Patient-initiated brief admission for patients with serious mental disorders

For patients with serious mental disorders and frequent healthcare use, patient-initiated brief admissions to inpatient care are used in many Scandinavian healthcare regions. Patient-initiated brief admissions are based on a contract between a healthcare provider and a patient, and gives the contract-holder the option to self-admit for a short inpatient stay at a psychiatric ward, without prior assessment by healthcare staff.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202120 Registration no: SBU 2021/152

Question

What scientific studies are published on patient-initiated brief admissions?

Identified literature

One relevant systematic review [1] and 27 primary studies [2–28] were identified. The systematic review was considered to have high risk of bias due to limited information on search strategy and limited risk of bias assessment of the included studies. Most of the primary studies that were identified in the SBU enquiry service report were published later than the systematic review. The primary studies were not assessed for risk of bias.

Table 1. Included systematic reviews
Included studies Population/Intervention Outcome and Results
Strand et al (2015) [1]
Patient-controlled hospital admission in psychiatry: A systematic review
6 publications (articles and reports) from 4 studies.
3 publications reporting quantitative data
5 publications reporting qualitative data
Setting: Norway, all studies		 Population:
Patients with severe mental illness and previously high inpatient care consumption.

Intervention:
Patient-controlled admission to inpatient care.

Control comparison: data from control period of similar length before intervention started.		 Number of admissions (total) control period vs intervention period
2 studies:
1) During control period 46, during intervention period 70, change +52%
2) During control period 69, during intervention period 178, change +158%

Days/weeks in inpatient care, control period vs intervention period
3 studies:
1) During control period 1560 days, during intervention period 684 days, change –56%
2) During control period 1099 days, during intervention period 854 days, change –22%
3) During control period 265 weeks, during intervention period 178 weeks, change –33%

Days/weeks in involuntary inpatient care
2 studies:
1) During control period 122 days, during intervention period 47 days, change –61%
2) During control period 181 weeks, during intervention period 88 weeks, change –51%

Days/weeks in psychiatric emergency care
2 studies:
1) During control period 198 days, during intervention period 52 days, change –74%
2) During control period 76 days, during intervention period 20 days, change –74%
Authors' conclusion:
“This review shows that patient-controlled admission can be a successful concept in promoting patient autonomy and reducing the total time spent hospitalized when aimed at heavy consumers of psychiatric care.”
“However, available studies are small and quality of evidence is generally low.”

