A Brief Case Management Intervention for People Involuntarily Admitted to a Psychiatric Hospital

Brief case management intervention group

Other: Brief case management intervention

The brief case management 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. The intervention starts during the hospital stay, at the latest one week after admission, and lasts for a maximum of one month after discharge. The intervention consists of five sessions, the order of which may vary according to the specific needs of the patient:

1. Personal account of involuntary hospitalisation and its consequences
2. Presentation of the personal recovery model and the tools to promote it and prevent coercion
3. Introduction to the personal recovery plan
4. Network meeting and discussion on "dignity of risk"
5. Personal recovery plan

Time frame: From start of study recruitment through study recruitment completion, on average 6 months

Number of eligible patients/number of patients involuntarily hospitalised on site during study period as reported in a structured flowchart by the case managers after each site visit

Time frame: From start of study recruitment through study recruitment completion, on average 6 months

Number of patients accepting to participate/number of approached patients as reported in a structured flowchart by the case managers after each site visit and based on the number of signed consent forms

Time frame: Up to 2 weeks from hospital admission and 2 months after hospital discharge

Number of patients who completed the programme/number of recruited patients as reported by case managers in a structured questionnaire detailing which intervention sessions were delivered to each patient

Time frame: Post-intervention, up to 2 months post hospital discharge

Mean number of sessions delivered per participant as reported by case managers in a structured questionnaire detailing which intervention sessions were delivered to each patient

Time frame: Up to 2 weeks from hospital admission and 2 months after hospital discharge

Number of missing data

Time frame: Up to 2 weeks after hospital admission through up to 2 months post hospital discharge

Number of unexpected adverse events related to the intervention reported in a structured form by the case managers or the investigator

Time frame: Post-intervention, up to 2 months post hospital discharge

Patients' acceptability of, and satisfaction with, the intervention and the research process were assessed qualitatively after the intervention, using semi-structured interviews with open-ended questions. Patients' verbatim responses were categorised according to four components of the Theoretical Framework for Acceptability (TFA): affective attitude, burden, ethicality, and perceived effectiveness. The table below shows, for each TFA component (one per row), the number of participants whose responses were coded to that component, out of all participants interviewed.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the Recovery Assessment Scale (24 item) is a patient-reported outcome measure of personal recovery. The instrument provides a total score of personal recovery as well as sub-scores on five specific dimensions : personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, no domination by symptoms. The RAS Total score is derived from 24 items rated on a 5 point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating better recovery. Scores on a scale: the total score ranges from 24 to 120 and is calculated by summing all item responses

