title: Short time effect of a self-referral to inpatient treatment for patients with severe mental disorders: a randomized controlled trial.
abstract: BACKGROUND
  Service user participation is a central principle in mental healthcare, and the opportunity to self-refer to inpatient treatment is used to increase service user involvement and activation. The aim of this study was to investigate the short-term effect of a self-referral system in an inpatient rehabilitation unit at a community mental health center on patient activation and recovery in individuals with severe mental disorders.
  
  
  METHODS
  A randomized controlled study including 53 patients (41 % females, mean age 40 years). Twenty-six patients in the intervention group were given a contract for self-referral to inpatient treatment, limited to maximum 5 days and a quarantine time of 14 days between each stay. The control group (27 participants) received treatment as usual, and was offered the intervention after 1 year. The Patient Activation Measure was the primary outcome and secondary outcome was the Recovery Assessment Scale. Mixed models were used to assess group differences.
  
  
  RESULTS
  During the 4 months period, 15 (58 %) of 26 participants in the intervention group used the contract of self-referral to inpatient treatment. The intervention group had more admissions than the control group but both groups had a similar total use of inpatient days and out-patient consultations. The self-referral to inpatient treatment counted for 11 % of all inpatient days for the intervention group. There were no significant differences in the outcome between the groups on patient activation (estimated mean difference 2.7, 95 % confidence interval = -5.5 to 10.8, p = 0.52) or recovery (estimated mean difference 0.01, 95 % confidence interval = -0.3 to 0.3, p = 0.92).
  
  
  CONCLUSIONS
  Giving persons with severe mental disorders the possibility to self-refer to inpatient treatment did not change their level of patient activation and recovery after 4 months and did not lead to increased use of health services. The cost-effectiveness and long-term effect of self-referral to inpatient treatment should be investigated further.
  
  
  BACKGROUND
  NCT01133587 , clinicaltrials.gov.
authors.affiliation: Division of Psychiatry, Nidaros Community Mental Health Center, St. Olav's University Hospital, Østmarkveien 21, Post box 1893 Lade, N-7440, Trondheim, Norway. inger.elise.opheim.moljord@stolav.no.|Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. inger.elise.opheim.moljord@stolav.no.|Division of Psychiatry, Department of Research and Development, St. Olav's University Hospital, Trondheim, Norway. inger.elise.opheim.moljord@stolav.no.
authors.forename: Inger Elise Opheim
authors.initials: IE
authors.lastname: Moljord
authors.affiliation: Division of Psychiatry, Nidaros Community Mental Health Center, St. Olav's University Hospital, Østmarkveien 21, Post box 1893 Lade, N-7440, Trondheim, Norway.
authors.forename: Kristel Antine
authors.initials: KA
authors.lastname: Helland-Hansen
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Salvesen
authors.affiliation: Norwegian Resource Center for Community Mental Health, Norwegian University of Science and Technology Social Research AS, Trondheim, Norway.
authors.forename: Turid Møller
authors.initials: TM
authors.lastname: Olsø
authors.affiliation: Forensic Department Brøset, Center for Research and Education in Forensic Psychiatry, St. Olav's University Hospital, Trondheim, Norway.|Department of Social Work and Health Science, Faculty of Social Science and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Camilla Buch
authors.initials: CB
authors.lastname: Gudde
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Marit By
authors.initials: MB
authors.lastname: Rise
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Aslak
authors.initials: A
authors.lastname: Steinsbekk
authors.affiliation: Division of Psychiatry, Nidaros Community Mental Health Center, St. Olav's University Hospital, Østmarkveien 21, Post box 1893 Lade, N-7440, Trondheim, Norway.|Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Lasse
authors.initials: L
authors.lastname: Eriksen
keywords: Patient activation; Patient controlled admission; Psychosis; Self-referral to inpatient treatment; User participation