References

  1. Strand M, von Hausswolff-Juhlin Y. Patient-controlled hospital admission in psychiatry: A systematic review. Nordic Journal of Psychiatry. 2015;69(8):574-86. Available from: https://doi.org/10.3109/08039488.2015.1025835.
  2. Cotgrove A, Zirinsky L, Black D, Weston D. Secondary prevention of attempted suicide in adolescence. Journal of Adolescence. 1995;18(5):569-77.
  3. Eckerström J, Allenius E, Helleman M, Flyckt L, Perseius KI, Omerov P. Brief admission (BA) for patients with emotional instability and self-harm: nurses’ perspectives - person-centred care in clinical practice. International Journal of Qualitative Studies on Health and Well-being. 2019;14(1). Available from: https://doi.org/10.1080/17482631.2019.1667133.
  4. Eckerström J, Flyckt L, Carlborg A, Jayaram-Lindström N, Perseius KI. Brief admission for patients with emotional instability and self-harm: A qualitative analysis of patients' experiences during crisis. International journal of mental health nursing. 2020;29(5):962-71. Available from: https://doi.org/10.1111/inm.12736.
  5. Ellegaard T, Bliksted V, Lomborg K, Mehlsen M. Use of patient-controlled psychiatric hospital admissions: patients’ perspective. Nordic Journal of Psychiatry. 2017;71(5):370-7. Available from: https://doi.org/10.1080/08039488.2017.1302505.
  6. Ellegaard T, Bliksted V, Mehlsen M, Lomborg K. Integrating a Patient-Controlled Admission Program Into Mental Health Hospital Service: A Multicenter Grounded Theory Study. Qualitative health research. 2018;28(6):888-99. Available from: https://doi.org/10.1177/1049732318756301.
  7. Ellegaard T, Bliksted V, Mehlsen M, Lomborg K. Feeling safe with patient-controlled admissions: A grounded theory study of the mental health patients' experiences. Journal of clinical nursing. 2020;29(13-14):2397-409. Available from: https://doi.org/10.1111/jocn.15252.
  8. Ellegaard T, Mehlsen M, Lomborg K, Bliksted V. Use of patient-controlled psychiatric hospital admissions: mental health professionals’ perspective. Nordic Journal of Psychiatry. 2017;71(5):362-9. Available from: https://doi.org/10.1080/08039488.2017.1301548.
  9. Helleman M, Goossens PJ, Kaasenbrood A, van Achterberg T. Experiences of patients with borderline personality disorder with the brief admission intervention: a phenomenological study. International journal of mental health nursing. 2014;23(5):442-50. Available from: https://doi.org/10.1111/inm.12074.
  10. Helleman M, Lundh LG, Liljedahl SI, Daukantaité D, Westling S. Individuals’ experiences with brief admission during the implementation of the brief admission skåne RCT, a qualitative study. Nordic Journal of Psychiatry. 2018;72(5):380-6. Available from: https://doi.org/10.1080/08039488.2018.1467966.
  11. Heskestad S, Tytlandsvik M. Brukerstyrte kriseinnleggelser ved alvorlig psykisk lidelse. Tidsskrift for Den Norske Laegeforening. 2008;128(1):32-5. Available from: https://tidsskriftet.no/2008/01/originalartikkel/brukerstyrte-kriseinnleggelser-ved-alvorlig-psykisk-lidelse.
  12. Lindkvist RM, Landgren K, Liljedahl SI, Daukantaitė 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 in mental health nursing. 2019;40(7):548-56. Available from: https://doi.org/10.1080/01612840.2019.1585497.
  13. Lindkvist RM, Westling S, Liljedahl SI, Landgren K. A Brief Breathing Space: Experiences of Brief Admission by Self-Referral for Self-Harming and Suicidal Individuals with a History of Extensive Psychiatric Inpatient Care. Issues in mental health nursing. 2021;42(2):172-82. Available from: https://doi.org/10.1080/01612840.2020.1789787.
  14. Moljord IEO, Helland-Hansen KA, Salvesen Ø, Olsø TM, Gudde CB, Rise MB, et al. Short time effect of a self-referral to inpatient treatment for patients with severe mental disorders: a randomized controlled trial. BMC Health Services Research. 2016;16(1):1-10. Available from: https://doi.org/10.1016/j.pec.2017.01.008.
  15. Moljord IEO, Lara-Cabrera ML, Salvesen O, Rise MB, Bjorgen D, Antonsen DO, et al. Twelve months effect of self-referral to inpatient treatment on patient activation, recovery, symptoms and functioning: A randomized controlled study. Patient Educ Couns. 2017;100(6):1144-52. Available from: https://dx.doi.org/10.1016/j.pec.2017.01.008.
  16. Mortimer-Jones S, Morrison P, Munib A, Paolucci F, Neale S, Hellewell A, et al. Staff and client perspectives of the Open Borders programme for people with borderline personality disorder. International journal of mental health nursing. 2019;28(4):971-9. Available from: https://doi.org/10.1111/inm.12602.
  17. Nyttingnes O, Ruud T. When patients decide the admission - a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts. BMC health services research. 2020;20(1):229. Available from: https://doi.org/10.1186/s12913-020-05101-z.
  18. Nyttingnes O, Šaltytė Benth J, Ruud T. Patient-controlled admission contracts: a longitudinal study of patient evaluations. BMC Health Services Research. 2021;21(1):1-13. Available from: https://doi.org/10.1186/s12913-020-06033-4.
  19. Olsø TM, Gudde CB, Moljord IEO, Evensen GH, Antonsen DO, Eriksen L. More than just a bed: Mental health service users' experiences of self-referral admission. International Journal of Mental Health Systems. 2016;10(1). Available from: https://doi.org/10.1186/s13033-016-0045-y.
  20. Rise MB, Evensen GH, Moljord IEO, Rø M, Bjørgen D, Eriksen L. How do patients with severe mental diagnosis cope in everyday life - A qualitative study comparing patients' experiences of self-referral inpatient treatment with treatment as usual? BMC Health Services Research. 2014;14(1). Available from: https://doi.org/10.1186/1472-6963-14-347.
  21. 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. Nordic Journal of Psychiatry. 2017;71(2):120-5. Available from: https://doi.org/10.1080/08039488.2016.1240231.
  22. Skott M, Durbeej N, Smitmanis-Lyle M, Hellner C, Allenius E, Salomonsson S, et al. Patient-controlled admissions to inpatient care: A twelve-month naturalistic study of patients with schizophrenia spectrum diagnoses and the effects on admissions to and days in inpatient care. BMC Health Services Research. 2021;21(1):598. Available from: https://doi.org/10.1186/s12913-021-06617-8.
  23. Strand M, Bulik CM, Gustafsson SA, von Hausswolff-Juhlin Y, Welch E. Self-admission to inpatient treatment in anorexia nervosa: Impact on healthcare utilization, eating disorder morbidity, and quality of life. International Journal of Eating Disorders. 2020;53(10):1685-95. Available from: https://doi.org/10.1002/eat.23346.
  24. Strand M, Bulik CM, Gustafsson SA, Welch E. Self-admission in the treatment of eating disorders: an analysis of healthcare resource reallocation. BMC Health Services Research. 2021;21(1):1-9. Available from: https://doi.org/10.1186/s12913-021-06478-1.
  25. Strand M, Bulik CM, von Hausswolff-Juhlin Y, Gustafsson SA. Self-admission to inpatient treatment for patients with anorexia nervosa: The patient's perspective. International Journal of Eating Disorders. 2017;50(4):398-405. Available from: https://doi.org/10.1002/eat.22659.
  26. Strand M, Gustafsson SA, Bulik CM, von Hausswolff-Juhlin Y. Self-admission to inpatient treatment in psychiatry: Lessons on implementation. BMC Psychiatry. 2017;17. Available from: https://doi.org/10.1186/s12888-017-1505-x.
  27. Thomsen CT, Benros ME, Maltesen T, Hastrup LH, Andersen PK, Giacco D, et al. Patient‐controlled hospital admission for patients with severe mental disorders: A nationwide prospective multicentre study. Acta Psychiatrica Scandinavica. 2018;137(4):355-63. Available from: https://doi.org/10.1111/acps.12868.
  28. Westling S, Daukantaite D, Liljedahl SI, Oh Y, Westrin A, Flyckt L, et al. 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 Network Open. 2019;2(6):e195463. Available from: https://doi.org/10.1001/jamanetworkopen.2019.5463.

