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People with borderline personality disorder have difficulties with work. The Individual Placement and Support model has shown its worldwide effectiveness in terms of vocational rehabilitation for individuals with psychiatric disorders. However, only a few recent studies have explored its results for people with personality disorders, and the findings were mitigated. Additionally, Individual Placement and Support job coaches reported difficulties in supporting this population. An evidence-based psychotherapeutic method, also applicable in a case management context, called Good Psychiatric Management for borderline personality disorder, could potentially overcome these obstacles. This study aimed to evaluate the initial integration of Good Psychiatric Management in Individual Placement and Support practice. Individual Placement and Support practitioners of Lausanne University Hospital, Switzerland, were trained in Good Psychiatric Management in January 2022. Five of them participated in a focus group to collect their impressions about the training, and six were interviewed 9 months later to assess the initial adoption of Good Psychiatric Management into their practice. Thematic analyses were conducted. Job coaches were positive about this new tool. All of them found it useful and beneficial both for them and their patients. They were able to follow the main Good Psychiatric Management principles in their practice However, the findings also suggested some additional improvements in the implementation process. Integrating Good Psychiatric Management in Individual Placement and Support seems feasible, and the team who appreciated it adopted it. The method offers new perspectives in community support for people living with borderline personality disorder.

The Health of the Nation Outcome Scales (HoNOS) is a widely used measure of health and social functioning of people with mental illness. The goals of this study were to verify the internal validity of the one factor and several four-factor scoring structures and to evaluate the predictive validity of HoNOS items with regards to duration of hospitalization, probability of readmission in the following year and time before readmission. 6175 hospital stays at the department of psychiatry of Lausanne University Hospital were screened and the first HoNOS of each patient was taken into account (N = 2722). Data were analyzed through Confirmatory Factor Analysis (CFA) and the predictive validity of HoNOS items was evaluated with two approaches: item level regressions and latent class analysis (LCA). CFA indicated that the suggested factor structures were not supported by the data. Predictive validity of the 12 items was weak but LCA revealed five distinct and meaningful profiles that were related to length of stay or readmission. HoNOS may be more adapted to the evaluation of patients case-mix rather than to the individual level and concepts such as predictive validity may be more appropriate than internal validity to guide its use.

Background In mental health care, experienced coercion, also known as perceived coercion, is defined as the patient’s subjective experience of being submitted to coercion. Besides formal coercion, many other factors have been identified as potentially affecting the experience of being coerced. This study aimed to explore the interplay between these factors and to provide new insights into how they lead to experienced coercion. Methods Cross-sectional network analysis was performed on data collected from 225 patients admitted to six psychiatric hospitals. Thirteen variables were selected and included in the analyses. A Gaussian Graphical Model (GGM) using Spearman’s rank-correlation method and EBICglasso regularisation was estimated. Centrality indices of strength and expected influence were computed. To evaluate the robustness of the estimated parameters, both edge-weight accuracy and centrality stability were investigated. Results The estimated network was densely connected. Formal coercion was only weakly associated with both experienced coercion at admission and during hospital stay. Experienced coercion at admission was most strongly associated with the patients’ perceived level of implication in the decision-making process. Experienced humiliation and coercion during hospital stay, the most central node in the network, was found to be most strongly related to the interpersonal separation that patients perceived from staff, the level of coercion perceived upon admission and their satisfaction with the decision taken and the level of information received. Conclusions Reducing formal coercion may not be sufficient to effectively reduce patients’ feeling of being coerced. Different factors seemed indeed to come into play and affect experienced coercion at different stages of the hospitalisation process. Interventions aimed at reducing experienced coercion and its negative effects should take these stage-specific elements into account and propose tailored strategies to address them.

