The effects of relapse prevention plan

The psychiatric hospital GGZ Westelijk Noord-Brabant has received a grant for
the project "Do not leave a serious sick alone ", aiming to reduce the number
and the average duration of seclusions. Seclusion is a controversial issue in
the mental health care, having provoked debate for several decades. It is
associated with neglect and emotional abuse of psychiatric patients. Seclusion
is an intrusive experience for both the patients and the staff. The Dutch
tradition in using seclusion as a method of restrain, has been criticized a lot
the last years, because of the higher usage and duration of seclusion, compared
with other European countries. The surrounding countries do not use seclusion
as a coercive method anymore or they are trying to reduce it significantly.
Although seclusion practices are becoming less popular the last years, there is
still lack of knowledge on alternative successful interventions to prevent
seclusion. Therefore it is important to research scientifically the
effectiveness of different implementation strategies. This is one of the
reasons for the significant practical relevance of this study. In addition, the
effect of the relapse preventions plans in preventing psychical crises and
seclusions in mental health institutions has not been until now investigated.

This experimental study addresses the question of whether the use of relapse
prevention plans in nursing practices will reduce the usage and the average
duration of seclusions with at least 30% in comparison with the control *care-
as-usual*condition. Early recognition and early intervention in psychiatric
patients using prevention relapse plans strive for preventing psychical crisis,
which in consequence may serve as prevention of seclusion.

The objective of this study will be investigated through randomized controlled
trial (RCT) with a follow-up of 3 months. After being informed about the
research, patients will get one-week to decide if they want to participate.
Patients will be included in the study only after signing an informed consent.
They have to be stabilized to the extent that he or she could collaborate in
the preparation of the relapse prevention plan. After the first data
collection, the patients will be divided at random between de experimental and
the control condition. For the participants of the experimental condition
individualized relapse prevention plans will be prepared, while the
participants of the control condition will receive care-as-usual. After the
completion of the relapse prevention plans in the experimental group, and after
a comparable period of time of care-as-usual in the control condition, the
first posttest will be conducted. The same measurement takes place three months
later, if the participants are still staying at the hospital. The participants
in the study will receive 10 euro for each measurement. The primary and the
secondary study parameters will be registered for the both experimental and
control group until the patients* stay at the hospital is ended. In addition,
the mediating variables between the relapse prevention plan and the primary and
the secondary study parameters will be investigated.

The relapse prevention plans focus on early recognition and early intervention
directed to prevent psychical crises by psychiatric patients. The preparation
of a relapse prevention plan takes about a week, in conjunction with the
patient and the members of his of her social network. This plan includes the
early signs of psychical crises that are worked out as well as the actions that
could be taken when psychical crises threaten. A detailed intervention protocol
for the preparation of relapse prevention plans will be submitted together with
this research protocol.

Self-registration scales will be administrated three times during the study.
Each measurement takes about 40 minutes. This means that totally 2 hours will
be enough to complete the three measurements. The time necessary for the
preparation of the relapse prevention plan depends on the individual needs of
the patient. Therefore a concrete estimation of the time is difficult to be
made in advance.