Brief Admission Skane: Replacing General Admission for Individuals With Self-harm and Acute Risk of Suicide

Region Skane125 enrolled

Overview

The purpose of the study is to test a standardized version of brief admission (BA) through randomized controlled trial (RCT). The main objective is to evaluate if BA can serve as a crisis management model for individuals with recurrent self-harm, including suicide attempts and at least three symptoms of Borderline Personality disorder. Participants will be allocated to BA + Treatment as Usual (TAU) or TAU.

When individuals with recurrent self-harm and suicidal behaviour seek acute admission to hospital due to a crisis and associated increased suicidal ideation, recommendations for clinical care are still conflicting. The risk for iatrogenic effects of inpatient care are considerable, and long hospital admissions without a clear treatment structure may predict decompensation in functioning. This has resulted in a clinical practice of avoiding admission for individuals diagnosed with Borderline Personality Disorder (BPD). Brief admission (BA) as an intervention has a longstanding history in the delivery of mental health services in the Netherlands. The core elements of brief admission were determined through consultation with Dutch researchers, interviews with individuals with experience, Dutch clinicians familiar with Brief Admission, and local guidelines from hospitals familiar with implementing this crisis management intervention. Core elements of the intervention were standardized into a protocol, and an educational manual was developed to train clinicians involved in the trial. An objectively rated fidelity measure was developed in order to ensure adherence.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

125

Conditions

Interventions

Brief AdmissionOTHER

Participants randomised to Brief admission (BA) will participate in a negotiation together with their out-patient clinician and a representative from the ward. The aim of the negotiation is to form an individualised contract defining how BA will work for them. After signing the contract, will have the possibility to admit themselves to hospital according to the procedure stated in the contract.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Current episodes of self-harm and/or recurrent suicidality. * Fulfilling at least three criteria for borderline personality disorder. * Admitted to psychiatric hospital for acute care for at least 7 days or presenting to the psychiatric emergency department at least 3 times during the last six months. Exclusion Criteria: * No regular contact with outpatient psychiatric services. * Homelessness. Housing crises are outside the scope of this RCT. * Medical disorder from other organs that significantly contributes to inclusion criteria (e.g. if self-harm only occurs during episodes of hypoglycemia in a diabetic patient).

Locations (1)

Division of Psychiatry, Region Skåne

Lund, Skåne County, Sweden

Outcomes

Primary Outcomes

Number of days with hospital admission

Number of days with Brief admission, general admission, forced (involuntary) admission

Time frame: Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively

Secondary Outcomes

Frequency of forced acts (e.g. restraints and forced medication)

Time frame: Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively

Individuals' Experiences of the intervention

Outcome from the questionnaires developed for the method: Individual's Experience Scale (IES)

Time frame: Data collected at each Brief Admission during a period of 140 weeks. A Brief Admission is defined as a hospital admission according to the procedure defined in the Brief Admission Skane Standardised Protocol.

Clinicians' Experiences of the intervention

Outcome from the questionnaires developed for the method: Clinician's Experience Scale (CES)

Frequency of all self-harming behaviours including suicide attempts

Outcome from Five Self-Harm Behaviour Groupings Measure (5S-HM)

Time frame: Change in frequency between baseline, 6 months and 12 months prospectively.

Severity of self-harming behaviours

Outcome from Five Self-Harm Behaviour Groupings Measure (5S-HM)

Time frame: Change in severity between baseline, 6 months and 12 months prospectively.

Level of functioning in activities of daily life

The World Health Organization Disability Assessment Schedule II (WHODAS 2.0)