Published: 05-01-2022 10:58 | Updated: 10-01-2022 11:11

Self-admission increases patients’ involvement

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What does it mean to admit yourself as a patient? Maria Smitmanis Lyle, a PhD student at the Department of Clinical Neuroscience and Coordinator at the Centre for Psychiatry Research, who researches self-admission for children and adolescents, explains.

Text: Ann Kjellqvist, in translation from Swedish for the magazine Medicinsk Vetenskap no 4/2021

What is patient-controlled admission?

“It means patients have the option to admit themselves to inpatient psychiatric care when they feel they need it – 24 hours a day, every day of the week. The way it works is that the psychiatric inpatient unit reserves a space solely for these patients, and nurses with delegated responsibilities admit and discharge the patients. Patients can admit themselves for up to four days at a time, a maximum of three times a month.” 

What do we know about the benefit to patients?

Maria Smitmanis Lyle
“Being able to decide for yourself when you need inpatient psychiatric care can be a source of reassurance,” says Maria Smitmanis Lyle. Photo: Anna Molander.

“In Region Stockholm, the care model has been evaluated in three earlier projects for patients with psychosis, emotional instability and eating disorders. The results show that the total number of 24-hour periods spent by the patients in inpatient care decreases, particularly when it comes to compulsory inpatient care, while the overall amount of voluntary engagement with the healthcare system appears to increase slightly. So the patients are seeking care on more occasions but are inpatients for a shorter time. There have also been qualitative studies in which the patients describe this access to elective admission as a source of reassurance and a safety net.” 

How is it being used today?

“In Region Stockholm, a common model for patient-controlled admission irrespective of psychiatric diagnosis was agreed in 2019 – known as the ‘generic model’. The model is currently available at 15 inpatient wards in partnership with 25 outpatient services across nine of the region’s psychiatric facilities and there are ongoing plans for implementation at additional units. But not very many patients are making use of the option.”

What knowledge is still lacking in this area?

“The care model has previously been tested and evaluated on specific patient groups where the data has been limited. It is still unclear how aspects other than healthcare consumption, such as self-assessed quality of life, perceived autonomy and psychiatric symptoms, are affected. We hope that we will get answers to this from the evaluation that is to come of the generic model. The aim is for the evaluation to sum up the costs and gains of patient-controlled admission being introduced.”

What is your own research about?

“It’s about how this works for children and young people. In that context there’s another perspective to take into consideration: that of the guardian. I’m looking at the effects of having access to patient-controlled admission on young patients and their guardians, in terms of how it affects care consumption, self-assessed health and the relationship with healthcare services. I’m also planning qualitative studies with healthcare staff.