Implementation of Brief Admission by Self-Referral in Child and Adolescent Psychiatry in Sweden: Insights from Implementers and Staff

Abstract

Brief admission by self-referral, which allows patients to briefly admit themselves to a psychiatric ward, is a crisis intervention designed to reduce suicide and self-harm. This method was introduced in Sweden for adult patients in 2015, achieving high patient satisfaction and good acceptance among staff. In 2018, the method was adapted and implemented in pediatric psychiatry. The present study comprehensively describes the multifaceted strategies for implementing brief admissions, including planning, education, financing, restructuring, quality management, and policy implementation and reform. It also includes staff's opinions of the practice of brief admissions for young people. Neither of these topics has been addressed in the existing literature. During the study period (April 2018-April 2021), 63 brief admission contracts were established. The number of new contracts increased exponentially (12.7%) per quarter (p < 0.05), and staff satisfaction with both the implementation and its benefits for unstable patients was high. Brief admission by self-referral can be successfully implemented in pediatric psychiatry and appears to be a functional crisis management method for adolescents.

Keywords: brief admission by self-referral; child and adolescent psychiatry; implementation.

Figure 1

The number of newly signed contracts per quarter (except the last), plus the trend line for the expected number of new contracts per quarter: y = 2.04 × 1.127^x, where x = number of quarters after 2018:1, i.e., 2018:2 is x = 1. This means that the number of new contracts increased (p = 0.0028) by 12.7% per quarter on average. Calculated using Poisson regression.