Short summary

The aim of the study is to investigate the effect of Early Recognition Method (ERM) on relapse, number of hospital admissions and application of coercive measures among outpatients in psychiatric care. ERM is a risk management tool, with focus on improving collaboration between caregiver and patient. The method describes identification of patients individual "Early Warning Signs" (EWS) of escalating psychosis, through caregiver - patient interviews. The Method is a longitudinal study, with mixed methods design, including case cross over. 125 patients with schizophrenia and bipolar disorder will be collected from Psychiatric outpatient clinics in the region of Southern Denmark. The method is presently used with success in some foreign forensic psychiatric hospitals.

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Rationale

Early Recognition Method is a risk management strategy applied within treatment and care used among (in)patients in forensic and psychiatric hospitals in Norway, Germany, Belgium and The Netherlands. ERM offers an approach to encourage and maintain patient treatment adherence in psychiatric care. ERM emphasize collaboration between staff and patients. The strategy is described by identification of individual EWS of imminent psychosis and aggression. The intention is to create coping-strategies for reversion of the process of increasing psychosis and aggression, based on the identified EWS, whereby preventing a crisis and possible enforced treatment. The purpose is to improve patient self-management skills by improving the patient's insight into his own EWS. ERM is a systematic approach, and yet flexible and dynamic allowing individual tailoring, distinct from ad hoc responses to violence and aggression. The strategies for ERM are precisely described and structured.

ERM used at forensic wards has resulted in decrease in the severity of inpatient incidents including also patients suffering from schizophrenia. The reduction of coercive initiatives and measures in psychiatric care has mainly been described among hospitalized patients. It has not been possible to identify research on ERM applied to outpatient psychiatric care. It is stated in the literature that the ERM design allows transfer from inpatient to outpatient settings. Research on patient involvement and patient - staff collaboration in risk management interventions for the purpose of preventing coercion, is scarce. This project will address the issues of escalating psychosis and/or aggression among psychiatric outpatients by applying ERM in a psychiatric outpatient setting. The objective of this study is to increase research-based knowledge and improve psychiatric outpatient treatment; including patients suffering from mental illness in research, ties together research and practical knowledge. The expected result is increased knowledge of patient's own disease and improved competences for the caregiver.

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Description of the cohort

The study will focus on adult patients, 18 - 64 years of age, diagnosed with Schizophrenia or Bipolar Disorder according to ICD-10, diagnostic code F20 and F31. Patients will be recruited from ACT teams and Affective Teams in the regional psychiatric outpatient care.

Data and biological material

Data collection will be from patient files, questionnaire surveys and semi structured interviews. The collected data will include information from both patients and staff.

Data will contain information regarding admissions /readmissions, acute or forced to psychiatric hospitals, information on relationship between patients and staff (nearness-distance), collaboration between staff and patients regarding the ERM plan, description of individual Early Warning Signs and how the patients and staff experienced using of ERM ( strengths and weaknesses).

Collaborating researchers and departments

OPEN Odense Patient data Explorative Network, Odense University Hospital and Department of Clinical Research, Faculty of Health Science, University of Southern Denmark

• Professor Lise Hounsgaard, PhD, MScN, RN

Dr. S. van Mesdag Forensic Psyciatric Center (FPC), Netherlands and Centre for Research and Education in Forensic Psychiatry, Ullevål University Hospital, Oslo, Norway

• Senior Researcher and Associate Professor Frans Fluttert, MSc, PhD

Research department, Mental Health Hospital, Esbjerg

• Postdoc Jens Peter Hansen, PhD

Outpatient clinic, Mental Health Hospital, Esbjerg

• Chief Physician Annette Gosvig