Self-referral to inpatient treatment program in a community mental health Centre in Central Norway: investigating the implementation, professionals' experiences and costs.

BACKGROUND: Self-referral to inpatient treatment (SRIT) is built on user participation and patient autonomy. SRIT was conducted for patients with severe mental disorders in a Norwegian Community Mental Health Centre. The aims of the present study were to describe the implementation of SRIT, explore the professionals' experiences of SRIT and assess the costs entailed. METHODS: Qualitative document analysis, interviews with professionals and quantitative analysis of register data from a randomized controlled trial were used. RESULTS: SRIT seemed to be implemented as intended. According to the professionals, SRIT allowed the patients to cope, be empowered, more active and responsible. Some professionals experienced increased responsibility for patients' medication and for assessing health and suicide risks. SRIT did not reduce hospital costs. The professionals were satisfied with nurse-led SRIT treatment. CONCLUSIONS: SRIT appears to be a high-quality mental health service that empowers and activates patients. Nurse-led treatment may entail more efficient use of professional resources. In future implementations of SRIT, the efficient use of service resources and the administration of beds should be investigated. More flexible availability should be considered in line with the intentions behind SRIT, as well as ensuring adequate professional training in assessing health and suicide risk.

A randomized controlled trial comparing self-referral to inpatient treatment and treatment as usual in patients with severe mental disorders.

BACKGROUND: There has been a call for increased patient autonomy and participation in psychiatry. Some Community Mental Health Centres (CMHC) have implemented services called 'self-referral to inpatient treatment' (SRIT) for patients with severe mental disorders. AIMS: To investigate whether SRIT could yield better outcomes after 12 months in use of mental health services for people with severe mental disorders than Treatment As Usual (TAU). METHODS: This was a randomized controlled trial at a CMHC in Norway comparing SRIT and TAU in 12 months. Fifty-four patients with severe mental disorders were included. The patients in the SRIT group could admit themselves as inpatients for up to 5 days for each admission with at least a 2 weeks pause between the admittances. RESULTS: Twenty out of 26 participants (77%) in the SRIT group used the SRIT for a median of 1.5 admissions and 5 inpatient days. With the exception of a somewhat larger number of admissions at the CMHC in the SRIT group, no significant differences were found between the two groups in days as inpatients, admissions, outpatient contacts or coercion. Both groups reduced their inpatients days by 40%. CONCLUSIONS: Both the SRIT and the TAU groups reduced their use of services during the 12 months intervention period. Giving patients with severe mental disorders the possibility to self-refer did not change the use of services. CLINICAL IMPLICATIONS: Self-referral to inpatient treatment for patients with severe mental disorders might increase patient autonomy, but does not seem to save use of inpatient services.

Re-establishing and preserving hope of recovery through user participation in patients with a severe mental disorder: the self-referral-to-inpatient-treatment project.

AIMS: The treatment of patients with a severe mental disorder is generally not good enough. The aim of this article was to illustrate some alternative approaches for better understanding and treatment for the individual, besides seeing and interpreting the symptoms. METHODS: The context of understanding is regulation of emotions whit a person-based approach. The self-referral-to-inpatient-treatment project is presented and discussed as a possible method of intervention to improve patient involvement. DESIGN: Theoretical approach. RESULTS: Involvement in genuine decisions, where the individual is in control and feels emotionally robust, is important. The experience of regaining authority through being self-empowered with sufficient environmental support is essential for re-establishing and preserving hope of recovery.

Short time effect of a self-referral to inpatient treatment for patients with severe mental disorders: a randomized controlled trial.

BACKGROUND: Service user participation is a central principle in mental healthcare, and the opportunity to self-refer to inpatient treatment is used to increase service user involvement and activation. The aim of this study was to investigate the short-term effect of a self-referral system in an inpatient rehabilitation unit at a community mental health center on patient activation and recovery in individuals with severe mental disorders. METHODS: A randomized controlled study including 53 patients (41 % females, mean age 40 years). Twenty-six patients in the intervention group were given a contract for self-referral to inpatient treatment, limited to maximum 5 days and a quarantine time of 14 days between each stay. The control group (27 participants) received treatment as usual, and was offered the intervention after 1 year. The Patient Activation Measure was the primary outcome and secondary outcome was the Recovery Assessment Scale. Mixed models were used to assess group differences. RESULTS: During the 4 months period, 15 (58 %) of 26 participants in the intervention group used the contract of self-referral to inpatient treatment. The intervention group had more admissions than the control group but both groups had a similar total use of inpatient days and out-patient consultations. The self-referral to inpatient treatment counted for 11 % of all inpatient days for the intervention group. There were no significant differences in the outcome between the groups on patient activation (estimated mean difference 2.7, 95 % confidence interval = -5.5 to 10.8, p = 0.52) or recovery (estimated mean difference 0.01, 95 % confidence interval = -0.3 to 0.3, p = 0.92). CONCLUSIONS: Giving persons with severe mental disorders the possibility to self-refer to inpatient treatment did not change their level of patient activation and recovery after 4 months and did not lead to increased use of health services. The cost-effectiveness and long-term effect of self-referral to inpatient treatment should be investigated further. TRIAL REGISTRATION: NCT01133587 , clinicaltrials.gov.

More than just a bed: mental health service users' experiences of self-referral admission.

BACKGROUND: Several community mental health centres and mental hospitals in Norway now allow users with a diagnosis of severe mental illness to self-refer for admission. This give a group of service users who are well-known to service providers the opportunity to refer themselves for short inpatient stays without contacting their doctor, a duty doctor or emergency department. Evidence on self-referral admissions is lacking. AIM: To explore service users' experiences of having the opportunity to refer themselves for a short inpatient stay. METHODS: Forty-two qualitative semi-structured interviews were undertaken between 2010 and 2014 in a group of 28 service users with serious mental illness and with or without substance abuse problems. All respondents had a contract which allowed them to self-refer for inpatient treatment. Systematic text condensation was applied in the analyses. RESULTS: Self-referral inpatient admission is more than just a bed. It was perceived as a new, unconventional health service, which differed substantially from earlier experiences of inpatient care and was characterised by different values and treatment principles. The differences were related to the content, quality and organisation of treatment. Having the option to decide about admission for oneself and having access to services focusing on individual needs seem to enhance service users' confidence, both in the services they use and in their own ability to cope with everyday life. CONCLUSIONS: Self-referral inpatient admission is a concrete example of how a user involvement policy can be implemented in mental health services. It is important to emphasise that the self-referral admission process described here is an offer in development and that we are awaiting findings from a larger RCT study. More evidence is needed to determine what aspects of the service are helpful to service users, the long-term effects, appropriateness and cost-effectiveness, and how the service can be integrated into the mental health system.

Stress and happiness among adolescents with varying frequency of physical activity.

The aim of this cross-sectional study was to investigate associations between physical activity, stress, and happiness, as well as possible sex and age differences on these variables in a survey of 1,508 adolescent pupils (13 to 18 yr.) in middle Norway. Adolescents who reported they participated in physical activity 2 to 3 times per week or more scored significantly lower on stress and higher on happiness than those who participated in physical activity 1 day per week or less. There was no significant difference on stress and happiness between those being physically active 2 or 3 times a week and those being active almost every day. There was no sex difference in physical activity frequency. Girls had higher mean scores on stress, and boys scored higher on happiness. Adolescents 15 to 16 years old showed higher stress scores than those 17 to 18 years old, but there were no significant differences between the different age groups when looking at happiness and physical activity. A statistically significant two-way interaction of sex by age was found on both stress and happiness.