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the Recovery Assessment Scale (24 item) is a patient-reported outcome measure of personal recovery. The instrument provides a total score of personal recovery as well as sub-scores on five specific dimensions : personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, no domination by symptoms. The Personal Confidence and Hope dimension is assessed with a subscale scored on a 5 point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating better outcomes (greater personal confidence and hope). The Personal Confidence and Hope subscale score ranges from 9 to 45 and is calculated by summing the corresponding item responses.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the Recovery Assessment Scale (24 item) is a patient-reported outcome measure of personal recovery. The instrument provides a total score of personal recovery as well as sub-scores on five specific dimensions : personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, no domination by symptoms. The Willingness to Ask for Help dimension is assessed with a subscale scored on a 5 point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating better outcomes (greater willingness to ask for help). The Willingness to Ask for Help subscale score ranges from 3 to 15 and is calculated by summing the corresponding item responses.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the Recovery Assessment Scale (24 item) is a patient-reported outcome measure of personal recovery. The instrument provides a total score of personal recovery as well as sub-scores on five specific dimensions : personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, no domination by symptoms. The Goal and Success Orientation dimension is assessed with a subscale scored on a 5 point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating better outcomes (greater goal and success orientation). The Goal and Success Orientation subscale score ranges from 5 to 25 and is calculated by summing the corresponding item responses.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the Recovery Assessment Scale (24 item) is a patient-reported outcome measure of personal recovery. The instrument provides a total score of personal recovery as well as sub-scores on five specific dimensions : personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, no domination by symptoms. The Reliance on Others dimension is assessed with a subscale scored on a 5 point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating better outcomes (greater reliance on others). The Reliance on Others subscale score ranges from 4 to 20 and is calculated by summing the corresponding item responses.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the Recovery Assessment Scale (24 item) is a patient-reported outcome measure of personal recovery. The instrument provides a total score of personal recovery as well as sub-scores on five specific dimensions : personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others, no domination by symptoms. The No Domination by Symptoms dimension is assessed with a subscale scored on a 5 point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating better outcomes (greater non-domination by symptoms). The No Domination by Symptoms subscale score ranges from 3 to 15 and is calculated by summing the corresponding item responses.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The Empowerment Scale (ES) is a 28 item self report instrument assessing subjective feelings of empowerment. It is scored on a 4 point Likert scale ranging from 1 ('strongly agree') to 4 ('strongly disagree'), with higher scores indicating greater perceived empowerment. The total Empowerment Scale score is obtained by summing the 28 item scores and ranges from 28 to 112.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the Rosenberg Self-Esteem Scale (RSS), a very short 10-item inventory measuring self-esteem on a four-point Likert scale from 1="strongly disagree" to 4="strongly agree". The RSS total score may range between 10 and 40, with higher scores indicating higher level of self-esteem.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The Paradox of Self-Stigma scale (PaSS-24) is a 24-item self-report instrument measuring self-stigma and related constructs (stereotype endorsement, righteous anger, and non disclosure) in French language. The Stereotype Endorsement (PaSS-24 SE) dimension is assessed with an 8-item subscale scored on a 5-point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating better more endorsement of common stereotypes about one's condition. The Stereotype Endorsement subscale score is obtained by summing the corresponding item scores and ranges from 8 to 40.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The Paradox of Self-Stigma scale (PaSS-24) is a 24-item self report instrument measuring self stigma and related constructs (stereotype endorsement, righteous anger, and non disclosure) in French. The Righteous Anger (PaSS 24 RA) dimension is assessed with an 8-item subscale scored on a 5-point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating more righteous anger. The Righteous Anger subscale score is obtained by summing the corresponding item scores and ranges from 8 to 40.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The Paradox of Self-Stigma scale (PaSS-24) is a 24-item self report instrument measuring self stigma and related constructs (stereotype endorsement, righteous anger, and non disclosure) in French. The Non-Disclosure (PaSS-24 RA) dimension is assessed with an 8-item subscale scored on a 5-point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), with higher scores indicating greater openness to disclose about one's condition. The Non-Disclosure subscale score is obtained by summing the corresponding item scores and ranges from 8 to 40.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the Beck Hopelessness Scale (BHS), an inventory of 20 true-false items which assess negative expectations about the future on three dimensions: feeling about the future, decrease in motivation and expectations. BHS total score can range between 0 and 20, with higher scores reflecting higher levels of hopelessness.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French-validated version of the World Health Organization Quality of Life - Brief version (WHOQOL-BREF) is a 26-item self-report questionnaire. Two items assess overall quality of life and overall health, the remaining 24 items assess four domains (physical health, psychological health, social relationships and environment). The instrument's items rely on 5-point Likert scales, with values going from 1 ('Not at all satisfied') to 5 ('Completely satisfied'), with reverse scoring for items 3, 4 and 26. Each domain score is the mean of its items multiplied by 4 (range 4-20), which makes it comparable with the original WHOQOL-100. It is then transformed to a 0-100 scale: (domain score - 4) × (100/16). The WHOQOL-BREF total score ranges from 0 to 100, where higher scores indicate better quality of life.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the International Trauma Questionnaire (ITQ), a scale to assess Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) symptoms among adults. The inventory includes 18 items: six to assess the PTSD, six to assess the Disorders in Self Organisation (DSO), and six to assess functional impairment in several important areas of life. Respondents are required to indicate, on a five-point scale from 0="not at all" to 4="extremely", how much each symptom has bothered them in the past month. A total score, ranging between 0 and 24, can be calculated for the PTSD and DSO subscale. A C-PTSD score, ranging between 0 and 48, can also be calculated by adding the PTSD and DSO subscales. Both the PTSD and the C-PTSD total scores will be used in the study.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The French validated version of the International Trauma Questionnaire (ITQ), a scale to assess Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) symptoms among adults. The inventory includes 18 items: six to assess the PTSD, six to assess the Disorders in Self Organisation (DSO), and six to assess functional impairment in several important areas of life. Respondents are required to indicate, on a five-point scale from 0="not at all" to 4="extremely", how much each symptom has bothered them in the past month. A total score, ranging between 0 and 24, can be calculated for the PTSD and DSO subscale. A C-PTSD score, ranging between 0 and 48, can also be calculated by adding the PTSD and DSO subscales. Both the PTSD and the C-PTSD total scores will be used in the study.

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The Coercion Ladder (CL), a single-item instrument asking patients to rate their experience of care on a visual analogue scale ranging from 1="minimum use of coercion" to 10="maximum use of coercion".

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The Index of Fairness is a 4-item self-administered inventory that assesses whether participants perceived the experienced treatment-related pressures as fair. It is rated on a 5-point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), yielding a total score ranging from 4 to 20. The Index of Fairness score is obtained by summing the four item scores, with higher values indicating better outcomes (greater perception of treatment leverage and pressures as fair).

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The Index of Effectiveness is a 4-item self-administered inventory that assesses whether participants perceived the experienced treatment-related pressures as effective. It is rated on a 5-point Likert scale from 1 ('strongly disagree') to 5 ('strongly agree'), yielding a total score ranging from 4 to 20. The Index of Effectiveness score is obtained by summing the four item scores, with higher values indicating better outcomes (greater perception of treatment leverage and pressures as effective).

Time frame: Two time points assessment: up to 2 weeks after hospital admission (pre-intervention) and up to 2 months post hospital discharge (post-intervention)

The Satisfaction with Psychiatric Hospital Care questionnaire (ANQ-Psy) is a 6-item patient-reported measure developed by the Swiss National Association for Quality Development in Hospitals and Clinics (ANQ). It evaluates inpatients' experiences and satisfaction with quality of care, clarity of information, explanations about medication, involvement in treatment decisions, and how well discharge planning meets their needs. Each item is rated on a 5-point verbal Likert scale ranging from 1 ('Poor'/'Never') to 5 ('Excellent'/Always'). The total satisfaction score is the sum of all six items, ranging from 6 to 30, with higher scores indicating greater satisfaction with hospital care.

Time frame: Post-intervention, up to 2 months after hospital discharge

The Brief INSPIRE scale, a service user-rated measure assessing perceived staff support for personal recovery. The Brief INSPIRE consists of five items, one for each personal recovery domain. Responders are asked to rate on a five-point Likert scale, from 0="not at all" to 4="very much", how much they feel supported by staff in each domain of their personal recovery. A total score between 0 and 100 can be computed, with higher scores indicating higher perceived support.

Supporting People Involuntarily Admitted to a Psychiatric Hospital Through a Brief Case Management Intervention That Promotes Personal Recovery and Reduces the Negative Effects of Coercion: a Pilot Study