Caring Model Development for Serious Mental Illness High Risk to Violence (SMI-V) with Community Participation: A Case Study of One District, Thailand

Abstract

This participatory action research aimed to develop the caring model for Serious Mental Illness High Risk to Violence (SMI-V) with community participation and to study the clinical outcome of SMI-V in a district of south Thailand. The model was developed from April to July 2023 in 4 steps: 1) joint planning, 2) joint execution, 3) joint observation, and 4) joint reflection. 54 informants consisted of 17 SMI-V, 10 patients' relatives, 18 drug-addicted mental health workers, 9 community leaders. Qualitative data were analyzed by content and narrative analysis, while descriptive statistics and t-tests were used to analyze quantitative data.

The results revealed that the caring model for SMI-V with community participation can be divided into 3 levels. The first level was pre-hospital care, which comprised 8 components: 1) Establishing an area working group and searching the key leaders or local leaders, 2) Arranging an incident action plan training, 3) Screening and assessing aggression, 4) Arranging an individual registration and grouping, 5) Following home visits, 6) Mapping patients, 7) Setting the channel for report incidents and community checkpoints, and 8) Setting the community measures and agreements. The second level was hospital caring, which comprised 5 components: 1) Preparing the medical personnel, 2) Preparing the inpatient safety system, 3) Assessing the patient symptoms and problems, 4) Following the referral guidelines, and 5) Preparing the families and communities before discharging patients. The third level was post-hospital caring, which comprised 5 components: 1) Establishing an area working team, 2) Establishing a community communication group, 3) Case managing, 4) Patient behavior monitoring and assessment, and 5) Patients healing by psychotherapy and rehabilitating with community participation. After the SMI-V caring model implementation, the average score of SMI-V in psychiatric symptoms statistically decreased significantly (t = 7.84, p-value < 0.05), while the overall ability of SMI-V in mental, social, and professional statistically improved significantly (t = -12.64, p-value < 0.05).