Literature search

Multi-database searching: CINAHL, Psychology and Behavioral Sciences Collection, PsycINFO, SocINDEX via EBSCO 24 June 2021

Title: Brief Admission
Search termsItems found
AB = Abstract; AU = Author; DE = Term from the thesaurus; MH= Exact Subject Heading from CINAHL Subject Headings; MM = Major Concept; TI = Title; TX = All Text. Performs a keyword search of all the database's searchable fields; ZC = Methodology Index; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; N = Near Operator (N) finds the words if they are a maximum of x words apart from one another, regardless of the order in which they appear.; W = Within Operator (W) finds the words if they are within x words of one another, in the order in which you entered them.
Intervention:
1. TI ( ((brief OR "patient controlled" OR "patient guided") N3 admission*) ) OR AB ( ((brief OR "patient controlled" OR "patient guided") N3 admission*) ) OR SU ( ((brief OR "patient controlled" OR "patient guided") N3 admission*) ) 231
2. TI (admission* N1 contract*) OR AB (admission* N1 contract*) OR SU (admission* N1 contract*) 22
3. TI "self admission*" OR AB "self admission*" OR SU "self admission*" 33
4. TI ( ("self referral*" OR selfreferral*) AND ("mental health" OR psychiatr* OR admission*) ) OR AB ( ("self referral*" OR selfreferral*) AND ("mental health" OR psychiatr* OR admission*) ) OR SU ( ("self referral*" OR selfreferral*) AND ("mental health" OR psychiatr* OR admission*) ) 373
5. TI ( ((crisis N3 admission*) AND ("mental health" OR psychiatr* OR inpatient)) ) OR AB ( ((crisis N3 admission*) AND ("mental health" OR psychiatr* OR inpatient)) ) OR SU ( ((crisis N3 admission*) AND ("mental health" OR psychiatr* OR inpatient)) ) 155
6. TI ( ((brief N1 hospitalization) AND ("mental health" OR psychiatr* OR admission*)) ) OR AB ( ((brief N1 hospitalization) AND ("mental health" OR psychiatr* OR admission*)) ) OR SU ( ((brief N1 hospitalization) AND ("mental health" OR psychiatr* OR admission*)) ) 177
Combined sets:
7. 1 OR 2 OR 3 OR 4 OR 5 OR 6  
Final result
8.   957

