Borderline Personality Disorder, Emergency Services, Psychiatric, Self-Injurious Behavior, Suicidal Ideation, Suicide, Attempted
Conditions
Keywords
Brief admission, admission, deliberate self-harm, self-harm
Brief summary
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.
Detailed description
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.
Interventions
OTHERBrief Admission
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.
Sponsors
Lund University
Radboud University Medical Center
Region Skane
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
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).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of days with hospital admission | Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively | Number of days with Brief admission, general admission, forced (involuntary) admission |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Individuals' Experiences of the intervention | 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. | Outcome from the questionnaires developed for the method: Individual's Experience Scale (IES) |
| Clinicians' Experiences of the intervention | 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. | Outcome from the questionnaires developed for the method: Clinician's Experience Scale (CES) |
| Frequency of all self-harming behaviours including suicide attempts | Change in frequency between baseline, 6 months and 12 months prospectively. | Outcome from Five Self-Harm Behaviour Groupings Measure (5S-HM) |
| Severity of self-harming behaviours | Change in severity between baseline, 6 months and 12 months prospectively. | Outcome from Five Self-Harm Behaviour Groupings Measure (5S-HM) |
| Frequency of forced acts (e.g. restraints and forced medication) | Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively | — |
| Ability to cope effectively with life stress | Change in ratings between baseline, 6 months and 12 months prospectively. | The Brief COPE |
| Ability to regulate emotions | Change in ratings between baseline, 6 months and 12 months prospectively. | The Difficulties in Emotion Regulation Scale |
| Global psychiatric symptoms | Change in ratings between baseline, 6 months and 12 months prospectively. | Outcome from Clinical Global Impression Severity Scale |
| Satisfaction with health care | Change in ratings between baseline, 6 months and 12 months prospectively. | Client Satisfaction Questionnaire (CSQ) |
| Level of functioning in activities of daily life | Change in ratings between baseline, 6 months and 12 months prospectively. | The World Health Organization Disability Assessment Schedule II (WHODAS 2.0) |
Countries
Sweden
Outcome results
None listed