ABSTRACT
INTRODUCTION: Compulsory admissions are associated with feelings of fear, humiliation and powerlessness. The number of compulsory admissions in Germany and other high-income countries has increased in recent years. Peer support has been shown to increase the self-efficacy of individuals with mental health conditions in acute crises and to reduce the use of coercive measures in clinical settings. The objective of this study is to reduce the number of compulsory admissions by involving peer support workers (PSWs) in acute mental health crises in outreach and outpatient settings. METHODS AND ANALYSIS: This one-year intervention is an exploratory, cluster randomised study. Trained PSWs will join the public crisis intervention services (CIS) in two of five regions (the intervention regions) in the city of Bremen (Germany). PSWs will participate in crisis interventions and aspects of the mental health services. They will be involved in developing and conducting an antistigma training for police officers. The remaining three regions will serve as control regions. All individuals aged 18 and older who experience an acute mental health crisis during the operating hours of the regional CIS in the city of Bremen (around 2000 in previous years) will be included in the study. Semistructured interviews will be conducted with PSWs, 30 patients from control and intervention regions, as well as two focus group discussions with CIS staff. A descriptive comparison between all participants in the intervention and control regions will assess the proportion of compulsory admissions in crisis interventions during the baseline and intervention years, including an analysis of temporal changes. ETHICS AND DISSEMINATION: This study was approved by the Ethics Committee of the University of Bremen (file 2022-09) on 20 June 2022. The results will be presented via scientific conferences, scientific journals and communicated to policy-makers and practitioners. TRIAL REGISTRATION NUMBER: DRKS00029377.
Subject(s)
Crisis Intervention , Mental Disorders , Peer Group , Qualitative Research , Humans , Crisis Intervention/methods , Germany , Mental Disorders/therapy , Randomized Controlled Trials as Topic , Commitment of Mentally Ill , Male , Adult , Female , Mental Health ServicesABSTRACT
OBJECTIVE: The existing legal framework to foster home treatment for severe mental illness imposes challenges for implementation. 'Bremen ambulant vor Ort (BravO)' provides home treatment on basis of the "Bundespflegesatzverordnung". METHODS: The concept and framework of BravO will be outlined, routine data on the BravO treatment from October 1st, 2019 to September 30th, 2021 were analysed. RESULTS: Financial and staff resources of 20 in-patient treatment places were equivalently transferred into BravO. 298 patients generating 392 cases received treatment. Median treatment span was 36 days, with 21 days (median) of service delivery. 74.7â% were diagnosed either in ICD-10 groups F2 or F3. CONCLUSION: BravO was successfully implemented into routine care. BravO allows flexible home treatment for people with severe mental illness apart from existing treatment framework.
