Patient Autonomy versus Compulsory Care

Our purpose is to perform a comprehensive evaluation of the intervention ‘Brief Admission by self-referral (BA)’ for adults with self-harm and borderline personality disorder (BPD) and to explore the lived experiences of BA for adolescents. 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.

Aims:To evaluate the effect of BA added to treatment as usual, on the extent of compulsory admissions in adults.To determine longitudinal changes in consumption of compulsory mental care, other health care, self-harm, and disability in adults with access to BA over 5-years.To estimate the cost-effectiveness of BA.To explore the lived experiences of BA for adolescents with self-harm.Work plan and methods:The project is carried out by the applicants and two doctoral students.

Publications are planned in 2024 for aim 1, 2023 for aim 2, 2022 for aim 3, and 2022-24 for aim 4.

Relevant data from medical records, national registers, self-report forms and interviews are analyzed using quantitative and qualitative methods.

Health-economic analyses are based on results from a randomized clinical trial conducted 2015-18.Significance:This project is important since: a) persons with self-harm and BPD are often subjected to compulsory care despite potential iatrogenic effects, and b) BA is implemented in many regions in Sweden, although its scientific basis is limited.