[Patient-guided crisis admissions for severe psychotic conditions].

BACKGROUND: Standard treatment for psychotic conditions has been criticized for being inflexible, with too many involuntary admissions and too little patient involvement.
MATERIAL AND METHODS: Two of 11 beds in a unit for schizophrenic patients at a psychiatric centre were converted to crisis beds. Patients who were known by the centre were given the right (through contracts) to use these beds without being referred by their primary care physician. Stays were limited to five days, with 14 days required between each stay. Data were obtained on the first 18 patients to complete at least a year on the program. Inpatient stays, including involuntary admissions, were compared to the same time frame before implementation of the program.
RESULTS: The number of admissions rose, but the number of days hospitalized fell by 33%. Involuntary hospitalization days were approximately cut in half. On the average, patients used the crisis beds just under five times per year, with an average duration of 2.5 days.
INTERPRETATION: By contracting to ensure patients' rights and by lowering the threshold for admission, patients and families experience greater autonomy and security. This explains the paradox that increased accessibility of care actually reduces the use of beds. The study shows that seriously ill psychiatric patients can cooperate productively about inpatient care.