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

NCT ID: NCT06406972

Last Updated: 2025-08-14

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 7000 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2010-09-15
• Study Completion Date: 2025-12-31

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

Study Design

• Observational Model Type: OTHER
• Study Time Perspective: OTHER

Study Groups

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

Lund, before implementation of Brief Admission by self-referral

No interventions assigned to this group

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

Brief Admission by self-referral (BA)

Intervention Type: 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.

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

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

Brief Admission by self-referral (BA)

Intervention Type: 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.

Linköping 2010-09-15-2015-09-14

Linköping before implementation of Brief Admission by self-referral

No interventions assigned to this group

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

No interventions assigned to this group

Linköping 2020-09-15-2025-09-14

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

Brief Admission by self-referral (BA)

Intervention Type: 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.

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

Helsingborg before implementation of Brief Admission by self-referral

No interventions assigned to this group

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

Brief Admission by self-referral (BA)

Intervention Type: 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.

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

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

Brief Admission by self-referral (BA)

Intervention Type: 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.

Norrköping 2014-02-15-2017-02-14

Norrköping before implementation of Brief Admission by self-referral

No interventions assigned to this group

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

No interventions assigned to this group

Norrköping 2020-02-15-2023-02-14

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

Brief Admission by self-referral (BA)

Intervention Type: 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.

Interventions

Brief Admission by self-referral (BA)

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

Intervention Type: OTHER

Other Intervention Names

Patient initiated Brief admission; Self-referral to inpatient treatment; Patient controlled hospital admission

Eligibility Criteria

Inclusion Criteria

• Living in the uptake area of Lund, Linköping, Helsingborg or Norrköping
• Age 18-65 years at the time of inclusion
• 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).

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Lund University

OTHER

Sponsor Role: collaborator

Linkoeping University

OTHER_GOV

Sponsor Role: collaborator

Region Skane

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Sofie Sofie, PhD

Role: PRINCIPAL_INVESTIGATOR

Lund University

Locations

Division of Psychiatry, Region Skåne

Lund, Skåne County, Sweden

Site Status: RECRUITING

Region Östergötland

Linköping, , Sweden

Site Status: RECRUITING

Statistiska centralbyrån

Solna, , Sweden

Site Status: RECRUITING

Socialstyrelsen

Stockholm, , Sweden

Site Status: RECRUITING

Countries

Sweden

Central Contacts

Sofie Sofie, PhD

Role: CONTACT

sofie.westling@med.lu.se

+46735626099

Josefin Vikström Eckevall, PhD

Role: CONTACT

josefin.vikstrom@liu.se

+46703320527

Facility Contacts

Erika Svanström, MD, PhD

Role: primary

erika.svanstrom@skane.se

Psychologist

Role: backup

Rolf Wiklund

Role: primary

Rolf.Wiklund@regionostergotland.se

Åsa Holmström

Role: primary

Asa.Holmstrom@scb.se

Jessica Magnusson

Role: primary

Jessica.Magnusson@socialstyrelsen.se

References

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Reference Type: BACKGROUND

PMID: 28100114 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 29369662 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 28619050 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 25832757 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 31173128 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 31099707 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 27739334 (View on PubMed)

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.

Reference Type: BACKGROUND

PMID: 29504127 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

2022-02307-01

Identifier Type: -

Identifier Source: org_study_id