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

Suicide Clinical Trial

Official title:

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

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06406972
• Other study ID #: 2022-02307-01
• Status: Recruiting
• Start date: September 15, 2010
• Est. completion date: September 14, 2025

Study information

• Verified date: April 2024
• Source: Region Skane
• Contact: Sofie Sofie, PhD
• Phone: +46735626099
• Email: sofie.westling[@]med.lu.se
• Is FDA regulated: No
• Study type: Observational [Patient Registry]

Clinical Trial 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.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 7000
• Est. completion date: September 14, 2025
• Est. primary completion date: September 14, 2025
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

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

Related Conditions & MeSH terms

• Borderline Personality Disorder
• Emergencies
• Emergency Psychiatric
• Personality Disorders
• Self-harm
• Self-Injurious Behavior
• Self-injury
• Suicide
• Suicide, Attempted

Intervention

Other:
• Brief Admission by self-referral (BA)
Through means of an individualised contract access to self-referral to inpatient treatment limited to a maximum of three nights, three times per month.

Locations

Country	Name	City	State
Sweden	Region Östergötland	Linköping
Sweden	Division of Psychiatry, Region Skåne	Lund	Skåne
Sweden	Statistiska centralbyrån	Solna
Sweden	Socialstyrelsen	Stockholm

Sponsors (3)

Lead Sponsor	Collaborator
Region Skane	Linkoeping University, Lund University

Country where clinical trial is conducted

Sweden, 

References & Publications (8)

Coyle TN, Shaver JA, Linehan MM. On the potential for iatrogenic effects of psychiatric crisis services: The example of dialectical behavior therapy for adult women with borderline personality disorder. J Consult Clin Psychol. 2018 Feb;86(2):116-124. doi: 10.1037/ccp0000275. — View Citation

Liljedahl SI, Helleman M, Daukantaite D, Westrin A, Westling S. A standardized crisis management model for self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder: The Brief Admission Skane randomized controlled trial protocol (BASRCT). BMC Psychiatry. 2017 Jun 15;17(1):220. doi: 10.1186/s12888-017-1371-6. — View Citation

Lindkvist RM, Landgren K, Liljedahl SI, Daukantaite D, Helleman M, Westling S. Predictable, Collaborative and Safe: Healthcare Provider Experiences of Introducing Brief Admissions by Self-referral for Self-harming and Suicidal Persons with a History of Extensive Psychiatric Inpatient Care. Issues Ment Health Nurs. 2019 Jul;40(7):548-556. doi: 10.1080/01612840.2019.1585497. Epub 2019 May 17. — View Citation

Sigrunarson V, Moljord IE, Steinsbekk A, Eriksen L, Morken G. A randomized controlled trial comparing self-referral to inpatient treatment and treatment as usual in patients with severe mental disorders. Nord J Psychiatry. 2017 Feb;71(2):120-125. doi: 10.1080/08039488.2016.1240231. Epub 2016 Oct 14. — View Citation

Strand M, von Hausswolff-Juhlin Y. Patient-controlled hospital admission in psychiatry: A systematic review. Nord J Psychiatry. 2015;69(8):574-86. doi: 10.3109/08039488.2015.1025835. Epub 2015 Apr 2. — View Citation

Thomsen CT, Benros ME, Maltesen T, Hastrup LH, Andersen PK, Giacco D, Nordentoft M. Patient-controlled hospital admission for patients with severe mental disorders: a nationwide prospective multicentre study. Acta Psychiatr Scand. 2018 Apr;137(4):355-363. doi: 10.1111/acps.12868. Epub 2018 Mar 4. — View Citation

Warrender D. Borderline personality disorder and the ethics of risk management: The action/consequence model. Nurs Ethics. 2018 Nov;25(7):918-927. doi: 10.1177/0969733016679467. Epub 2017 Jan 19. — View Citation

Westling S, Daukantaite D, Liljedahl SI, Oh Y, Westrin A, Flyckt L, Helleman M. Effect of Brief Admission to Hospital by Self-referral for Individuals Who Self-harm and Are at Risk of Suicide: A Randomized Clinical Trial. JAMA Netw Open. 2019 Jun 5;2(6):e195463. doi: 10.1001/jamanetworkopen.2019.5463. Erratum In: JAMA Netw Open. 2019 Oct 2;2(10):e1913724. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Gender distribution	Differences in distribution of diagnoses between men and women	2010-09-15 - 2025-09-14
Other	Number of admissions with Brief admission by self-referral (BA)	Number of BA admissions (admissions/year)	2010-09-15 - 2025-09-14
Other	Compulsory admission - median length	Compulsory admission - median length (days/admission)	2010-09-15 - 2025-09-14
Other	Voluntary psychiatric admissions - median length	Voluntary psychiatric admissions - median length (days/admission)	2010-09-15 - 2025-09-14
Other	Number of voluntary psychiatric admissions	Number of voluntary psychiatric admissions (admissions/year)	2010-09-15 - 2025-09-14
Primary	Days with compulsory admission	Days with compulsory admission (days/year)	2010-09-15 - 2025-09-14
Secondary	Days with voluntary psychiatric admission	Days with voluntary psychiatric admission (days/year)	2010-09-15 - 2025-09-14
Secondary	Duration of free intervals between admissions	Duration of free intervals between admissions (days)	2010-09-15 - 2025-09-14
Secondary	Mortality	All cause mortality as well as death by suicide specifically (X60-X84 and Y10-Y34 in ICD10)	2010-09-15 - 2025-09-14
Secondary	Number of compulsory admissions	Number of compulsory admissions (admissions/year)	2010-09-15 - 2025-09-14
Secondary	Number of voluntary psychiatric admissions (admissions/year)	Number of voluntary psychiatric admissions	2010-09-15 - 2025-09-14
Secondary	Number of compulsory acts/year	Number of compulsory acts/year	2010-09-15 - 2025-09-14