title: Twelve months effect of self-referral to inpatient treatment on patient activation, recovery, symptoms and functioning: A randomized controlled study.
abstract: To investigate the effect of having a contract for self-referral to inpatient treatment (SRIT) in patients with severe mental disorders.
  
  
  
  A randomized controlled trial with 53 adult patients; 26 participants received a SRIT contract, which they could use to refer themselves into a Community Mental Health Centre up to five days for each referral without contacting a doctor in advance. Outcomes were assessed after 12 months with the self-report questionnaires Patient Activation Measure (PAM-13), Recovery Assessment Scale (RAS), and the Behavior and Symptom Identification Scale (BASIS-32) and analyzed using linear mixed and regression models.
  
  
  
  There was no significant effect on PAM-13 (estimated mean difference (emd) -0.41, 95% CI (CI):-7.49-6.67), nor on the RAS (emd 0.02, CI:-0.27-0.31) or BASIS-32 (0.09, CI:-0.28-0.45). An exploratory post hoc analysis showed effect of SRIT in those with low PAM below ≤47 (p=0.049).
  
  
  
  There were no group differences after 12 months, but both groups maintained their baseline levels.
  
  
  
  SRIT contracts can be recommended as it supports the rights to self-determination, promote user participation in decision-making in own treatment without any indication of adverse effects.
authors.affiliation: Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway. Electronic address: inger.elise.opheim.moljord@stolav.no.
authors.forename: I E O
authors.initials: IEO
authors.lastname: Moljord
authors.affiliation: Tiller Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.
authors.forename: M L
authors.initials: ML
authors.lastname: Lara-Cabrera
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, NTNU, Trondheim, Norway.
authors.forename: Ø
authors.initials: Ø
authors.lastname: Salvesen
authors.affiliation: Department of Applied Social Sciences, Faculty of Health and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: M B
authors.initials: MB
authors.lastname: Rise
authors.affiliation: KBT, Department of User Experience and Service Development, Trondheim, Norway.
authors.forename: D
authors.initials: D
authors.lastname: Bjørgen
authors.affiliation: KBT, Department of User Experience and Service Development, Trondheim, Norway.
authors.forename: D Ø
authors.initials: DØ
authors.lastname: Antonsen
authors.affiliation: NAPHA, Norwegian Resource Centre for Community Mental Health, Trondheim, Norway.
authors.forename: T M
authors.initials: TM
authors.lastname: Olsø
authors.affiliation: NAPHA, Norwegian Resource Centre for Community Mental Health, Trondheim, Norway.
authors.forename: G H
authors.initials: GH
authors.lastname: Evensen
authors.affiliation: Department of Brøset, Centre for Research and Education, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Social Work and Health Science, Faculty of Social Science and Technology Management, NTNU, Trondheim, Norway.
authors.forename: C B
authors.initials: CB
authors.lastname: Gudde
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.
authors.forename: O M
authors.initials: OM
authors.lastname: Linaker
authors.affiliation: Department of Public Health and General Practice, Faculty of Medicine, NTNU, Trondheim, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Steinsbekk
authors.affiliation: Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Eriksen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009664:Norway; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010358:Patient Participation; D012017:Referral and Consultation / Q000706:statistics & numerical data*
keywords: Patient activation; Patient controlled admission; Patient participation; Recovery; Self-referral to inpatient treatment