Brief Admission Skane: Replacing General Admission for Individuals With Self-harm and Acute Risk of Suicide

Study Overview
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Brief Summary
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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
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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.

Official Title
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Brief Admission Skane: Can Brief Admission Replace General Admission for Individuals With Self-harm and Acute Risk of Suicide

Conditions
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Self-Injurious Behavior, Suicidal Ideation, Suicide, Attempted, Borderline Personality Disorder, Emergency Services, Psychiatric

Intervention / Treatment
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* Other: Brief Admission


Participation Criteria
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Eligibility Criteria
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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).

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Brief Admission<br>Participants randomised to Brief admission (BA) will have the possibility of admitting themselves to hospital for a maximum duration of three consecutive days at a maximum frequency of three times per month. Apart from BA they have access to all psychiatric care that they would have if they had not participated in the study (including general admission to hospital). | Other: Brief Admission<br>* 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.<br>* Other names: Brukarstyrd Inläggning (Swedish);|
| No Intervention: Control<br>Participants randomized to Treatment as Usual will receive no intervention from the study protocol, except the baseline assessments and repeated assessments administered on the same schedule as described above for the treatment group. They will not be given the evaluation measures that are specific to the intervention. Participants have access to all psychiatric care that they would have if they had not participated in the study (including general admission to hospital). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of days with hospital admission | Number of days with Brief admission, general admission, forced (involuntary) admission | Change between the period from 12 month retrospectively to Baseline and the period from baseline to 12 months prospectively | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 
| Individuals' Experiences of the intervention | Outcome from the questionnaires developed for the method: Individual's Experience Scale (IES) | 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. | 
| Clinicians' Experiences of the intervention | Outcome from the questionnaires developed for the method: Clinician's Experience Scale (CES) | 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. | 
| Frequency of all self-harming behaviours including suicide attempts | Outcome from Five Self-Harm Behaviour Groupings Measure (5S-HM) | Change in frequency between baseline, 6 months and 12 months prospectively. | 
| Severity of self-harming behaviours | Outcome from Five Self-Harm Behaviour Groupings Measure (5S-HM) | Change in severity between baseline, 6 months and 12 months prospectively. | 
| Level of functioning in activities of daily life | The World Health Organization Disability Assessment Schedule II (WHODAS 2.0) | Change in ratings between baseline, 6 months and 12 months prospectively. | 
| Ability to cope effectively with life stress | The Brief COPE | Change in ratings between baseline, 6 months and 12 months prospectively. | 
| Ability to regulate emotions | The Difficulties in Emotion Regulation Scale | Change in ratings between baseline, 6 months and 12 months prospectively. | 
| Global psychiatric symptoms | Outcome from Clinical Global Impression Severity Scale | Change in ratings between baseline, 6 months and 12 months prospectively. | 
| Satisfaction with health care | Client Satisfaction Questionnaire (CSQ) | Change in ratings between baseline, 6 months and 12 months prospectively. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Brief admission, admission, deliberate self-harm, self-harm