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

NCT06406972 | Recruiting

• 1 other identifier: 2022-02307-01
• Study Type: observational
• Target: 7,000
• Locations: 1 country
• Sites: 4

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.

Conditions

Self-injury; Suicide; Suicide, Attempted; Self-harm; Borderline Personality Disorder; Emergency Psychiatric; Hospitalizations Psychiatric

Keywords

Brief Admission by self-referral; self-harm; traits of borderline personality disorder; compulsory care

Outcome Measures

Primary Outcomes (1)

• Days with compulsory admission

  Days with compulsory admission (days/year)

  2010-09-15 - 2025-09-14

Secondary Outcomes (6)

• Days with voluntary psychiatric admission

  2010-09-15 - 2025-09-14

• Duration of free intervals between admissions

  2010-09-15 - 2025-09-14

• Mortality

  2010-09-15 - 2025-09-14

• Number of compulsory admissions

  2010-09-15 - 2025-09-14

• Number of voluntary psychiatric admissions (admissions/year)

  2010-09-15 - 2025-09-14

Other Outcomes (5)

• Gender distribution

  2010-09-15 - 2025-09-14

• Number of admissions with Brief admission by self-referral (BA)

  2010-09-15 - 2025-09-14

• Compulsory admission - median length

  2010-09-15 - 2025-09-14

Study Arms (12)

Lund 2010-09-15-2015-09-14

Lund, before implementation of Brief Admission by self-referral

Lund 2015-09-15-2020-09-14

Lund, after implementation of Brief Admission by self-referral in Lund, before implementation of Brief Admission by self-referral in Linköping

Other: Brief Admission by self-referral (BA)

Lund 2020-09-15-2025-09-14

Lund, after implementation of Brief Admission by self-referral in Lund and in Linköping

Other: Brief Admission by self-referral (BA)

Linköping 2010-09-15-2015-09-14

Linköping before implementation of Brief Admission by self-referral

Linköping 2015-09-15-2020-09-14

Linköping after implementation of Brief Admission by self-referral in Lund, before implementation of Brief Admission by self-referral in Linköping

Linköping 2020-09-15-2025-09-14

Linköping after implementation of Brief Admission by self-referral in Lund and in Linköping

Other: Brief Admission by self-referral (BA)

Helsingborg 2014-02-15-2017-02-14

Helsingborg before implementation of Brief Admission by self-referral

Helsingborg 2017-02-15-2020-02-14

Helsingborg after implementation of Brief Admission by self-referral in Helsingborg, before implementation of Brief Admission by self-referral in Norrköping

Other: Brief Admission by self-referral (BA)

Helsingborg 2020-02-15-2023-02-14

Helsingborg after implementation of Brief Admission by self-referral in Helsingborg and in Norrköping

Other: Brief Admission by self-referral (BA)

Norrköping 2014-02-15-2017-02-14

Norrköping before implementation of Brief Admission by self-referral

Norrköping 2017-02-15-2020-02-14

Norrköping after implementation of Brief Admission by self-referral in Helsingborg, before implementation of Brief Admission by self-referral in Norrköping

Norrköping 2020-02-15-2023-02-14

Norrköping after implementation of Brief Admission by self-referral in Helsingborg and in Norrköping

Other: Brief Admission by self-referral (BA)

Interventions

Brief Admission by self-referral (BA) OTHER

Through means of an individualised contract access to self-referral to inpatient treatment limited to a maximum of three nights, three times per month.

Also known as: Patient initiated Brief admission, Self-referral to inpatient treatment, Patient controlled hospital admission

Helsingborg 2017-02-15-2020-02-14; Helsingborg 2020-02-15-2023-02-14; Linköping 2020-09-15-2025-09-14; Lund 2015-09-15-2020-09-14; Lund 2020-09-15-2025-09-14; Norrköping 2020-02-15-2023-02-14

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

Individuals with repeated self-harm and traits of Borderline personality disorder

You may qualify if:

• Living in the uptake area of Lund, Linköping, Helsingborg or Norrköping
• 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).

Sponsors & Collaborators

• Region Skane: lead
• Lund University: collaborator
• Linkoeping University: collaborator

Study Sites (4)

Division of Psychiatry, Region Skåne

Lund, Skåne County, 22185, Sweden

RECRUITING

Region Östergötland

Linköping, 581 91, Sweden

RECRUITING

Statistiska centralbyrån

Solna, 171 54, Sweden

RECRUITING

Socialstyrelsen

Stockholm, SE-106 30, Sweden

RECRUITING

Related Publications (8)

• 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.

  PMID: 28100114 BACKGROUND

• 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.

  PMID: 29369662 BACKGROUND

• 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.

  PMID: 28619050 BACKGROUND

• 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.

  PMID: 25832757 BACKGROUND

• 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.

  PMID: 31173128 BACKGROUND

• 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.

  PMID: 31099707 BACKGROUND

• 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.

  PMID: 27739334 BACKGROUND

• 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.

  PMID: 29504127 BACKGROUND

MeSH Terms

Conditions

Self-Injurious Behavior; Suicide; Suicide, Attempted; Borderline Personality Disorder

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior; Personality Disorders; Mental Disorders

Study Officials

• Sofie Sofie, PhD

  Lund University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Sofie Sofie, PhD

CONTACT

+46735626099; sofie.westling@med.lu.se

Josefin Vikström Eckevall, PhD

CONTACT

+46703320527; josefin.vikstrom@liu.se

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: OTHER
• Target Duration: 5 Years
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 19, 2024
• First Posted: May 9, 2024
• Study Start: September 15, 2010
• Primary Completion: December 31, 2025
• Study Completion: December 31, 2025
• Last Updated: August 14, 2025

Record last verified: 2025-08

Locations

SE (4)