A Brief Case Management Intervention to Promote Personal Recovery and Prevent Psychiatric Involuntary Readmissions.
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Brief Case Management intervention, TAU.
- Who it may be relevant to
- Registry conditions: Psychiatric Disorder, Involuntary Psychiatric Hospitalization. Basic parameters: 18 years — 64 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Switzerland
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Official title
A Brief Case Management Intervention to Promote Personal Recovery and Prevent Psychiatric Involuntary Readmissions: a Randomised Controlled Trial
Overview
The goal of this randomized control trial is to assess the effectiveness of a Brief Case Management (BCM) intervention aimed at promoting personal recovery and reducing the negative effects of coercion among people involuntarily admitted to a psychiatric hospital. The main questions it aims to answer are : * Does the Brief Case Management intervention reduce the incidence of involuntary readmission18 months after the initial involuntary hospitalisation? * What impact does the Brief Case Management intervention have on patients' involuntary readmission 6 months after the initial involuntary hospitalisation, as well as on their personal recovery, perceived coercion, satisfaction with treatment, and on their exposure to other forms of formal and informal coercion? Participants will be randomly assigned to either the control or the intervention group, accordingly they will be asked to take part in: Control Group: * Three evaluation sessions (baseline, 6 and 18 months follow-up); Intervention Group : * Three evaluation sessions (baseline, 6 and 18 months follow-up); * The 5 sessions of the brief case management intervention (6th session optional).
Detailed description
Background: The use of coercion in psychiatry has been increasing for many years, both in Switzerland and abroad. While it is justified by the need to protect the health and safety of the concerned patients, coercion also represents an infringement of their fundamental rights. It can have negative effects on their health and care, for example, by causing post-traumatic stress disorder or leading to a breakdown in care. Having been involuntarily hospitalised in psychiatry is one of the main predictors of compulsory readmission. While numerous interventions have been proposed to limit the use of coercion, very few have been rigorously studied, and even fewer have been shown to be effective. Personal recovery involves leading a satisfying, contributory life, full of hope and meaning, despite the existence of a mental disorder and the resulting limitations. According to the WHO, services should be recovery-oriented to respect and promote human rights. To date, very little work has been done on the links between personal recovery and coercion. A brief case management intervention designed to promote the personal recovery of involuntarily hospitalised psychiatric patients has been developed in partnership with service-users. Its acceptability, feasibility and patients' satisfaction with the intervention were demonstrated in a six-month pilot phase.
Aims: The primary aim of the study is to test, by means of a randomised controlled trial, the effectiveness of the intervention in reducing involuntary readmissions incidence in a population of adult patients involuntarily hospitalised in psychiatry. The secondary aim is to assess the impact of the intervention on patients' personal recovery, perceived coercion, satisfaction with treatment, and on their exposure to other forms of formal and informal coercion.
Methods: 262 patients involuntarily hospitalised in psychiatry will be randomly assigned to either the intervention or control group. Patients in the intervention group will receive, in addition to standard care, a 5-session case management intervention starting within the first two weeks of hospitalisation and lasting a maximum of two months after discharge. During the sessions, patients will discuss their experience of coercion and its impact on their personal recovery. The intervention is designed to enable them to identify and mobilise their resources, improve their self-esteem, restore their confidence in the future and strengthen ties and collaborations with their entourage. They will also be invited to draw up a personal recovery plan. The number of involuntary readmissions at 18 months after inclusion will be measured in both groups as the primary outcome. The shorter-term impact of the intervention on the number of involuntary readmissions will also be assessed at the 6-month follow-up. Changes in personal recovery and other relevant variables, such as self-esteem, self-stigma, post-traumatic stress symptoms, satisfaction with care and exposure to other forms of formal or informal coercion, will also be measured at the 6- and 18-month follow-ups as secondary outcomes. Results will be evaluated on an Intent To Treat basis. Generalized linear models (GLMs) with a Poisson or negative binomial regression, based on overdispersion diagnostics, will be used to determine group differences. Other estimands such as treatment effect for patients who would not experience the intercurrent event will be considered as sensitivity analysis.
Expected results and impact: Promoting personal recovery of involuntarily admitted patients by helping them to develop and implement strategies that improve their mental well-being should mitigate the adverse consequences of coercion and reduce the risk of exposure to new coercive measures. This study will also provide a deeper understanding of the links between personal recovery and coercion.
Interventions
- Other Brief Case Management intervention
The BCM intervention aims to support patients during the difficult phase of involuntary hospitalisation and reduce the impact of this short-term event on their long-term recovery process. It is provided by a nurse or social worker case manager. Developed in collaboration with people who have experienced coercion, the intervention starts during the hospital stay, at the latest two weeks after admission, and lasts for a maximum of two months after discharge. The intervention consists of five sessi - Other TAU
Standard inpatient and outpatient psychiatric care.
Primary outcome measures
- Number of involuntary readmission(s) (long-term) [Time frame: Assessed at 18-month follow-up (T2).]
Secondary outcome measures (12)
- Number of involuntary readmission(s) (short-term) [Time frame: Assessed at 6-month follow-up (T1).]
- Recovery Assessment Scale (RAS) [Time frame: 3 time point assessment: at baseline (T0), 6-month follow-up (T1), 18-month follow-up (T2).]
- Empowerment Scale [Time frame: 3 time point assessment: at baseline (T0), 6-month follow-up (T1) and 18-month follow-up (T2).]
- Rosenberg Self-Esteem Scale (RSS) [Time frame: 3 time point assessment : at baseline (T0), 6-month follow-up (T1), 18-month follow-up (T2).]
- Paradox of Self-Stigma scale (PaSS-24) [Time frame: 3 time point assessment : at baseline (T0), 6-month follow-up (T1) and 18-month follow-up (T2).]
- Beck Hopelessness Scale (BHS) [Time frame: 3 time point assessment: at baseline (T0), 6-month follow-up (T1), and 18-month follow-up (T2).]
- WHOQOL-BREF Scale [Time frame: 3 time point assessment : at baseline (T0), 6-month follow-up (T1), and 18-month follow-up (T2).]
- International Trauma Questionnaire (ITQ) [Time frame: 3 time point assessment : at baseline (T0), 6-month follow-up (T1), 18-month follow-up (T2).]
- Pressures in Psychiatry Scale (P-PSY35) [Time frame: 3 time point assessment : at baseline (T0), 6-month follow-up (T1) and 18-month follow-up (T2).]
- Coercion Ladder (CL) [Time frame: 3 time point assessment : at baseline (T0), 6-month follow-up (T1) and 18-month (T2).]
- Index of Fairness and the Index of Effectiveness [Time frame: 3 time point assessment: at baseline (T0), 6-month follow-up (T1), and 18-month follow-up (T2).]
- Satisfaction with hospital care (ANQ) [Time frame: 2 time point assessment : at baseline (T0) and 6-month follow-up (T1).]
Eligibility criteria
Inclusion criteria
- To have been involuntarily admitted by a medical doctor;
- To be aged between 18 and 64 years;
- To domiciled in the Greater Lausanne area;
Exclusion criteria
- Patients with an organic mental disorder (F0, ICD-10);
- Patients with intellectual disability (F7, ICD-10);
- Patients unable to provide written consent due to a lack of discernment;
- Patients unable to speak French well enough to participate in the study without the help of an interpreter.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Single blind
- Primary purpose
- Other
Study locations
Switzerland · 1 center
- Lausanne University Hospital — Lausanne
Identifiers
NCT: NCT07497763 · 2026-00250 · 10.005.859