Preventing compulsory admission to psychiatric inpatient care using psycho-education and monitoring: feasibility and outcomes after 12 months

Abstract

The aim of this study was to evaluate an intervention programme for people with severe mental illness that targets the reduction in compulsory psychiatric admissions. In the current study, we examine the feasibility of retaining patients in this programme and compare outcomes over the first 12 months to those after treatment as usual (TAU). Study participants were recruited in four psychiatric hospitals in the Canton of Zurich, Switzerland. Patients were eligible if they had at least one compulsory admission during the past 24 months. Participants were assigned at random to the intervention or to the TAU group. The intervention programme consists of individualised psycho-education focusing on behaviours prior to illness-related crisis, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 (of 756 approached) inpatients were included in the trial. After 12 months, 80 (67.2%) in the intervention group and 102 (85.7%) in the TAU group were still participating in the trial. Of these, 22.5% in the intervention group (35.3% TAU) had been compulsorily readmitted to psychiatry; results suggest a significantly lower number of compulsory readmissions per patient (0.3 intervention; 0.7 TAU). Dropouts are characterised by younger age and unemployment. This interim analysis suggests beneficial effects of this intervention for targeted psychiatric patients.

Interventions to Reduce Compulsory Psychiatric Admissions

“…When the study by Staring et al 29 was excluded, the effect was no longer significant (intercept, −1.86; 95% CI, −4.40 to 0.69; P = .14). The result of the study by Lay et al 34 is on the margin of the 95% pseudoconfidence area.…”

“…Pooling of the only 4 studies 24,26,30,34 that also reported the total number of compulsory admissions (in contrast to the number of compulsorily admitted patients) produced a nonsignificant RR of 0.76 (95% CI, 0.54-1.06). Heterogeneity in this subgroup of 4 studies was considerable (I 2 = 87.6%).…”

Preventing and reducing ‘coercion’ in mental health services: an international scoping review of English‐language studies

“…In addition to these three major focus areas, studies in this category also concerned the following: changing environmental factors within health settings which seem to increase the likelihood of coercion under current conditions (83,88) the number/ratio of service users to staff and staff characteristics (50,78), the impact of reporting registries and requirements to report on coercive practices (57), and the use of de-escalation techniques (79,89). Bowers and colleagues undertook an analysis of wards with the counterintuitive combination of 'low containment and high conflict' or 'high containment and low conflict', and sought to understand the contributing factors (81).…”

Preventing Compulsory Admission to Psychiatric Inpatient Care: Perceived Coercion, Empowerment, and Self-Reported Mental Health Functioning after 12 Months of Preventive Monitoring

“…The study is implemented as a subproject within the framework of the Zurich Program for Sustainable Development of Mental Health Services ( 27 ). An analysis of compulsory readmissions to psychiatric hospital treatment during the first 12 months of this trial had suggested beneficial effects of the intervention program in terms of a lower number of compulsory readmissions among patients who had remained in the program for so long ( 28 ).…”