Development of Care System for a Severe Mental IlIness with High Risk to Violence (SMI-V) in Sikhoraphum Hospital: The SIMPLE Model

Abstract

Background: A severe mental illness with high risk to violence (SMI-V) has shown an increasing trend and impacts the mental health of family members and close contacts. In Sikhoraphum district, the existing surveillance and prevention system for SMI-V lacks sufficient effectiveness. Objective: To develop a care system for SMI-V patients and study the effectiveness of the SMI-V patient care system in Sikhoraphum District. Methods: This study employed a research and development approach. The sample consisted of 101 psychiatric patients at Sikhoraphum Hospital, 101 patient caregivers, and 48 personnel in the community mental health network of Sikhoraphum District between October 1, 2023 - December 31, 2024. The instruments included a data record form, Overt Aggression Scale (OAS), community patient follow-up form, and satisfaction assessment form. The project steps were divided into 3 phases: 1) studying the situation, 2) developing a care system, and 3) evaluating outcomes. Data were analyzed using descriptive statistics and Wilcoxon signed rank test. Results: The SMI-V patient care system called the "SIMPLE Model" was developed, consisting of 6 main components: Screening (S), Immediate intervention (I), Monitoring (M), Promoting community participation (P), Locating patient homes (L), and Educating patients and relatives (E). After development, warning signs before exacerbation clearly decreased. The rate of patients with severe recurrent exacerbations decreased to 21.78%, the missed appointment rate decreased to 7.92%, and the percentage of patients with controlled symptoms who could live in the community increased to 86.14%. All indicators met the set criteria. The 10 aspects of patient follow-up in the community significantly improved after development (p < .001). Satisfaction with using the new system was high in all aspects. Conclusion: The developed SMI-V patient care system is effective. It can reduce exacerbations, reduce missed appointments, increase patients living in the community, and increase practitioners' satisfaction in caring for this patient group.