Developing a Care Model for High-risk Schizophrenia Patients to Prevent Severe Violence Occurrences, Pattani Hospital

Abstract

     This research and development study aimed to: 1) investigate the condition of recurrent relapse problems among high-risk schizophrenia patients prone to severe violence, 2) develop a care model for high-risk schizophrenia patients to prevent severe violence occurrences, and 3) evaluate the effectiveness of the care model for high-risk schizophrenia patients prone to severe violence at Pattani Hospital, divided into three phases. Phase 1 involved reviewing 5-year retrospective statistics on relapse rates and examining the problems faced by high-risk schizophrenia patients prone to severe violence through group interviews with 25 key informants. Phase 2 involved using the quantitative and qualitative data obtained from Phase 1 to develop a model through brainstorming sessions and assessing the model's benefits with 17 stakeholders. The research tool used was a questionnaire on the benefits developed by the researchers, with a content validity index ranging from 0.67 to 1.00. Data analysis included mean and standard deviation. Phase 3 involved evaluating the effectiveness of the model by assessing the psychiatric symptoms of schizophrenia patients before and after using the model. The sample group consists of 14 high-risk schizophrenia patients meeting the inclusion criteria. The assessment tool used was the psychiatric symptom assessment form developed by the Department of Mental Health. Data analysis was performed using the Wilcoxon signed-rank test.

     The research findings were as follows:

     1. The problems identified were: 1) inability of relatives to manage the violent behavior of patients and their relatives, 2) unclear assistance guidelines for patients, 3) high risk of recurrence both within the family and the community, 4) lack of readiness of patients and relatives, as well as ineffective referral systems, and 5) insufficient continuous treatment.

     2. The care model for high-risk psychiatric patients prone to severe violence was the SMART Model, consisting of: S: SMI-V; M: Mitigation; A: Admit; R: Recovery; and T: Team.

     3. The effectiveness of the SMART Model, when comparing the difference in scores of psychiatric symptom assessments before and after implementation, showed a statistically significant difference at the .05 level.

     The SMART Model is a comprehensive care model for high-risk psychiatric patients prone to severe violence that can integrate all aspects of teamwork effectively.