John Wallert

Research problem and specific questionsInvoluntary psychiatric care (IPC) patients are at particularly high risk for suicide, self-harm, and acute readmission after hospital discharge. Deciding on discharge after IPC is therefore critical, yet today it is based on subjective judgement and limited data. The overarching purpose of this project is to develop and validate a novel risk calculator for IPC patients when planning for their discharge. The calculator will add a novel and transparent evidence-base that can improve the decision process and reduce adverse events.Data and methodsThe project has three aims. (1) Qualitative feasibility study with a medical ethics focus involving clinicians and patient representatives to influence the calculator design. (2) Quantitative modelling study using national register data from over 70,000 IPC patients to construct the first-of-its-kind risk calculator for IPC patients. The calculator will predict suicide, self-harm, and acute readmission. (3) Mixed methods pilot study as part of a multi-site clinical trial within Region Stockholm´s psychiatry, with randomisation of clinicians to either standard care or the addition of the calculator as decision support tool.Societal relevance and utilisationShortly after discharge, psychiatric inpatients have a suicide rate about 200 times higher than the general population, with those in IPC at even greater risk. Moreover, IPC patients are treated against their will due to their indispensable need for care, posing unique ethical and legal challenges. While inpatient care is well-researched, less is known about the more severely ill IPC patients. In line with FORTE’s vision of good and equal care, and to address challenges related to public welfare, this project will contribute to a better understanding of IPC patients. The novel decision support could improve discharge decisions, thereby reducing risk of adverse events. The tool will be co-developed with Region Stockholm, ensuring public benefit without private vested interests.Plan for project realisationThe project stands on solid ground within specialised psychiatric care with patient, clinician and organisational stakeholder representation. The project’s main clinical site is Psychiatry Southwest, with prominent researchers and the clinic director as co-applicants. The project is further quality-assured by an interdisciplinary team of experts. Partial funding is secured, but FORTE support is now needed for project completion.

Research problem and specific questionsSuicide prevention is a high-priority public health goal. Assessing patients´ suicide risk is a basis for clinical decisions in psychiatry, including decisions about involuntary care. However, there is currently a lack of clear evidence on how suicide risk should be assessed and how risk assessments should be used, leading to uncertainty and possible inequality in clinical assessments and decisions.- How are suicide risk assessments conducted and what basis do they provide for clinical decisions, including decisions about involuntary care?- How do patients perceive suicide risk assessments and what is their view on the role of suicide risk assessments in psychiatry?- How do judges perceive suicide risk assessments and what relevance do they have for court decisions regarding involuntary psychiatric care?- How should suicide risk assessments be conducted and how should they be used in healthcare?Data and methods1) Interviews with psychiatrists about how they conduct suicide risk assessments and how they use their assessments. The data will be analyzed using qualitative content analysis.2) Interviews with patients about their experiences and views of suicide risk assessments. We will use thematic analysis to analyse the data.3) A survey study based on case vignettes and questions on suicide risk assessments and involuntary psychiatric care. The survey will be sent to Swedish psychiatrists. We will use descriptive and inferential methods to analyze the results.4) Focus group interviews with judges in the Administrative Courts regarding suicide risk as a reason for involuntary psychiatric care. We will use qualitative content analysis to analyze the data. 5) Ethical analysis based on studies 1-4 and current research on suicide prediction. The aim is to present an analysis and an ethical framework to guide assessments of suicide risk in healthcare.Social Relevance and utilisationThe overarching goal of the project is to provide a basis for evidence-based, clinically meaningful, equal, and patient-centered assessments of suicide risk.Plan for project realisationThe project will be conducted over three years by an interdisciplinary research team that includes expertise in psychiatry, medical ethics, and law. We intend to publish the results in the form of research articles and also to develop a framework for suicide risk assessments to be used as decision support in healthcare