Kortvarige brukerstyrte innleggelser som alternativ til tvangsinnleggelse hos pasienter med alvorlig selvskading

Abstract

Background: Treatment guidelines recommend that patients with extreme self-harm behavior avoid admission to psychiatric wards. Some patients may escalate their self-harm until admission is granted for safety reasons. The resulting admissions often result in escalating self-harm that is managed with coercive measures. To prevent negative, repeated episodes of acute admissions with escalating self-harm and coercion before discharge, Lovisenberg Diaconal Hospital in 2013 developed a service providing brief acute ward admissions by self-referral. This article presents the first survey of users’ satisfaction with this targeted self-referral service and reflections on further development and evaluation of the service. Material and methods: In 2018, a total of 32 patients were enrolled in the self-referral service and were asked to respond to a survey on service satisfaction that included both multiple-choice and free-text responses. Twenty-three patients consented to participate. Group-based descriptive statistics of real-life service use was conducted to control for survey bias. Results: The majority had been diagnosed with borderline personality disorder. A total of 16 respondents were satisfied or very satisfied with the self-referral service. About 40% of the respondents had no new admissions following their enrolment in the self-referral service. Most respondents reported that the option of self-referral increased their everyday sense of safety and control, and emphasized the absence of emergency-room evaluation as a major advantage. Conclusion: Users’ responses indicate that a self-referral service tailored to this small group of patients may enhance their sense of self-control and everyday safety and reduce the need to escalate the level of self-harm necessary to qualify for regular acute psychiatric admission. This is consistent with studies of similar services in other countries. Keywords: long-term suicidal behavior, self-referral, brief hospital admissions, patient satisfaction