Effectiveness of a peer-supported crisis intervention to reduce the proportion of compulsory admissions in acute psychiatric crisis interventions in an outreach and outpatient setting: study protocol for an exploratory cluster randomised trial combined with qualitative methods.

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.

[Reorganising a department of psychiatry according to recovery principles: A pilot study with mixed-method design]. / Umstrukturierung einer psychiatrischen Abteilung nach Recovery-Grundsätzen: eine Pilotstudie mit "mixed-method design".

Considering the impact of mental disorders, control and evaluation of treatment programs are important topics. Here, we report on a pilot study composed of a qualitative and a quantitative part to monitor the recovery-oriented reorganisation of a psychiatric department. For this purpose 13 and 15, respectively, stakeholders of the change management were interviewed between 2012 (T1) and 2014 (T2). Moreover, patients and staff were asked to complete a German version of the Recovery Self Assessment (RSA) questionnaire. The main result of the first investigation (T1) was that nursing staff fostered the projected transformation, while physicians and psychologists focused on risk management and worried about losing their role. The patients' and staff's questionnaire ratings of the recovery orientation of the department were surprisingly positive. However, most of the staff members were not correctly informed about patients' rights to see their files. In the second investigation (T2), many of the interviewees were under the impression that either their participation had decreased and/or that the reorganisation, from their point of view, had already been completed. Nevertheless, staff assessed the recovery orientation of their work as significantly improved, while the patients' evaluation of the recovery orientation of the department was unchanged. Concerning single items of the RSA questionnaire, the support of occupational rehabilitation and aspects of participation were rated worst. Methodological problems and possible implications of the results are discussed.

[Recovery Self Assessment: Translation and cultural adaption of a recovery oriented assessment instrument]. / Recovery Self Assessment - Übersetzung und kulturelle Anpassung eines recovery-orientierten Einschätzungsinstrumentes.

BACKGROUND: The recovery approach is becoming increasingly important in mental health services and research. In English-speaking countries, its practical implementation as well as the scientific discussion is far more advanced. To support the approach, assessment instruments are required. A widespread and recognised tool is the Recovery Self Assessment Scale {RSA}. This includes four versions of a questionnaire, which cover the perspectives of users, providers, family members and management. AIM/METHOD: In this article, the development of the instrument and the system atictranslation process are presented. Two independent research groups applied different translation. METHODS: The Swiss research group {AGS} used the ISOPR principles, the German research group (AGN} the Guidelines of the European Social Survey Programme for survey translations TRAPD. The methods differ in the fact,that TRAPD uses focus groups. The results of both groups were combined by means of a consensus process. RESULTS: Within the translation and cultural adjustment of the RSA-D, the the oretical framework of the RSA as well as the transferability into the German speaking context has been ensured. CONCLUSION: Before the RSA-D c~n beused in practice and research, further studies towards psychometric testing should be conducted.