 

Embase via Elsevier 24 June 2021

Title: Brief Admission
/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
Search termsItems found
Intervention:
1. ((brief NEAR/2 hospitalization):ti,ab,kw) AND ('mental health':ti,ab,kw OR psychiatr*:ti,ab,kw OR admission*:ti,ab,kw) 275
2. (admission* NEAR/2 contract*):ti,ab,kw 54
3. 'self admission*':ti,ab,kw 35
4. ('self referral*':ti,ab,kw OR selfreferral*:ti,ab,kw) AND ('mental health':ti,ab,kw OR psychiatr*:ti,ab,kw OR admission*:ti,ab,kw) 361
5. ((crisis NEAR/4 admission*):ti,ab,kw) AND ('mental health':ti,ab,kw OR psychiatr*:ti,ab,kw OR inpatient:ti,ab,kw) 118
6. ((brief NEAR/2 hospitalization):ti,ab,kw) AND ('mental health':ti,ab,kw OR psychiatr*:ti,ab,kw OR admission*:ti,ab,kw) 91
Combined sets
7. 1 OR 2 OR 3 OR 4 OR 5 OR 6 904
Final result
8.   904

 

Medline via OvidSP 24 June 2021

Title: Brief Admission
.ab. = Abstract; .ab,ti. = Abstract or title; .af. = All fields; Exp = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; .sh. = Term from the Medline controlled vocabulary; .ti. = Title; / = Term from the Medline controlled vocabulary, but does not include terms found below this term in the MeSH hierarchy; * = Focus (if found in front of a MeSH-term); * or $ = Truncation (if found at the end of a free text term); .mp = Text, heading word, subject area node, title; “ “ = Citation Marks; searches for an exact phrase; ADJn = Positional operator that lets you retrieve records that contain your terms (in any order) within a specified number (n) of words of each other.
Search termsItems found
Intervention: XX / Index test: XX
1. ((brief or patient controlled or patient guided) adj4 admission*).ab,kf,ti. 167
2. (admission* adj2 contract*).ab,kf,ti. 33
3. "self admission*".ab,kf,ti. 26
4. (self referral* or selfreferral*).ab,kf,ti and (mental health or psychiatr* or admission*).ab,kf,ti. 241
5. (crisis adj4 admission*).ab,kf,ti and (mental health or psychiatr* or inpatient).ab,kf,ti. 73
6. (brief adj2 hospitalization).ab,kf,ti and (mental health or psychiatr* or admission*).ab,kf,ti. 66
Combined sets
7. 1 or 2 or 3 or 4 or 5 or 6 580
Final result
8.   580

 

Scopus via Elsevier 24 June 2021

Title: Brief Admission
Search termsItems found
TITLE-ABS-KEY = Title or abstract or keywords; ALL = All fields; PRE/n = "precedes by". The first term in the search must precede the second by a specified number of terms (n).; W/n = "Within". The terms in the search must be within a specified number of terms (n) in any order.; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; LIMIT-TO (SRCTYPE, "j" = Limit to source type journal; LIMIT-TO (DOCTYPE, "ar" = Limit to document type article; LIMIT-TO (DOCTYPE, "re" = Limit to document type review
Intervention:
1. TITLE-ABS-KEY ( ( brief OR "patient controlled" OR "patient guided" ) W/3 admission* ) 204
2. TITLE-ABS-KEY ( admission* W/1 contract* ) 56
3. TITLE-ABS-KEY ( "self admission*" ) 38
4. TITLE-ABS-KEY ( ( "self referral*" OR selfreferral* ) AND ( "mental health" OR psychiatr* OR admission* ) ) 365
5. TITLE-ABS-KEY ( ( crisis W/3 admission* ) AND ( "mental health" OR psychiatr* OR inpatient ) ) 117
6. TITLE-ABS-KEY ( ( brief W/1 hospitalization ) AND ( "mental health" OR psychiatr* OR admission* ) ) 124
Combined sets
7. 1 OR 2 OR 3 OR 4 OR 5 OR 6 873
Final result
8.   873
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