BackgroundCoercion in psychiatry is a controversial issue. Identifying its predictors and their interaction using traditional statistical methods is difficult, given the large number of variables involved. The purpose of this study was to use machine-learning (ML) models to identify socio-demographic, clinical and procedural characteristics that predict the use of compulsory admission on a large sample of psychiatric patients.MethodsWe retrospectively analyzed the routinely collected data of all psychiatric admissions that occurred between 2013 and 2017 in the canton of Vaud, Switzerland (N = 25,584). The main predictors of involuntary hospitalization were identified using two ML algorithms: Classification and Regression Tree (CART) and Random Forests (RFs). Their predictive power was compared with that obtained through traditional logistic regression. Sensitivity analyses were also performed and missing data were imputed through multiple imputation using chain equations.ResultsThe three models achieved similar predictive balanced accuracy, ranging between 68 and 72%. CART showed the lowest predictive power (68%) but the most parsimonious model, allowing to estimate the probability of being involuntarily admitted with only three checks: aggressive behaviors, who referred the patient to hospital and primary diagnosis. The results of CART and RFs on the imputed data were almost identical to those obtained on the original data, confirming the robustness of our models.ConclusionsIdentifying predictors of coercion is essential to efficiently target the development of professional training, preventive strategies and alternative interventions. ML methodologies could offer new effective tools to achieve this goal, providing accurate but simple models that could be used in clinical practice.

Background Exposure to public stigma can lead to stereotype endorsement and resignation, which are constructs related to self-stigma. This latter phenomenon has well-documented deleterious consequences for people living with mental illness. Paradoxically, it can also lead to the empowering reactions of righteous anger and coming out proud. Aim The aim of this study was to develop and validate a brief tool to measure stereotype endorsement, righteous anger, and non-disclosure across different groups of stigmatized persons. This process was conducted in collaboration with users. Method Using focus groups with mental health professionals and people living with mental illness, 72 items were developed to measure various aspects of self-stigma. The Paradox of Self-Stigma scale (PaSS-24) containing 24 items and three subscores (stereotype endorsement, non-disclosure, and righteous anger) resulted from a calibration phase using factor analysis. This structure was cross-validated on an independent sample. Internal consistency, test–retest reliability, and convergent validity were also evaluated. Results 202 patients were assessed. The PaSS-24 demonstrated good internal validity. Internal consistency, test–retest reliability, and convergent validity estimates were also good. Conclusions The PaSS-24 is a short but psychometrically rigorous tool designed to measure self-stigma and related constructs in French language, developed in collaboration with users. The development and validation of the PaSS-24 represent a first step towards implementing and evaluating programs aimed at reducing negative consequences of self-stigma.

During the prodromal phase of psychosis, individuals may experience an aberrant attribution of salience to irrelevant stimuli. The concept of aberrant salience has been hypothesized to be a central mechanism in the emergence and maintenance of psychosis. The 29-item Aberrant Salience Inventory (ASI) was designed to measure five aspects of aberrant salience. The aim of this study was to investigate the psychometric properties of the French version of the ASI comparing patients with psychosis, patients with other diagnosis and healthy, non-clinical participants. The French-language ASI was adapted using the back-translation procedure. Two hundred and eighty-two participants issued from the general population and 150 psychiatric patients were evaluated. Internal validity was assessed using a two-parameter logistic item response model. Reliability was estimated using a test–retest procedure. Convergent validity was estimated using correlations between the ASI scores and several other scales. Sensitivity was evaluated by comparing the scores of participants with a diagnosis of psychosis, patients with other diagnoses and the general population. The best model distinguished three factors: Enhanced Interpretation and Emotionality, Sharpening of Senses and Heightened Cognition. Reliability and convergent validity estimates were good in both groups. The Sharpening of Senses factor was able to discriminate between patients and the general population. Only the Heightened Cognition factor was able to discriminate patients with psychosis from the other psychiatric patients. The ASI is a valid and reliable tool to study not only the aberrant salience phenomenon in patients with psychosis, but also with other diagnoses and within the general population.

Background The Coercion Experience Scale (CES) was designed to measure the psychological impact of psychiatric coercive interventions. The French-language CES was adapted using a translation/back-translation procedure. It consists originally of 31 items and 6 subscores. Aim The goal of this study was aimed to assess the psychometric properties of the French-language CES. Method 146 inpatients were evaluated. Internal validity was assessed using confirmatory factor analysis. Reliability was estimated using internal consistency coefficients and a test–retest procedure. Convergent validity was estimated using correlations between the AES scores and the Coercion Ladder (CL), the MacArthur’s Admission Experience Survey (AES) and the World Health Organization Quality of Life (WHOQOL-BREF) scale. Discriminatory power was evaluated by comparing the scores of patients undergoing voluntary or compulsory admission. Results Although the six-factor original model of the CES showed adequate fit to the data of the French-language version, two factors were almost indistinguishable. A well-defined five-factor alternative was proposed. The CES scores showed good internal consistency. Test–retest reliability varied from good to weak among the five subscores. Correlations between CES and CL, AES and WHOQOL scores suggested good convergent validity for most scores. Two CES scores were significantly higher among patients subject to compulsory psychiatric hospital admission than among those admitted voluntarily. Conclusions Overall, the French-language version of the CES is a usable tool to study different aspects of perceived coercion.

