Brief Admission by Self-referral for Individuals With Self-harm: Effects on Compulsory Care

Recruiting

• Conditions: Self-harm; Suicide; Borderline Personality Disorder; Hospitalizations Psychiatric; Suicide, Attempted; Emergency Psychiatric; Self-injury
• Interventions: Other: Brief Admission by self-referral (BA)

• Registration Number: NCT06406972
• Lead Sponsor: Region Skane

Brief Summary

Brief Admission by self-referral (BA) is a standardized treatment model, providing patient-controlled and person-centered care. It was developed to reduce self-harm and compulsory care by promoting autonomy. Randomized clinical trials have not yielded significant between group differences with respect to inpatient care, including compulsory care. The major difficulty in evaluating BA is preventing the control group from cross-contamination, as in the implementation process of BA, all physicians, all inpatient and outpatient staff as well as managers need to be informed and undergo basic education regarding the intervention. As BA addresses a prevalent and frustrating issue in psychiatric health care, there is considerable risk that the approach leaks to the control group, reducing the possibility to detect between-group differences. In the current study this will be addressed through a register-based approach, comparing similar clinics, implementing BA at different timepoints over time. Individuals with traits of borderline personality disorder will be included and comparisons will be made with respect to compulsory care, voluntary inpatient care and mortality.

Detailed Description

Not available

Study Timeline

• Study Start: 2010-09-15
• Status Verified: 2024-04
• Study First Submitted: 2024-04-19
• Study First Submitted QC: 2024-05-07
• Last Update Submitted: 2024-05-07
• Study First Posted: 2024-05-09
• Last Update Posted: 2024-05-09
• Primary Completion: 2025-09-14
• Study Completion: 2025-09-14

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 7000

Inclusion Criteria

• Living in the uptake area of Lund, Linköping, Helsingborg or Norrköping
• Age 18-65 years at the time of inclusion
• Admitted to hospital either diagnosed with ICD-10 diagnosis BPD F60.3, or admitted at least twice with Intentional self-harm X60-83 in combination with one of more of the following diagnoses ADHD (F90.0-F90.X), Bipolar disorder type 2, (F31.8W, F318A-F, F31.0, F31.8-9, F31.8W) or Autism, Atypical autism, Aspergers syndrome (F84.0, F84.1, F84.5) or Mild intellectual disability (F70.0-F70.9).

Exclusion Criteria

• not fulfilling inclusion criteria

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Lund 2015-09-15-2020-09-14	Brief Admission by self-referral (BA)	Lund, after implementation of Brief Admission by self-referral in Lund, before implementation of Brief Admission by self-referral in Linköping
Lund 2020-09-15-2025-09-14	Brief Admission by self-referral (BA)	Lund, after implementation of Brief Admission by self-referral in Lund and in Linköping
Helsingborg 2017-02-15-2020-02-14	Brief Admission by self-referral (BA)	Helsingborg after implementation of Brief Admission by self-referral in Helsingborg, before implementation of Brief Admission by self-referral in Norrköping
Linköping 2020-09-15-2025-09-14	Brief Admission by self-referral (BA)	Linköping after implementation of Brief Admission by self-referral in Lund and in Linköping
Norrköping 2020-02-15-2023-02-14	Brief Admission by self-referral (BA)	Norrköping after implementation of Brief Admission by self-referral in Helsingborg and in Norrköping
Helsingborg 2020-02-15-2023-02-14	Brief Admission by self-referral (BA)	Helsingborg after implementation of Brief Admission by self-referral in Helsingborg and in Norrköping

Primary Outcome Measures

Name	Time	Method
Days with compulsory admission	2010-09-15 - 2025-09-14	Days with compulsory admission (days/year)

Secondary Outcome Measures

Name	Time	Method
Number of compulsory acts/year	2010-09-15 - 2025-09-14	Number of compulsory acts/year
Days with voluntary psychiatric admission	2010-09-15 - 2025-09-14	Days with voluntary psychiatric admission (days/year)
Mortality	2010-09-15 - 2025-09-14	All cause mortality as well as death by suicide specifically (X60-X84 and Y10-Y34 in ICD10)
Number of voluntary psychiatric admissions (admissions/year)	2010-09-15 - 2025-09-14	Number of voluntary psychiatric admissions
Duration of free intervals between admissions	2010-09-15 - 2025-09-14	Duration of free intervals between admissions (days)
Number of compulsory admissions	2010-09-15 - 2025-09-14	Number of compulsory admissions (admissions/year)

Trial Locations

Locations (4)

Division of Psychiatry, Region Skåne; 🇸🇪 Lund, Skåne, Sweden

Region Östergötland; 🇸🇪 Linköping, Sweden

Statistiska centralbyrån; 🇸🇪 Solna, Sweden

Socialstyrelsen; 🇸🇪 Stockholm, Sweden