The Development of a Surveillance and Continuous Care System for Psychiatric Patients with Substance Abuse and High Risk of Violence through Community Participation in the Service Area of Mukdahan Hospital

Abstract

Continued drug use damages the brain areas that control thought and emotion, resulting in a lack of self-control and potentially leading to aggressive and violent behavior towards oneself, one’s family, and the community. This can result in a high risk of violence for psychiatric patients with substance abuse disorders.  This research and development aimed to develop and evaluate the effectiveness of a surveillance and continuous care system for psychiatric patients with substance abuse and a high risk of violence through community participation mechanisms in the service area of Mukdahan Hospital. The study proceeded by three phases: (1) situation analysis from key informants; (2) development of a prototype system; and (3) effectiveness evaluation, using a pretest-posttest design with independent experimental and control groups (33 each). The participants were psychiatric patients with substance abuse and a high risk of violence, selected by purposive sampling. Instruments included the continuous surveillance and care system, in-depth interview guidelines, the Overt Aggression Scale (OAS), and the Prasri Violence Severity Scale (PVSS). Data were analyzed using descriptive statistics, ANCOVA, and GEE.

The findings from Phase 1 revealed three systemic problems: (1) decreased observation of risky behaviors and warning signs; (2) discontinuity in community care; and (3) community fear related to the problem. In Phase 2, a prototype system was developed comprising two processes: surveillance of violent behavior and prevention of repeated violence. In Phase 3, the effectiveness of the surveillance and continuity-of-care system was evaluated. The experimental group had significantly lower aggressive behavior scores and violence risk severity scores than the control group at each monthly follow-up (p < 0.001). Overall, the mean difference in aggressive behavior scores between the control and experimental group was 0.70 (95% CI: 0.49–0.90, p < 0.001). Similarly, the overall mean difference in violence risk severity scores was 5.79 (95% CI: 4.44–7.14, p < 0.001) with lower scores observed in the experimental group. 

These findings indicate that the system was effective. Therefore, it should be further implemented in high-risk areas as a step toward provincial-level implementation. This expansion should involve the integration of relevant agencies and community stakeholders to establish community-level operational teams.