Development of an Integrated Post-Treatment Follow-up Model for High-Risk Psychiatric Patients with Substance Abuse and Violence Risk: A Case Study in Mueang Maha Sarakham District, Maha Sarakham Province.
Abstract
Abstract
This action research aimed to study the current situation, develop an integrated network follow-up model for high-risk psychiatric patients with substance abuse and violence risk, and evaluate the model's effectiveness in Mueang Maha Sarakham District, Maha Sarakham Province. The study followed the action research framework consisting of three phases and two cycles. The participants included 82 stakeholders selected through purposive sampling from public health, local administration, police, local government, the prison, and the Provincial Office of Social Development and Human Security. Research instruments comprised the Ministry of Public Health’s screening forms (V.2), Overt Aggression Scale (OAS), 10-dimension follow-up assessment, 5 red flags warning signs checklist, and focus group discussion guides. Quantitative data were analyzed using frequency and percentage, while qualitative data were analyzed through content analysis.
The results in the initial phase revealed a continuous increase in high-risk cases from 239 in 2021 to 447 in 2023. Approximately 67% of these patients had more than three readmissions due to the lack of clear follow-up protocols and fragmented communication among agencies. In response, an "Integrated Follow-up Model" was developed based on the 3C framework—Client (accessible medication and self-reliance), Caregiver (understanding, access, and monitoring), and Community (acceptance, mutual aid, and opportunity). The model was implemented by a "4-Party Coordination Team" (public health, local administration, police, and local government), ensuring the first visit within 3–7 days post-discharge and subsequent follow-ups at 1, 3, 6, and 12 months. Following implementation, the continuous follow-up rate increased to 98.97%, and violent recidivism significantly decreased to 1.03%. Furthermore, 100% of the vulnerable patients received comprehensive social support and vocational rehabilitation. In conclusion, the integrated network model effectively bridged communication gaps and reduced violent incidents, fostering safety and sustainability in community-based psychiatric care.
Keywords : Psychiatric patients with substance abuse, High risk of violence, Post-treatment follow-up, Integrated network
