiatric bed days, psychiatric history, urbanity and suicidal behaviour. Additionally, a historical control study will be undertaken in which patients serve as their own control group prior to index date.Ethics and disseminationThe study has been approved by The Danish Health and Medicines Authority (j.nr.: 3-3013-934/1/) and by The Danish Data Protection Agency (j.nr.: 2012-58-0004). The study was categorised as a register study by The Danish Health Research Ethics Committee and therefore no further approval was needed (j.nr.: H-2-2014-FSP70). Findings will be disseminated through scientific publications, presentations and in a PhD thesis.

Integrating a Patient-Controlled Admission Program Into Mental Health Hospital Service: A Multicenter Grounded Theory Study

“…Previously, studies about self-referral admission programs have been reported from the United States (Nehls, 1994a, 1994b), Australia (Little & Stephens, 1999; Mortimer-Jones et al, 2016), Norway (Heskestad & Tytlandsvik, 2008; Moljord et al, 2016; Moljord et al, 2017; Rise et al, 2014; Sigrunarson, Moljord, Steinsbekk, Eriksen, & Morken, 2017; Tytlandsvik & Heskestad, 2009), the Netherlands (Helleman, Goossens, Kaasenbrood, & Achterberg, 2014; Koekkoek, van der Snoek, Oosterwijk, & van Meijel, 2010), Sweden (Strand, Bulik, von Hausswolff-Juhlin, & Gustafsson, 2017; Strand, Gustafsson, Bulik, & von Hausswolff-Juhlin, 2017), and Denmark (Ellegaard, Bliksted, Lomborg, & Mehlsen, 2017; Ellegaard, Mehlsen, Lomborg, & Bliksted, 2017; Thomsen et al, 2016). This indicates an international interest in new ways to organize mental health services and engage patients in self-management.…”

Kortvarige brukerstyrte innleggelser som alternativ til tvangsinnleggelse hos pasienter med alvorlig selvskading

“…Brukerstyring av innleggelser innen psykisk helsevern er et av flere virkemidler som kan vaere et alternativ til tvang, men der empiriske studier har hatt ulike resultater med forskjellige pasientgrupper: For pasienter med lidelser hovedsakelig innenfor bipolarog schizofrenispekteret har norske (Nyttingnes & Ruud, 2020;Sigrunarson et al, 2017), danske (Thomsen et al, 2016) og svenske (Skott et al, 2021) undersøkelser vist få fordeler i behandlingsresultater eller tjenestebruk fremfor vanlig henvisning og inntak.…”