Objectives Small area analysis is a health services research technique that facilitates geographical comparison of services supply and utilization rates between health service areas (HSAs). HSAs are functionally relevant regions around medical facilities within which most residents undergo treatment. We aimed to identify HSAs for psychiatric outpatient care (HSA‐PSY) in Switzerland. Methods We used HSAr, a new and automated methodological approach, and comprehensive psychiatric service use data from insurances to identify HSA‐PSY based on travel patterns between patients' residences and service sites. Resulting HSA‐PSY were compared geographically, demographically and regarding the use of inpatient and outpatient psychiatric services. Results We identified 68 HSA‐PSY, which were reviewed and validated by local mental health services experts. The population‐based rate of inpatient and outpatient service utilization varied considerably between HSA‐PSY. Utilization of inpatient and outpatient services tended to be positively associated across HSA‐PSY. Conclusions Wide variation of service use between HSA‐PSY can hardly be fully explained by underlying differences in the prevalence or incidence of disorders. Whether other factors such as the amount of services supply did add to the high variation should be addressed in further studies, for which our functional mapping on a small‐scale regional level provides a good analytical framework.

Purpose Formal coercion in psychiatry is widely studied yet much less is known about pressures patients may experience, partly because of the very few measures available. The goal of this study was to validate the P-PSY35 (Pressures in Psychiatry Scale) and provide a paper-and-pencil and a computerised adaptive test (CAT) to measure pressures experienced by patients in psychiatry. Methods The P-PSY35 items were developed with users. Patients were evaluated during psychiatric hospitalisation or through an online survey. Mokken scale analysis and Item response theory (IRT) were used to select and estimate the items parameters. A Monte-Carlo simulation was performed to evaluate the number of items needed to transform the paper-and-pencil test into a reliable psychometric CAT. Results A total of 274 patients were assessed. The P-PSY35 demonstrated good internal validity, internal consistency, convergent and divergent validity. The P-PSY35 could be substantially shortened while maintaining excellent reliability using the CAT procedure. Conclusion The P-PSY35 was developed in collaboration with users. It is a psychometrically rigorous tool designed to measure experienced pressures in French-language. The development and successful validation of the P-PSY35 represent a welcome step towards implementing and evaluating programs aimed at reducing negative consequences of coercion.

Background Co-occurring severe mental and substance use disorders are associated with physical, psychological and social complications such as homelessness and unemployment. People with severe mental and substance use disorders are difficult to engage with care. The lack of treatment worsens their health and social conditions and increases treatment costs, as emergency department visits arise. Case management has proved to be effective in promoting engagement with care of people with severe mental and substance use disorders. However, this impact seemed mainly related to the case management model. The Intensive Case Management for Addiction (ICMA) aimed to improve engagement with care of people with severe mental and substance use disorders, insufficiently engaged with standard treatment. This innovative multidisciplinary mobile team programme combined Assertive Community Treatment and Critical Time Intervention methodologies. The aim of the study was to observe the impact of ICMA upon service use, treatment adherence and quality of support networks. Participants’ psychosocial and mental functioning, and substance use were also assessed throughout the intervention. Methods The study was observational. Eligible participants were all the people entering the programme during the first year of implementation (April 2014–April 2015). Data were collected through structured questionnaires and medical charts. Assessments were conducted at baseline and at 12 months follow-up or at the end of the programme if completed earlier. McNemar-Bowker’s Test, General Linear Model repeated-measures analysis of variance and non-parametric Wilcoxon Signed Rank tests were used for the analysis. Results A total of 30 participants took part in the study. Results showed a significant reduction in the number of participants visiting the general emergency department compared to baseline. A significantly decreased number of psychiatric emergency department visits was also registered. Moreover, at follow-up participants improved significantly their treatment adherence, clinical status, social functioning, and substance intake and frequency of use. Conclusions These promising results highlight the efficacy of the ICMA. The intervention improved engagement with care and the psychosocial situation of people with severe mental and substance use disorders, with consequent direct impact on their substance misuse.