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

摘要

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.